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Matsumoto K, Kikuchi K, Namura Y, Watanabe A, Tsunashima H, Doi S. Histological improvement in chronic hepatitis C-autoimmune hepatitis overlap syndrome by glecaprevir and pibrentasvir. Clin J Gastroenterol 2023:10.1007/s12328-023-01809-7. [PMID: 37118643 DOI: 10.1007/s12328-023-01809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
A 60-year-old man with type-2 diabetes and chronic hepatitis C (HCV) was diagnosed with single hepatocellular carcinoma (HCC) of 67 mm in the hepatic posterior right lobe. Lenvatinib 8 mg was initiated but discontinued because of grade 3 liver injury. The patient continued to have prolonged liver injury and persistently high immunoglobulin G levels. Antinuclear antibody titer increased from 1:40 to 1:320. Histopathological examination of a liver biopsy specimen revealed interface hepatitis with lymphocyte and plasma cell infiltration, rosette formation, and emperipolesis, suggesting the possibility of autoimmune hepatitis (AIH). First, treatment with prednisolone was initiated; however, the response was poor. After starting glecaprevir/pibrentasvir (GLE/PIB) as direct-acting antivirals (DAA), HCV RNA rapidly disappeared, and serological liver function improved. After confirmation of sustained virological response 24, HCC recurrence was observed, and partial hepatectomy was performed. Background liver findings showed that liver parenchymal inflammation improved compared with that before DAA treatment. This is the first case of HCV-AIH overlap syndrome treated with DAA using GLE/PIB. Liver function improved within a short treatment period of 8 weeks, as confirmed using serology and histology.
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Affiliation(s)
- Kotaro Matsumoto
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, 213-8507, Japan.
| | - Kentaro Kikuchi
- Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Yuta Namura
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, 213-8507, Japan
| | - Ayako Watanabe
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, 213-8507, Japan
| | - Hiromichi Tsunashima
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, 213-8507, Japan
| | - Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-Ku, Kawasaki, 213-8507, Japan
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2
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Razin M, Abdel-Ghaffar ARB, Hamdy GM, Abd-Elshafy DN, Kamel S, Bahgat MM, Maghraby AS. TLR3\TLR7 as Differentially Expressed Markers Among Viral, Nonviral, and Autoimmune Diseases in Egyptian Patients. Viral Immunol 2021; 34:607-621. [PMID: 34342515 DOI: 10.1089/vim.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Toll-like receptors (TLRs) represent the immune link between the innate and the adaptive immune signals against various pathogens. This study aimed to evaluate the TLRs3 and 7 as immune-markers in differentiating between hepatitis C virus (HCV)-infected and -uninfected patients. Also, the use of the TLR3 and TLR7 as immune markers was compared with the prevalent bio and immune markers for autoimmune diseases in HCV-infected or -uninfected patients. The levels of GPT, GOT, B cell activated factors, tumor necrosis factor-alpha (TNF-α), and interleukin (IL)-10 were measured in plasma, while the levels of TLR3 and TLR7 were quantified in lysates of peripheral blood mononuclear cells from healthy donors, HCV-infected patients, nonalcoholic fatty liver (NAFL) patients without autoimmune diseases and with autoimmune diseases (HCV-infected patients with autoimmune diseases [HCV+auto], nonalcoholic fatty liver patients with autoimmune diseases [NAFL+auto]), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) patients. The relative expression of TLR3, TLR7, TNF, and IL-10 in cell lysates was assessed against glyceraldehyde 3-phosphate dehydrogenase (GAPDH) by quantitative real time-polymerase chain reaction (qRT-PCR). Results showed that TLRs 3 and 7 levels were significantly higher in SLE, RA, HCV, HCV+auto, and the NAFL patients compared to the normal control. The cell lysates from SLE patients expressed TLR3 at relatively significantly higher mRNA levels compared to normal subjects or other patient groups. The NAFL+auto patients expressed TLR7 at relatively significantly high mRNA levels compared to normal subjects or other patients. The RA patients expressed TLR7 at relatively significantly higher mRNA levels when compared to HCV, HCV+auto, and NAFL+auto patients. Conclusions: At the protein level, TLR7 can differentiate between HCV and NAFL patients. In addition, both TLRs3 and 7 can serve as potent markers in differentiating between NAFL and NAFL+auto.
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Affiliation(s)
- Mona Razin
- Division of Pharmaceutical and Drug Industries Research, Department of Therapeutic Chemistry, Cairo, Egypt.,Research Group Immune- and Bio-markers for Infection, the Centre of Excellence for Advanced Sciences, the National Research Centre, Cairo, Egypt
| | | | - Germine M Hamdy
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Dina N Abd-Elshafy
- Research Group Immune- and Bio-markers for Infection, the Centre of Excellence for Advanced Sciences, the National Research Centre, Cairo, Egypt.,Department of Water Pollution Research, the National Research Centre, Cairo, Egypt
| | - Solaf Kamel
- Department of Clinical and Chemical Pathology, the National Research Centre, Cairo, Egypt
| | - Mahmoud Mohamed Bahgat
- Division of Pharmaceutical and Drug Industries Research, Department of Therapeutic Chemistry, Cairo, Egypt.,Research Group Immune- and Bio-markers for Infection, the Centre of Excellence for Advanced Sciences, the National Research Centre, Cairo, Egypt
| | - Amany Sayed Maghraby
- Division of Pharmaceutical and Drug Industries Research, Department of Therapeutic Chemistry, Cairo, Egypt.,Research Group Immune- and Bio-markers for Infection, the Centre of Excellence for Advanced Sciences, the National Research Centre, Cairo, Egypt
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Cacciato V, Casagrande E, Bodini G, Furnari M, Marabotto E, Grillo F, Giannini EG. Eradication of hepatitis C virus infection disclosing a previously hidden, underlying autoimmune hepatitis: Autoimmune hepatitis and HCV. Ann Hepatol 2021; 19:222-225. [PMID: 32029393 DOI: 10.1016/j.aohep.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C virus (HCV) infection and autoimmune disorders show a complex interplay, with HCV often being identified as the trigger of autoimmune phenomena or diseases. While there is evidence of successful HCV treatment with direct-acting antivirals (DAA) in patients with concomitant HCV and autoimmune hepatitis (AIH), there are also sparse reports of AIH developing during, or following, DAA treatment. Here we report a case of a patient with suspected concomitant HCV and AIH who underwent liver biopsy but showed no histological hallmarks of autoimmunity. The patient later developed a hepatitic flare following DAA-induced viral clearance, and a second liver biopsy showed features compatible with AIH. Response to corticosteroid and azathioprine treatment was seen. This reports demonstrates that patients with features of auto-reactivity and HCV after DAA-induced viral clearance require careful follow-up.
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Affiliation(s)
- Valentina Cacciato
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo Casagrande
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
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López Couceiro L, Gómez Domínguez E, Muñoz Gómez R, Castellano Tortajada G, Ibarrola de Andrés C, Fernández Vázquez I. Healing of autoimmune hepatitis associated with hepatitis C virus infection treated with direct-acting antivirals. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:159-161. [PMID: 30449122 DOI: 10.17235/reed.2018.5528/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The use of direct-acting antivirals (DAA) for the hepatitis C virus (HCV) has yielded a significant improvement in the treatment of autoimmune hepatitis (AIH) associated with HCV infection. Interferon was the cornerstone of HCV therapy before the introduction of these agents into the clinical practice. Herein, we report the case of an HCV-infected patient who developed an interferon-induced AIH and since then, has received immunosuppressive therapy. Administration of DAA resulted in a sustained virologic response (SVR) and clinical AIH remission which allowed a discontinuation of immunosuppressive treatment.
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Successful treatment with glecaprevir/pibrentasvir for chronic hepatitis C complicated by primary biliary cholangitis. Clin J Gastroenterol 2020; 13:896-901. [PMID: 32065362 DOI: 10.1007/s12328-020-01103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cases of autoimmune liver diseases complicated with hepatitis C (HCV) infection have occasionally been reported. However, the efficacy and safety of direct acting antivirals for chronic hepatitis C (CHC) complicated with autoimmune liver diseases remain unclear. CASE REPORT A 74-year-old woman was referred to our hospital for an acute exacerbation of liver dysfunction. She had been diagnosed with CHC 10 years previously. Laboratory data showed elevated immunoglobulin G (IgG), and she was positive for antinuclear antibody (ANA), anti-mitochondrial M2 antibody, and HCV-RNA (genotype 2a). Liver biopsy revealed significant infiltration of lymphocytes and plasma cells in the portal triad, moderate interface hepatitis with mild bridging fibrosis, and chronic non-suppurative destructive cholangitis. She was diagnosed with chronic active hepatitis and primary biliary cholangitis (PBC). Combination therapy with glecaprevir/pibrentasvir (GLE/PIB) rapidly improved her serum transaminase and HCV-RNA levels. A sustained viral response was achieved 24 weeks after GLE/PIB. No adverse events were observed, and her IgG and ANA levels were normalized 6 months after GLE/PIB. The second liver biopsy performed 10 months after GLE/PIB demonstrated the remarkable improvement of active hepatitis. However, the findings suggesting PBC were remained and the AMA-M2 titer was decreased but positive at that time. CONCLUSION GLE/PIB is an effective and tolerated choice for the treatment in cases of CHC complicated by PBC.
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Putra J, Schiano TD, Fiel MI. Resolution of HCV-Autoimmune Hepatitis Overlap Syndrome With Antiviral TreatmentA Paired Liver Biopsy Study. Am J Clin Pathol 2019; 152:735-741. [PMID: 31310654 DOI: 10.1093/ajcp/aqz095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate histologic changes occurring in patients having chronic hepatitis C and autoimmune hepatitis overlap (HCV-AIH), and who achieved virologic cure using direct-acting antiviral agents (DAA). METHODS Characteristics of HCV-AIH patients who underwent paired liver biopsies before and after receiving DAA treatment from 2011 to 2018 were evaluated. RESULTS Five HCV-AIH patients (three male; mean age, 60.4 years) underwent paired liver biopsies (average interval, 2.3 years) before and after achieving cure with DAA treatment. All patients showed virologic response, while four showed decreased inflammation, and three cases showed features of fibrosis regression. Immunohistochemical staining demonstrated significant decrease in plasma cell count in three patients (20.6 vs 11.9 plasma cells/high power field; P = .02, t test). CONCLUSIONS Histologic improvements in inflammation and fibrosis are noted in most HCV-AIH patients after DAA treatment, suggesting that the autoimmune component of the HCV-AIH overlap syndrome is merely a secondary phenomenon of viral infection.
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Affiliation(s)
- Juan Putra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Thomas D Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
- Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
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Terziroli Beretta-Piccoli B, Di Bartolomeo C, Deleonardi G, Grondona AG, Silvestri T, Tesei C, Melidona L, Cerny A, Mertens J, Semmo N, Semela D, Moradpour D, Mieli-Vergani G, Vergani D, Muratori L. Autoimmune liver serology before and after successful treatment of chronic hepatitis C by direct acting antiviral agents. J Autoimmun 2019; 102:89-95. [DOI: 10.1016/j.jaut.2019.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 12/26/2022]
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Simoes CC, Saldarriaga OA, Utay NS, Stueck AE, Merwat SK, Merwat SN, Schiano TD, Fiel MI, Stevenson HL. Direct-Acting Antiviral Treatment of Patients with Hepatitis C Resolves Serologic and Histopathologic Features of Autoimmune Hepatitis. Hepatol Commun 2019; 3:1113-1123. [PMID: 31388631 PMCID: PMC6671831 DOI: 10.1002/hep4.1388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/17/2019] [Indexed: 12/15/2022] Open
Abstract
Patients with hepatitis C virus (HCV) often have elevated serum markers and histologic features of autoimmune hepatitis (AIH). We evaluated an HCV-positive (HCV+) study group that had elevated serum markers of AIH before starting direct-acting antiviral (DAA) therapy (n = 21) and compared them to an HCV+ control group that did not have laboratory studies suggesting AIH (n = 21). Several patients in the study (17/21) and control (11/21) groups had liver biopsies before DAA treatment, and many were biopsied due to elevated serum markers of AIH. Evaluation of pre-DAA treatment liver biopsies showed histologic features suggestive of AIH in 64.7% (11/17) of the study group and 45.5% (5/11) of the control group. Patients who were HCV+ with elevated serum markers of AIH had significantly increased hepatitis activity (P < 0.001) and slightly increased fibrosis stages (P = 0.039) in their pretreatment liver biopsies compared to controls. We hypothesized that the elevated serum markers and histologic features of AIH would resolve following DAA treatment. Serum markers of AIH in the study group began decreasing by 6 months posttreatment, and 52.4% (11/21) had complete resolution. Alanine aminotransferase levels significantly decreased into the normal range for all patients (21/21). Even patients that had persistence of serum markers of AIH after DAA treatment had normal transaminases. Six patients from the study patient group and 4 patients from the control group had follow-up liver biopsies after DAA treatment, and all biopsies showed resolution of the histologic features of AIH. Conclusion: The majority of HCV+ patients that have serum markers and/or histopathologic features of AIH should initially be treated with DAA.
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Affiliation(s)
- Camila C Simoes
- Department of Pathology University of Texas Medical Branch Galveston TX
| | | | - Netanya S Utay
- Infectious Disease Division, Department of Internal Medicine University of Texas Health Science Center at Houston Houston TX
| | | | - Sheharyar K Merwat
- Department of Gastroenterology and Hepatology University of Texas Medical Branch Galveston TX
| | - Shehzad N Merwat
- Department of Gastroenterology and Hepatology University of Texas Medical Branch Galveston TX
| | - Thomas D Schiano
- Department of Hepatology Icahn School of Medicine at Mount Sinai New York NY
| | - Maria Isabel Fiel
- Department of Pathology Icahn School of Medicine at Mount Sinai New York NY
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Successful DAA Treatment and Global Improvement in a Cirrhotic Patient with Concomitant HCV Infection and Autoimmune Hepatitis. Dig Dis Sci 2019; 64:591-593. [PMID: 30386944 DOI: 10.1007/s10620-018-5356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 01/20/2023]
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10
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Christen U, Hintermann E. Pathogens and autoimmune hepatitis. Clin Exp Immunol 2018; 195:35-51. [PMID: 30113082 DOI: 10.1111/cei.13203] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
Autoimmune hepatitis (AIH) is a severe form of hepatitis resulting in the autoimmune-mediated destruction of the liver parenchyma. Whereas many of the immunopathogenic events have been elucidated and some of the drivers of the disease have been identified, little is known about the aetiology of the disease. There are certain risk factors, such as particular human leucocyte antigen (HLA) haplotypes, that enhance the susceptibility for AIH or influence the severity of the disease. However, as for many other autoimmune diseases, the mere presence of such risk factors does not warrant the occurrence of the disease. Not all individuals carrying risk factors develop AIH, and not all patients with AIH are carriers of high-risk alleles. Thus, additional environmental factors need to be considered as triggers for AIH. Environmental factors include diet, sunlight exposure, stress, medication and hygiene, as well as pathogen infections and vaccinations. This review discusses if pathogens should be considered as triggers for the initiation and/or propagation of AIH.
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Affiliation(s)
- U Christen
- Pharmazentrum Frankfurt / ZAFES, Goethe University Hospital, Frankfurt am Main, Germany
| | - E Hintermann
- Pharmazentrum Frankfurt / ZAFES, Goethe University Hospital, Frankfurt am Main, Germany
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Covini G, Bredi E, Badalamenti S, Roncalli M, Aghemo A, Colombo M. Autoimmune Hepatitis During Ledipasvir/Sofosbuvir Treatment of Hepatitis C: A Case Report. Hepatol Commun 2018; 2:1179-1183. [PMID: 30288473 PMCID: PMC6167068 DOI: 10.1002/hep4.1248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023] Open
Abstract
We report the case of a woman with chronic hepatitis C and idiopathic thrombocytopenic purpura (ITP) who developed autoimmune hepatitis (AIH) during antiviral therapy with ledipasvir (LDV)/sofosbuvir (SOF). The onset of acute hepatitis rose two weeks after starting treatment with LDV/SOF when HCV‐RNA tested negative, suggesting a link between rapid HCV clearance and de novo autoimmune diseases. Conclusion: This case report proposes new immunologic scenarios in patients with hepatitis C virus (HCV) with laboratory or clinical signs of autoimmunity during direct‐acting antiviral (DAA) therapy.
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Affiliation(s)
| | | | | | - Massimo Roncalli
- Department of Pathology Humanitas Clinical and Research Center Rozzano Italy
| | - Alessio Aghemo
- Liver Unit and Department of Biomedical Sciences Humanitas University Rozzano Italy
| | - Massimo Colombo
- Liver Unit and Department of Biomedical Sciences Humanitas University Rozzano Italy
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