Conclusions
The concept of autoimmue hepatitis has developed over the past 35–40 years. Despite continuing debate over the nosologie status of this disease, there are certain “realities” that argue for autoimmune hepatitis as an entity.
The uncertainties include valid criteria for distinguishing the autoimmune from other types of CAH, and the applicability of the marker antibodies for diagnosis. A reliable animal model is lacking. The initiating process, infectious or other, is unknown. The immunological events that determine self-perpetuation need elucidation. These include the identity of the liver membrane autoantigen, the immunogenetic contribution, the respective roles in pathogenesis of helper, suppressor and cytotoxic T lymphocytes, and the identification of a specific liver membrane autoantibody. Clear advances are perceptible on each of these fronts.
Similar content being viewed by others
References
Mackay IR: Chronic active hepatitides, In: Van derReis, L. ed. Frontiers of Gastrointestinal Research, Karger, Basel, 1975; vol. 1:142–187
Mackay IR, Taft LI, Cowling DC: Lupoid hepatitis. Lancet 1956;ii: 1323–1326
Mackay IR: Treatment of chronic active hepatitis and other liver diseases with cortico steroid agents. Med J Australia 1987; 146: 370–374
Mackay IR. O’Brien RM, Whittingham SF and Tait BD: Autoimmune and Other Diseases of the Liver: Immunogenetic Aspects. In: The Immunogenetics of Autoimmune Disease, edited by N Farid CRC Press, in press. 1990
Wang KW and Czaja AJ: Hepatocellular carcinoma in corticosteriod-treated severe autoimmune chronic active hepatitis. Hepatology 1989;8:1679–1683
Mackay IR: Autoimmune (lupoid) hepatitis: An entity in the spectrum of chronic active liver disease. J Gastroenterol Hepatol 1990;5:352–359
Czaja A: Autoimmune chronic active hepatitis. A specific entity? The negative argument. J Gastroenterol Hepatol 1990;5: 343–351
Mackay IR: Autoimmune disease of the liver: chronic active hepatitis and primary biliary cirrhosis. In: Rose, NR and Mackay, IR (Eds),The Auto Immune Diseases, Orlando, Academic Press, 1985;291–337
Mackay IR: Mechanisms of Chtonic Hepatitis. In:Modern Concepts of Acute and Chronic Hepatitis Gitnick G Ed Plenum New York 1989;229–246
Taguchi O. Nishizuka Y: Self tolerance and localized autoimmunity. Mouse models of autoimmune disease that suggest tissuespecific suppressor T cells are involved in self-tolerancc. J Exp Med 1987;165:146–156
Morahan G. Brennan FE, Bhatal PS, Allison J, Cox, KO, and Miller JFAP: Expression in transgenic mice of class 1 histocompatibility antigens controlled by the met allothionine promoter. Proc Nat Acad Sci USA 1989;86:3782–3786
Krams SM, Dorshkind K, and Gershwin ME: Generation of biliary lesions after transfer of human lymphocytes into severe combined immunodeficient mice. J Exp Med 1989; 170:1919–1930
Esteban JI, Esteban R, Viladomiu et al: Hepatitis virus C antibodies among risk groups in Spain. Lancet 1989;ii:294–297
Lenzi M. Ballardini G, Fusconi M, Cassani F, Selleri L, Volta U, Zauli D, and Bianchi FM: Type 2 autoimmune hepatitis and hepatitis C virus infection. Lancet 1990;i:258–259
Franco A. Barnaba V. Kuberti G. Benvenuto R. Balsano C, and Musca A: Liver-derived T cell clones in autoimmune chronic active hepatitis: accessory function of hepatocytes expressing class 11 major histocompatibility molecules. Clin Immunol Immunopathol 1990;54:382–394
Frazer I H.Jordan TW, Collins EC, Andrews P, and Mackay IR: Antibody to liver membrane antigens in chronic active hepatitis. Hepatology 1987;7:4–10
Swanson NR, Reed WD, Yarred LJ. Shilkin KB, and Joske RA: Autoantibodies to isolated plasma membranes in chronic active hepatitis. II Specificity of antibodies. Hepatology 1990;11:613–621
Hopf U. John HU, Möller B, Stemcrowiez R, Witenbrink C, Klein R. and Berg PA: Liver membrance antibodies (LMA) recognise a 26kD protein on the hepatocellular surface. Clin Exp Immunol 1990;79:54–61
Frazer IH, Mackay IR. Bell J. and Becker G: Cellular infiltrate in the liver in autoimmune chronic active hepatitis. Liver 1985;5:162–72
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mackay, I.R. Autoimmune hepatitis: The realities and the uncertainties. Gastroenterol Jpn 26, 102–108 (1991). https://doi.org/10.1007/BF02779520
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02779520