Juvenile autoimmune hepatitis: Spectrum of the disease

Abstract

Juvenile autoimmune hepatitis (JAIH) is a progressive inflammatory liver disease, affecting mainly young girls, from infancy to late adolescence, characterized by active liver damage, as shown by high serum activity of aminotransferases, by elevated immunoglobulin G levels, high titers of serum non organ-specific and organ-specific autoantibodies, and by interface hepatitis on liver biopsy. It is a multifactorial disease of unknown etiology in which environmental factors act as a trigger in genetically predisposed individuals. Two types of JAIH are identified according to the autoantibody panel detected at diagnosis: AIH-1, characterized by the presence of anti-smooth muscle antibody and/or antinuclear antibody and AIH-2, by anti-liver-kidney microsomal antibody type 1 and/or by the presence of anti-liver cytosol type 1 antibody. Epidemiological distribution, genetic markers, clinical presentation and pattern of serum cytokines differentiate the two types of AIH suggesting possible pathogenetic mechanisms. The most effective therapy for AIH is pharmacological suppression of the immune response. Treatment should be started as soon as the diagnosis is made to avoid severe liver damage and progression of fibrosis. The aim of this review is to outline the most significant and peculiar features of JAIH, based largely on our own personal database and on a review of current literature.

Keywords: Juvenile autoimmune hepatitis; Autoimmune hepatitis; Autoantibodies; Autoimmune liver disease; Chronic hepatitis; Acute liver failure

Core tip: Juvenile autoimmune hepatitis is an inflammatory liver disease affecting mainly young girls from infancy to late adolescence, characterized by active liver damage, elevated immunoglobulin G levels, high titers of serum non organ-specific and organ-specific autoantibodies, and interface hepatitis on liver biopsy. Two types are identified according to the autoantibody panel, with differences in the epidemiological distribution, genetic markers and clinical presentation. The most effective therapy for autoimmune hepatitis is pharmacological suppression of the immune response. Treatment should be started as soon as the diagnosis is made to avoid severe liver damage and progression of fibrosis.