Sequence of events leading to primary biliary cholangitis

Figure 1 From immune mediated damage to bile acids injury. In primary biliary cholangitis the inflammatory process induces a decrease in chloride-bicarbonate exchangerexpression. This in turn determines a reduction of bicarbonate film (bicarbonate umbrella) on the canalicular portion of bile duct cells, exposing them to hydrophobic bile acids injury. AE2: Chloride-bicarbonate exchanger.

Figure 2 Central role of ductular reaction in the progression of primary biliary cholangitis. Ductular reaction contributes to the activation of hepatic stellate cells and simultaneously favours a cell senescent phenotype. These events support the ductopenic/cirrhotic evolution of liver tissue during this cholestatic disease. PBC: Primary biliary cholangitis; SASP: Senescence-associated secretory phenotype.