The apoptosis protector, bcl-2 protein, is downregulated in bile duct epithelial cells of human liver allografts

Apoptosis of bile duct cells occurs in hepatic allografts and is correlated with acute rejection. bcl-2 protein counteracts apoptosis and prolongs cell survival. We therefore tested the expression of bcl-2 protein in bile ducts of liver grafts in comparison with those of liver cirrhosis.

115 biopsies from 17 liver allografts and 47 biopsies of liver cirrhosis were analyzed and compared with 22 normal controls and with biopsies from patients with primary sclerosing cholangitis or primary biliary cirrhosis. bcl-2 protein and PCNA (proliferating cell nuclear antigen) expression was assessed using immunohistochemistry, and apoptosis was analyzed employing in situ DNA end-labeling.

A high apoptotic rate was detected in bile duct cells of allograft biopsies. In contrast to controls, bile duct cells of allografts and liver cirrhosis had high proliferative activity (mean PCNA labeling index: 1.0% vs. 40.7% and 18.6%, respectively). In liver grafts, bcl-2 protein positivity of bile duct and ductular cells was found in 3.6% and 4.4% of sections, respectively, and in cirrhosis in 44% and 79%, respectively (allografts vs. cirrhosis p<0.01). In controls, only one biopsy was bcl-2 positive.

Whereas increased proliferative activity of small bile ducts and ductules in cirrhosis is associated with a high degree of bcl-2 expression, bile duct and ductular cells in liver grafts have a very low bcl-2 protein reactivity, even though their proliferative activity is high. These findings suggest that downregulation of bcl-2 expression in allograft bile duct cells might play a role in the increased apoptosis of these cells in acute rejection.