title: Presence of disease specific autoantibodies against liver sinusoidal cells in primary biliary cirrhosis.
abstract: OBJECTIVE
  To investigate the presence of autoantibodies directed against liver sinusoidal cells in primary biliary cirrhosis (PBC).
  
  
  METHODS
  Liver biopsies from 21 PBC patients were studied and compared with 12 liver biopsies from disease controls [3 patients with hepatitis B (HBV) virus, 3 patients with hepatitis C virus (HCV), 3 patients with non-alcoholic steatohepatitis and 3 patients with acute alcoholic hepatitis (AAH)]. As healthy controls, we used tissue specimens adjacent to metastatic liver adenocarcinoma. Normal serum was taken from staff members of the unit. The determination of the cell type targeted by autoantibodies present in the patients sera was performed by indirect immunofluorescence (IIF) analysis using paraffin-embedded liver sections as a substrate. Sera from homologous or heterologous PBC patients or sera from the disease control group were used as primary antibodies. The presence of autoantibodies was identified using confocal microscopy.
  
  
  RESULTS
  In total, 18/21 (85.7%) PBC patients exhibited positive staining in the sinusoidal cells, 10/21 (47.6%) in lymphocytes, 8/21 (38%) in cholangiocytes and 7/21 (33.3%) in hepatocytes, when homologous serum and fluorescein isothiocyanate-conjugated immunoglobulin type G (IgG) secondary antibody were used. PBC sections incubated with heterologous PBC serum showed reduced staining (20% for sinusoidal cells, 20% for lymphocytes, 20% for cholangiocytes and 13.3% for hepatocytes). When IgM immunoglobulin, instead of IgG, was used as secondary antibody, positive staining was observed in 75% of lymphocytes, 62.5% of cholangiocytes, 37.5% of hepatocytes and 50% of the sinusoidal cells with a much stronger staining intensity. No staining was observed when either normal or PBC sera were used as a primary antibody on liver sections from the disease control group. When PBC sera were incubated with healthy control sections, weak positive staining of cholangiocytes was observed in 3/21 (14.3%) PBC serum samples. Steatohepatitis serum on PBC sections gave a positive staining of some hepatocytes and lymphocytes but no staining on viral hepatitis sections. Incubation with HBV sera stained some hepatocytes, cholangiocytes and intra-sinusoidal or portal lymphocytes of PBC, HBV and AAH patients but not HCV patients.
  
  
  CONCLUSIONS
  In this study, for the first time in diseased liver tissue, we have demonstrated that a large proportion of PBC patients have disease specific autoantibodies against liver sinusoidal cells.
authors.affiliation: Ourania Sfakianaki, Argyro Voumvouraki, Elias Kouroumalis, Liver Research Laboratory, Medical School, University of Crete, 71003 Voutes, Crete, Greece.
authors.forename: Ourania
authors.initials: O
authors.lastname: Sfakianaki
authors.forename: Maria
authors.initials: M
authors.lastname: Tzardi
authors.forename: Argyro
authors.initials: A
authors.lastname: Voumvouraki
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Afgoustaki
authors.forename: Meri
authors.initials: M
authors.lastname: Koulentaki
authors.forename: Elias
authors.initials: E
authors.lastname: Kouroumalis
keywords: Autoantibodies; Cholangiocytes; Liver tissue; Primary biliary cirrhosis; Sinusoidal cells