Abstract
Autoimmune hepatitis (AIH) is a severe liver disease that affects children and adults worldwide. The diagnosis of AIH relies on increased serum transaminase and immunoglobulin G levels, presence of autoantibodies and interface hepatitis on liver histology. AIH arises in genetically predisposed individuals when a trigger, such as exposure to a virus, leads to a T cell-mediated autoimmune response directed against liver autoantigens; this immune response is permitted by inadequate regulatory immune control leading to a loss of tolerance. AIH responds favourably to immunosuppressive treatment, which should be started as soon as the diagnosis is made. Standard regimens include fairly high initial doses of corticosteroids (prednisone or prednisolone), which are tapered gradually as azathioprine is introduced. For those patients who do not respond to standard treatment, second-line drugs should be considered, including mycophenolate mofetil, calcineurin inhibitors, mechanistic target of rapamycin (mTOR) inhibitors and biologic agents, which should be administered only in specialized hepatology centres. Liver transplantation is a life-saving option for those who progress to end-stage liver disease, although AIH can recur or develop de novo after transplantation. In-depth investigation of immune pathways and analysis of changes to the intestinal microbiota should advance our knowledge of the pathogenesis of AIH and lead to novel, tailored and better tolerated therapies.
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Acknowledgements
The authors thank S. Dhingra for the contribution of Fig. 2.
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Introduction (M.P.M.); Epidemiology (E.L.K.); Mechanisms/pathophysiology (D.V.); Diagnosis, screening and prevention (J.M.V. and G.M.-V.); Management (A.W.L. and G.M.-V.); Quality of life (A.J.M.-L.); Outlook (A.J.C.); Overview of Primer (D.V. and G.M.-V.).
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M.P.M. received research grants and trial support from and serves as a consultant for Falk Foundation and Novartis Pharma. J.M.V. is a recipient of research grants from Gilead, Intercept, Novartis, Sundise and TaiwanJ and serves as a scientific adviser to BioIncept, Bristol-Myers Squibb, Gilead, Intercept, Novartis and Sundise. In addition, he is a co-author of âImmunosuppression in Liver Transplantationâ for Up-to-Date. A.W.L. holds the patent on SLA/LP diagnostic testing, but all revenues from this patent go to the charitable YAEL foundation supporting patients and research in autoimmune liver diseases. G.M.-V., D.V., A.J.C., E.L.K. and A.J.M.-L. declare no competing interests.
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Mieli-Vergani, G., Vergani, D., Czaja, A. et al. Autoimmune hepatitis. Nat Rev Dis Primers 4, 18017 (2018). https://doi.org/10.1038/nrdp.2018.17
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DOI: https://doi.org/10.1038/nrdp.2018.17
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