Concurrent autoimmune hepatitis and grave's disease in hepatitis C during pegylated interferon α-2a and ribavirin therapy

Immunological crossroads: The intriguing dance between hepatitis C and autoimmune hepatitis

Delving into the immunological crossroads of liver diseases, this editorial explores the dynamic interplay between hepatitis C virus (HCV) and autoimmune hepatitis (AIH). While HCV primarily manifests as a viral infection impacting the liver, previous studies unveil a captivating connection between HCV and the emergence of AIH. The dance of the immune system in response to HCV appears to set the stage for an intriguing phenomenon-an aberrant autoimmune response leading to the onset of AIH. Evidence suggests a heightened presence of autoimmune markers in individuals with chronic HCV infection, hinting at a potential overlap between viral and autoimmune liver diseases. Navigating the intricate terrain of viral replication, immune response dynamics, and genetic predisposition, this editorial adds a layer of complexity to our understanding of the relationship between HCV and AIH. In this immunological crossroads, we aim to unearth insights into the complex interplay, using a compelling case where AIH and primary sclerosing cholangitis overlapped following HCV treatment with direct-acting antivirals as background.

ITM2A Expands Evidence for Genetic and Environmental Interaction in Graves Disease Pathogenesis

CONTEXT

Graves disease (GD) is a common autoimmune disease triggered by genetic predisposition and environmental factors. However, the mechanisms of interaction between genetic and environmental factors contributing to the development of GD remain unknown.

OBJECTIVE

We aimed to identify GD susceptibility variants and genes on Xq21.1 locus and interpret the contribution of interaction between genetic predisposition on Xq21.1 and environmental factors to GD.

DESIGN

We performed refining study on Xq21.1 in a 2-stage study and carried out expression quantitative trait locus analysis of the best association signal with GD.

SETTING AND PARTICIPANTS

A total of 4316 GD patients and 4374 sex-matched controls were collected from the Chinese Han population by cooperation with multiple hospitals.

RESULTS

We identified that rs3827440 or its linkage single nucleotide polymorphisms (SNPs) were probably the causal variant in the Xq21.1 locus, with the most substantial association with GD in our combined cohorts (P = 2.45 × 10-15). The genotypes of rs3827440 were correlated with the expression of ITM2A in monocytes and peripheral blood mononuclear cells (PBMCs) from healthy volunteers. Notably, the expression of ITM2A in monocytes after lipopolysaccharide (LPS) and interferon-γ (INF-γ) stimulation showed substantial difference among the volunteers that carried different genotypes of rs3827440 (P = 9.40 × 10-7 and P = 1.26 × 10-5 for 24 hours' LPS and INF-γ stimulation, respectively). Moreover, ITM2A expression was significantly decreased in PBMCs from untreated GD patients than that from controls.

CONCLUSION

The results suggest that ITM2A might be a susceptibility gene for GD in the Xq21.1 locus, and environmental factors, such as viral and bacterial infections, probably contribute to GD pathogenesis by interacting with the risk SNP rs3827440 mediating the regulation of ITM2A expression.

Late autoimmune hepatitis after hepatitis C therapy

BACKGROUND

De-novo or reactivated autoimmune hepatitis (AIH) has been reported during or a short time after administration of interferon (IFN) in patients treated for hepatitis C (HCV). Reports on AIH during long-term follow-up after IFN treatment are scarce.

PATIENTS AND METHODS

Patients diagnosed with both HCV and AIH were identified in clinical databases of four gastroenterology departments. The medical records of patients diagnosed with AIH after IFN therapy were retrospectively assessed.

RESULTS

Five patients (four female, one male) with a mean age of 50 years (range: 34-59) were identified. AIH developed at a mean duration of 4.8 years (range: 1-10) after HCV therapy. Three of five patients had a sustained viral response to antiviral therapy, whereas two were nonresponders. All patients were treated with immunosuppressive therapy after being diagnosed with AIH. Biochemical remission was achieved in four patients; however, one patient had an aggressive course and died despite immunosuppressive therapy. We could not identify any risk factors associated with the development of AIH.

CONCLUSION

AIH may develop in patients treated with IFN, not only during or after a short time from therapy but also after a long time from discontinuation of therapy.