The progress of autoimmune hepatitis research and future challenges

Abstract

Autoimmune hepatitis (AIH) is a chronic liver inflammatory disease with various immune system manifestations, showing a global trend of increased prevalence. AIH is diagnosed through histological abnormalities, clinical manifestations, and biochemical indicators. The biochemical markers involve interfacial hepatitis, transaminase abnormalities, positive autoantibodies, etc. Although AIH pathogenesis is unclear, gene mutations and immunological factors could be the leading factors. AIH usually presents as a chronic liver disease and sometimes as acute hepatitis, making it challenging to distinguish it from drug-related hepatitis due to similar clinical symptoms. Normalizing transaminases and serum IgG levels is essential in assessing the remission status of AIH treatment. Glucocorticoids and azathioprine are the first-line AIH treatment, with lifelong maintenance therapy in some patients. The quality of life and survival can be improved after appropriate treatment. However, certain limitations jeopardize the quality of treatment, including long treatment cycles, side effects, poor patient compliance, and inability to inhibit liver fibrosis and cirrhosis. Accurate AIH animal models will help us understand the pathophysiology of the disease while providing fresh perspectives for avoiding and treating AIH. This review will help us understand AIH better, from the cellular and molecular causes to the clinical features, and will provide insight into new therapy techniques with fewer side effects.

The significance of gut microbiota in the etiology of autoimmune hepatitis: a narrative review

“…Compared to the typical structures observed in healthy individuals, study has revealed modified intestinal tight junctions and inflammatory infiltrates within the lamina propria of AIH patients. These modifications result in damage to the intestinal mucosa and elevated levels of endotoxins in the bloodstream, thereby triggering the immune tolerance impairment mechanism and causing liver injury (Kharrazian et al, 2023;Zhang et al, 2023b;Zhu et al, 2023). Under normal physiological conditions, anaerobic/aerobic bacteria in the intestinal microbiota maintain a dynamic balance and participate in physiological processes, and the disruption of this balance also can lead to intestinal barrier damage and bacterial translocation across the intestinal barrier to other organs, resulting in inflammation, immune disorders, and various other adverse effects (Lin et al, 2015).…”