title: Serum markers of infections in patients with primary biliary cirrhosis: evidence of infection burden.
abstract: BACKGROUND
  Currently not much is known regarding the environmental factors involved in primary biliary cirrhosis (PBC). It is even more unclear which factors may determine the subgroup (i.e., AMA status) of patients with PBC. We thus tested AMA+and AMA- PBC patients' sera for antibodies (Abs) against multiple infectious agents.
  
  
  METHODS
  Sera from 69 patients with PBC (49 AMA+and 20 AMA-) and 100 matched controls were screened for IgG-Abs against Toxoplasma gondii, Helicobacter pylori, Epstein-Barr virus (EBV), cytomegalovirus (CMV), hepatitis B, and hepatitis C utilizing the BioPlex 2200 and ELISA kits (Bio-Rad Laboratories, USA).
  
  
  RESULTS
  The prevalence of four anti-infectious agents Abs was significantly elevated among PBC patients when compared with controls, namely anti-T. gondii (ATxA; 71% vs. 40%, p<0.0001), EBV early antigen (EA; 44% vs. 12%, p<0.0001), H. pylori (54% vs. 31%, p<0.01), and CMV (90% vs. 75%, p<0.05) Abs, respectively. The co-occurrence of these four anti-infectious agents Abs was highly common in PBC, whereas this infection burden was rare in healthy subjects (20% vs. 3% respectively, p<0.0001). Furthermore, specific infections interactions possibly increasing PBC risk were noted as well. Seropositivity of ATxA was inversely associated with cirrhosis among PBC patients (p<0.05). Finally, no differences were observed between AMA- sera and their AMA+counterparts with regard to seroprevalence of any of the investigated infectious agents.
  
  
  CONCLUSIONS
  We note the association of ATxA and PBC, with the possibility of a milder disease manifestation. We also suggest that multiple exposures to infectious agents may contribute to PBC risk.
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.
authors.forename: Yinon
authors.initials: Y
authors.lastname: Shapira
authors.forename: Nancy
authors.initials: N
authors.lastname: Agmon-Levin
authors.forename: Yves
authors.initials: Y
authors.lastname: Renaudineau
authors.forename: Bat Sheva
authors.initials: BS
authors.lastname: Porat-Katz
authors.forename: Ori
authors.initials: O
authors.lastname: Barzilai
authors.forename: Maya
authors.initials: M
authors.lastname: Ram
authors.forename: Pierre
authors.initials: P
authors.lastname: Youinou
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood*; D001424:Bacterial Infections / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology; D015415:Biomarkers / Q000097:blood*; D005260:Female; D054884:Host-Pathogen Interactions; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016036:Seroepidemiologic Studies; D014777:Virus Diseases / Q000097:blood* / Q000175:diagnosis / Q000821:virology
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D015415:Biomarkers