Low incidence of positive smooth muscle antibody and high incidence of isolated IgM elevation in Chinese patients with autoimmune hepatitis and primary biliary cirrhosis overlap syndrome: a retrospective study

Zhao, Pan; Han, Yu-kun

doi:10.1186/1471-230x-12-1

Cited by 93 publications

(66 citation statements)

References 21 publications

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“…In general, our patients fulfill the criteria of the PBC-AIH overlap syndrome described in western cohorts, although the prevalence of ASMA positivity is lower, a finding which also occurred in another study of Chinese patients [39] and noted in our previous multi-center study [30]. PBC patients with AIH features in our study demonstrated diminished 5-year adverse outcome-free survival than patients with classical PBC (58 vs. 81 %, p=0.038), a result comparable to that of Silveira et al [40] while inconsistent with that of Joshi et al [28].…”

Section: Discussionsupporting

confidence: 59%

The Natural History and Prognosis of Primary Biliary Cirrhosis with Clinical Features of Autoimmune Hepatitis

Yang

Wang

et al. 2015

Clinic Rev Allerg Immunol

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Although a variant of primary biliary cirrhosis (PBC) characterized by features of autoimmune hepatitis (AIH) has been recognized for many years, few studies with ample numbers of patients have focused on its natural history. This study aimed to clarify the natural history, prognosis, and response to therapy in a cohort of patients with PBC with AIH features. We retrospectively analyzed 277 PBC patients without AIH features and 46 PBC patients with AIH features seen between September 2004 and April 2014. The 5-year adverse outcome-free survival of PBC patients with AIH features was 58% compared to 81% in PBC patients without AIH features. Multivariate analysis in the patients with AIH features indicated that total bilirubin ≥ 2.70× the upper limit of normal predicted a poor prognosis (p = 0.008, relative risk 8.39, 95% confidence interval (CI) 1.73, 40.73). Combination therapy with ursodeoxycholic acid (UDCA) and immunosuppression provided better short-term responses in PBC patients with AIH features, defined by multiple criteria. Higher aspartate aminotransferase (AST) level at accession suggested better prognosis for PBC patients with AIH features while worse prognosis for PBC patients without AIH features. PBC patients with AIH features differ from those without AIH features in terms of natural history, prognostic indicators, and response to therapy.

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Section: Discussionsupporting

confidence: 59%

The Natural History and Prognosis of Primary Biliary Cirrhosis with Clinical Features of Autoimmune Hepatitis

Yang

Wang

et al. 2015

Clinic Rev Allerg Immunol

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“…In HLA-B27 transgenic rats, a highcalcium diet inhibited diarrhea and intestinal permeability 52 . Mice with dextran sulfate sodiuminduced colitis had firmer stools, less blood loss, and weight recovery following administration of the active form of vitamin D 53 . Vitamin D was shown to promote epithelial cell resistance to injury and suppress the inflammatory response to luminal antigens.…”

Section: Nutrient-dependent Regulation Of Intestinal Inflammation In mentioning

confidence: 97%

Diet in the Pathogenesis and Treatment of Inflammatory Bowel Diseases

et al. 2015

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Some of the most common symptoms of the inflammatory bowel diseases (IBD, which include ulcerative colitis and Crohn’s disease) are abdominal pain, diarrhea, and weight loss. It is therefore not surprising that clinicians and patients have wondered whether dietary patterns influence the onset or course of IBD. The question of what to eat is among the most commonly asked by patients and among the most difficult to answer by clinicians. There are therefore substantial variations in dietary behaviors of patients and recommendations for them, although clinicians do not routinely endorse specific diets for patients with IBD. Dietary clinical trials have been limited by their inability to include a placebo control, contamination of study groups, and inclusion of patients receiving medical therapies. Further challenges include accuracy of information on dietary intake, complex interactions between foods consumed, and differences in food metabolism among individuals. We review the roles of diet in the etiology and management of IBD, based on plausible mechanisms and clinical evidence. Researchers have learned much about the effects of diet on the mucosal immune system, epithelial function, and the intestinal microbiome; these findings could have significant practical implications. Controlled studies of patients receiving enteral nutrition and observations made from patients on exclusion diets have shown that components of whole foods can have deleterious effects for patients with IBD. Additionally, studies in animal models suggested that certain nutrients can reduce intestinal inflammation. In the future, engineered diets that restrict deleterious components but supplement beneficial nutrients could be used to modify the luminal intestinal environment of patients with IBD—these might be used alone or in combination with immunosuppressive agents, or as salvage therapy for patients who do not respond or lose responsiveness to medical therapies. Stricter diets might be required to induce remission, whereas more sustainable exclusion diets could be used to maintain long-term remission.

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“…Within the immune system, 1,25-dihydroxyvitamin D 3 (1,25(OH)D 3 ) inhibits T helper-1 type immune function in cells, induces T regulatory cells, and enhances phagocytosis by white blood cells [11]. 1,25(OH)D 3 targets more than 900 genes [12], some of which are involved in intestinal homeostasis [13], which may play a role in IBD development [9,14]. In humans, early life nutrition [15] and season of birth [16] have been linked to later risk of developing IBD, indicating that a critical window for nutritional interventions to lower the risk of developing IBD exists.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Vitamin D3 Supplementation Does Not Prevent Colonic Inflammation or Modulate Bone Health in IL-10 Knockout Mice at Young Adulthood

et al. 2014

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Inflammatory bowel disease (IBD) is an idiopathic disease that can impair bone metabolism. Low vitamin D status has been implicated in its progress. This study used interleukin (IL)-10 knockout (KO) mice, that develop an intestinal inflammation when housed in a non-sterile environment, to determine if supplementation with vitamin D3 throughout life could mitigate inflammation and attenuate the lower bone mineral content (BMC) and density (BMD), and bone strength. Female IL-10 KO mice were randomized 25 or 5000 IU vitamin D3/kg diet throughout pregnancy and lactation. At weaning, offspring received the same or opposite diet as their mother until age three months. Body weight growth was similar among groups within a sex. At three months of age, there were no differences in inflammation and gene expression in the colon of offspring. Male offspring exposed to continuous 25 IU vitamin D3/kg diet had lower (p < 0.001) colonic VDR expression and those exposed only to low vitamin D3 until weaning had higher serum IL-6. There were no differences in femur or vertebral BMC, BMD or bone strength. In summary, long-term exposure to vitamin D3 did not attenuate intestinal inflammation or preserve bone mineral or bone strength. Thus, supplementation with vitamin D3 does not exert anti-inflammatory effects in this mouse model that mimics human inflammatory bowel disease.

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Low incidence of positive smooth muscle antibody and high incidence of isolated IgM elevation in Chinese patients with autoimmune hepatitis and primary biliary cirrhosis overlap syndrome: a retrospective study

Cited by 93 publications

References 21 publications

The Natural History and Prognosis of Primary Biliary Cirrhosis with Clinical Features of Autoimmune Hepatitis

The Natural History and Prognosis of Primary Biliary Cirrhosis with Clinical Features of Autoimmune Hepatitis

Diet in the Pathogenesis and Treatment of Inflammatory Bowel Diseases

Long-Term Vitamin D3 Supplementation Does Not Prevent Colonic Inflammation or Modulate Bone Health in IL-10 Knockout Mice at Young Adulthood

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