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Frequency and significance of antibodies to actin in type 1 autoimmune hepatitis
Author(s) -
Czaja A J,
Cassani F,
Cataleta M,
Valentini P,
Bianchi F B
Publication year - 1996
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.510240515
Subject(s) - autoimmune hepatitis , antibody , anti nuclear antibody , medicine , immunology , liver transplantation , hepatitis , actin , sma* , transplantation , autoantibody , biology , mathematics , combinatorics , microbiology and biotechnology
Antibodies to actin have been proposed as diagnostic markers for type 1 autoimmune hepatitis. Our aims were to determine (1) if testing for antibodies to actin is superior to testing for smooth muscle antibodies (SMA); (2) if these antibodies identify patients with distinctive clinical features; and (3) if the production of antibodies to actin is associated with genetic risk factors for autoimmune hepatitis. Sera from 99 patients with type 1 autoimmune hepatitis were tested. The frequencies of HLA B8, DR3, DR4, and A1‐B8‐DR3 in patient subsets were compared with those in 80 normal subjects. Seventy‐three patients (74%) had antibodies to actin. Antibodies to actin were found more commonly in patients with SMA than in patients without them (86% vs. 7%, P < .0001). Screening only for antibodies to actin and antinuclear antibodies (ANA) failed to establish the diagnosis of autoimmune hepatitis in 5 patients. Patients with antibodies to actin were younger than seronegative patients. They were also more commonly DR3‐positive than normal subjects and more frequently B8‐positive than patients with non‐actin‐associated SMA (49% vs. 0%, P = .004). Only patients with antibodies to actin died of liver failure (6% vs. 0%), and 10 of 11 patients requiring liver transplantation were seropositive for these antibodies. Indeed, death and liver transplantation occurred more frequently in these patients than in actin‐negative patients with ANA (19% vs. 0%, P = .03). We conclude that routine screening for antibodies to actin may miss patients with type 1 autoimmune hepatitis. Antibodies to actin are associated with HLA B8 and DR3, and they identify patients with a poor prognosis.