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

Article information

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

Publication date (electronic) : 2021 March 22

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

Linda Beenet

Department of Pathology & Laboratory Medicine, University of California Los Angeles (UCLA) Technology Center for Genomics & Bioinformatics, Los Angeles, CA, USA

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 2021 February 21; Revised 2021 March 5; Accepted 2021 March 19.

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].