Autoimmune hepatitis: current challenges and future prospects

Abstract

Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by high levels of aminotransferases and autoantibodies, hypergammaglobulinemia, and interface hepatitis. AIH affects all races and all ages worldwide, regardless of sex, although a preponderance of females is a constant finding. The etiology of AIH has not been completely elucidated, but immunogenetic background and environmental parameters may contribute to its development. The most important genetic factor is human leukocyte antigens (HLAs), especially HLA-DR, whereas the role of environmental factors is not completely understood. Immunologically, disruption of the immune tolerance to autologous liver antigens may be a trigger of AIH. The diagnosis of classical AIH is fairly easy, though not without pitfalls. In contrast, the diagnosis of atypical AIH poses great challenges. There is confusion as to the definition of the disease entity and its boundaries in the diagnosis of overlap syndrome, drug-induced autoimmune hepatitis, and AIH with concomitant nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C. Centrilobular zonal necrosis is now included in the histological spectrum of AIH. However, the definition and the significance of AIH presenting with centrilobular zonal necrosis have not been examined extensively. In ~20% of AIH patients who are treated for the first time with standard therapy, remission is not achieved. The development of more effective and better tolerated novel therapies is an urgent need. In this review, we discuss the current challenges and the future prospects in relation to the diagnosis and treatment of AIH, which have been attracting considerable recent attention.

DNA Microsystems for Biodiagnosis

“…As there are many variations of autoimmune diseases, the diagnosis is done based on a set of exam results, making it susceptible to misdiagnosis [11]. The detection of autoimmune hepatitis (AIH) is no longer an issue in the medical field because of the availability of reliable procedures used to diagnose other hepatic conditions [23]. However, an ideal detection procedure would not count on the exclusion method.…”

“…However, an ideal detection procedure would not count on the exclusion method. For instance, the presence of antinuclear antibodies (ANA) does not indicate AIH, as other liver diseases can also trigger this autoantibody [23]. Moreover, healthy patients might also be seropositive, which challenges the use of ANA as a sufficient biomarker for autoimmunity; thus, the liver biopsy is often necessary to obtain a more comprehensive diagnosis of autoimmune hepatitis [24,25].…”

“…The standard treatment for autoimmune hepatitis is to administer medication such as prednisolone (PSL) or azathioprine to the patient. However, some patients might not respond well to the treatments mentioned, so the current alternative medication is mycophenolate mofetil, which unfortunately causes undesired side-effects [23]. For the reasons mentioned above, the utility of DNA nanotechnology applications would be beneficial to develop adequate and precise histological procedures to detect, monitor, and treat autoimmune diseases.…”

Review article: unanswered clinical and research questions in autoimmune hepatitis‐conclusions of the International Autoimmune Hepatitis Group Research Workshop

“…Liver biopsy remains a cornerstone for the diagnosis of AIH and an important guide to patient management including assessment of disease activity prior to stopping immunosuppression . In terms of establishing an initial diagnosis of AIH, problems exist with the classification of cases as “typical of AIH” or “compatible with AIH” according to the simplified IAIHG criteria .…”

Frequency and Presentation of Autoimmune Hepatitis and Type of Autoantibodies among Yemeni Patients Attending Private Medical Clinic in Aden Yemen

“…The most important genetic factor is Human Leukocyte Antigens (HLAs), especially HLA-DR, whereas the role of environmental factors is not completely understood. Immunologically, disruption of the immune tolerance to autologous liver antigens may be a trigger of autoimmune hepatitis [9] .…”