Plasma cells and the chronic nonsuppurative destructive cholangitis of primary biliary cirrhosis.
There has been increased interest in the role of B cells in the pathogenesis of primary biliary cirrhosis (PBC). Although the vast majority of patients with this disease have anti-mitochondrial antibodies, there is no correlation of anti-mitochondrial antibody titer and/or presence with disease severity. Furthermore, in murine models of PBC, it has been suggested that depletion of B cells may exacerbate biliary pathology. To address this issue, we focused on a detailed phenotypic characterization of mononuclear cell infiltrates surrounding the intrahepatic bile ducts of patients with PBC, primary sclerosing cholangitis, autoimmune hepatitis, chronic hepatitis C, and graft-versus-host disease, including CD3, CD4, CD8, CD20, CD38, and immunoglobulin classes, as well as double immunohistochemical staining for CD38 and IgM. Interestingly, CD20 B lymphocytes, which are a precursor of plasma cells, were found in scattered locations or occasionally forming follicle-like aggregations but were not noted at the proximal location of chronic nonsuppurative destructive cholangitis. In contrast, there was a unique and distinct coronal arrangement of CD38 cells around the intrahepatic ducts in PBC but not controls; the majority of such cells were considered plasma cells based on their expression of intracellular immunoglobulins, including IgM and IgG, but not IgA. Patients with PBC who manifest this unique coronal arrangement were those with significantly higher titers of anti-mitochondrial antibodies.


CONCLUSIONS
These data collectively suggest a role for plasma cells in the specific destruction of intrahepatic bile ducts in PBC and confirm the increasing interest in plasma cells and autoimmunity.
Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan. torutoru@uonumahosp.jp
Toru
T
Takahashi
Tomofumi
T
Miura
Junichiro
J
Nakamura
Satoshi
S
Yamada
Tsutomu
T
Miura
Masahiko
M
Yanagi
Yasunobu
Y
Matsuda
Hiroyuki
H
Usuda
Iwao
I
Emura
Koichi
K
Tsuneyama
Xiao-Song
XS
He
M Eric
ME
Gershwin
D051997:ADP-ribosyl Cyclase 1 / Q000378:metabolism; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000378:metabolism; D001706:Biopsy; D016022:Case-Control Studies; D002761:Cholangitis / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D015209:Cholangitis, Sclerosing / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006086:Graft vs Host Disease / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D019698:Hepatitis C, Chronic / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D019693:Hepatitis, Autoimmune / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000276:immunology; D010950:Plasma Cells / Q000378:metabolism / Q000473:pathology* / Q000502:physiology*
D000888:Antibodies, Anti-Idiotypic; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D051997:ADP-ribosyl Cyclase 1