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Autoimmune Hepatitis

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Albert J Czaja – One of the best experts on this subject based on the ideXlab platform.

  • Current concepts in Autoimmune Hepatitis.
    Annals of Hepatology, 2020
    Co-Authors: Albert J Czaja

    Abstract:

    Autoimmune Hepatitis has a global occurrence, diverse clinical phenotype, and evolving treatment options. The goals of this report are to review the codified diagnostic criteria, spectrum of clinical presentations, proposed pathogenic mechanisms, conventional treatment strategies, and promising interventions. The literature published in English from 1980-2005 was reviewed and an updated current perspective provided. Autoimmune Hepatitis affects all ages, may be asymptomatic, frequently has an acute onset, and can present as fulminant Hepatitis. Perivenular (zone 3) necrosis is within the histological spectrum. Autoimmune Hepatitis can recur or develop de novo after liver transplantation. CD4+ T-helper cells and natural killer T cells have been implicated in the pathogenesis, and molecular mimicry may break self-tolerance. DRB1*0301 and DRB1*0401 are the susceptibility alleles among white North Americans and northern Europeans, whereas diverse alleles of HLA DR4 have been associated with the disease in Japan, mainland China, and Mexico. DRB1*1301 is associated with Autoimmune Hepatitis in South American children, and it may predispose to an indigenous etiologic agent. Antibodies to soluble liver antigen/liver pancreas may have prognostic importance, and cyclosporine and mycophenolate mofetil must be assessed by clinical trial before incorporation into management algorithms. Sitespecific interventions are feasible, and they require a confident experimental animal model for evaluation. Variant syndromes lack diagnostic and therapeutic guidelines. In conclusion, Autoimmune Hepatitis must be considered in all patients with acute and chronic liver disease and those with allograft dysfunction after transplantation. New immunosuppressive agents and site-specific interventions promise to improve care.

  • Targeting Hepatic Fibrosis in Autoimmune Hepatitis
    Digestive Diseases and Sciences, 2016
    Co-Authors: Aldo J. Montano-loza, Ragesh B. Thandassery, Albert J Czaja

    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.

  • Transitioning from Idiopathic to Explainable Autoimmune Hepatitis
    Digestive Diseases and Sciences, 2015
    Co-Authors: Albert J Czaja

    Abstract:

    Autoimmune Hepatitis lacks an identifiable cause, and its diagnosis requires the exclusion of etiologically defined diseases that resemble it. Insights into its pathogenesis are moving Autoimmune Hepatitis from an idiopathic to explainable disease, and the goal of this review is to describe the insights that are hastening this transition. Two types of Autoimmune Hepatitis are justified by serological markers, but they also have distinctive genetic associations ( DRB1 and DQB1 genes ) and autoantigens. DRB1 alleles are the principal susceptibility factors in white adults, and a six amino acid sequence encoded in the antigen-binding groove of class II molecules of the major histocompatibility complex can influence the selection of autoantigens. Polymorphisms, including variants of SH2B3 and CARD10 genes, may affect immune reactivity and disease severity. The cytochrome mono-oxygenase, CYP2D6, is the autoantigen associated with type 2 Autoimmune Hepatitis, and it shares homologies with multiple viruses that might promote self-intolerance by molecular mimicry. Chemokines, especially CXCL9 and CXCL10, orchestrate the migration of effector cells to sites of injury and are associated with disease severity. Cells of the innate and adaptive immune responses promote tissue damage, and possible deficiencies in the number and function of regulatory T cells may facilitate the injurious process. Receptor-mediated apoptosis is the principal mechanism of hepatocyte loss, and cell-mediated and antibody-dependent mechanisms of cytotoxicity also contribute. Insights that explain Autoimmune Hepatitis will allow triggering exogenous antigens to be characterized, risk management to be improved, prognostic indices to be refined, and site-specific therapeutic interventions to emerge.

Meral Akdogan – One of the best experts on this subject based on the ideXlab platform.

  • ornidazole induced Autoimmune Hepatitis
    European Journal of Gastroenterology & Hepatology, 2001
    Co-Authors: Y Kosar, Nurgul Sasmaz, P Oguz, Sabite Kacar, E Erden, Erkan Parlak, Meral Akdogan

    Abstract:

    Ornidazole is a commonly prescribed antiparasitic drug for parasitic infestations, including amoebiasis, giardiasis and Trichomonas vaginalis. Several cases of antibiotic-induced Autoimmune Hepatitis (AIH) or AIH-like syndrome have been reported recently. In this report, we describe a 35-year-old woman with two relapses of AIH induced by ornidazole prescribed for diarrhoea and vaginal infection.

Y Kosar – One of the best experts on this subject based on the ideXlab platform.

  • ornidazole induced Autoimmune Hepatitis
    European Journal of Gastroenterology & Hepatology, 2001
    Co-Authors: Y Kosar, Nurgul Sasmaz, P Oguz, Sabite Kacar, E Erden, Erkan Parlak, Meral Akdogan

    Abstract:

    Ornidazole is a commonly prescribed antiparasitic drug for parasitic infestations, including amoebiasis, giardiasis and Trichomonas vaginalis. Several cases of antibiotic-induced Autoimmune Hepatitis (AIH) or AIH-like syndrome have been reported recently. In this report, we describe a 35-year-old woman with two relapses of AIH induced by ornidazole prescribed for diarrhoea and vaginal infection.