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Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis
Author(s) -
Taubert Richard,
Engel Bastian,
Diestelhorst Jana,
HupaBreier Katharina L.,
Behrendt Patrick,
Baerlecken Niklas T.,
Sühs KurtWolfram,
Janik Maciej K.,
Zachou Kalliopi,
Sebode Marcial,
Schramm Christoph,
Londoño MaríaCarlota,
Habes Sarah,
Oo Ye H.,
Lalanne Claudine,
Pape Simon,
Schubert Maren,
Hust Michael,
Dübel Stefan,
Thevis Mario,
Jonigk Danny,
Beimdiek Julia,
Buettner Falk F. R.,
Drenth Joost P. H.,
Muratori Luigi,
Adams David H.,
Dyson Jessica K.,
Renand Amédée,
Graupera Isabel,
Lohse Ansgar W.,
Dalekos George N.,
Milkiewicz Piotr,
Stangel Martin,
Maasoumy Benjamin,
Witte Torsten,
Wedemeyer Heiner,
Manns Michael P.,
Jaeckel Elmar
Publication year - 2022
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.32134
Subject(s) - autoimmune hepatitis , autoantibody , medicine , anti nuclear antibody , antibody , serology , immunology , gastroenterology , hepatitis
Background and Aims Detection of autoantibodies is a mainstay of diagnosing autoimmune hepatitis (AIH). However, conventional autoantibodies for the workup of AIH lack either sensitivity or specificity, leading to substantial diagnostic uncertainty. We aimed to identify more accurate serological markers of AIH with a protein macroarray. Approach and Results During the search for more‐precise autoantibodies to distinguish AIH from non‐AIH liver diseases (non‐AIH‐LD), IgG antibodies with binding capacities to many human and foreign proteins were identified with a protein macroarray and confirmed with solid‐phase ELISAs in AIH patients. Subsequently, polyreactive IgG (pIgG) was exemplarily quantified by reactivity against human huntingtin‐interacting protein 1‐related protein in bovine serum albumin blocked ELISA (HIP1R/BSA). The diagnostic fidelity of HIP1R/BSA binding pIgG to diagnose AIH was assessed in a retrospective training, a retrospective multicenter validation, and a prospective validation cohort in cryoconserved samples from 1,568 adults from 10 centers from eight countries. Reactivity against HIP1R/BSA had a 25% and 14% higher specificity to diagnose AIH than conventional antinuclear and antismooth muscle antibodies, a significantly higher sensitivity than liver kidney microsomal antibodies and antisoluble liver antigen/liver pancreas antigen, and a 12%–20% higher accuracy than conventional autoantibodies. Importantly, HIP1R/BSA reactivity was present in up to 88% of patients with seronegative AIH and in up to 71% of AIH patients with normal IgG levels. Under therapy, pIgG returns to background levels of non‐AIH‐LD. Conclusions pIgG could be used as a promising marker to improve the diagnostic workup of liver diseases with a higher specificity for AIH compared to conventional autoantibodies and a utility in autoantibody‐negative AIH. Likewise, pIgG could be a major source of assay interference in untreated AIH.