Autoantibodies and serum immunoglobulins in chronic liver diseases

A re-examination of patients with previously detected autoantibodies to smooth muscle

A group of patients which previously had been found to possess smooth muscle antibody (SMA) activity was re-examined for persistence of the autoantibody. The mean observation time was four years (range 0.5-9 years). Thirty out of 140 patients, who initially had SMA associated with rheumatic or other symptoms, had autoantibody activity at re-examination. Most were low in titer, and none of the 30 had developed chronic liver disease. Twenty-four patients with SMA at the first testing were analyzed because of liver pathology. Five had CAH at that time. SMA in low titer associated with liver pathology was a transient phenomenon. SMA in high titer combined with liver pathology seems to be a persistent condition with respect to both parameters, although no additional patients developed CAH between the first testing and re-examination.

Autoantibodies and immunoglobulins in alcoholic steatosis and cirrhosis

Antinuclear antibodies were significantly more prevalent (p less than 0.01) in 143 patients with alcoholic cirrhosis than in 64 patients with alcoholic steatosis and in 94 controls. Smooth muscle antibodies were significantly more prevalent (p less than 0.05) in patients with alcoholic steatosis and cirrhosis than in controls. The prevalence of antimitochondrial antibodies and IgG liver membrane antibodies did not differ significantly between the three groups. Immunoglobulin G, A, and M concentrations were only occasionally increased in patients with steatosis. Patients with cirrhosis had significantly increased (p less than 0.005) concentrations of immunoglobulins G, A, and M when compared to patients with steatosis. These results indicate that the degree of liver damage has more effect than chronic alcoholism on the humoral immune system. Whether this influence is direct or indirect remains to be established.

Laboratory tests as indicators of alcohol consumption in patients with chronic low back pain

The use of laboratory screening tests for the detection of heavy drinking in outpatients implies among other things knowledge about their relation to the degree of alcohol consumption. In this study of 95 patients with chronic low back pain, serum gamma-glutamyltransferase demonstrated the best correlation with the mean daily amount of alcohol consumed (r = 0.74). Adding other serological tests, such as high density lipoprotein cholesterol, aminotransferases and linoleic acid content in lecithin, did not improve this correlation, although these tests also correlated well with the alcohol intake.

Antibody to G-actin in different categories of alcoholic liver disease: quantification by an ELISA and significance for alcoholic cirrhosis

Autoantibodies to smooth muscle (ASMA), and to actin which is a major determinant of such reactivity, were measured in the serum of 94 patients with three defined categories of alcoholic liver disease, fatty liver, alcoholic hepatitis, and alcoholic cirrhosis, and in controls matched individually by age and sex with the patients. Autoantibody to monomeric G-actin was detected by an ELISA and autoantibody to polymeric F-actin by immunofluorescence staining of fibroblast stress fibers in cultured cells. Values for the ELISA were expressed as a percentage of the value for a strongly reactive standard serum. The mean value for antibody to G-actin in 40 patients with alcoholic cirrhosis (70 +/- 33%) was significantly greater than that for the matched controls (28 +/- 18%), but the mean value for the 30 patients with alcoholic hepatitis (46 +/- 16%) and the 24 with fatty liver (42 +/- 24%) did not differ significantly from the controls. High levels of reactivity with G-actin correlated significantly with HLA B7. ASMA was demonstrable to low titer in 11 of the 94 sera, and positive ASMA reactions by immunofluorescence correlated with high binding values to G-actin in the ELISA. Antibody to F-actin was found in only one serum and no controls. Thus in different liver diseases the reactivity of antibodies to monomeric G-actin and polymeric F-actin may differ, presumably because of specificity for different determinants of the actin molecule. Reactivity to G-actin may distinguish a group of alcoholic subjects in whom a predisposition to autoimmune reactivity is one of the determinants of progression of liver damage to cirrhosis.

Value of serum immunoglobulins in the diagnosis of liver disease

Serum immunoglobulins were determined in 145 consecutive patients with biopsy-proven steatosis, alcoholic hepatitis, alcoholic hepatitis with fibrosis, alcoholic hepatitis with cirrhosis, inactive cirrhosis, chronic active alcoholic hepatitis, chronic active hepatitis, primary biliary cirrhosis and nonspecific hepatitis. IgM was both a sensitive (90.5%) and specific (86.2%) marker for primary biliary cirrhosis, and mean IgM levels were higher in primary biliary cirrhosis than in other diagnostic categories (p less than 0.05). IgA levels were most commonly elevated in alcoholic liver disease (p less than 0.005). IgA detected 95% of alcoholic disease, but was poorly specific (41.1%). A trend of rising IgA with increasing severity of alcoholic injury was observed, but the differences were not significant. IgG was most commonly elevated in chronic active hepatitis and alcoholic hepatitis with cirrhosis, but the IgG values did not differ significantly from those found in other diagnostic categories. Our results substantiate assertions of a diagnostic sensitivity for elevated IgA in alcoholic liver disease and IgM in primary biliary cirrhosis. With the exception of IgM in primary biliary cirrhosis, however, serum immunoglobulins are not specific markers of liver histology.

Azathioprine versus prednisone in non-alcoholic chronic liver disease (CLD). Relation to a serological classification

One hundred and forty-eight patients with non-alcoholic cirrhosis or chronic aggressive hepatitis entered a prospective, unblinded, randomized trial on the effect of azathioprine versus prednisone. For all 148 patients, there were no differences in survival related to the two drugs. In 99 patients the disease was classified as autoimmune, in 23 as posthepatitic, and in 26 as cryptogenic. No significant differences were seen in survival between these three groups of patients and no differences in survival related to the two drugs were registered within any of the groups. The autoimmune group included the patients with the biochemically most active disease, and a statistically significant reduction in activity was obtained with prednisone as well as azathioprine. Most remarkably, the frequencies of the autoantibodies were reduced parallel to the biochemical improvement in these patients. Immunosuppressive treatment was found to be rather ineffective in posthepatic chronic liver disease of type B; however, no signs of activation of the hepatitis B virus were seen.

Different types of smooth muscle antibodies in chronic active hepatitis and primary biliary cirrhosis: their diagnostic and prognostic significance

The diagnostic and prognostic significance of the different types of serum smooth muscle antibodies (SMA) were investigated in sera of 24 patients with chronic active hepatitis (CAH) and 15 patients with primary biliary cirrhosis (PBC). SMA of IgG class were found in 92% of sera from patients with CAH but in only 20% of sera from PBC patients, whereas the incidence of IgM-SMA was higher in PBC (67%) than in CAH (38%). All six patients with the atypical cholestatic form of CAH has SMA of IgM class, whereas other CAH patients had SMA of mainly IgG class. SMA reacting with rabbit liver (bile canaliculus antibodies, BCA) and with rat glomeruli (glomerulus antibodies) were of anti-actin specificity and were more common in CAH than in PBC. Organ specific BCA or glomerulus antibodies were not found. Anti-actin antibodies were detected in the majority of the investigated sera by an immunoenzymatic anti-actin assay. The results suggest that the determination of SMA titres with heavy chain specific antisera may help in the assessment of diagnosis and prognosis of chronic hepatitis.

Smooth-muscle antibodies in rheumatoid arthritis

Smooth-muscle antibodies (SMA) detected by the indirect immunofluorescence method were found more often in rheumatoid arthritis (RA) patients (15.3%) than in normal controls (7.6%) (0.02 > p > 0.01). The increased frequency was due to IgG-antibodies which occurred in 12.2% of RA patients, in 4.1% of normal controls and in 7.3% of patients with other arthritic diseases. Eight of 9 IgG-SMA-positive RA sera reacted with F-actin, and one serum contained non-actin antibodies. In RA, ANA were found in 35.7%, glomerular antibodies in 1.0%, parietal cell antibodies in 4.1% and mitochondrial antibodies in 2.0%. SMA were associated with the occurrence of rheumatoid factors and mitochondrial antibodies (0.02% > p and 2p = 0.04, respectively). In the SMA-positive group the erythrocyte sedimentation rate was higher and elevated serum alkaline phosphatase values were found more often than in the SMA-negative group.