Antimitochondrial Antibody and AMA M2

Also Known As

Mitochondrial Antibody

Formal Name

Antimitochondrial Antibody and Antimitochondrial M2 Antibody

This article was last reviewed on

March 17, 2017.

This article waslast modified on January 5, 2021.

At a Glance

Why Get Tested?

To help diagnose primary biliary cholangitis, also sometimes called primary biliary cirrhosis (PBC)

When To Get Tested?

When you have abnormal results on a liver panel and/or symptoms that your healthcare practitioner suspects may be due to PBC

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

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The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Antimitochondrial antibodies (AMA) are autoantibodies that are strongly associated with primary biliary cholangitis (PBC), formerly called primary biliary cirrhosis. This test detects and measures the amount (titer) of AMA in the blood.

Primary biliary cholangitis is a chronic autoimmune disorder that causes inflammation and scarring of the bile ducts inside the liver. It is a slow-progressing disease that causes worsening liver destruction and blockage of the bile flow. Blocked bile ducts can lead to a build-up of harmful substances within the liver and may eventually lead to permanent scarring (cirrhosis). PBC is found most frequently in women between the ages of 35 and 60. About 90-95% of those affected by PBC will have significant titers of antimitochondrial antibodies.

AMA are autoantibodies that develop against antigens within the body. There are nine types of AMA antigens (M1 – M9) of which M2 and M9 are the most likely to cause illness (clinically significant). The presence of the M2 type of AMA has been particularly evident in PBC, while the other types may be found in other conditions. Some laboratories offer the AMA-M2 as a more specific test for PBC.

For more information on PBC, see the links in the Related Content section.

Common Questions

How is the test used?
The antimitochondrial antibody (AMA) test or the AMA-M2 test may be ordered to help diagnose primary biliary cholangitis (PBC).

Other tests that may be ordered include:

Smooth muscle antibodies (SMA)

Antinuclear antibodies (ANA)

Alkaline phosphatase (ALP)

IgM level

Bilirubin

Albumin

Prothrombin time (PT)

C-reactive protein (CRP)

GGT

These tests often help detect PBC, distinguishing it from other autoimmune conditions causing liver damage, and may be useful in helping to predict whether a person may need a liver transplant.
When is it ordered?
The AMA or AMA-M2 test is ordered when a healthcare practitioner suspects that someone has an autoimmune disorder such as PBC that is affecting the liver. A person may have symptoms that include:

Itching (pruritus)

Jaundice

Fatigue

Abdominal pain

Enlarged liver

Many of those affected with early PBC do not have any symptoms. The condition is often initially identified because a person has abnormal results on a liver panel (elevated liver enzymes), especially alkaline phosphatase (ALP).

An AMA or AMA-M2 test may be ordered along with or following a variety of tests that are used to help diagnose and/or rule out other causes of liver disease or injury. These causes can include infections, such as viral hepatitis, drugs, alcohol abuse, toxins, genetic conditions, metabolic conditions, and autoimmune hepatitis.
What does the test result mean?

A high AMA or AMA-M2 level (titer) in the blood indicates that the most likely cause of symptoms and/or liver damage is PBC. The level of AMA is not related to the severity of PBC symptoms or to a person's prognosis.

A negative AMA or AMA-M2 means that it is likely that a person's symptoms are due to something other than PBC, but the result does not rule out the condition. About 5-10% of those with PBC will not have significant amounts of AMA or AMA-M2.
Is there anything else I should know?

By themselves, AMA and AMA-M2 are not diagnostic of PBC, but in conjunction with other laboratory tests and clinical symptoms, the diagnosis of PBC can be made. A liver biopsy may be performed to look for characteristic signs of PBC in the liver tissue and to confirm the diagnosis but is not always necessary. Imaging scans of the liver may also be ordered to look for bile duct obstructions.

About 50% of the cases of PBC will be discovered before a person has noticeable symptoms.
What causes primary biliary cholangitis (PBC)?

The cause is currently not known. It is not infectious and not inherited, although an increased susceptibility to develop autoimmune disorders may occur in some families. It can occur in anyone at any age, but it is primarily seen in middle-aged women.
How fast does PBC progress?

The course and severity of PBC is difficult to predict. Many people will have no or few symptoms for many years. For more information, consult with your healthcare practitioner and see the links in the Related Pages section.
Can I have an AMA or AMA-M2 test done in my healthcare practitioner's office?

No, the test requires specialized equipment and will not be offered by all laboratories. Your blood will likely be sent to a reference laboratory.
If I have AMA, will the antibodies ever go away?

The level of antibody (titer) may vary over time but, in most cases, once a person has detectable AMA, that person will continue to do so.

See More Common Questions See Less Common Questions

View Sources

Sources Used in Current Review

Pyrsopoulos, N. and Reddy, K. (2016 June 3 Updated). Primary Biliary Cholangitis (Primary Biliary Cirrhosis). Medscape Drugs and Diseases. Available online at http://emedicine.medscape.com/article/171117-overview. Accessed on 02/18/17.

Lal, S. (2016 May 11 Updated). Primary biliary cirrhosis. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/000282.htm. Accessed on 02/18/17.

(2016 December 6, Updated). Primary Biliary Cholangitis (PBC, previously Primary Biliary Cirrhosis). American Liver Foundation. Available online at http://www.liverfoundation.org/abouttheliver/info/pbc/. Accessed on 02/18/17.

Tebo, A. (2016 November Updated). Primary Biliary Cirrhosis – PBC. ARUP Consult. Available online at https://arupconsult.com/content/primary-biliary-cirrhosis. Accessed on 02/18/17.

Shin, Y. (2014 December 5, Updated). Antimitochondrial Antibody. Medscape Laboratory Medicine. Available online at http://emedicine.medscape.com/article/2086548-overview Accessed on 02/18/17.

(2014 April Updated). Primary Biliary Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases Available online at https://www.niddk.nih.gov/health-information/liver-disease/primary-biliary-cirrhosis. Accessed on 02/18/17.

(© 1995–2017). Mitochondrial Antibodies (M2), Serum. Mayo Clinic Mayo Medical Laboratories. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8176. Accessed on 02/18/17.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp 82-83.

(© 1995-2005). Primary Biliary Cirrhosis. The Merck Manual of Medical Information – Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/print/sec10/ch136/ch136d.html.

(© 1995-2005). Primary Sclerosing Cholangitis. The Merck Manual of Medical Information – Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec10/ch136/ch136e.html.

Beuers, U. and Rust, C. (2005 October 27). Overlap Syndromes. Medscape, from Semin Liver Dis. 2005; 25(3): 311-320. [On-line information]. Available online at http://www.medscape.com/viewarticle/512463.

Stone, C. (2004 November 10, Updated). Autoimmune liver disease panel. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003328.htm.

Stone, C. (2004 May 14). Primary biliary cirrhosis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000282.htm.

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Christopher-Stine, L. (Updated 2006 August 22). Systemic lupus erythematosus. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000435.htm. Accessed 1/29/09.

Lehrer, J (2006 July 25 Updated). Autoimmune hepatitis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000245.htm. Accessed 1/29/09.

Stone, C. (2008 May 20, Updated). Primary biliary cirrhosis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000282.htm. Accessed 1/29/09.

Hill, H. (Updated 2008 September). Primary Biliary Cirrhosis. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/AutoimmuneDz/PBC.html#. Accessed 1/29/09.

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(Updated 2012 September 26). Antimitochondrial Antibody. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2086548-overview#showall. Accessed February 2013.

Tebo, A. (Updated 2012 August). Primary Biliary Cirrhosis – PBC. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/PBC.html?client_ID=LTD#tabs=0. Accessed February 2013.

(© 1995–2013). Mitochondrial Antibodies (M2), Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8176. Accessed February 2013.

Makover, M. (Updeate 2011 February 10). Antimitochondrial antibody. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003529.htm. Accessed February 2013.

Pyrsopoulos, N. and Reddy, K. (Updated 2012 January 4). Primary Biliary Cirrhosis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/171117-overview. Accessed February 2013.

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