Clinicopathological Features of Hepatobiliary Cells in Primary Biliary Cholangitis Patients with Ursodeoxycholic acid respond incompletely

Background: The mechanisms underlying the incomplete response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) patients are not clear. This study investigated the Clinicopathological characteristics and mechanism of hepatobiliary (HB) cells among PBC patients who demonstrated an incomplete response to UDCA. Methods: This study involved 132 patients with PBC undergoing ultrasound-guided liver biopsies. The obtained samples were subjected to various staining techniques. Demographic data, clinical features, hematological factors, auto-antibody levels, and liver biochemistry of patients were retrospectively analyzed. The response to UDCA was determined per Paris criteria. We also performed high-performance liquid chromatography-mass spectrometry (LC-MS) to test bile acid metabolomics on paraffin-embedded tissue samples from 25 patients with PBC. Results: Among 132 patients, 52 (39.4%) had an inadequate UDCA response. The quantity of CK7 ⁺ HB cells, degree of copper deposition in hepatocytes, alkaline phosphatase (ALP), total bile acid (TBA) and GP210 showed the strong association with this inadequate UDCA response. These factors exhibited AUC values of 0.775, 0.699, 0.799, 0.758 and 0.623, respectively. The concentrations of TBA ( p =0.010) and glycoursodeoxycholic (GUDCA, p =0.037) in liver tissues revealed significantly increased in the group with incomplete response to UDCA than in the group with complete response to UDCA. Additionally, a notable positive correlation was observed between the quantity of CK7 ⁺ HB cells and the content of TBA ( r =0.544, p ＜0.01) and GUDCA ( r =0.480, p ＜0.05) in liver tissues. Conclusions: Hepatobiliary cells in PBC are correlated with bile acid metabolism and inadequate response to UDCA.