Significance And Roles Of Salivary AMA-M2 Detection And Oral Immunological Environment In Primary Biliary Cholangitis

Backgrouds:Primary biliary cholangitis(PBC)is a progressive autoimmune liver disease that causes accumulative damage of intrahepatic bile ducts and subsequently,cholestasis,advanced fibrosis and finally liver failure,but it specifically pathogenesis still was not clear.However,there is non-specific clinical feature in PBC patients so the diagnosis is still difficult.When diagnosed early and properly treated,many PBC patients respond well to medical therapy,while some patients with diagnosis and treatment delayed have to undergo liver transplantion.The improvement of PBC early diagnosis may help to increase the therapeutic effect.Anti-mitochondrial antibody M2(AMA-M2)is considered a pivotal biomarker for the diagnosis of Primary biliary cholangitis(PBC).Currently,AMA-M2 levels in the blood are determined serologically.However,these tests have many limitations,including inconvenience,invasiveness,and a risk of infection for the patient.Consequently,detection of this biomarker through a less invasive method is needed.This research aims to explore the oral immune state in PBC patients and evaluate the diagnostic value of salivary AMA-M2 in PBC.Methods:In this study,we prospectively collected serum and saliva samples from 151 individuals,which were divided into three groups-PBC patients(PBC),oral lichen planus patients(OLP)and healthy controls(HCs).AMA-M2 was assayed in saliva and serum samples from all patients and controls by enzyme-linked immuno sorbent assay(ELISA).Levels of inflammatory cytokines as well as alkaline phosphatase(ALP)and gamma-glutamyl transferase(GGT)were also measured in collected samples.Comparisons between groups were calculated by a paired t-test and one-way ANOVA.Pearson's correlation analysis was performed to analyze the association between salivary and serum AMA-M2 as well as inflammatory cytokines levels.Results:We found that AMA-M2 could be detected in saliva from serum AMA-M2-positive PBC patients,but not in serum AMA-M2-negative patients,OLP patients,or HCs.Furthermore,the concentration of salivary AMA-M2 we detected positively correlated with the amount of serum AMA-M2 in patients.The levels of salivary inflammatory cytokines were upregulated in both PBC and OLP groups compared to the healthy individuals that IL-6?IFN-?,TNF-?,IL-17A were significantly upregulated,while IL-10 had no obvious change.While compared to OLP groups,the levels of salivary inflammatory cytokines in PBC groups were relatively lower.Conclusions:Saliva may be a less invasive medium to accurately test for AMA-M2 levels,and this is a promising development for the diagnosis and monitoring of PBC.The elevated levels of inflammatory cytokines in saliva may reflect the Thl/Th2 imbalance as well as the mild immune injury in the oral of PBC patients.These results may provide novel therapeutic strategies to the treatment of PBC.