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Related Experiment Video

Updated: Feb 6, 2026

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Pathogen infections and primary biliary cholangitis.

A Tanaka1, P S C Leung2, M E Gershwin2

  • 1Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.

Clinical and Experimental Immunology
|August 13, 2018
PubMed
Summary

Bacterial infections, particularly Escherichia coli, are strongly linked to primary biliary cholangitis (PBC) by breaking immune tolerance. However, rising PBC rates in males and improved hygiene raise questions about this bacterial role.

Keywords:
Escherichia coliNovosphingobium aromaticivoransanti-mitochondrial autoantibodiesmolecular mimicrypyruvate dehydrogenase E2 subuniturinary tract infection

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Area of Science:

  • Hepatology
  • Immunology
  • Microbiology

Background:

  • Primary biliary cholangitis (PBC) is a complex liver disease with genetic and environmental factors.
  • Bacterial infections, especially urinary tract infections (UTIs), are investigated as a key environmental trigger for PBC.
  • Escherichia coli is a common UTI pathogen implicated in breaking immune tolerance.

Purpose of the Study:

  • To explore the role of bacterial infections, specifically E. coli, in the etiology of primary biliary cholangitis.
  • To investigate the mechanism of molecular mimicry between E. coli and host mitochondria in PBC pathogenesis.
  • To evaluate conflicting evidence regarding bacterial infection's role in PBC, considering changing prevalence patterns.

Main Methods:

  • Review of epidemiological data linking recurrent UTIs to PBC.
  • Analysis of animal studies and molecular mimicry between E. coli and human mitochondrial components.
  • Examination of E. coli's role in inducing anti-mitochondrial autoantibodies (AMA).

Main Results:

  • Recurrent UTIs, often caused by E. coli, are consistently associated with PBC.
  • E. coli infection can induce anti-mitochondrial autoantibodies (AMA) through molecular mimicry, a hallmark of PBC.
  • Other bacteria like Novosphingobium aromaticivorans are also considered potential contributors.

Conclusions:

  • Bacterial infections, particularly E. coli, are likely a dominant pathway in PBC etiology, especially in females, by disrupting immunological tolerance.
  • Rising PBC prevalence in males and improved hygiene present a counterargument, necessitating further research.
  • Systematically designed studies are crucial to fully elucidate the environmental factors and definitive role of bacterial infections in PBC.