title: Clues to the etiology of bile duct injury in biliary atresia.
abstract: Biliary atresia (BA) is an infantile obstructive cholangiopathy of unknown etiology with suboptimal therapy, which is responsible for 40 to 50% of all pediatric liver transplants. Although the etiology of bile duct injury in BA in unknown, it is postulated that a pre- or perinatal viral infection initiates cholangiocyte apoptosis and release of antigens that trigger a Th1 immune response that leads to further bile duct injury, inflammation, and obstructive fibrosis. Humoral immunity and activation of the innate immune system may also play key roles in this process. Moreover, recent investigations from the murine BA model and human data suggest that regulatory T cells and genetic susceptibility factors may orchestrate autoimmune mechanisms. What controls the coordination of these events, why the disease only occurs in the first few months of life, and why a minority of infants with perinatal viral infections develop BA are remaining questions to be answered.
authors: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, and Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado 80045, USA.
authors: Cara L
authors: CL
authors: Mack
authors: Amy G
authors: AG
authors: Feldman
authors: Ronald J
authors: RJ
authors: Sokol
mesh_terms: D015551:Autoimmunity / Q000276:immunology; D001656:Biliary Atresia / Q000209:etiology / Q000235:genetics / Q000276:immunology*; D044127:Epigenesis, Genetic; D020022:Genetic Predisposition to Disease; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D007113:Immunity, Innate / Q000276:immunology*; D014777:Virus Diseases / Q000150:complications
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