Bile acid therapy and markers of immune-mediated damage in primary biliary cirrhosis

In primary biliary cirrhosis (PBC), liver damage results from both immune- and bile acid-mediated mechanisms. Therapies directed against the former have been either ineffective or toxic, while bile salt therapy is well tolerated but of uncertain long-term benefit. Because of slow disease progression, there is a need for surrogate markers of long-term efficacy. Candidates include markers of immune activation, such as soluble intercellular adhesion molecule-1 (sICAM-1) which shows promise in this respect. Using this marker, evidence has been presented to suggest an additive effect of the combination of ursodeoxycholic acid (UDCA) with azathioprine and prednisone in a short-term trial in PBC.