Thus, it is instructive

to contrast the pathophysiological features of biliary atresia with the normal programmed loss of entire biliary apparatus in sea lamprey larvae. Biliary atresia in human infants is characterized by the complete obstruction of bile flow as a result of the destruction or absence of all or a portion of the extrahepatic bile ducts.2–4 As this website part of the underlying disease process or as a result of biliary obstruction, concomitant injury and fibrosis of the intrahepatic bile ducts also occurs to a variable extent. The disorder occurs in 1 in 10,000 to 15,000 live births in the United States, and accounts for approximately one-third of cases of neonatal cholestatic jaundice. It is the most frequent cause of death from liver disease and accounts for about 50% of all liver transplants in children. There is some evidence for two forms of biliary atresia, a fetal or embryonic form

and a peri- or postnatal form. In infants with the less common fetal variant (∼10%-25% of cases) cholestasis with acholic stools is present from birth with no jaundice-free interval after resolution of normal physiological hyperbilirubinemia. At the time of exploratory laparotomy, little or none of http://www.selleckchem.com/products/r428.html the extrahepatic biliary structures can be found in the hepatic hilum, and there are often associated malformations such as the polysplenia syndrome and abdominal situs inversus. In contrast, in click here the postnatal form there is progressive inflammatory destruction of the extrahepatic biliary tract in a baby appearing healthy in the first weeks of life. Clinical features support the concept that in most cases injury to the biliary tract occurs after biliary morphogenesis usually after birth. In practice, differentiation of

these clinical forms on the basis of the onset of liver dysfunction and occurrence of congenital malformations is inexact. Indeed, a recent study showed that over half of patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth.5 The cause of biliary atresia is unknown. Several mechanisms have been proposed to account for the progressive obliteration of the extrahepatic biliary tree. There is no evidence that biliary atresia results from a failure in morphogenesis in the majority of affected infants or from an ischemic or toxic injury to the bile ducts. There is emerging, convincing evidence for initiation of the process probably in response to a common viral infection or unknown environmental factor in a genetically susceptible host. A dysregulated cellular, humoral, and innate immune response all seem to be involved based on studies in humans and a mouse model of the disease.