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Home > Healthcare Professionals > Research Awards > Researcher Profiles > Dr. Joseph Palermo

Dr. Joseph Palermo, Jr., MD, PhD

2008 Primary Biliary Cirrhosis Special Research Initiative. Washington University, St. Louis, Missouri. "Role of Recurrent Urinary Tract Infection in Immune Mediated Cholangiopathy."


Dr. Joseph J. Palermo, Jr., MD, PhD

Primary biliary cirrhosis (PBC) is a serious and potentially fatal disease that accounts for nearly 10% of adult liver transplants in the United States, yet the causes for this disease remain unclear. This study will evaluate whether urinary tract infection (UTI) can contribute to the development of PBC. Women with PBC are more likely to have bacteria in their urine, making UTI a significant independent risk factor for PBC.

Dr. Palermo and his colleagues have already shown that bacteria responsible for UTI can build colonies within the cells lining the urinary bladder where it is hard for antibiotics or the immune system to reach them. He hypothesizes that when the immune system responds to this unusual bacterial activity, it may launch a misdirected attack that injures the bile duct as an unwanted side effect. He has observed that lab mice with chronic UTI develop liver lesions and other markers characteristic of early PBC. This is the first time mice without a preexisting autoimmune disorder have been observed to develop PBC-like biliary disease entirely as a result of a common bacterial infection.

Through this study, Dr. Palermo hopes to identify the exact mechanisms by which UTI gives rise to PBC. He is working to document what happens to the bladder and liver during UTI, looking closely at changes in cells and blood plasma, and at the concentration of chemical messengers associated with the immune response. He will also isolate bacteria from the urine of actual PBC patients and make physical and genetic comparisons to bacteria from patients with UTI but not PBC. This comparison will help pinpoint the specific features of these bacteria that may contribute to the development of PBC.

A better understanding of the connection between UTI and PBC would allow physicians to screen UTI patients for those who may also be at risk for PBC. Findings from this study may also provide avenues for future research into diagnostic measures and therapies.

Page updated: October 20th, 2008