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Clin Mol Hepatol > Volume 27(3); 2021 > Article
Beenet: The major diagnostic role of autoantibodies in the diagnosis of autoimmune hepatitis, a disease of all ages

Letter to the Editor

Clin Mol Hepatol. 2021; 27(3): 510-511.

Published online: March 22, 2021

DOI: https://doi.org/10.3350/cmh.2021.0058

The major diagnostic role of autoantibodies in the diagnosis of autoimmune hepatitis, a disease of all ages

Linda Beenet

Corresponding author : Linda Beenet Department of Pathology & Laboratory Medicine, University of California Los Angeles (UCLA) Technology Center for Genomics & Bioinformatics, 405 Hilgard Avenue, Los Angeles, CA 90095, USA
Tel: +1-310-825-1717, Fax: +1-310-794-2765 E-mail: linda.beenet@gmail.com

Editor: Sook-Hyang Jeong, Seoul National University College of Medicine, Korea

Received February 21, 2021       Revised March 5, 2021       Accepted March 19, 2021

Copyright © 2021 by The Korean Association for the Study of the Liver

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Hepatitis, Autoimmune; Autoantibodies; Autoimmune liver diseases

Dear Editor,
I read with great interest the very comprehensive review article by Komori who summarized the recent updates regarding the management of autoimmune hepatitis (AIH), focusing on the manifestations of the disease, its diagnosis and treatment [1].
Although I consider this review to be of significant interest as it is very up-to-date, I feel that some issues would have deserved more emphasis owing to their clinical relevance.
In particular, when the author discussed the diagnostic process, in my opinion a limited analysis of autoantibodies and their major relevance in both diagnostic systems used for the AIH diagnosis has been presented.
AIH can present different autoantibody positivity that allow to classify it in a distinct way and includes anti-smooth muscle antibodies (SMA) and/or anti-nuclear antibodies (ANA) characterizing the disease affecting young/adult patients; liver/kidney microsomal antibody type 1 (LKM1) and/or liver-cytosol type 1 (LC1) antibodies characterizing pediatric AIH patients and, more rarely, anti-soluble liver antigen (anti-SLA) antibodies. Lastly, a further entity characterized by autoantibody negativity, but exhibiting the same clinical/laboratory features of the classic AIH and the typical response to immunosuppressive therapy, has been hypothesized [2-4].
The search for autoantibodies is a crucial step in the diagnosis of AIH and needs to be stressed because there are still many differences in the world regarding the familiarity of physicians and laboratories with these autoantibodies [5].
The proper knowledge of autoantibodies and the optimal methods for their research allows to correctly diagnose chronic liver diseases initially classified as cryptogenic [6-9].
Another aspect that deserves to be stressed is that AIH is a condition that can potentially affect all ages, even the elderly, and therefore this diagnosis should be taken into account in all age groups, from childhood to older age [10].

FOOTNOTES

Conflicts of Interest: The author has no conflicts of interest to disclose.

Abbreviations

AIH
autoimmune hepatitis
ANA
anti-nuclear antibodies
LC1
liver-cytosol type 1
LKM1
liver/kidney microsomal antibody type 1
SLA
soluble liver antigen
SMA
smooth muscle antibodies

REFERENCES

1. Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol 2021;27:58-69.
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2. Liberal R, de Boer YS, Andrade RJ, Bouma G, Dalekos GN, Floreani A, et al. Expert clinical management of autoimmune hepatitis in the real world. Aliment Pharmacol Ther 2017;45:723-732.
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3. Granito A, Muratori P, Ferri S, Pappas G, Quarneti C, Lenzi M, et al. Diagnosis and therapy of autoimmune hepatitis. Mini Rev Med Chem 2009;9:847-860.
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4. Muratori L, Muratori P, Granito A, Pappas G, Cassani F, Lenzi M. Current topics in autoimmune hepatitis. Dig Liver Dis 2010;42:757-764.
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5. Vergani D, Alvarez F, Bianchi FB, Cançado EL, Mackay IR, Manns MP, et al. Liver autoimmune serology: a consensus statement from the committee for autoimmune serology of the International Autoimmune Hepatitis Group. J Hepatol 2004;41:677-683.
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6. Granito A, Muratori L, Muratori P, Pappas G, Guidi M, Cassani F, et al. Antibodies to filamentous actin (F-actin) in type 1 autoimmune hepatitis. J Clin Pathol 2006;59:280-284.
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7. Muratori P, Granito A, Pappas G, Muratori L. Validation of simplified diagnostic criteria for autoimmune hepatitis in Italian patients. Hepatology 2009;49:1782-1783 author reply 1783.
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8. Granito A, Pascolini S, Ricci C, Ferronato M, Muratori L, Vasuri F, et al. Decompensated cirrhosis as presentation of LKM1/LC1 positive type 2 autoimmune hepatitis in adulthood. A rare clinical entity of difficult management. Gastroenterology Insights 2021;12:67-75.
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9. Muratori P, Granito A, Lenzi M, Muratori L. Limitation of the simplified scoring system for the diagnosis of autoimmune hepatitis with acute onset. Liver Int 2021;41:529-534.
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10. Granito A, Muratori L, Pappas G, Muratori P, Ferri S, Cassani F, et al. Clinical features of type 1 autoimmune hepatitis in elderly Italian patients. Aliment Pharmacol Ther 2005;21:1273-1277.
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Linda Beenet
https://orcid.org/0000-0002-9812-9368

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