Tumor necrosis factor-alpha and transforming growth factor-beta reflect severity of liver damage in primary biliary cirrhosis

J Gastroenterol Hepatol. 2002 Feb;17(2):196-202. doi: 10.1046/j.1440-1746.2002.02672.x.


Background and aims: The pathogenesis of primary biliary cirrhosis (PBC) is unknown. The role of cytokines such as tumor necrosis factor-alpha (TNF-alpha) and transforming growth factor-beta (TGF-beta), and the effect of ursodeoxycholic acid (UDCA) in modifying the cytokine environment in patients with PBC has remained largely unstudied. Our aims were to determine: (i) the relationship between serum levels of TNF-alpha and TGF-beta and the severity of PBC; and (ii) the effects of UDCA therapy on TNF-alpha and TGF-beta levels in patients with PBC.

Methods: We studied 90 patients who had been treated with UDCA (53 patients) or placebo (37 patients) for 2 years as part of a randomized, double-blind, controlled trial. Patients were divided into histological stage I/II or stage III/IV disease. Serum TNF-alpha and TGF-beta levels were quantified by enzyme-linked immunoabsorbent assay.

Results: Baseline levels of TNF-alpha were significantly greater in patients with stage III/IV compared to stage I/II disease. After 2 years of treatment with UDCA, patients showed a significantly greater decrease in TNF-alpha levels and progression risk score compared to placebo-treated patients. TNF-alpha and TGF-beta levels were significantly reduced compared to baseline levels in the UDCA-treated group after 2 years, while there was no significant change in the levels of placebo-treated patients.

Conclusions: Serum TNF-alpha and TGF-beta levels may reflect severity of disease in patients with PBC. The beneficial effects of UDCA therapy may be explained by lowering serum levels of these two cytokines.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Biopsy
  • Cholagogues and Choleretics / therapeutic use*
  • Cholangitis, Sclerosing / blood
  • Cholangitis, Sclerosing / pathology
  • Double-Blind Method
  • Female
  • Hepatitis C / blood
  • Hepatitis C / pathology
  • Humans
  • Liver / pathology*
  • Liver Cirrhosis, Biliary / blood
  • Liver Cirrhosis, Biliary / drug therapy
  • Liver Cirrhosis, Biliary / pathology*
  • Liver Diseases, Alcoholic / blood
  • Liver Diseases, Alcoholic / pathology
  • Male
  • Middle Aged
  • Transforming Growth Factor beta / blood*
  • Tumor Necrosis Factor-alpha / analysis*
  • Ursodeoxycholic Acid / therapeutic use*


  • Biomarkers
  • Cholagogues and Choleretics
  • Transforming Growth Factor beta
  • Tumor Necrosis Factor-alpha
  • Ursodeoxycholic Acid