Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2021; 27(29): 4890-4899
Published online Aug 7, 2021. doi: 10.3748/wjg.v27.i29.4890
Poor performance of anti-mitochondrial antibodies for the diagnosis of primary biliary cholangitis in female Colombian patients: A single-center study
Valentina Guatibonza-García, Paula Valentina Gaete, Agustín Pérez-Londoño, Danna Kathalina Puerto-Baracaldo, Sebastián Antonio Gutiérrez-Romero, Carlos O Mendivil, Monica Tapias
Valentina Guatibonza-García, Paula Valentina Gaete, Agustín Pérez-Londoño, Danna Kathalina Puerto-Baracaldo, Sebastián Antonio Gutiérrez-Romero, Monica Tapias, School of Medicine, Universidad de los Andes, Bogotá 110111, Colombia
Carlos O Mendivil, Section of Endocrinology, Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
Monica Tapias, Department of Hepatology, Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
Author contributions: Tapias M and Mendivil CO conceived and supervised the study execution, and took part in the data analysis; Guatibonza-García V, Gaete PV, Pérez-Londoño A, Puerto-Baracaldo DK, and Gutiérrez-Romero SA participated in data collection, analysis, and interpretation; All authors drafted the manuscript and revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Research Ethics Committee of the Universidad de los Andes.
Informed consent statement: Being a retrospective analysis of anonymized data, this study was exempt from informed consent requirement by the Research Ethics Committee of the Universidad de los Andes.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Data are available from the corresponding author upon written request from a qualified researcher.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monica Tapias, MD, Attending Doctor, Department of Hepatology, Fundación Santa Fe de Bogotá, Carrera 7 No.117-15, Bogotá 110111, Colombia. monictapias@yahoo.com
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: March 29, 2021
Revised: April 3, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: August 7, 2021
Processing time: 187 Days and 7.4 Hours
Abstract
BACKGROUND

Primary biliary cholangitis (PBC) is a serious disease that causes significant morbidity. PBC is confirmed with liver biopsy but autoantibodies are frequently used as proxies for diagnosis. The performance of autoantibodies for the diagnosis of PBC seems to vary widely across populations.

AIM

To assess the diagnostic performance of several autoantibodies for the diagnosis of PBC in Latin American individuals.

METHODS

We studied 85 female adult Colombians, 43 cases with biopsy-confirmed PBC and 42 controls in whom a liver biopsy ruled out PBC. Plasma anti-mitochondrial antibodies (AMAs), anti-smooth muscle antibodies (ASMAs) and anti-nuclear antibodies (ANAs), as well as total immunoglobulin (Ig) M and IgG were determined using immunofluorescence or enzyme-linked immunosorbent assay in all study participants within 1 year of the biopsy. For all variables, values analyzed were those closest to the date of the biopsy. Patients with viral or alcoholic hepatitis were excluded.

RESULTS

Mean age at diagnosis was 58.7 years for cases and 56.9 years for controls, and the body mass index was lower among cases. Most cases received ursodeoxycholic acid, while most controls received vitamin E. Sjögren syndrome and Hashimoto’s thyroiditis were the most frequent autoimmune comorbidities of PBC. The prevalence of AMA positivity among PBC cases was unexpectedly low. The sensitivity and specificity values were respectively 44.2% and 76.2% for AMA, 74.4% and 38.1% for ANA, 14.0% and 73.8% for ASMA, 26.7% and 80.0% for IgG, and 57.1% and 85.7% for IgM. The combination of positive AMA plus positive IgM had 91% positive predictive value for PBC. Among AMA-negative cases, the most prevalent antibodies were ANA (87.5%). In all, 62% of AMA-positive and 84.6% of IgM-positive individuals had fibrosis in their biopsy.

CONCLUSION

AMA positivity was very low among female Latin American patients with PBC. The performance of all antibodies was quite limited. These results highlight the urgent need for better PBC biomarkers.

Keywords: Primary biliary cholangitis; Antibodies; Anti-mitochondrial antibodies; Latin America; Anti-smooth muscle antibodies

Core Tip: Primary biliary cholangitis (PBC) is confirmed by liver biopsy, but autoantibodies are frequently employed as an indirect diagnostic method. We studied 85 female adult Latin American patients, 43 with biopsy-confirmed PBC and 42 in whom liver biopsy ruled out PBC. The prevalence of anti-mitochondrial antibodies among PBC cases was only 44.2%. Anti-nuclear antibodies and anti-smooth muscle antibodies had similarly low diagnostic performance. Eighty-two percent of immunoglobulin M-positive individuals had fibrosis in their biopsy. Among female Latin American patients with PBC, the performance of any individual antibody for PBC diagnosis was quite limited.