Abstract
BackgroundAntibodies to chromatin and soluble liver antigen have been associated with severe form of autoimmune hepatitis and/or poor treatment response and may provide guidance in defining subsets of patients with different disease behaviors. The major clinical limitation of these antibodies is their lower individual occurrence in patients with autoimmune hepatitis.AimTo estimate the value of detection of these non-standard antibodies in autoimmune hepatitis as prognostic markers.MethodsBoth antibodies were tested by enzyme immunoassay in 20 patients with autoimmune hepatitis.ResultsAntibodies to soluble liver antigen were not detected in any of our patients. On the other hand anti chromatin antibodies were present in 50% (10/20). Antibodies to chromatin occurred more commonly in females than males (8/14 versus 2/6). Of the 14 patients who relapsed 8(57%) had antichromatin antibodies while they were present in only 2 out of 6(33.3%) non relapsers. Antichromatin antibodies were found more in patients with antinuclear (3/4) and anti smooth muscle antibodies (9/13) more than in those with liver kidney microsomal antibodies (1/4) and those seronegative (1/4) i.e. they were +ve in patients with type I (8/12(66.6%)) more than those with type II (1/4(25%)) and those seronegative (1/4(25%)). Antibodies to chromatin are associated with high levels of γ globulin but yet with no statistical difference between seropositive and seronegative counterparts (p = 0.65).ConclusionAntibodies to chromatin may be superior than those to soluble liver antigen in predicting relapse and may be useful as prognostic marker. Further studies with larger number of patients and combined testing of more than one antibody will improve the performance parameters of these antibodies and define optimal testing conditions for them before they can be incorporated into management algorithms that project prognosis.
Highlights
Autoimmune hepatitis (AIH) is a progressive inflammatory liver disorder preferentially affecting females and characterized serologically by high amino-transferase levels, elevated immunoglobulin G (IgG), and presence of auto antibodies and histologically by interface hepatitis in the absence of a known etiology[1].Auto immune hepatitis is divided into two types according to the auto antibody profile: Patients with type I are positive for antinuclear antibody (ANA) and/or antismooth muscle antibody (ASMA), patients with type 2 are positive for anti-liver-kidney-microsomal antibody type 1 (Anti-LKM-1)
ANA were found to be positive in 4 patients, two of them have ASMA positive, and the other two have both ASMA and anti- LKM antibodies positive
ASMA were found in 13 patients, two of those patients have ANA positive, and another two of the 13 patients have both ANA and anti- LKM antibodies positive
Summary
Autoimmune hepatitis (AIH) is a progressive inflammatory liver disorder preferentially affecting females and characterized serologically by high amino-transferase levels, elevated immunoglobulin G (IgG), and presence of auto antibodies and histologically by interface hepatitis in the absence of a known etiology[1].Auto immune hepatitis is divided into two types according to the auto antibody profile: Patients with type I are positive for antinuclear antibody (ANA) and/or antismooth muscle antibody (ASMA), patients with type 2 are positive for anti-liver-kidney-microsomal antibody type 1 (Anti-LKM-1). Anti-nuclear antibodies (ANA), antismooth muscle antibodies (SMA) and anti-bodies to liver kidney microsome type (1) are the conventional markers of the disease, and each has been ascribed diagnostic significance, when present in the appropriate clinical context[2] These diagnostic instruments lack prognostic value, and new auto antibodies continue to be characterized in the hope of defining pertinent target auto antigens and markers reflective of treatment outcome [3]. Anti-bodies to soluble liver antigen/liver pancreas (AntiSLA/LP), actin (anti-actin), chromatin (anti-chromatin) and liver cytosol type 1 (anti-LC1) have been associated with severe disease and/or poor treatment response They constitute non-standard markers of auto immune hepatitis, and they may provide guidance in-defining subsets of patients with different disease behaviors [4]. The major clinical limitation of these antibodies is their lower individual occurrence in patients with autoimmune hepatitis
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