Dihydrolipoamide acetyltransferase (DLAT) transfers an acetyl group from pyruvate to CoA to synthesize acetyl-CoA. This protein, also known as the E2 subunit of the pyruvate dehydrogenase complex (PDC-E2), has been implicated in the literature as the primary autoantigen in primary biliary cirrhosis. Antimitochondrial antibodies (AMAs) are likely formed when DLAT is exposed to the immune system in apoptotic cells of the bile duct. Research studies have shown that in some cases, cosmetics, NSAIDs, chewing gum, acetaminophen, and other compounds could trigger exposure of DLAT in sensitive individuals. The presence of AMAs is often detectable before disease diagnosis. Research studies have also shown that activation of the Toll-like receptor-3 (TLR-3) pathway is involved in the progression from a subclinical to clinical state.