Deceptive Tweet or Great ‘Hook?’

The title was tweeted by the AGA and definitely piqued my interest.  The link that was provided connects to a full-text article (Mack C, CMGH 2015; 1: 267-74) on the potential immunopathogeneis of biliary atresia in the neonatal period.  While the article provides a lot of information, it really does not come close to answering the title question.  In my view, this article reminds me of many other articles on other enigmatic liver diseases in which the clues on pathogenesis led in the wrong direction (eg. antioxidants for gestational alloimmune liver disease)

Here’s from the abstract and the summary:

From abstract:

The neonatal presentation of BA prompts the question of what potential modifications of unique aspects of the neonatal immune system set the stage for the progressive biliary disease. This review also discusses the characteristics of neonatal immune response and the theories on how alterations of this response could contribute to the pathogenesis of BA. These include aberrant type 1 helper T-cell (T_H1) and T_H17 responses, deficiencies in regulatory T cells, activation of humoral immunity, and autoimmunity. To advance our understanding of the etiology of BA, future studies should focus on the unique aspects of the neonatal immune system that have gone awry.

From summary:

Biliary atresia is a devastating disease wherein the vast majority of patients require liver transplantation for survival. It is critical to grasp the immunopathogenesis of BA in order to provide future therapies that control the intrahepatic biliary inflammation and prevent subsequent fibrosis. Evidence exists for a key role of both arms of the adaptive immune response in bile duct injury. The neonatal presentation of BA provides a clue to disease pathogenesis. Early events that impact the neonatal immune system (ie, perinatal virus infection) may alter the immune response and promote a progressive inflammatory or biliary autoimmune disease. To advance our understanding of the etiology of BA, future studies should focus on those unique aspects of the neonatal immune system that have gone awry, as detailed throughout this review.

Bottomline: Clues are important but do not answer the question of what causes biliary atresia.

Related blog posts:

• Stool Color Cards -Not Flashy but Effective | gutsandgrowth
• START Study: Steroids Not Effective For Biliary … – gutsandgrowth
• Biliary Atresia More Common in Preterm Infants | gutsandgrowth
• Working on biomarkers for Biliary Atresia | gutsandgrowth
• Reclassifying Biliary Atresia -Three Subtypes | gutsandgrowth
• Diagnosing biliary atresia earlier | gutsandgrowth
• MicroRNAs and biliary atresia | gutsandgrowth
• Learning a lot from ChiLDREN (part 1) | gutsandgrowth