title: Smoking as a risk factor for autoimmune liver disease: what we can learn from primary biliary cirrhosis.
abstract: Primary biliary cirrhosis (PBC) is a cholestatic liver disease characterised by the immune-mediated destruction of biliary epithelial cells in small intrahepatic bile ducts. The disease is characterised by circulating anti-mitochondrial antibodies (AMA) as well as disease specific anti-nuclear antibodies (ANA), cholestatic liver biochemistry, and characteristic histology. The disease primarily affects middle-aged females, and its incidence is apparently increasing worldwide. Epidemiological studies have indicated several risk factors for the development of PBC, with family history of PBC, recurrent urinary tract infection, and smoking being the most widely cited. Smoking has been implicated as a risk factor in several autoimmune diseases, including the liver, by complex mechanisms involving the endocrine and immunological systems to name a few. Studies of smoking in liver disease have also shown that smoking may progress the disease towards fibrosis and subsequent cirrhosis. This review will examine the literature surrounding smoking as a risk factor for PBC, as well as a potential factor in the progression of fibrosis in PBC patients.
authors.affiliation: Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill Campus, London SE5 9RS, UK.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Smyk
authors.forename: Eirini I
authors.initials: EI
authors.lastname: Rigopoulou
authors.forename: Luigi
authors.initials: L
authors.lastname: Muratori
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Bogdanos
mesh_terms: D018450:Disease Progression; D019693:Hepatitis, Autoimmune / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D008105:Liver Cirrhosis, Biliary / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*