Autoimmune liver disease serology in acute hepatitis E virus infection

Benedetta Terziroli Beretta-piccoli; Paolo Ripellino; Claudio Gobbi; Andreas Cerny; Adriana Baserga; Claudia Di Bartolomeo; Florian Bihl; Gaia Deleonardi; Laura Melidona; Ana Gabriela Grondona; Giorgina Mieli-Vergani; Diego Vergani; Luigi Muratori

doi:10.1016/j.jaut.2018.07.006

Autoimmune liver disease serology in acute hepatitis E virus infection

Benedetta Terziroli Beretta-piccoli, Paolo Ripellino, Claudio Gobbi, Andreas Cerny, Adriana Baserga, Claudia Di Bartolomeo, Florian Bihl, Gaia Deleonardi, Laura Melidona, Ana Gabriela Grondona, Giorgina Mieli-Vergani, Diego Vergani, Luigi Muratori

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Abstract

The etiology of autoimmune hepatitis (AIH) is unknown, though hepatotropic viruses may be potential triggers. Hepatitis E virus (HEV) infection, an increasingly recognized cause of acute hepatitis, has been misdiagnosed as AIH due to the occurrence of autoantibodies during its acute phase. It has also been suggested that HEV infection may lead to or unmask AIH. The HEV seroprevalence has been ascertained in patients with AIH, but the prevalence of AIH-related autoantibodies in patients with HEV infection has not been systematically tested. We aimed to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies, following the liver autoimmune serology guidelines of the International AIH Group. We tested 48 patients with acute HEV infection. Half of them had at least one autoantibody, 17% two autoantibodies. Anti-nuclear antibody (ANA) were detected in 16 (33%), anti-smooth muscle antibody (SMA) in 10 (21%), and anti-neutrophil cytoplasmic antibody (ANCA) in 7 (14.6%). Of note, two patients showed SMA with VG or VGT patterns and five had ANA with homogeneous appearance, both being typical of AIH type 1. Other AIH-specific autoantibodies were negative. Atypical anti-mitochondrial antibody, without evidence of primary biliary cholangitis, was positive in one patient, disappearing at follow-up. Follow-up (median 12 months) serum was available from seven autoantibody positive patients: two became negative, while five remained positive, although no patient developed AIH to date. In conclusion, autoantibodies are frequently present during acute HEV infection, indicating that HEV should always be excluded before diagnosing AIH. Importantly, a minority of patients with acute hepatitis E develops AIH-specific autoantibodies, and, though they did not progress to autoimmune liver disease in the short-term, they warrant long-term monitoring.

Original language	English
Journal	Journal of Autoimmunity
Early online date	7 Jul 2018
DOIs	https://doi.org/10.1016/j.jaut.2018.07.006
Publication status	E-pub ahead of print - 7 Jul 2018

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Autoimmune liver disease serology_BERETTA-PICCOLI_Firstonline7July2018_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 320 KBLicence: CC BY-NC-ND

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Terziroli Beretta-piccoli, B., Ripellino, P., Gobbi, C., Cerny, A., Baserga, A., Di Bartolomeo, C., Bihl, F., Deleonardi, G., Melidona, L., Grondona, A. G., Mieli-Vergani, G., Vergani, D., & Muratori, L. (2018). Autoimmune liver disease serology in acute hepatitis E virus infection. Journal of Autoimmunity. Advance online publication. https://doi.org/10.1016/j.jaut.2018.07.006

@article{28c9599cc51b4b05b59b4ac18c578d21,

title = "Autoimmune liver disease serology in acute hepatitis E virus infection",

abstract = "The etiology of autoimmune hepatitis (AIH) is unknown, though hepatotropic viruses may be potential triggers. Hepatitis E virus (HEV) infection, an increasingly recognized cause of acute hepatitis, has been misdiagnosed as AIH due to the occurrence of autoantibodies during its acute phase. It has also been suggested that HEV infection may lead to or unmask AIH. The HEV seroprevalence has been ascertained in patients with AIH, but the prevalence of AIH-related autoantibodies in patients with HEV infection has not been systematically tested. We aimed to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies, following the liver autoimmune serology guidelines of the International AIH Group. We tested 48 patients with acute HEV infection. Half of them had at least one autoantibody, 17% two autoantibodies. Anti-nuclear antibody (ANA) were detected in 16 (33%), anti-smooth muscle antibody (SMA) in 10 (21%), and anti-neutrophil cytoplasmic antibody (ANCA) in 7 (14.6%). Of note, two patients showed SMA with VG or VGT patterns and five had ANA with homogeneous appearance, both being typical of AIH type 1. Other AIH-specific autoantibodies were negative. Atypical anti-mitochondrial antibody, without evidence of primary biliary cholangitis, was positive in one patient, disappearing at follow-up. Follow-up (median 12 months) serum was available from seven autoantibody positive patients: two became negative, while five remained positive, although no patient developed AIH to date. In conclusion, autoantibodies are frequently present during acute HEV infection, indicating that HEV should always be excluded before diagnosing AIH. Importantly, a minority of patients with acute hepatitis E develops AIH-specific autoantibodies, and, though they did not progress to autoimmune liver disease in the short-term, they warrant long-term monitoring.",

author = "{Terziroli Beretta-piccoli}, Benedetta and Paolo Ripellino and Claudio Gobbi and Andreas Cerny and Adriana Baserga and {Di Bartolomeo}, Claudia and Florian Bihl and Gaia Deleonardi and Laura Melidona and Grondona, {Ana Gabriela} and Giorgina Mieli-Vergani and Diego Vergani and Luigi Muratori",

year = "2018",

month = jul,

day = "7",

doi = "10.1016/j.jaut.2018.07.006",

language = "English",

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TY - JOUR

T1 - Autoimmune liver disease serology in acute hepatitis E virus infection

AU - Terziroli Beretta-piccoli, Benedetta

AU - Ripellino, Paolo

AU - Gobbi, Claudio

AU - Cerny, Andreas

AU - Baserga, Adriana

AU - Di Bartolomeo, Claudia

AU - Bihl, Florian

AU - Deleonardi, Gaia

AU - Melidona, Laura

AU - Grondona, Ana Gabriela

AU - Mieli-Vergani, Giorgina

AU - Vergani, Diego

AU - Muratori, Luigi

PY - 2018/7/7

Y1 - 2018/7/7

N2 - The etiology of autoimmune hepatitis (AIH) is unknown, though hepatotropic viruses may be potential triggers. Hepatitis E virus (HEV) infection, an increasingly recognized cause of acute hepatitis, has been misdiagnosed as AIH due to the occurrence of autoantibodies during its acute phase. It has also been suggested that HEV infection may lead to or unmask AIH. The HEV seroprevalence has been ascertained in patients with AIH, but the prevalence of AIH-related autoantibodies in patients with HEV infection has not been systematically tested. We aimed to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies, following the liver autoimmune serology guidelines of the International AIH Group. We tested 48 patients with acute HEV infection. Half of them had at least one autoantibody, 17% two autoantibodies. Anti-nuclear antibody (ANA) were detected in 16 (33%), anti-smooth muscle antibody (SMA) in 10 (21%), and anti-neutrophil cytoplasmic antibody (ANCA) in 7 (14.6%). Of note, two patients showed SMA with VG or VGT patterns and five had ANA with homogeneous appearance, both being typical of AIH type 1. Other AIH-specific autoantibodies were negative. Atypical anti-mitochondrial antibody, without evidence of primary biliary cholangitis, was positive in one patient, disappearing at follow-up. Follow-up (median 12 months) serum was available from seven autoantibody positive patients: two became negative, while five remained positive, although no patient developed AIH to date. In conclusion, autoantibodies are frequently present during acute HEV infection, indicating that HEV should always be excluded before diagnosing AIH. Importantly, a minority of patients with acute hepatitis E develops AIH-specific autoantibodies, and, though they did not progress to autoimmune liver disease in the short-term, they warrant long-term monitoring.

AB - The etiology of autoimmune hepatitis (AIH) is unknown, though hepatotropic viruses may be potential triggers. Hepatitis E virus (HEV) infection, an increasingly recognized cause of acute hepatitis, has been misdiagnosed as AIH due to the occurrence of autoantibodies during its acute phase. It has also been suggested that HEV infection may lead to or unmask AIH. The HEV seroprevalence has been ascertained in patients with AIH, but the prevalence of AIH-related autoantibodies in patients with HEV infection has not been systematically tested. We aimed to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies, following the liver autoimmune serology guidelines of the International AIH Group. We tested 48 patients with acute HEV infection. Half of them had at least one autoantibody, 17% two autoantibodies. Anti-nuclear antibody (ANA) were detected in 16 (33%), anti-smooth muscle antibody (SMA) in 10 (21%), and anti-neutrophil cytoplasmic antibody (ANCA) in 7 (14.6%). Of note, two patients showed SMA with VG or VGT patterns and five had ANA with homogeneous appearance, both being typical of AIH type 1. Other AIH-specific autoantibodies were negative. Atypical anti-mitochondrial antibody, without evidence of primary biliary cholangitis, was positive in one patient, disappearing at follow-up. Follow-up (median 12 months) serum was available from seven autoantibody positive patients: two became negative, while five remained positive, although no patient developed AIH to date. In conclusion, autoantibodies are frequently present during acute HEV infection, indicating that HEV should always be excluded before diagnosing AIH. Importantly, a minority of patients with acute hepatitis E develops AIH-specific autoantibodies, and, though they did not progress to autoimmune liver disease in the short-term, they warrant long-term monitoring.

U2 - 10.1016/j.jaut.2018.07.006

DO - 10.1016/j.jaut.2018.07.006

M3 - Article

SN - 0896-8411

JO - Journal of Autoimmunity

JF - Journal of Autoimmunity

ER -

Autoimmune liver disease serology in acute hepatitis E virus infection

Abstract

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