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      The immunogenetics of primary biliary cirrhosis: A comprehensive review


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          Primary biliary cirrhosis (PBC), a classic autoimmune liver disease, is characterised by a progressive T cell predominant lymphocytic cholangitis, and a serologic pattern of reactivity in the form of specific anti-mitochondrial antibodies (AMA). CD4+ T cells are particularly implicated by PBC's cytokine signature, the presence of CD4+ T cells specific to mitochondrial auto-antigens, the expression of MHC II on injured biliary epithelial cells, and PBC's coincidence with other similar T cell mediated autoimmune conditions. CD4+ T cells are also central to current animal models of PBC, and their transfer typically also transfers disease. The importance of genetic risk to developing PBC is evidenced by a much higher concordance rate in monozygotic than dizygotic twins, increased AMA rates in asymptomatic relatives, and disproportionate rates of disease in siblings of PBC patients, PBC family members and certain genetically defined populations. Recently, high-throughput genetic studies have greatly expanded our understanding of the gene variants underpinning risk for PBC development, so linking genetics and immunology. Here we summarize genetic association data that has emerged from large scale genome-wide association studies and discuss the evidence for the potential functional significance of the individual genes and pathways identified; we particularly highlight associations in the IL-12-STAT4-Th1 pathway. HLA associations and epigenetic effects are specifically considered and individual variants are linked to clinical phenotypes where data exist. We also consider why there is a gap between calculated genetic risk and clinical data: so-called missing heritability, and how immunogenetic observations are being translated to novel therapies. Ultimately whilst genetic risk factors will only account for a proportion of disease risk, ongoing efforts to refine associations and understand biologic links to disease pathways are hoped to drive more rational therapy for patients.


          • Primary biliary cirrhosis is a typical autoimmune disease with a strong genetic component.

          • Genome-wide studies have greatly expanded understanding of genetic risk.

          • This review highlights individual associations including HLA types and the IL-12-STAT4 pathway.

          • Animal models, epigenetics and novel immunological therapies are also considered.

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          Most cited references98

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          IRFs: master regulators of signalling by Toll-like receptors and cytosolic pattern-recognition receptors.

          The interferon-regulatory factor (IRF) family of transcription factors was initially found to be involved in the induction of genes that encode type I interferons. IRFs have now been shown to have functionally diverse roles in the regulation of the immune system. Recently, the crucial involvement of IRFs in innate and adaptive immune responses has been gaining much attention, particularly with the discovery of their role in immunoregulation by Toll-like receptors and other pattern-recognition receptors.
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            Early lymphocyte expansion is severely impaired in interleukin 7 receptor-deficient mice

            Interleukin 7 (IL-7) stimulates the proliferation of B cell progenitors, thymocytes, and mature T cells through an interaction with a high affinity receptor (IL-7R) belonging to the hematopoietin receptor superfamily. We have further addressed the role of IL-7 and its receptor during B and T cell development by generating mice genetically deficient in IL-7R. Mutant mice display a profound reduction in thymic and peripheral lymphoid cellularity. Analyses of lymphoid progenitor populations in IL-7R-deficient mice define precisely those developmental stages affected by the mutation and reveal a critical role for IL-7R during early lymphoid development. Significantly, these studies indicate that the phase of thymocyte expansion occurring before the onset of T cell receptor gene rearrangement is critically dependent upon, and mediated by the high affinity receptor for IL-7.
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              Genome-wide association study identifies 12 new susceptibility loci for primary biliary cirrhosis

              In addition to the HLA-locus, six genetic risk factors for primary biliary cirrhosis (PBC) have been identified in recent genome-wide association studies (GWAS). To identify additional loci, we carried out a GWAS using 1,840 cases from the UK PBC Consortium and 5,163 UK population controls as part of the Wellcome Trust Case Control Consortium 3 (WTCCC3). Twenty-eight loci were followed up in an additional UK cohort of 620 PBC cases and 2,514 population controls. We identified 12 novel risk loci (P<5×10−8) and replicated all previously associated loci. Three further novel loci were identified by meta-analysis of data from our study and previously published GWAS results. New candidate genes include STAT4, DENND1B, CD80, IL7R, CXCR5, TNFRSF1A, CLEC16A, and NFKB1. This study has considerably expanded our knowledge of the genetic architecture of PBC.

                Author and article information

                J Autoimmun
                J. Autoimmun
                Journal of Autoimmunity
                Academic Press
                1 November 2015
                November 2015
                : 64
                : 42-52
                [a ]NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham, UK
                [b ]Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto General Research Institute, and Departments of Immunology and Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
                Author notes
                []Corresponding author. Centre for Liver Research, Institute of Biomedical Research, Wolfson Drive, University of Birmingham, Birmingham, B15 2TT, UK.
                © 2015 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Review Article

                genome-wide association study,immunochip,hla,cd4+ t cell,animal models,regulatory t cell
                genome-wide association study, immunochip, hla, cd4+ t cell, animal models, regulatory t cell


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