Editorial
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2006; 12(45): 7250-7262
Published online Dec 7, 2006. doi: 10.3748/wjg.v12.i45.7250
Concept on the pathogenesis and treatment of primary biliary cirrhosis
Vasiliy Ivanovich Reshetnyak
Vasiliy Ivanovich Reshetnyak, Scientific Research Institute of General Reanimatology, Russia Academy of Medical Sciences, Moscow, Russia
Correspondence to: Vasiliy Ivanovich Reshetnyak, Scientific Research Institute of General Reanimatology, 25-2, Petrovka str., Moscow 107031, Russia. v_reshetnyak@yahoo.com
Telephone: +7-495-2006505 Fax: +7-495-2006505
Received: July 18, 2006
Revised: July 28, 2006
Accepted: September 4, 2006
Published online: December 7, 2006
Abstract

Primary biliary cirrhosis (PBC) is an organ-specific autoimmune disease that predominantly affects women and is characterized by chronic, progressive destruction of small intrahepatic bile ducts with portal inflammation and ultimately fibrosis, leading to liver failure in the absence of treatment. Little is known about the etiology of PBC. PBC is characterized by anti-mitochondrial antibodies and destruction of intra-hepatic bile ducts. The serologic hallmark of PBC is the presence of auto-antibodies to mitochondria, especially to the E2 component of the pyruvate dehydrogenase complex (PDC). Current theories on the pathogenesis of PBC favor the hypothesis that the disease develops as a result of an inappropriate immune response following stimulation by an environmental or infectious agent. Some reports suggest that xenobiotics and viral infections may induce PBC. The pathogenetic mechanism is believed to be caused by a defect in immunologic tolerance, resulting in the activation and expansion of self-antigen specific T and B lymphocyte clones and the production of circulating autoantibodies in addition to a myriad of cytokines and other inflammatory mediators. This leads to ductulopenia and persistent cholestasis, by developing end-stage hepatic-cell failure. In this review are given our own and literary data about mechanisms of development of intrahepatic cholestasis and possible ways of its correction.

Keywords: Primary biliary cirrhosis; Pathogenesis; Treatment