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Biliary atresia (BA) is thought to be associated with infections by viruses such as Reoviridae and is characterized histologically by fibrosclerosing cholangitis with proinflammatory cytokine-mediated inflammation. Interleukin (IL)-32 affects the continuous inflammation by increasing the production of proinflammatory cytokines. In this study, the role of IL-32 in the cholangitis of BA was examined. Immunohistochemistry for IL-32 and caspase 1 was performed using 21 samples of extrahepatic bile ducts resected from BA patients. Moreover, using cultured human biliary epithelial cells (BECs), the expression of IL-32 and its induction on stimulation with a Toll-like receptor [(TLR)-3 ligand (poly(I:C)] and proinflammatory cytokines was examined. BECs composing extrahepatic bile ducts showing cholangitis expressed IL-32 in BA, but not in controls. Caspase 1 was expressed constantly on BECs of both BA and control subjects. Furthermore, poly(I:C) and proinflammatory cytokines [(IL-1β, interferon (IFN)-γ and tumour necrosis factor (TNF)-α] induced IL-32 expression strongly in cultured BECs, accompanying the constant expression of TLR-3 and caspase 1. Our results imply that the expression of IL-32 in BECs was found in the damaged bile ducts of BA and induced by biliary innate immunity via TLR-3 and proinflammatory cytokines. These findings suggest that IL-32 is involved initially in the pathogenic mechanisms of cholangitis in BA and also plays an important role in the amplification and continuance of periductal inflammatory reactions. It is therefore tempting to speculate that inhibitors of IL-32 could be useful for attenuating cholangitis in BA., (© 2013 British Society for Immunology.)

An increase in mRNA levels for TNF and Tnfrsf1 in the bile ducts of Tnfsf5-/-(CD40 ligand or CD154 knockout) mice developing cholangitis following infection by Cryptosporidium parvum (CP) is accompanied by staining for TNFalpha in areas of inflammation. To determine whether TNF contributed to the bile duct damage seen in chronically-infected animals, we bred B6 mice with disrupted genes for Tnfrsf1a, Tnfrsf1b and Tnfsf5. Following CP infection, the Tnfsf5-/- Tnfrsf1a & 1b-/- mice were spared from cholangitis, even though their intestinal and bile duct infection by CP persisted. Mice with disruptions of Tnfsf5, and either Tnfrsf1a or Tnfrsf1b, developed bile duct sclerosis similar to that seen in CD40 and Tnfsf5 knockouts. Our data indicate that signalling through either TNF receptor is sufficient for the bile duct damage that follows chronic CP infection in mice, with disruption of the Tnfsf5 molecule.

During routine screening for anti-nuclear antibodies, using rat liver tissue as substrate, a reactivity against bile duct epithelium was observed in sera from carcinoid tumour patients given human leucocyte-derived IFN-alpha (HuLe IFN-alpha). In a retrospective study, initiated by this observation, the development of serum antibodies to bile duct epithelium was observed in nine out of 12 patients with carcinoid tumours and in three out of 14 patients with hairy-cell leukaemia during their treatment with HuLe IFN-alpha. However, no bile duct reactivity was observed in sera from carcinoid or hairy-cell leukaemia in patients given recombinant IFN-alpha. When analysing the reactivity of positive sera against a panel of rat and human tissues, a uniform reactivity was observed against simple epithelial cells lining the gastrointestinal tract, pancreatic secretory ducts, fallopian tube, kidney tubuli, mesothelium and also against carcinoid tumour cells. The mechanisms promoting autoreactivity against this simple epithelial cell autoantigen is so far unknown. The cytoplasmic as well as the restricted staining pattern of simple epithelial cells may indicate autoreactivity against certain cytoskeletal intermediate filaments, such as cytokeratin 19, 18 and 8, known to be exclusively present in simple epithelial cells and tumours derived from them.

IgA synthesized in hepatobiliary tissues accounts for about one-half of the IgA present in human hepatic bile, but the location of the IgA synthesizing cells has been in doubt because few plasma cells are present in normal liver. Therefore, we immunocytochemically localized IgA, J chain and secretory component in bile duct tissues of six patients operated upon for biliary duct obstruction. Numerous plasma cells containing IgA and J chain were found surrounding the accessory glands of the major bile ducts and in the area just beneath the surface epithelium of the ducts. At the ultrastructural level, IgA and SC in the epithelial cells had the features characteristic of secretory component-mediated endocytic translocation of IgA. We conclude that plasma cells in biliary duct mucosa are the likely source of much of the locally synthesized IgA that is secreted into human hepatic bile. The IgA probably reaches the bile by direct transfer across biliary epithelium.

Using immunohistological techniques, leucocytes were enumerated in portal tracts and bile duct epithelium in bone marrow transplant recipients with and without evidence of hepatic graft versus host disease (GvHD) and compared with normal subjects. Samples were obtained 8-169 days after transplantation. In marrow recipients without graft versus host disease (GvHD), inducer and suppressor/cytotoxic lymphocytes were reduced in number in the portal tracts compared with normal subjects. In GvHD, suppressor/cytotoxic lymphocytes were increased relative to non-GvHD recipients, but did not exceed normal values, while inducer cell numbers remained low. Natural killer cells (HNK1+) were not found in normal subjects, were present in small numbers in non-GvHD transplant cases and significantly increased in GvHD. The total number of portal tract leucocytes was not elevated in GvHD and the changes in the relative proportions of cells were similar to those that have been observed in the peripheral blood after transplantation. There was no increase in the number of lymphocytes expressing the activation markers Tac, T10 and HLA-DR nor in the number of leucocytes within the bile duct epithelium itself. These findings differ from those we have previously obtained in a similarly treated group of patients with cutaneous GvHD where lymphocytes were increased in the epithelium and stroma and expressed activation markers. Like the epidermis of the skin, however, the bile duct epithelium showed increased staining for HLA-DR antigens in all cases, but focal staining was also present in four of the seven marrow recipients without GvHD. The significance of these findings is discussed.

Recently we observed the expression of MHC class II antigens on bile duct epithelium in human liver transplantation rejection. In this report we present evidence for the expression of MHC class II antigens on bile duct epithelium in experimental GVHD. These findings support the idea, that the target tissue elements in liver transplantation rejection and GVHD are the bile ducts, on the other hand this is a new experimental model for the analysis of MHC class II antigen expression on epithelial tissue.

The distribution of HLA-A,B,C, HLA-D/DR and HLA-D/DQ molecules was studied by indirect immunofluorescence with an avidin-biotin technique and monoclonal antibodies, in unfixed cryostat sections of liver biopsies from 76 patients with chronic liver diseases of various aetiologies and five normal liver biopsy specimens. In pathological liver, strong cytoplasmic or membrane-like positivity for HLA-A,B,C of hepatocytes was observed in piecemeal necrosis areas in all groups. Cytoplasmic staining was mainly seen in lobular areas in autoimmune, cryptogenic and HBV-related cases with viral replication, while membrane-like positivity was more frequently observed in primary biliary cirrhosis, alcoholic and HBV-related cases without viral replication. A weak cytoplasmic staining for HLA-D/DR was observed in piecemeal necrosis and lobular areas mainly in HBV-related cases with viral replication. While bile duct cells were positive for both HLA-D/DR and HLA-D/DQ, hepatocytes were consistently HLA-D/DQ negative. The increased HLA-A,B,C expression on hepatocytes should allow T cytotoxic cell aggression. Hepatocellular HLA-D/DR expression is definite but weak and probably does not allow direct autoantigen presentation and induction of autoimmunity. Negativity for HLA-D/DQ further supports this hypothesis. Since cytoplasmic staining for Class I and II molecules is greatly lowered by fixing cryostat liver sections, prestaining conditions should be taken into account when comparing different studies.

The human liver probably removes circulating polymeric IgA by two routes: (1) secretory component-mediated endocytic transport of polymeric IgA from portal tract blood vessels into bile across biliary epithelial cells and (2) uptake with possible catabolism by hepatocytes and/or sinusoidal phagocytic cells by uncharacterized receptor(s). Failure of either clearance mechanism due to liver disease results in elevated serum polymeric IgA levels. In patients with cholestasis, the raised serum polymeric IgA concentration is due to reflux of biliary secretory immunoglobulin into the blood.