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
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].


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


autoimmune hepatitis
anti-nuclear antibodies
liver-cytosol type 1
liver/kidney microsomal antibody type 1
soluble liver antigen
smooth muscle antibodies


1. Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol 2021;27:58-69.
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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.
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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