Immunological effects of ciclosporin in primary biliary cirrhosis: suppression of activated T cells and autoantibody levels.

The effects of ciclosporin (CS) on liver immunohistology and peripheral blood T lymphocyte distribution were studied in 5 patients with primary biliary cirrhosis (PBC) receiving CS treatment for 6 months. Several significant immunological changes were seen during the course of treatment: the numbers of infiltrating T cells (Leu4+) and HLA-DR+ cells (mainly macrophage/dendritic-like) within the lobule parenchyma decreased; the total circulating T cell numbers increased and the percentage of activated, HLA-DR-expressing Leu2a+ ('suppressor/cytotoxic') T cells and Leu3a+ ('helper/inducer') T cells decreased. Moreover, using a highly sensitive enzyme immunoassay for antimitochondrial antibody (AMA), a selective decrease of IgM-type (but not IgG-type) AMA levels was observed in 4 patients. A reversal towards pretreatment values was observed for all these immunological parameters 3-6 months after withdrawal of therapy. We conclude that CS may inhibit both cell-mediated and antibody-mediated autoimmune mechanisms operating in PBC.