Autoimmune hepatitis: from immunopathogenesis to diagnostic and therapeutic innovation
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Autoimmune hepatitis: from immunopathogenesis to diagnostic and therapeutic innovation. / Weiler-Normann, Christina; Lohse, Ansgar W.
In: CURR OPIN GASTROEN, Vol. 37, No. 2, 01.03.2021, p. 86-90.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Autoimmune hepatitis: from immunopathogenesis to diagnostic and therapeutic innovation
AU - Weiler-Normann, Christina
AU - Lohse, Ansgar W
N1 - Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - PURPOSE OF REVIEW: To understand the pathogenesis of autoimmune hepatitis (AIH) and the accuracy of diagnosis and treatment options that have improved lately. We summarize the latest research.RECENT FINDINGS: Concerning pathogenesis of AIH, different groups have identified pieces of the puzzle that fit together well: An altered microbiome in the gut results in a proinflammatory response in the liver. This response is built by type II natural killer cells and CD4 T cells with an inflammatory phenotype and marked tumor necrosis factor production. When looking specifically at autoantigenic CD4 T cells, these have a B-helper phenotype on transcriptomic analysis. This explains not only elevation of immunoglobulins in AIH, but also mechanistically the effect of anti-B-cell substances in treatment. Diagnosis is now facilitated by an improved diagnostic score for AIH also recognizing modern techniques for autoantibody detection. Treatment in the future will increasingly be focused on reducing dosage and duration of steroid exposition. In addition, B-cell-targeted treatments have been evaluated with considerable success.SUMMARY: Research in the past 18 months has improved the understanding of pathogenesis and thereby opened a number of possible treatment options. In addition, steroid use is cautioned by the recent findings.
AB - PURPOSE OF REVIEW: To understand the pathogenesis of autoimmune hepatitis (AIH) and the accuracy of diagnosis and treatment options that have improved lately. We summarize the latest research.RECENT FINDINGS: Concerning pathogenesis of AIH, different groups have identified pieces of the puzzle that fit together well: An altered microbiome in the gut results in a proinflammatory response in the liver. This response is built by type II natural killer cells and CD4 T cells with an inflammatory phenotype and marked tumor necrosis factor production. When looking specifically at autoantigenic CD4 T cells, these have a B-helper phenotype on transcriptomic analysis. This explains not only elevation of immunoglobulins in AIH, but also mechanistically the effect of anti-B-cell substances in treatment. Diagnosis is now facilitated by an improved diagnostic score for AIH also recognizing modern techniques for autoantibody detection. Treatment in the future will increasingly be focused on reducing dosage and duration of steroid exposition. In addition, B-cell-targeted treatments have been evaluated with considerable success.SUMMARY: Research in the past 18 months has improved the understanding of pathogenesis and thereby opened a number of possible treatment options. In addition, steroid use is cautioned by the recent findings.
KW - Autoantibodies
KW - Hepatitis, Autoimmune/diagnosis
KW - Humans
KW - T-Lymphocytes
U2 - 10.1097/MOG.0000000000000701
DO - 10.1097/MOG.0000000000000701
M3 - SCORING: Review article
C2 - 33315793
VL - 37
SP - 86
EP - 90
JO - CURR OPIN GASTROEN
JF - CURR OPIN GASTROEN
SN - 0267-1379
IS - 2
ER -
