Assessment of the histopathological key features in autoimmune hepatitis.

AIMS: In this study, we aimed to evaluate the use of typical histological features of both the revised original (1999) and simplified (2008) criteria in the diagnosis of autoimmune hepatitis (AIH) in clinical practice. METHODS AND RESULTS: We performed a detailed histopathological evaluation of the pretreatment biopsies of 63 AIH patients, and used biopsies of 62 untreated chronic viral hepatitis patients [hepatitis B (n = 21) or hepatitis C (n = 41)] as a reference cohort. Biopsies were systematically reviewed for inflammation, fibrosis and the presence of interface hepatitis, plasma cells, rosettes and emperipolesis with a well-defined assessment method. AIH biopsies showed more interface hepatitis (87% versus 63%, P = 0.002), more plasma cell-rich infiltrates (48% versus 27%, P = 0.02), more rosettes (49% versus 23%, P = 0.004) and more emperipolesis (78% versus 50%, P = 0.001) than chronic viral hepatitis biopsies. Emperipolesis (P = 0.01) and rosettes (P < 0.01) were superior to plasma cells and interface hepatitis as independent predictors for AIH. Moderate to severe lymphocytic cholangitis was found in 28% of AIH patients. CONCLUSIONS: Emperipolesis and rosette formation are superior histological predictors of AIH than the classic hallmark features of interface hepatitis and plasma cells. In addition, moderate to severe lymphocytic cholangitis does not preclude the diagnosis of AIH.

The therapeutic spectrum of infliximab and tumor necrosis factor immunomodulation in chronic inflammatory diseases.

This review summarizes the clinical results of Infliximab for the treatment of Crohn's disease, the limited data of its use in other digestive disorders and disorders related to the gastrointestinal tract. The etiology of these disorders remains enigmatic. As long as the precise etiology remains unknown, therapeutic options to treat these patients are predominantly symptomatic (i.e., immunosuppressive drugs or surgical intervention). To be able to develop more rational therapeutic regimens, it is pivotal to understand the immunopathological events that lead to, or are involved in, the pathogenesis of these diseases. Therefore, we also briefly summarize what at the present is known in this respect.