Autoantibodies in Primary Biliary Cholangitis: From Classical Markers to Emerging Targets

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive destruction of intrahepatic bile ducts. Autoantibodies, particularly anti-mitochondrial antibodies (AMA) and antinuclear antibodies (ANA), are central to diagnosis, prognosis, and pathogenesis. This review provides a comprehensive overview of classical and emerging autoantibodies associated with PBC, including AMA-M2, anti-gp210, anti-sp100, anti-KLHL12, and anti-RPL30. We discuss their diagnostic significance, pathogenic implications, and potential utility in patient stratification and therapeutic monitoring. Furthermore, we explore the role of microbial factors and environmental triggers in autoantibody generation, highlighting molecular mimicry and gut–liver axis interactions. Advances in autoantibody profiling may pave the way for personalized medicine and improved outcomes in PBC.