Update of the simplified criteria for autoimmune hepatitis: Evaluation of the methodology for immunoserological testing

Galaski, Johanna; Weiler‐Normann, Christina; Schakat, Miriam; Zachou, Kalliopi; Muratori, Paolo; Lampalzer, Sibylle; Haag, Friedrich; Schramm, Christoph; Lenzi, Marco; Dalekos, Georgios N.; Lohse, Ansgar W.

doi:10.1016/j.jhep.2020.07.032

Cited by 43 publications

(54 citation statements)

References 23 publications

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“…High serum IgG values have been reported in 95% of patients and 61.5% of patients by previous studies. 53,54 The IgG plays a significant role in the pathogenesis and diagnosis of AIH and as a result, IgG values along with transaminases are utilised as biomarkers for monitoring disease progress and response to treatment. 55 Additionally, factors such as age, race, gender, and the environment, could influence the occurrence and nature of associated immune diseases in AIH patients.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Hepatitis: Evaluation of Clinical Presentation, Diagnosis and Response to Treatment in Iraqi Patients

Algraittee

2021

JCD

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Introduction: Autoimmune hepatitis (AIH) is a chronic heterogeneous inflammatory disease of the liver activated by unknown triggers. The details of its pathogenesis remain unclear. Sufficient data on AIH in terms of epidemiology as well as disease phenotype amongst the Iraqi population is not available. Objectives: To evaluate and document the experience of Iraqi AIH patients with respect to clinical presentation, diagnosis, treatment and response to treatment in accordance with the IAIHG guidelines. Method: A prospective study was conducted on patients who attended the Gastroenterology Hepatology Teaching Hospital in Baghdad, Iraq. After examination, many biochemical and pathological parameters were analysed. Liver biopsy, abdominal ultrasound, and upper endoscopy were done. Results: Among the 70 respondents, jaundice, fatigue, arthralgia, and itching were the major symptoms recorded at presentation. Immunologic findings were positive for ANA (31 patients) and ASMA (25 patients) while hypergammaglobulinemia was recorded in 97% of all patients. Pre-treatment scoring revealed 56 definite and 14 probable AIH patients while post-treatment scoring yielded 13 definite and 23 probable AIH patients. Response to treatment showed 6 patients as non-responders, 34 patients (49%) exhibited complete response while 30 patients (43%) had a partial response. Conclusions: Iraqi patients with AIH presented late at the advanced stage of the disease with a majority having hypergammaglobulinemia which forms a solid base for disease suspicion. It is recommended that a complementary study with a larger sample size, longer follow-up duration and inclusion of cases of idiopathic hepatitis is needed.

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Section: Discussionmentioning

confidence: 99%

Autoimmune Hepatitis: Evaluation of Clinical Presentation, Diagnosis and Response to Treatment in Iraqi Patients

Algraittee

2021

JCD

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“…While the V pattern was detected also in serum of patients with viral infections, drug-induced liver injury, malignancies, fatty liver disease, primary sclerosing cholangitis (PSC) and PBC, the VG and VGT patterns were predominantly detected in serum of patients with AIH, at that time referred to as chronic active hepatitis [35,36]. This association was validated in later studies [14,37]. Therefore, clinical laboratory reports should include the IIF staining pattern of SMA-positive sera.…”

Section: Anti-smooth Muscle and Anti-actin Antibodiesmentioning

confidence: 91%

“…Nevertheless, this recommendation, which relates to the clinical context of liver diseases, is nowadays rarely followed by clinical laboratories, and HEp2 cells are widely used for ANA testing [18][19][20]. Therefore, HEp2 cells are used as a screening substrate also in the context of liver diseases, with a suggested higher positivity cut-off ≥ 1:160 [14]. The clinical performance of this approach needs to be validated in further studies.…”

Section: Anti-nuclear Antibodymentioning

confidence: 99%

Autoimmune Hepatitis: Serum Autoantibodies in Clinical Practice

Beretta‐Piccoli

Mieli‐Vergani

Vergani

2021

Clinic Rev Allerg Immunol

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Circulating autoantibodies are a key diagnostic tool in autoimmune hepatitis (AIH), being positive in 95% of the cases if tested according to dedicated guidelines issued by the International Autoimmune Hepatitis Group. They also allow the distinction between type 1 AIH, characterized by positive anti-nuclear and/or anti-smooth muscle antibody, and type 2 AIH, characterized by positive anti-liver kidney microsomal type 1 and/or anti-liver cytosol type 1 antibody. Anti-soluble liver antigen is the only AIH-specific autoantibody, and is found in 20–30% of both type 1 and type 2 AIH. Anti-neutrophil cytoplasmic antibody is frequently positive in type 1 AIH, being associated also with inflammatory bowel disease and with primary/autoimmune sclerosing cholangitis. The reference method for autoantibody testing remains indirect immunofluorescence on triple tissue (rodent liver, kidney and stomach), allowing both the detection of the majority of liver-relevant reactivities, including those autoantibodies whose molecular target antigens are unknown. Of note, the current knowledge of the clinical significance of autoantibodies relies on studies based on this technique. However, immunofluorescence requires trained laboratory personnel, is observer-dependent, and lacks standardization, leading to ongoing attempts at replacing this method with automated assays, the sensitivity, and specificity of which, however, require further studies before they can be used as a reliable alternative to immunofluorescence; currently, they may be used as complementary to immunofluorescence.

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“…The diagnosis is based solely on a combination of clinical, serological, biochemical, and histological findings. One of the most important diagnostic criteria for autoimmune hepatitis is the presence of serum autoantibodies, which can be detected by such methods as: indirect immunofluorescence technique (IIFT) [103], enzyme-linked immunosorbent assay (ELISA) [104] or immunoblotting [105] (Figure 2). Laboratory tests demonstrate hypergammaglobulinemia and a selective increase in IgG, sometimes a slight increase in IgM, elevated transaminase activity, especially of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), usually 5-fold above normal values.…”

Section: Clinical Symptoms and Diagnostics Of Aihmentioning

confidence: 99%

Etiopathogenesis and Diagnostic Strategies in Autoimmune Hepatitis

et al. 2021

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Autoimmune hepatitis (AIH) is a chronic liver disease with the incidence of 10 to 17 per 100,000 people in Europe. It affects people of any age, but most often occurs in the 40–60 age group. The clinical picture is varied, from asymptomatic to severe acute hepatitis or liver failure. The disease onset is probably associated with the impaired function of T lymphocytes, the development of molecular mimicry, intestinal dysbiosis, or infiltration with low density neutrophils, which, alongside autoantibodies (i.e., ANA, ASMA), implicate the formation of neutrophil extracellular traps (NETs), as a component of the disease process, and mediate the inappropriate immune response. AIH is characterized with an increased activity of aminotransferases, elevated concentration of serum immunoglobulin G, the presence of circulating autoantibodies and liver inflammation. The result of the histological examination of the liver and the presence of autoantibodies, although not pathognomonic, still remain a distinguishing feature. The diagnosis of AIH determines lifelong treatment in most patients. The treatment is implemented to prevent the development of cirrhosis and end-stage liver failure. This work focuses mainly on the etiopathogenesis and diagnosis of AIH.

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Update of the simplified criteria for autoimmune hepatitis: Evaluation of the methodology for immunoserological testing

Cited by 43 publications

References 23 publications

Autoimmune Hepatitis: Evaluation of Clinical Presentation, Diagnosis and Response to Treatment in Iraqi Patients

Autoimmune Hepatitis: Evaluation of Clinical Presentation, Diagnosis and Response to Treatment in Iraqi Patients

Autoimmune Hepatitis: Serum Autoantibodies in Clinical Practice

Etiopathogenesis and Diagnostic Strategies in Autoimmune Hepatitis

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