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Staging of biliary atresia at diagnosis by molecular profiling of the liver

Katie Moyer1, Vivek Kaimal6, Cristina Pacheco25, Reena Mourya1, Huan Xu1, Pranavkumar Shivakumar1, Ranajit Chakraborty3, Marepalli Rao3, John C Magee4, Kevin Bove2, Bruce J Aronow6, Anil G Jegga6 and Jorge A Bezerra1*

Author Affiliations

1 Division of Pediatric Gastroenterology, Hepatology and Nutrition of Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA

2 Division of Pediatric Pathology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA

3 Department of Environmental Health, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA

4 Department of Surgery of the University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA

5 Current address: Children's Pathology Services, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404, USA

6 Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA

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Genome Medicine 2010, 2:33  doi:10.1186/gm154

Published: 13 May 2010

Abstract

Background

Young age at portoenterostomy has been linked to improved outcome in biliary atresia, but pre-existing biological factors may influence the rate of disease progression. In this study, we aimed to determine whether molecular profiling of the liver identifies stages of disease at diagnosis.

Methods

We examined liver biopsies from 47 infants with biliary atresia enrolled in a prospective observational study. Biopsies were scored for inflammation and fibrosis, used for gene expression profiles, and tested for association with indicators of disease severity, response to surgery, and survival at 2 years.

Results

Fourteen of 47 livers displayed predominant histological features of inflammation (N = 9) or fibrosis (N = 5), with the remainder showing similar levels of both simultaneously. By differential profiling of gene expression, the 14 livers had a unique molecular signature containing 150 gene probes. Applying prediction analysis models, the probes classified 29 of the remaining 33 livers into inflammation or fibrosis. Molecular classification into the two groups was validated by the findings of increased hepatic population of lymphocyte subsets or tissue accumulation of matrix substrates. The groups had no association with traditional markers of liver injury or function, response to surgery, or complications of cirrhosis. However, infants with an inflammation signature were younger, while those with a fibrosis signature had decreased transplant-free survival.

Conclusions

Molecular profiling at diagnosis of biliary atresia uncovers a signature of inflammation or fibrosis in most livers. This signature may relate to staging of disease at diagnosis and has implications to clinical outcomes.