There is a need for new noninvasive biomarkers (NIBMs) able to assess cholestasis and fibrosis in chronic cholestatic liver diseases (CCLDs). autoantibodies were significantly increased from week one to week five after BDL. The highest correlation was observed with total bilirubin (= 3.04? 12). In conclusion anti-VEGFR-3 autoantibodies are early produced during BDL-induced cholestatic injury and they are closely related to cholestasis suggesting the potential of anti-VEGFR-3 autoantibodies as NIBMs of cholestasis in CCLDs and justifying the need for further investigations in patients with CCLD. 1 Introduction Cholestasis is defined as a decrease in bile flow. It can arise at the hepatocellular level because of impairment of bile secretion by hepatocytes or at cholangiocellular level generally by obstruction of bile flow through intra- or extrahepatic bile ducts by gall stones or local malignancies . Cholestasis is the pivotal hallmark of the so-called chronic cholestatic liver diseases (CCLDs) but it may also occur in the advanced stage of other chronic liver Phenylpiracetam diseases (CLDs) such as alcoholic liver disease nonalcoholic fatty liver disease and Phenylpiracetam chronic hepatitis B and chronic hepatitis C . When left untreated cholestasis may drive in the long term to tumorigenesis of cholangiocytes  the epithelial cells that line bile ducts and normally contribute to the modification of bile volume and composition. This evolution to a malignant phenotype of cholangiocytes similar to cholangiocarcinoma takes place through a series of functional and structural changes that affect cholangiocytes starting early after the initial cholestatic insult by activation proliferation and secretion of neuroendocrine factors . Chronic cholestatic liver injury is also accompanied by the development of hepatic fibrosis referring to the inappropriate tissue repairviaexcessive connective tissue deposition in the liver  which is a common scenario CCLDs share with all CLDs. Fibrosis is dynamical as it can progress to cirrhosis a condition hardly reversible with significant morbidity and mortality and growing prevalence worldwide . Cholestasis and fibrosis have enormous economic impact on health care expenditures which further increase when cirrhosis and malignant states are reached . Moreover current screening methods for cholestasis and fibrosis especially liver biopsy have significant limitations  thus justifying the exploration of new accurate noninvasive biomarkers (NIBMs) able to early assess cholestasis and fibrosis to estimate the prognosis and determine the surveillance strategies in CCLDs. Autoantibodies against tumor-associated antigens (TAA) represent promising candidates for NIBMs in liver malignancies such Phenylpiracetam as cholangiocarcinoma  and early states of malignancies like early chronic cholestatic liver injury. In some case the mere presence of autoantibodies to TAA may precede the clinical diagnosis of liver cancer . This offers a AKT1 window of opportunity to intervene and prevent or redirect the course of the disease. In addition contrastingly to polypeptides antibodies do not undergo proteolysis in serum and therefore they are highly stable with half time in the bloodstream ranging from 7 to 30 days depending on the subclass of immunoglobulin . In cholangiocarcinoma patients autoantibodies directed against p53 heat shock protein 70 enolase 1 and ribonuclease/angiogenin inhibitor 1 have already been reported [12 13 The mechanism that triggers the autoantibody response against TAA has still not been Phenylpiracetam elucidated but could be consequent to abnormal self-antigen expression by tumor cells through chemical alteration mutation posttranslational modification misfolding aberrant cleavage or localization and overexposure and/or exposure or spillage of new TAA in conjunction with the development of an inflammatory reaction within the tumor microenvironment [11 14 The elicited autoantibodies oriented to these neoepitopes may be involved in tumor surveillance and regulation a process that involves activation of immunocompetent cells leading to tumor cell apoptosis . Nowadays thanks to the progress in the knowledge of CCLDs in part through the development of animal models like the bile duct ligation (BDL) model of chronic cholestatic liver injury new autoantibodies to TAA with potential as NIBM can be discovered. Even though to date only autoantibodies to vascular endothelial growth factor receptor-2 have been.