Gastroenterology

Gastroenterology

Volume 120, Issue 1, January 2001, Pages 239-249
Gastroenterology

Special Reports and Reviews
Autoantibodies in liver diseaseā˜†

https://doi.org/10.1053/gast.2001.20223Get rights and content

Abstract

GASTROENTEROLOGY 2001;120:239-249

Section snippets

Role of autoantibody testing in the evaluation of liver disease

Autoantibodies are assessed in liver disease mainly to diagnose autoimmune conditions (Table 2).A definite diagnosis of autoimmune hepatitis (AIH) requires the presence of autoantibodies, including antinuclear antibody (ANA), SMA, or antibody to liver/kidney microsome type 1 (anti-LKM1),36 and the diagnosis of primary biliary cirrhosis (PBC) is made by detection of antimitochondrial antibody (AMA) in patients with cholestatic features (Table 2).37 Perinuclear antineutrophil cytoplasmic antibody

Repertoire of standard autoantibodies in the evaluation of liver disease

ANA is the principal serologic marker of AIH; together with SMA, the presence of ANA defines a subgroup designated type 1 AIH (Table 3).70Nuclear reactivity can be assessed by indirect immunofluorescence on Hep-2 cell lines, and patterns are commonly homogeneous (Figure 1A) or speckled (Figure 1B).71, 72, 73, 74, 75

. (A) ANA (homogeneous pattern) by indirect immunofluorescence on HEp-2 cells (original magnification 125Ɨ). (B) ANA (speckled pattern) by indirect immunofluorescence on HEp-2 cells

Repertoire of investigational autoantibodies in the evaluation of liver disease

Anti-ASGPR can coexist with ANA, SMA, and anti-LKM1 (Table 4).52This antibody is directed against a transmembrane glycoprotein on the hepatocyte surface that can capture, internalize, and display potential antigens to immunocytes.120, 121, 122 Anti-human anti-ASGPR occurs in 88% of patients with AIH, compared with 7% of patients with chronic hepatitis B, 8% of patients with alcoholic liver disease, and 14% of patients with PBC.52, 123 Its presence correlates with inflammatory activity; its

Diagnostic and treatment algorithms

Tests for ANA, SMA, AMA, and anti-LKM1 should be performed in all patients with liver disease of unknown cause, regardless of duration (Figure 6).

. Diagnostic applications of autoantibody tests. ANA, SMA, AMA, and anti-LKM1 must be sought first in the evaluation of liver disease of unknown cause. Seropositivity for one or more of these autoantibodies in conjunction with the appropriate clinical syndrome allows designation of the disease as type 1 AIH, type 2 AIH, or PBC. Seronegativity for the

Acknowledgements

The authors thank Linda Grande for secretarial support.

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    ā˜†

    Address requests for reprints to: Albert J. Czaja, M.D., Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905. Fax: (507) 284-0538; e-mail: [email protected].

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    Copyright Ā© 2001 American Gastroenterological Association. Published by Elsevier Inc. All rights reserved.