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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 41 Issue 6
Jun.  2025
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Article Contents

Research advances in immunopathogenesis and targeted therapeutic strategies for primary biliary cholangitis comorbid with Sjögrens syndrome

DOI: 10.12449/JCH250627
Research funding:

Natural Science Foundation Project of Liaoning Province (2023-MS-189)

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  • Corresponding author: ZHAI Yongzhen, zhaiyz@sj-hospital.org (ORCID: 0000-0002-7665-9683)
  • Received Date: 2024-11-11
  • Accepted Date: 2025-01-10
  • Published Date: 2025-06-25
  • Primary biliary cholangitis (PBC) and Sjögren’s syndrome (SS) are both autoimmune disorders characterized by the involvement of epithelial tissue, and comorbidity of PBC and SS is often observed in clinical practice, suggesting that these two diseases may have common pathogeneses. Currently, there are still no specific targeted therapies for PBC and SS, and the therapeutic approach for systemic manifestations mainly relies on the treatment regimens for other autoimmune disorders. This article reviews the various potential therapeutic targets that have been clarified in the pathogenesis of PBC and SS and points out that targeted therapies for these two diseases can be developed based on the common immunopathological mechanism of PBC and SS, thereby providing valuable ideas for developing novel therapies.

     

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  • [1]
    LIU ZC, WANG ZL, ZHENG JR, et al. Prevalence of primary biliary cholangitis in the Chinese general population and its influencing factors: A systematic review[J]. J Clin Hepatol, 2023, 39( 2): 325- 332. DOI: 10.3969/j.issn.1001-5256.2023.02.011.

    刘智成, 王资隆, 郑佳睿, 等. 我国一般人群原发性胆汁性胆管炎患病率及其影响因素的系统综述[J]. 临床肝胆病杂志, 2023, 39( 2): 325- 332. DOI: 10.3969/j.issn.1001-5256.2023.02.011.
    [2]
    RAMOS-CASALS M, BRITO-ZERÓN P, KOSTOV B, et al. Google-driven search for big data in autoimmune geoepidemiology: Analysis of 394, 827 patients with systemic autoimmune diseases[J]. Autoimmun Rev, 2015, 14( 8): 670- 679. DOI: 10.1016/j.autrev.2015.03.008.
    [3]
    CHEN S, LI MQ, DUAN WJ, et al. Concomitant extrahepatic autoimmune diseases do not compromise the long-term outcomes of primary biliary cholangitis[J]. Hepatobiliary Pancreat Dis Int, 2022, 21( 6): 577- 582. DOI: 10.1016/j.hbpd.2022.05.009.
    [4]
    SUN Y, ZHANG WC, LI BS, et al. The coexistence of Sjögren’s syndrome and primary biliary cirrhosis: A comprehensive review[J]. Clin Rev Allergy Immunol, 2015, 48( 2-3): 301- 315. DOI: 10.1007/s12016-015-8471-1.
    [5]
    SELMI C, MERONI PL, GERSHWIN ME. Primary biliary cirrhosis and Sjögren’s syndrome: Autoimmune epithelitis[J]. J Autoimmun, 2012, 39( 1-2): 34- 42. DOI: 10.1016/j.jaut.2011.11.005.
    [6]
    ADAMSON TC 3rd, RI FOX, FRISMAN DM, et al. Immunohistologic analysis of lymphoid infiltrates in primary Sjogren’s syndrome using monoclonal antibodies[J]. J Immunol, 1983, 130( 1): 203- 208.
    [7]
    SHIMODA S, MIYAKAWA H, NAKAMURA M, et al. CD4 T-cell autoreactivity to the mitochondrial autoantigen PDC-E2 in AMA-negative primary biliary cirrhosis[J]. J Autoimmun, 2008, 31( 2): 110- 115. DOI: 10.1016/j.jaut.2008.05.003.
    [8]
    KITA H, LIAN ZX, van de WATER J, et al. Identification of HLA-A2-restricted CD8+ cytotoxic T cell responses in primary biliary cirrhosis: T cell activation is augmented by immune complexes cross-presented by dendritic cells[J]. J Exp Med, 2002, 195( 1): 113- 123. DOI: 10.1084/jem.20010956.
    [9]
    QIN Y, GAO C, LUO J. Metabolism characteristics of Th17 and regulatory T cells in autoimmune diseases[J]. Front Immunol, 2022, 13: 828191. DOI: 10.3389/fimmu.2022.828191.
    [10]
    LIN X, RUI K, DENG J, et al. Th17 cells play a critical role in the development of experimental Sjögren’s syndrome[J]. Ann Rheum Dis, 2015, 74( 6): 1302- 1310. DOI: 10.1136/annrheumdis-2013-204584.
    [11]
    RONG G, ZHOU Y, XIONG Y, et al. Imbalance between T helper type 17 and T regulatory cells in patients with primary biliary cirrhosis: The serum cytokine profile and peripheral cell population[J]. Clin Exp Immunol, 2009, 156( 2): 217- 225. DOI: 10.1111/j.1365-2249.2009.03898.x.
    [12]
    HUAN W, SHI LP. Percentage of Th17/Treg cells in peripheral blood of patients with Sjogren’s syndrome and primary biliary cirrhosis and their clinical characteristics[J]. Chin Hepatol, 2020, 25( 2): 155- 157. DOI: 10.14000/j.cnki.issn.1008-1704.2020.02.019.

    郇稳, 史丽璞. 干燥综合征合并原发性胆汁性肝硬化患者的外周血Th17/Treg细胞百分比及临床特征[J]. 肝脏, 2020, 25( 2): 155- 157. DOI: 10.14000/j.cnki.issn.1008-1704.2020.02.019.
    [13]
    WANG YF, FENG RL, CHENG G, et al. Low dose interleukin-2 ameliorates Sjögren’s syndrome in a murine model[J]. Front Med(Lausanne), 2022, 9: 887354. DOI: 10.3389/fmed.2022.887354.
    [14]
    WANG ZL, LIU ZC, ZHENG JR, et al. The effects of low-dose IL-2 on Th17/Treg cell imbalance in primary biliary cholangitis mouse models[J]. BMC Gastroenterol, 2024, 24( 1): 87. DOI: 10.1186/s12876-024-03176-0.
    [15]
    HE J, CHEN JL, MIAO M, et al. Efficacy and safety of low-dose interleukin 2 for primary sjögren syndrome: A randomized clinical trial[J]. JAMA Netw Open, 2022, 5( 11): e2241451. DOI: 10.1001/jamanetworkopen.2022.41451.
    [16]
    YAO Y, YANG W, YANG YQ, et al. Distinct from its canonical effects, deletion of IL-12p40 induces cholangitis and fibrosis in interleukin-2Rα(-/-) mice[J]. J Autoimmun, 2014, 51: 99- 108. DOI: 10.1016/j.jaut.2014.02.009.
    [17]
    ZUCKERMAN BP, YANG ZJ, WARWICK A, et al. Association between interleukin-12 p40 subunit and risk of primary Sjögren’s syndrome: A Mendelian randomization study[J]. Rheumatology(Oxford), 2024: keae475. DOI: 10.1093/rheumatology/keae475.
    [18]
    HIRSCHFIELD GM, ERIC GERSHWIN M, STRAUSS R, et al. Ustekinumab for patients with primary biliary cholangitis who have an inadequate response to ursodeoxycholic acid: A proof-of-concept study[J]. Hepatology, 2016, 64( 1): 189- 199. DOI: 10.1002/hep.28359.
    [19]
    LIASKOU E, PATEL SR, WEBB G, et al. Increased sensitivity of Treg cells from patients with PBC to low dose IL-12 drives their differentiation into IFN-γ secreting cells[J]. J Autoimmun, 2018, 94: 143- 155. DOI: 10.1016/j.jaut.2018.07.020.
    [20]
    SUN QN, WANG Q, FENG N, et al. The expression and clinical significance of serum IL-17 in patients with primary biliary cirrhosis[J]. Ann Transl Med, 2019, 7( 16): 389. DOI: 10.21037/atm.2019.07.100.
    [21]
    CHAN CW, CHEN HW, WANG YW, et al. IL-21, not IL-17A, exacerbates murine primary biliary cholangitis[J]. Clin Exp Immunol, 2024, 215( 2): 137- 147. DOI: 10.1093/cei/uxad107.
    [22]
    GAN YZ, ZHAO XZ, HE J, et al. Increased interleukin-17F is associated with elevated autoantibody levels and more clinically relevant than interleukin-17A in primary Sjögren’s syndrome[J]. J Immunol Res, 2017, 2017: 4768408. DOI: 10.1155/2017/4768408.
    [23]
    MAGDALENO-TAPIAL J, LÓPEZ-MARTÍ C, ORTIZ-SALVADOR JM, et al. Can secukinumab improve liver fibrosis? A pilot prospective study of 10 psoriatic patients[J]. Dermatol Ther, 2021, 34( 5): e15065. DOI: 10.1111/dth.15065.
    [24]
    GREER ME, MORAN SK, FELDMAN SR. Bimekizumab-bkzx for the treatment of plaque psoriasis: A drug review[J]. Ann Pharmacother, 2024: 10600280241288553. DOI: 10.1177/10600280241288553.
    [25]
    TIMILSHINA M, YOU ZW, LACHER SM, et al. Activation of mevalonate pathway via LKB1 is essential for stability of Treg cells[J]. Cell Rep, 2019, 27( 10): 2948- 2961. e 7. DOI: 10.1016/j.celrep.2019.05.020.
    [26]
    ZHU HP, LIU ZY, AN JQ, et al. Activation of AMPKα1 is essential for regulatory T cell function and autoimmune liver disease prevention[J]. Cell Mol Immunol, 2021, 18( 12): 2609- 2617. DOI: 10.1038/s41423-021-00790-w.
    [27]
    KIM JW, KIM SM, PARK JS, et al. Metformin improves salivary gland inflammation and hypofunction in murine Sjögren’s syndrome[J]. Arthritis Res Ther, 2019, 21( 1): 136. DOI: 10.1186/s13075-019-1904-0.
    [28]
    DHIRAPONG A, YANG GX, NADLER S, et al. Therapeutic effect of cytotoxic T lymphocyte antigen 4/immunoglobulin on a murine model of primary biliary cirrhosis[J]. Hepatology, 2013, 57( 2): 708- 715. DOI: 10.1002/hep.26067.
    [29]
    BOWLUS CL, YANG GX, LIU CH, et al. Therapeutic trials of biologics in primary biliary cholangitis: An open label study of abatacept and review of the literature[J]. J Autoimmun, 2019, 101: 26- 34. DOI: 10.1016/j.jaut.2019.04.005.
    [30]
    ADLER S, KÖRNER M, FÖRGER F, et al. Evaluation of histologic, serologic, and clinical changes in response to abatacept treatment of primary Sjögren’s syndrome: A pilot study[J]. Arthritis Care Res(Hoboken), 2013, 65( 11): 1862- 1868. DOI: 10.1002/acr.22052.
    [31]
    MEINERS PM, VISSINK A, KROESE FM, et al. Abatacept treatment reduces disease activity in early primary Sjögren’s syndrome(open-label proof of concept ASAP study)[J]. Ann Rheum Dis, 2014, 73( 7): 1393- 1396. DOI: 10.1136/annrheumdis-2013-204653.
    [32]
    MACHADO AC, DOS SANTOS LC, FIDELIX T, et al. Effectiveness and safety of abatacept for the treatment of patients with primary Sjögren’s syndrome[J]. Clin Rheumatol, 2020, 39( 1): 243- 248. DOI: 10.1007/s10067-019-04724-w.
    [33]
    van NIMWEGEN JF, MOSSEL E, van ZUIDEN GS, et al. Abatacept treatment for patients with early active primary Sjögren’s syndrome: A single-centre, randomised, double-blind, placebo-controlled, phase 3 trial(ASAP-III study)[J]. Lancet Rheumatol, 2020, 2( 3): e153- e163. DOI: 10.1016/S2665-9913(19)30160-2.
    [34]
    de WOLFF L, van NIMWEGEN JF, MOSSEL E, et al. Long-term abatacept treatment for 48 weeks in patients with primary Sjögren’s syndrome: The open-label extension phase of the ASAP-III trial[J]. Semin Arthritis Rheum, 2022, 53: 151955. DOI: 10.1016/j.semarthrit.2022.151955.
    [35]
    OIKAWA T, TAKAHASHI H, ISHIKAWA T, et al. Intrahepatic expression of the co-stimulatory molecules programmed death-1, and its ligands in autoimmune liver disease[J]. Pathol Int, 2007, 57( 8): 485- 492. DOI: 10.1111/j.1440-1827.2007.02129.x.
    [36]
    MARIETTE X, ROUX S, ZHANG J, et al. The level of BLyS(BAFF) correlates with the titre of autoantibodies in human Sjögren’s syndrome[J]. Ann Rheum Dis, 2003, 62( 2): 168- 171. DOI: 10.1136/ard.62.2.168.
    [37]
    ZHOU HM, YANG J, TIAN J, et al. CD8+ T lymphocytes: Crucial players in Sjögren’s syndrome[J]. Front Immunol, 2021, 11: 602823. DOI: 10.3389/fimmu.2020.602823.
    [38]
    TANG LB, ZHONG RH, HE XQ, et al. Evidence for the association between IgG-antimitochondrial antibody and biochemical response to ursodeoxycholic acid treatment in primary biliary cholangitis[J]. J Gastroenterol Hepatol, 2017, 32( 3): 659- 666. DOI: 10.1111/jgh.13534.
    [39]
    MYERS RP, SWAIN MG, LEE SS, et al. B-cell depletion with rituximab in patients with primary biliary cirrhosis refractory to ursodeoxycholic acid[J]. Am J Gastroenterol, 2013, 108( 6): 933- 941. DOI: 10.1038/ajg.2013.51.
    [40]
    KHANNA A, JOPSON L, HOWEL D, et al. Rituximab is ineffective for treatment of fatigue in primary biliary cholangitis: A phase 2 randomized controlled trial[J]. Hepatology, 2019, 70( 5): 1646- 1657. DOI: 10.1002/hep.30099.
    [41]
    RAMOS-CASALS M, BRITO-ZERÓN P, BOMBARDIERI S, et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies[J]. Ann Rheum Dis, 2020, 79( 1): 3- 18. DOI: 10.1136/annrheumdis-2019-216114.
    [42]
    CHU LL, CUI KP, POPE JE. Meta-analysis of treatment for primary Sjögren’s syndrome[J]. Arthritis Care Res(Hoboken), 2020, 72( 7): 1011- 1021. DOI: 10.1002/acr.23917.
    [43]
    BOWMAN SJ, EVERETT CC, O’DWYER JL, et al. Randomized controlled trial of rituximab and cost-effectiveness analysis in treating fatigue and oral dryness in primary Sjögren’s syndrome[J]. Arthritis Rheumatol, 2017, 69( 7): 1440- 1450. DOI: 10.1002/art.40093.
    [44]
    POLIDO-PEREIRA J, RODRIGUES AM, CANHÃO H, et al. Primary biliary cirrhosis in a rheumatoid arthritis patient treated with rituximab, a case-based review[J]. Clin Rheumatol, 2012, 31( 2): 385- 389. DOI: 10.1007/s10067-011-1879-y.
    [45]
    MARIETTE X, SEROR R, QUARTUCCIO L, et al. Efficacy and safety of belimumab in primary Sjögren’s syndrome: Results of the BELISS open-label phase II study[J]. Ann Rheum Dis, 2015, 74( 3): 526- 531. DOI: 10.1136/annrheumdis-2013-203991.
    [46]
    KOLEV M, SARBU AC, MÖLLER B, et al. Belimumab treatment in autoimmune hepatitis and primary biliary cholangitis- a case series[J]. J Transl Autoimmun, 2023, 6: 100189. DOI: 10.1016/j.jtauto.2023.100189.
    [47]
    ZHANG WC, SHAO TH, LEUNG PSC, et al. Dual B-cell targeting therapy ameliorates autoimmune cholangitis[J]. J Autoimmun, 2022, 132: 102897. DOI: 10.1016/j.jaut.2022.102897.
    [48]
    MARIETTE X, BARONE F, BALDINI C, et al. A randomized, phase II study of sequential belimumab and rituximab in primary Sjögren’s syndrome[J]. JCI Insight, 2022, 7( 23): e163030. DOI: 10.1172/jci.insight.163030.
    [49]
    ZENG LT, YANG KL, WU Y, et al. Telitacicept: A novel horizon in targeting autoimmunity and rheumatic diseases[J]. J Autoimmun, 2024, 148: 103291. DOI: 10.1016/j.jaut.2024.103291.
    [50]
    XU D, FANG JM, ZHANG SZ, et al. Efficacy and safety of telitacicept in primary Sjögren’s syndrome: A randomized, double-blind, placebo-controlled, phase 2 trial[J]. Rheumatology(Oxford), 2024, 63( 3): 698- 705. DOI: 10.1093/rheumatology/kead265.
    [51]
    GORDON SC, TRUDEAU S, REGEV A, et al. Baricitinib and primary biliary cholangitis[J]. J Transl Autoimmun, 2021, 4: 100107. DOI: 10.1016/j.jtauto.2021.100107.
    [52]
    AOTA K, YAMANOI T, KANI K, et al. Inhibition of JAK-STAT signaling by baricitinib reduces interferon-γ-induced CXCL10 production in human salivary gland ductal cells[J]. Inflammation, 2021, 44( 1): 206- 216. DOI: 10.1007/s10753-020-01322-w.
    [53]
    BAI W, YANG F, XU HJ, et al. A multi-center, open-label, randomized study to explore efficacy and safety of baricitinib in active primary Sjogren’s syndrome patients[J]. Trials, 2023, 24( 1): 112. DOI: 10.1186/s13063-023-07087-5.
    [54]
    PRICE E, BOMBARDIERI M, KIVITZ A, et al. Safety and efficacy of filgotinib, lanraplenib and tirabrutinib in Sjögren’s syndrome: A randomized, phase 2, double-blind, placebo-controlled study[J]. Rheumatology(Oxford), 2022, 61( 12): 4797- 4808. DOI: 10.1093/rheumatology/keac167.
    [55]
    LI Y, XI YH, TAO GH, et al. Sirtuin 1 activation alleviates primary biliary cholangitis via the blocking of the NF-κB signaling pathway[J]. Int Immunopharmacol, 2020, 83: 106386. DOI: 10.1016/j.intimp.2020.106386.
    [56]
    NOCTURNE G, MARIETTE X. Advances in understanding the pathogenesis of primary Sjögren’s syndrome[J]. Nat Rev Rheumatol, 2013, 9( 9): 544- 556. DOI: 10.1038/nrrheum.2013.110.
    [57]
    GALLUCCI GM, ALSUWAYT B, AUCLAIR AM, et al. Fenofibrate downregulates NF-κB signaling to inhibit pro-inflammatory cytokine secretion in human THP-1 macrophages and during primary biliary cholangitis[J]. Inflammation, 2022, 45( 6): 2570- 2581. DOI: 10.1007/s10753-022-01713-1.
    [58]
    CHUNG SW, LEE JH, KIM MA, et al. Additional fibrate treatment in UDCA-refractory PBC patients[J]. Liver Int, 2019, 39( 9): 1776- 1785. DOI: 10.1111/liv.14165.
    [59]
    KHAKOO NS, SULTAN S, REYNOLDS JM, et al. Efficacy and safety of bezafibrate alone or in combination with ursodeoxycholic acid in primary biliary cholangitis: Systematic review and meta-analysis[J]. Dig Dis Sci, 2023, 68( 4): 1559- 1573. DOI: 10.1007/s10620-022-07704-4.
    [60]
    GUO XY, DANG WY, LI N, et al. PPAR-α agonist fenofibrate ameliorates Sjögren syndrome-like dacryoadenitis by modulating Th1/Th17 and Treg cell responses in NOD mice[J]. Invest Ophthalmol Vis Sci, 2022, 63( 6): 12. DOI: 10.1167/iovs.63.6.12.
    [61]
    UDDENFELDT P, DANIELSSON A, FORSSELL A, et al. Features of Sjögren’s syndrome in patients with primary biliary cirrhosis[J]. J Intern Med, 1991, 230( 5): 443- 448. DOI: 10.1111/j.1365-2796.1991.tb00470.x.
    [62]
    NI P, MEN RT, SHEN MY, et al. Concomitant Sjögren’s syndrome was not associated with a poorer response or outcomes in ursodeoxycholic acid-treated patients with primary biliary cholangitis[J]. Can J Gastroenterol Hepatol, 2019, 2019: 7396870. DOI: 10.1155/2019/7396870.
    [63]
    JIN C, GAO BB, ZHOU WJ, et al. Hydroxychloroquine attenuates autoimmune hepatitis by suppressing the interaction of GRK2 with PI3K in T lymphocytes[J]. Front Pharmacol, 2022, 13: 972397. DOI: 10.3389/fphar.2022.972397.
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