Measurement of IgG4 in bile: a new approach for the diagnosis of IgG4-associated cholangiopathy

Vosskuhl, Katja; Negm, AA; Framke, Theodor; Weismüller, Tobias J.; Manns, MP; Wedemeyer, Heiner; Plentz, Ruben R.; Wedemeyer, Jochen; Lankisch, TO

doi:10.1055/s-0030-1256872

Cited by 39 publications

(23 citation statements)

References 7 publications

(17 reference statements)

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“…In contrast, ANCA was frequently found in the serum of patients without PSC. This finding corroborates a previous study in which we were able to distinguish IgG 4associated cholangitis from other biliary diseases by measuring IgG 4 in the bile with a higher sensitivity and specificity than IgG 4 in the serum [14]. Consequently, the analysis of IgG ANCA in bile may be helpful to distinguish PSC from other biliary disorders.…”

Section: Discussionsupporting

confidence: 91%

“…The analysis of the markers in bile may be more sensitive than of those in serum, which is pathophysiologically plausible since the cause of biliary diseases typically resides in the epithelium, where various markers are secreted [25]. We recently demonstrated that bile measurements are helpful in the diagnosis of biliary diseases [12][13][14]. Because the inflammation of PSC takes place at the biliary epithelium, we hypothesized that a local immune response might occur in the presence of ANCA.…”

Section: Discussionmentioning

confidence: 99%

“…Bile obtained from patients with PSC was also used for other studies [12][13][14]. Patients with PSC, cholangiocarcinoma (CCA) -according to the international nomenclature/abbreviations for cholangiocarcinoma, pancreatic cancer, chronic pancreatitis, secondary sclerosing cholangitis (SSC) and choledocholithiasis and IgG 4 cholangitis were included in the study.…”

Section: Study Populationmentioning

confidence: 99%

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Antineutrophil cytoplasmic antibodies in bile are associated with disease activity in primary sclerosing cholangitis

Lenzen

Weismüller

Negm

et al. 2013

Scandinavian Journal of Gastroenterology

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OBJECTIVE. Primary sclerosing cholangitis (PSC) is an autoimmune cholestatic liver disease of unknown etiology. The role of antineutrophil cytoplasmic antibodies (ANCAs) in the serum of patients with PSC remains unclear. We hypothesized that ANCA may be detectable in bile, potentially providing diagnostic and prognostic information. METHODS. Serum and bile were prospectively collected during endoscopic retrograde cholangiography (ERC) in 72 patients with PSC and other non-PSC obstructive biliary diseases. ANCA measurements were performed by indirect immunofluorescence (IIF). RESULTS. Immunoglobulin G (IgG) ANCA was detected significantly more often in the bile of PSC patients (15/39; 38%) than without (2/33; 6%) (p = 0.001). IgG ANCA in bile was associated with a ten times higher risk of PSC (p = 0.005). In addition, IgG ANCA positivity in bile was associated with the presence of dominant strictures (p = 0.03), cholangiographic severity (p = 0.004), number of ERC (p = 0.01) and interventions performed (p = 0.03). However, IgG ANCA in bile did not correlate with transplantation, cholangiocarcinoma or death. No association was observed between ANCA positivity in sera and ANA and ASCA positivity in sera or bile with the above-mentioned clinical features. CONCLUSIONS. The presence of ANCA in the bile of patients with PSC is a novel finding and highly suggestive of PSC. Biliary IgG ANCA correlates with the severity of bile duct strictures and the ensuing number of ERCs and interventions. Therefore, a positive ANCA status in bile may serve as a diagnostic and prognostic marker of the disease progression and biliary complications.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

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Antineutrophil cytoplasmic antibodies in bile are associated with disease activity in primary sclerosing cholangitis

Lenzen

Weismüller

Negm

et al. 2013

Scandinavian Journal of Gastroenterology

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“…However, in a recent study from Europe, elevated IgG4 was seen in 6/23 (26.1%) of PSC patients similar to our study. 26 In our cohort of 142 patients, only 50 had serum IgG4 measured. To account for the possible bias involved in serum IgG4 measurement, we had compared disease activity in the 50 patients with serum IgG4 measurement and the remaining 92 patients who did not have IgG4 measured.…”

Section: Figurementioning

confidence: 78%

Elevated immunoglobulin G4 level is associated with reduced colectomy-free survival in patients with primary sclerosing cholangitis and ulcerative colitis

Navaneethan

Venkatesh

Choudhary

et al. 2013

Journal of Crohn's and Colitis

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“…Biopsies of the duodenal papilla are easily accessible [72], yet only moderately sensitive, and precaution must be taken to avoid papilla injury with an increased risk of complicating pancreatitis. IgG4 is also detectable in bile [73]. Differential diagnostic assessments versus malignancy (e.g., cholangiocarcinoma) may sometimes represent a challenge [74].…”

Section: Igg4 and Sclerosing Cholangitismentioning

confidence: 99%

Update on primary sclerosing cholangitis

Karlsen

Schrumpf

Boberg

2010

Digestive and Liver Disease

105

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SummaryPrimary sclerosing cholangitis (PSC) remains one of the most challenging conditions of clinical hepatology. There has been a steady growth in research to overcome this fact and the present review aims at summarizing the most recently published literature. The main emphasis will be put on the link of recent pathogenetic insights to clinical characteristics and patient management. With regard to pathogenesis, there is no consensus yet as to whether immune mediated injury or factors related to bile acid physiology are the most important. It also remains to be clarified whether PSC is a mixed bag of various secondary etiologies yet to be defined, or a disease entity predominantly represented by sclerosing cholangitis in the context of inflammatory bowel disease. Most important, there is no available medical therapy with proven influence on clinical end points, and timing of liver transplantation and patient follow-up are challenging due to the unpredictable and high risk of cholangiocarcinoma. Ó

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Measurement of IgG4 in bile: a new approach for the diagnosis of IgG4-associated cholangiopathy

Abstract: The study demonstrates that bile IgG4 measurement is possible and may help to distinguish IAC from other diseases.

Cited by 39 publications

References 7 publications

Antineutrophil cytoplasmic antibodies in bile are associated with disease activity in primary sclerosing cholangitis

Antineutrophil cytoplasmic antibodies in bile are associated with disease activity in primary sclerosing cholangitis

Elevated immunoglobulin G4 level is associated with reduced colectomy-free survival in patients with primary sclerosing cholangitis and ulcerative colitis

Update on primary sclerosing cholangitis

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