RESUMO
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.
Assuntos
Hepatite Autoimune/diagnóstico , Interleucina-17/sangue , Adulto , Idoso , Feminino , Hepatite Autoimune/sangue , Humanos , Inflamação , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Transformador beta1/sangue , Adulto JovemRESUMO
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.