Serum interleukin­17 levels predict inflammatory activity in patients with autoimmune hepatitis.

INTRODUCTION    The etiology of autoimmune hepatitis (AIH) is unclear, with molecular mimicry between host and viral/drug antigens being the most plausible mechanism initiating the immune cascade that induces hepatocyte injury. Finding a serologic parameter that closely relates to the liver histology would be beneficial for monitoring AIH activity and optimizing treatment. OBJECTIVES    We studied serum interleukin (IL)-17 levels and IL­17 activators (IL­6 and transforming growth factor ß1 [TGF-ß1]) in treatment-naive and immunosuppressed patients with AIH. We also analyzed the relationships between these cytokines and histological inflammation scores. PATIENTS AND METHODS    A total of 44 patients with confirmed AIH were enrolled to the study (22 treatment-naive patients and 22 patients in clinical remission after at least 3 years of immunosuppression). Liver biopsies were performed, and the histological grading of inflammatory activity was performed by a single pathologist. The control group comprised 30 healthy age- and sex­matched subjects. Serum IL­17, IL­6, and TGF­ß1 levels were measured by a quantitative sandwich enzyme immunoassay. RESULTS    Serum IL­17, IL­6, and TGF­ß1 levels were higher in treatment-naive patients compared with controls (23.2 pg/ml vs 15.3 pg/ml, P = 0.0001; 5.20 pg/ml vs 1.42 pg/ml, P = 0.0001; and 40.5 ng/ml vs 30.1 ng/ml, P = 0.04; respectively). In treatment-naive patients, serum IL­17 negatively correlated with hepatic inflammation (r = -0.63, P = 0.01). A reduced serum IL­17 concentration correlated with an increased TGF­ß1 concentration in patients in clinical remission (r = -0.51, P = 0.03). CONCLUSIONS    Serum IL­17 levels may be a useful parameter for assessing disease activity in patients with AIH.

[Nonalcoholic steatohepatitis--current treatment options]. / Niealkoholowe stluszczeniowe zapalenie watroby--aktualne mozliwosci leczenia.

Nonalcoholic steatohepatitis (NASH) is the term used to describe the distinct clinical entity in which the liver biopsy findings are similar to that observed in alcoholic hepatitis, but patients lack a history of significant alcohol consumption. The most widely supported theory implicates insulin resistance as the key mechanism leading first to hepatic steatosis, and next to steatohepatitis. In spite of lacking proof by EBM (evidence based medicine) and effective therapy for NASH, modification of risk factors, such as obesity, hyperlipidemia, and good diabetic control is generally recommended. Although there is no consensus of treatment form, the new drugs which can be useful in NASH treatment are continously tested. The aim of our study is to present current knowledge about nonalcoholic steatohepatitis, focusing on present and being in various phases of clinical trials treatment options.