Reviewer's report 
 Maternal Microchimerism in the Livers of Patients with Biliary Atresia: A Preliminary Title: 
Investigation 
 1  29 May 2004 Version: Date: 
 Tatsuo Ichinohe Reviewer: 
Reviewer's report: 
General 
This manuscript describes the presence of maternal microchimerism in the liver samples of infants 
with biliary atresia (BA), which the authors regarded as potential etiology of this intractable disease. 
Although the chimeric presence of maternal nucleated cells was clearly demonstrated in this study, 
the lack of control samples, for instance, obtained from children with other hepatic diseases, made it 
uncertain whether the presence of maternal cells in the liver is unique phenomenon with respect to 
the development of BA. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
#1 The chimerism status of control samples derived from the liver of children who do not suffer from 
BA, should be added to the paper, if such an analysis is available. 
#2 Although long-term maternal cell microchimerism is not uncommon among healthy children, only 
a small proportion of them suffer from BA. The authors should discuss an explanation for this 
discrepancy. Furthermore, Shimazaki et al suggested that long-term maternal chimerism might have 
a tolerogenic, rather than an immunogenic role in a study showing less GVH reactions among 
HLA-mismatched microchimeric family members (Blood 2003;101:3334). 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None 
Reviewer's report 
 Maternal Microchimerism in the Livers of Patients with Biliary Atresia: A Preliminary Title: 
Investigation 
 1  29 May 2004 Version: Date: 
 Tatsuo Ichinohe Reviewer: 
Reviewer's report: 
General 
This manuscript describes the presence of maternal microchimerism in the liver samples of infants 
with biliary atresia (BA), which the authors regarded as potential etiology of this intractable disease. 
Although the chimeric presence of maternal nucleated cells was clearly demonstrated in this study, 
the lack of control samples, for instance, obtained from children with other hepatic diseases, made it 
uncertain whether the presence of maternal cells in the liver is unique phenomenon with respect to 
the development of BA. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
#1 The chimerism status of control samples derived from the liver of children who do not suffer from 
BA, should be added to the paper, if such an analysis is available. 
#2 Although long-term maternal cell microchimerism is not uncommon among healthy children, only 
a small proportion of them suffer from BA. The authors should discuss an explanation for this 
discrepancy. Furthermore, Shimazaki et al suggested that long-term maternal chimerism might have 
a tolerogenic, rather than an immunogenic role in a study showing less GVH reactions among 
HLA-mismatched microchimeric family members (Blood 2003;101:3334). 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None 
Please review this paper.
user
Reviewer's report 
 Maternal Microchimerism in the Livers of Patients with Biliary Atresia: A Preliminary Title: 
Investigation 
 1  29 May 2004 Version: Date: 
 Tatsuo Ichinohe Reviewer: 
Reviewer's report: 
General 
This manuscript describes the presence of maternal microchimerism in the liver samples of infants 
with biliary atresia (BA), which the authors regarded as potential etiology of this intractable disease. 
Although the chimeric presence of maternal nucleated cells was clearly demonstrated in this study, 
the lack of control samples, for instance, obtained from children with other hepatic diseases, made it 
uncertain whether the presence of maternal cells in the liver is unique phenomenon with respect to 
the development of BA. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
#1 The chimerism status of control samples derived from the liver of children who do not suffer from 
BA, should be added to the paper, if such an analysis is available. 
#2 Although long-term maternal cell microchimerism is not uncommon among healthy children, only 
a small proportion of them suffer from BA. The authors should discuss an explanation for this 
discrepancy. Furthermore, Shimazaki et al suggested that long-term maternal chimerism might have 
a tolerogenic, rather than an immunogenic role in a study showing less GVH reactions among 
HLA-mismatched microchimeric family members (Blood 2003;101:3334). 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None 
assistant