Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol.

Autoimmune hepatitis, formerly called lupoid hepatitis, is a chronic, autoimmune disease of the liver that occurs when the body's immune system attacks liver cells causing the liver to be inflamed, or when your body makes antibodies against your liver tissue.

Autoimmune hepatitis is a rare disease of low prevalence that is associated with diagnostic autoantibodies. These autoantibodies are useful disease markers that facilitate the early diagnosis of autoimmune hepatitis for therapeutic intervention to prevent progression to liver cirrhosis and associated complications. Adult onset type-1 autoimmune hepatitis is associated with F-actin reactive smooth muscle SMA-T or SMA-G autoantibody, antinuclear autoantibody in 60% of patients and autoantibody to SLA/LP in 15-20%. Juvenile onset type-2 autoimmune hepatitis is associated with LKM-1 and LC-1 autoantibodies. Liver autoantibodies in asymptomatic patients with normal liver function may precede the subsequent development of overt autoimmune liver disease. For routine diagnostic immunology laboratories, initial screening for smooth muscle SMA-T antibody by immunofluorescence remains the method of choice with confirmation for reactivity with F-actin by immunofluorescence.

Autoantibodies are produced by humoral immune responses against self-cellular proteins and nucleic acids and have been well established as serological hallmarks of autoimmune disease. Numerous autoantibodies have been isolated from sera of patients with liver diseases. These autoantibodies have often clinical values for the diagnosis, disease activity and/or prognosis. Such autoantigens are primarily engaged in essential cellular functions including DNA replication, DNA transcription, and RNA processing.

Autoantibodies in the field of liver disease are mainly classified into two entities: (1) non-organ specific autoantibodies including antinuclear antibodies (ANA), smooth muscle antibodies (SMA), antimitochondrial antibodies (AMA), and antibodies to liver kidney microsome type-1 (LKM-1), (2) liver-specific autoantibodies such as antibodies to soluble liver antigen (SLA) and antibodies to asialoglycoprotein receptor (ASGPR).

Treatment

Regardless of which type of autoimmune hepatitis you have, the goal of treatment is to slow or stop the immune system attack on your liver. This may help slow the progression of the disease. To meet this goal, you'll need medications that lower immune system activity. The initial treatment is usually prednisone. A second medication, azathioprine (Azasan, Imuran), may be recommended in addition to prednisone.

When medications don't halt the progress of the disease or you develop irreversible scarring (cirrhosis) or liver failure, the remaining option is a liver transplant.

During a liver transplant, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplants most often use livers from deceased organ donors. In some cases, a living-donor liver transplant can be used. During a living-donor liver transplant, you receive only a portion of a healthy liver from a living donor. Both livers begin regenerating new cells almost immediately.

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