Autoimmune hepatitis: current challenges and future prospects
| Autor: | Yoshio Aizawa, Atsushi Hokari |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
centrilobular zonal necrosis
Anti-nuclear antibody immunosuppressive therapy Review Human leukocyte antigen Autoimmune hepatitis overlap syndrome 03 medical and health sciences 0302 clinical medicine immune system diseases Nonalcoholic fatty liver disease Medicine autoimmune hepatitis business.industry Gastroenterology Autoantibody Hypergammaglobulinemia Overlap syndrome medicine.disease digestive system diseases 030220 oncology & carcinogenesis Immunology immunogenetic background Etiology 030211 gastroenterology & hepatology antinuclear antibody business |
| Zdroj: | Clinical and Experimental Gastroenterology |
| ISSN: | 1178-7023 |
| DOI: | 10.2147/ceg.s101440 |
| Popis: | Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by high levels of aminotransferases and autoantibodies, hypergammaglobulinemia, and interface hepatitis. AIH affects all races and all ages worldwide, regardless of sex, although a preponderance of females is a constant finding. The etiology of AIH has not been completely elucidated, but immunogenetic background and environmental parameters may contribute to its development. The most important genetic factor is human leukocyte antigens (HLAs), especially HLA-DR, whereas the role of environmental factors is not completely understood. Immunologically, disruption of the immune tolerance to autologous liver antigens may be a trigger of AIH. The diagnosis of classical AIH is fairly easy, though not without pitfalls. In contrast, the diagnosis of atypical AIH poses great challenges. There is confusion as to the definition of the disease entity and its boundaries in the diagnosis of overlap syndrome, drug-induced autoimmune hepatitis, and AIH with concomitant nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C. Centrilobular zonal necrosis is now included in the histological spectrum of AIH. However, the definition and the significance of AIH presenting with centrilobular zonal necrosis have not been examined extensively. In ~20% of AIH patients who are treated for the first time with standard therapy, remission is not achieved. The development of more effective and better tolerated novel therapies is an urgent need. In this review, we discuss the current challenges and the future prospects in relation to the diagnosis and treatment of AIH, which have been attracting considerable recent attention. |
| Databáze: | OpenAIRE |
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