title: Primary biliary cirrhosis following Lactobacillus vaccination for recurrent vaginitis.
abstract: OBJECTIVE
  Antimitochondrial antibodies directed against the E2 subunit of the pyruvate dehydrogenase complex, PDC-E2, and other mitochondrial 2-oxoacid dehydrogenases (AMA-M2) are the hallmark for diagnosis of primary biliary cirrhosis (PBC). AMA-M2 formation as an early step in the pathogenesis of PBC has recently been assumed to be triggered by bacterial mimics of the E2 subunit and certain reactant xenobiotics. We report a case of symptomatic PBC diagnosed after sequential immunization with a lactobacillus vaccine for recurrent vaginitis over years.
  
  
  METHODS
  Serum AMA-M2 specificity of the patient was evaluated by indirect immunofluorescence, immunoblotting and ELISA. Serum antibody responses against pyruvate dehydrogenase complex-E2 subunit (PDC-E2(212-226)), the major PBC-specific mitochondrial autoepitope, and microbial mimics revealed cross-reactivity with beta-galactosidase of Lactobacillus delbrueckii (LACDE BGAL(266-280)) which shows a high local homology with that of Lactobacillus species administered via the vaccine. The relative affinity of antibody reactivity to LACDE BGAL(266-280) was significantly higher than that against human PDC-E2(212-226).
  
  
  CONCLUSIONS
  We conclude that lactobacillus vaccination therapy may be another culprit for the development of PBC in genetically susceptible women.
authors.affiliation: Institute of Liver Studies, King's College, London School of Medicine at King's College Hospital, London, United Kingdom.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bogdanos
authors.forename: Thomas
authors.initials: T
authors.lastname: Pusl
authors.forename: Christian
authors.initials: C
authors.lastname: Rust
authors.forename: Diego
authors.initials: D
authors.lastname: Vergani
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beuers
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D001428:Bacterial Vaccines / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000276:immunology*; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D008928:Mitochondria / Q000276:immunology; D012008:Recurrence; D016585:Vaginosis, Bacterial / Q000517:prevention & control*
chemical_list: D000888:Antibodies, Anti-Idiotypic; D001428:Bacterial Vaccines