Loci identified in GWAS in PBC suggest a role for T-lymphocyte differentiation in the development of the disease [6, 8, 9]. Th1 immune responses have been implicated in many autoimmune diseases [52] and may be involved in the development of autoreactive T cells, consistent with the putative role of the pyruvate dehydrogenase complex (PDC)-specific autoreactive Th1 cells in the pathogenesis of human PBC [53]. Anti-IL-12 signaling promotes Th1-type immune responses by driving differentiation of activated, naïve T cells to Th1 cells. This, together with the IL-12-driven interferon-γ (IFN-γ) production, contributes to loss of tolerance in several

models of autoimmunity [54]. Three loci containing genes involved in IL-12 signaling have been identified PLX3397 molecular weight in GWAS of PBC: the genes learn more IL12A, IL12RB2 [19-21], and STAT4 [21] codifying the subunit p35 of the IL-12, the chain IL12Rβ2 of the IL-12 receptor, and the signal transducer and activator of transcription (STAT4), respectively [55]. Studies conducted in an animal model of PBC have strongly suggested a role for the IL-12 pathway in PBC [56]. Currently, multiple clinical trials have been initiated to test whether monoclonal antibody or transcription-inhibitors of p40 (a subunit of the IL-12 receptor) is of therapeutic benefit in psoriasis [44] and CD [45, 46]. Of note, the p40 subunit of IL-12 is also a component

of the dimeric cytokine IL-23, which is essential for the differentiation of Th17 cells. Pilot studies are under way to test the efficacy and safety of the human monoclonal anti-IL-12/IL-23 Ustekinumab in patients with PBC (http://clinicaltrials.gov/ct2/show/NCT01389973?term=NCT01389973&rank=1 identifier: NCT01389973). Additional studies are nevertheless required: O-methylated flavonoid specifically, genetic association studies and sequencing studies to enable the definition of the specific IL12A and IL12RB2 alleles

conferring risk for PBC; molecular analyses that clarify the crosstalk between IL-12 and IL-23 signaling pathways; and in vivo experiments that elucidate the relative contributions of Th17, Treg cells, and other immune cellular subpopulations to PBC. A role for IL-35 is also worthy of investigation, given the subunit nature of the cytokine IL-35 and its receptor, which includes IL-12 p35 and IL-12Rβ2, respectively. Findings from these investigative approaches should then be translated into novel therapy and better outcomes for patients with PBC and other associated autoimmune diseases. Two GWAS in PBC [21, 22] identified loci containing genes involved in activation of nuclear factor κB (NF-κB), a transcription factor which regulates expression of many genes involved in the immune response; NF-κB is also highly activated in other autoimmune disorders such as RA, MS, and asthma [57]. The loci identified in PBC contain the NFKB1 gene itself, and genes in pathways leading to NF-κB activation such as TNFRSF1A, CD80, and RPS6KA4.