The acquired or perinatal form of biliary atresia is a Th1 fibro-inflammatory disease affecting both the extrahepatic and intrahepatic bile ducts. Osteopontin (OPN) is a Th1 cytokine implicated in several fibro-inflammatory and autoimmune diseases. We examined the expression of OPN in acquired biliary atresia in comparison to normal liver and several pediatric cholestatic liver diseases. We also assessed OPN expression by cultured human bile duct epithelial cells. We found that liver OPN mRNA and protein expression were significantly increased in biliary atresia versus normal and other cholestatic diseases. OPN expression in biliary atresia was localized to epithelium of proliferating biliary structures (ductules and/or ducts) and bile plugs contained therein. No portal biliary OPN expression could be demonstrated in normal liver, syndromic biliary atresia, biliary obstruction not due to biliary atresia, and idiopathic neonatal hepatitis. OPN expression by human bile duct epithelial cells in culture was responsive to IL-2 and TNF-␣. Our results demonstrate an up-regulation of OPN expression by interlobular biliary epithelium in biliary atresia, which correlates with biliary proliferation and portal fibrosis. These findings suggest a role for OPN in the pathogenesis of biliary atresia. Biliary atresia is the most common liver disease of infancy that leads to cirrhosis, end-stage liver disease and the need for liver transplantation (1). A small proportion of cases are thought to be congenital in that they are associated with other developmental anomalies, whereas most cases are diagnosed at 4 -8 wk of age and appear to represent a disease acquired in perinatal or neonatal life. The etiology and pathogenesis of biliary atresia remain unknown. A current working unifying hypothesis that can explain the clinical and pathologic features of the acquired form of biliary atresia is that some injury to the bile ducts, likely a perinatal viral infection, leads to an autonomous immune response that results in progressive bile duct injury and fibrosis (2). This progressive, inflammatory cholangiopathy results in extrahepatic bile duct obstruction (1,3). The extrahepatic bile duct is partially or entirely obliterated by fibrosis in association with inflammation within the fibrous remnant. The intrahepatic biliary system also appears to be affected by the primary disease process. Portal areas are expanded with fibrosis and exhibit marked proliferation of biliary elements (ductules and/or ducts) (4 -8). These duct structures often contain bile plugs. Biliary proliferation may still be a feature of the disease even at end-stage, but in some cases all duct structures disappear.Previous studies have shown that the mononuclear inflammatory infiltrate in the portal tracts comprises macrophages, CD4ϩ T-cells and NK cells (9 -13). We have shown that the inflammation is typically Th1 in character, in that it consists mainly of macrophages, CD4ϩ T-cells and CD8 ϩ T-cells with production of IL-2, IFN-␥, . The inciting agent leading to thi...