Author information

¹Scientific Institute for Research, Hospitalization and Healthcare, Negrar, VeronaItaly.

²University of Padova, Padova, Italy.

³Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.

Abstract

Introduction: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by the immune-mediated destruction of small and medium intrahepatic bile ducts, involving predominantly females. PBC has long been described as an autoimmune liver disease, also because it is very often associated with many autoimmune conditions. More recently, another pathogenic mechanism exploring the damage of cholangiocytes has been hypothesized, i.e. a defect in the biliary umbrella which is physiologically responsible for the exchange of the ions Cl^-and HCO₃^- and maintains the integrity of glycocalyx. To provide a state-of-the-art analysis of this topic, a systematic review of literature in PubMed, Scopus and Science Direct was conducted (inclusive dates: 1986-2023).

Area covered: Although the aetiology remains unknown, the pathogenesis consists of a complex immune-mediated process resulting from a genetic susceptibility. PBC can be triggered by an immune-mediated response to an autoantigen, which leads to a progressive destruction of bile ducts and eventually to a progressive fibrosis with cirrhosis. The defect in the "bicarbonate umbrella" acts as a protection against the toxic hydrophobic bile acids, leading to a toxic composition of bile.

Expert opinion: This review offers a summary of the current knowledges about the pathogenesis of PBC, indicating that this is probably based on the mutual relationships between the immune insult and the unbalanced secretory mechanisms.