title: Targeting Hepatic Fibrosis in Autoimmune Hepatitis.
abstract: Hepatic fibrosis develops or progresses in 25 % of patients with autoimmune hepatitis despite corticosteroid therapy. Current management regimens lack reliable noninvasive methods to assess changes in hepatic fibrosis and interventions that disrupt fibrotic pathways. The goals of this review are to indicate promising noninvasive methods to monitor hepatic fibrosis in autoimmune hepatitis and identify anti-fibrotic interventions that warrant evaluation. Laboratory methods can differentiate cirrhosis from non-cirrhosis, but their accuracy in distinguishing changes in histological stage is uncertain. Radiological methods include transient elastography, acoustic radiation force impulse imaging, and magnetic resonance elastography. Methods based on ultrasonography are comparable in detecting advanced fibrosis and cirrhosis, but their performances may be compromised by hepatic inflammation and obesity. Magnetic resonance elastography has excellent performance parameters for all histological stages in diverse liver diseases, is uninfluenced by inflammatory activity or body habitus, has been superior to other radiological methods in nonalcoholic fatty liver disease, and may emerge as the preferred instrument to evaluate fibrosis in autoimmune hepatitis. Promising anti-fibrotic interventions are site- and organelle-specific agents, especially inhibitors of nicotinamide adenine dinucleotide phosphate oxidases, transforming growth factor beta, inducible nitric oxide synthase, lysyl oxidases, and C-C chemokine receptors types 2 and 5. Autoimmune hepatitis has a pro-fibrotic propensity, and noninvasive radiological methods, especially magnetic resonance elastography, and site- and organelle-specific interventions, especially selective antioxidants and inhibitors of collagen cross-linkage, may emerge to strengthen current management strategies.
authors.affiliation: Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: Aldo J
authors.initials: AJ
authors.lastname: Montano-Loza
authors.affiliation: Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: Ragesh B
authors.initials: RB
authors.lastname: Thandassery
authors.affiliation: Professor Emeritus of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN, 55905, USA. czaja.albert@mayo.edu.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Czaja
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D017209:Apoptosis / Q000276:immunology; D065100:CCR5 Receptor Antagonists / Q000627:therapeutic use*; D016207:Cytokines / Q000276:immunology; D054459:Elasticity Imaging Techniques; D005109:Extracellular Matrix / Q000378:metabolism; D019693:Hepatitis, Autoimmune / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000276:immunology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D019255:NADPH Oxidases / Q000037:antagonists & inhibitors; D052247:Nitric Oxide Synthase Type II / Q000037:antagonists & inhibitors; D018384:Oxidative Stress / Q000276:immunology; D008249:Protein-Lysine 6-Oxidase / Q000037:antagonists & inhibitors; D054390:Receptors, CCR2 / Q000037:antagonists & inhibitors; D012720:Severity of Illness Index; D016212:Transforming Growth Factor beta / Q000037:antagonists & inhibitors; D014808:Vitamin D Deficiency / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D000975:Antioxidants; D065100:CCR5 Receptor Antagonists; D016207:Cytokines; D054390:Receptors, CCR2; D016212:Transforming Growth Factor beta; D052247:Nitric Oxide Synthase Type II; D008249:Protein-Lysine 6-Oxidase; D019255:NADPH Oxidases
keywords: Anti-fibrotic interventions; Assessments; Autoimmune hepatitis; Fibrosis