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
liver/kidney microsomal antibody type 1
REFERENCES
- 1. Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol 2021;27:58-69.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Citations
Citations to this article as recorded by
- Working Algorithms and Detection Methods of Autoantibodies in Autoimmune Liver Disease: A Nationwide Study
Guillermo Muñoz-Sánchez, Albert Pérez-Isidro, Iñaki Ortiz de Landazuri, Antonio López-Gómez, Luz Yadira Bravo-Gallego, Milagros Garcia-Ormaechea, Maria Rosa Julià, Odette Viñas, Estíbaliz Ruiz-Ortiz
Diagnostics.2022; 12(3): 697. CrossRef
