title: Primary and secondary liver/kidney microsomal autoantibody response following infection with hepatitis C virus.
abstract: Liver/kidney microsomal autoantibody type 1 (LKM-1), which characterizes a subtype of autoimmune hepatitis, is also found in some patients with chronic hepatitis C virus (HCV) infection. Whether HCV and LKM-1 are accidentally or causally related is unknown. This case report describes a child who became infected by HCV after liver transplantation for end-stage liver disease caused by alpha 1-antitrypsin deficiency. LKM-1 was detected by immunofluorescence, anti-microsomal reactivity by Western blotting, anti-HCV and anti-GOR by immunoenzymatic assays, and HCV RNA by polymerase chain reaction. Two weeks after HCV infection, immunoglobulin (Ig) M LKM-1 appeared, followed by IgG1 LKM-1, with titers increasing to 1/2560; antibodies to a 50-kilodalton liver microsomal protein appeared 2 months later. Sera from day 1 posttransplant became positive for HCV RNA. HCV RNA was also detected in a liver biopsy specimen obtained 3 months after surgery. The patient did not produce anti-HCV and anti-GOR antibodies throughout the study and had no histological evidence of hepatitis. The temporal relationship between HCV infection and LKM-1 production suggests that HCV may trigger a primary autoimmune response. The lack of liver damage attributable to autoimmunity or viral infection may be caused by immunosuppression.
authors.affiliation: Department of Immunology, King's College School of Medicine and Dentistry, London, England.
authors.forename: F D
authors.initials: FD
authors.lastname: Mackie
authors.forename: M
authors.initials: M
authors.lastname: Peakman
authors.forename: M
authors.initials: M
authors.lastname: Yun
authors.forename: R
authors.initials: R
authors.lastname: Sallie
authors.forename: H
authors.initials: H
authors.lastname: Smith
authors.forename: E T
authors.initials: ET
authors.lastname: Davies
authors.forename: G
authors.initials: G
authors.lastname: Mieli-Vergani
authors.forename: D
authors.initials: D
authors.lastname: Vergani
mesh_terms: D000917:Antibody Formation; D001323:Autoantibodies / Q000276:immunology*; D002648:Child; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000209:etiology / Q000276:immunology* / Q000382:microbiology; D006801:Humans; D016031:Liver Transplantation; D011183:Postoperative Complications; D012367:RNA, Viral / Q000032:analysis
chemical_list: D001323:Autoantibodies; D012367:RNA, Viral; C060729:anti-liver kidney microsome antibody