Hepatic stellate cell activation and hepatic fibrosis in children with type 1 autoimmune hepatitis: an immunohistochemical study of paired liver biopsies before treatment and after clinical remission.
OBJECTIVE
The activation of hepatic stellate cells (HSC) is considered the most important event in hepatic fibrogenesis. The precise mechanism of this process is unknown in autoimmune hepatitis (AIH), and more evidence is needed on the evolution of fibrosis. The aim of this study was to assess these aspects in children with type 1 AIH.


METHODS
We analyzed 16 liver biopsy samples from eight patients, paired before treatment and after clinical remission, performed an immunohistochemical study with anti-alpha actin smooth muscle antibody and graded fibrosis and inflammation on a scale of 0-4 (Batts and Ludwig scoring system).


RESULTS
There was no significant reduction in fibrosis scores after 24+/-18 months (2.5+/-0.93 vs. 2.0+/-0.53, P=0.2012). There was an important decrease in inflammation: portal (2.6+/-0.74 vs. 1.3+/-0.89, P=0.0277), periportal/periseptal (3.0+/-0.76 vs. 1.4+/-1.06, P=0.0277), and lobular (2.8+/-1.04 vs. 0.9+/-0.99, P=0.0179). Anti-alpha actin smooth muscle antibodies were expressed in the HSC of the initial biopsies (3491.93+/-2051.48 mum), showing a significant reduction after remission (377.91+/-439.47 microm) (P=0.0117).


CONCLUSIONS
HSC activation was demonstrated in the AIH of children. The reduction of this activation after clinical remission, which may precede a decrease in fibrosis, opens important perspectives in the follow-up of AIH.
Maia
Jussara Melo de Cerqueira
JM
Postgraduate Program in Health Sciences, Department of PediatricsFederal University of Rio Grande do Norte, Natal, Brazil.
Maranhão
Helcio de Sousa
Hde S
Sena
Lauro Virgilio de
LV
Rocha
Luiz Reginaldo Menezes da
LR
Medeiros
Italo Azevedo de
IA
Ramos
Ana Maria de Oliveira
AM
D000199:Actins / Q000276:immunology; D001323:Autoantibodies / Q000378:metabolism; D001707:Biopsy, Needle; D002648:Child; D005260:Female; D055166:Hepatic Stellate Cells / Q000276:immunology / Q000473:pathology*; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000276:immunology / Q000473:pathology*; D008103:Liver Cirrhosis / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000199:Actins; D001323:Autoantibodies; D007166:Immunosuppressive Agents