Value of autoantibody analysis in the differential diagnosis of chronic cholestatic liver disease.

Abstract

BACKGROUND & AIMS:

It is challenging to diagnose patients with chronic cholestatic liver diseases when all the classic criteria are not fulfilled. We evaluated the performance of the recently developed MIT3-based enzyme-linked immunosorbent assay (ELISA), which detects antimitochondrial autoantibodies (AMAs), together with ELISAs for other autoimmune liver disease-related antibodies in patients with chronic cholestatic liver disease.

METHODS:

Sera from 281 patients with chronic cholestatic conditions, including primary biliary cirrhosis (PBC), primary sclerosing cholangitis, AMA-positive autoimmune hepatitis, and "undetermined cholangiopathy" were tested for the following PBC-associated autoantibodies: anti-gp210, anti-sp100, conventional anti-M2, anti-M2 (MIT3) IgG, anti-M2 (MIT3) IgA, as well as anti-centromere, anti-soluble liver antigen, and anti-chromatin.

RESULTS:

Of 57 patients with PBC who were AMA-negative by conventional M2 ELISA, 14 were found to be AMA-positive by the MIT3-IgG assay. Furthermore, on the basis of the data from 3 tests (MIT3-IgG, gp210, and sp100), PBC was confirmed in 20 of 57 (35%) patients diagnosed with AMA-negative PBC. We confirmed that sp100 and gp210 antibodies were detected only in patients with PBC and AMA-positive autoimmune hepatitis, whereas gp210 was detected more frequently in patients known to have had a poor outcome. Of the 11 patients with an undetermined cholangiopathy, 3 (27%) tested positive for PBC with the MIT3-IgG assay. In contrast to previous findings, anti-centromere antibodies were not found to be associated with poor outcome in PBC.

CONCLUSIONS:

ELISAs for AMAs and antinuclear antibodies are useful in diagnosis and prognosis of patients with features of PBC who lack conventional AMA and in patients with a cholangiopathy of undetermined etiology.

• Authors: Piotr Milkiewicz, Hayman Buwaneswaran, Catalina Coltescu, Zakera Shums, Gary L Norman, E Jenny Heathcote
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 7 Issue 12 Pg. 1355-60 (Dec 2009) ISSN: 1542-7714 [Electronic] United States
• PMID: 19631286 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Antinuclear
• Autoantibodies
• Mitochondrial Proteins

Topics

• Aged
• Antibodies, Antinuclear (blood)
• Autoantibodies (blood)
• Autoimmune Diseases (diagnosis)
• Cholestasis (complications)
• Diagnosis, Differential
• Enzyme-Linked Immunosorbent Assay (methods)
• Female
• Humans
• Liver Diseases (diagnosis)
• Male
• Middle Aged
• Mitochondrial Proteins (immunology)