Antismooth muscle and antiactin antibodies are indirect markers of histological and biochemical activity of autoimmune hepatitis.
Reactivity and titers of autoantibodies vary during the course of autoimmune hepatitis (AIH), and some autoantibodies have been associated with disease activity and adverse outcomes after treatment. The aim of this study was to assess the autoantibody behavior in AIH and its significance as predictors of biochemical and histological remission. A total of 117 patients with AIH (mean age 18.6 [4-69] years) were evaluated and tested for autoantibodies at disease onset and successively (mean 3.2 [2-6] times) after a mean follow-up evaluation of 70 [20-185] months. Antismooth muscle (ASMA), antiliver kidney microsome type 1 (anti-LKM1), antiliver cytosol type 1 (anti-LC1), antimitochondrial, antinuclear (ANA), and antiactin antibodies (AAA) were determined at disease onset and 379 other times during the follow-up evaluation through indirect immunofluorescence in rodent tissues, HEp-2 cells, and human fibroblasts. Anti-SLA/LP were assessed 45 times in the follow-up evaluation of 19 patients using enzyme-linked immunosorbent assay (ELISA). Upon admission, AIH types 1 and 2 were observed in 95 and 17 patients, respectively. Five subjects had AIH with anti-SLA/LP as the sole markers. Patients initially negative for AAA did not develop these antibodies thereafter. ANA were detected de novo in six and three subjects with AIH types 1 and 2, respectively. After treatment, only ASMA (>1:80) and AAA (>1:40) were significantly associated with biochemical (76.9% and 79.8%) and histological features (100% and 100%) of disease activity (P < 0.001).


CONCLUSIONS
With the exception of ANA, the autoantibody profile does not markedly vary in the course of AIH. The persistence of high titers of ASMA and/or AAA in patients with AIH is associated with disease activity.
Universidade Federal de Minas Gerais, Department of Internal Medicine, School of Medicine, Belo Horizonte, Minas Gerais, Brazil; Universidade Federal de Minas Gerais, University Hospital, Alfa Institute of Gastroenterology, Belo Horizonte, Minas Gerais, Brazil.
Claudia A
CA
Couto
Paulo L
PL
Bittencourt
Gilda
G
Porta
Clarice P
CP
Abrantes-Lemos
Flair J
FJ
Carrilho
Bianca D
BD
Guardia
Eduardo L R
EL
Cançado
D000199:Actins / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000276:immunology*; D011379:Prognosis; D012720:Severity of Illness Index; D055815:Young Adult
D000199:Actins; D000888:Antibodies, Anti-Idiotypic; D015415:Biomarkers