Avances en la inmunopatogenia de la hepatitis autoinmune

Deyanira La Rosa Hernández, Marlem Ivón Castellanos Fernández

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Resumen

Introducción: en la hepatitis autoinmune los mecanismos inmunopatogénicos no están totalmente esclarecidos, múltiples son las investigaciones en este campo, con vistas a enriquecer los conocimientos y ampliar las opciones terapéuticas.

Objetivo: sintetizar los conocimientos más recientes acerca de la inmunopatogenia de esta enfermedad.

Material y Método: se efectúa una búsqueda exhaustiva de la bibliografía disponible en SciELO, ScienceDirect, Google Académico y PubMed, incluyendo artículos de revisión, estudios experimentales, clínicos, de cohorte y metaanálisis.

Desarrollo: se explican los principales mecanismos de tolerancia central y periférica, así como el papel de las subpoblaciones linfoides, las citocinas y el microambiente en la patogenia de la enfermedad.

Conclusiones: los avances en el conocimiento de la inmunopatogenia de la hepatitis autoinmune permiten una mejor comprensión de esta enfermedad y son el referente para el diseño de estrategias futuras de tratamiento.

Palabras clave

hepatitis autoinmune, tolerancia hepática, células presentadoras de antígenos, subpoblaciones linfoides, autoanticuerpos, microbiota intestinal.

Referencias

Czaja AJ. Incorporating mucosal-associated invariant T cells into the pathogenesis of chronic liver disease. World Journal Gastroenterology. 2021;27(25):3705-33.

Assis DN. Immunopathogenesis of Autoimmune Hepatitis. Clinical Liver Disease [Internet]. 2020 [Citado 17/06/2021];15(3):129-32. Disponible en: https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/cld.873

Sucher E, Sucher R. Autoimmune Hepatitis-Immunologically Triggered Liver Pathogenesis-Diagnostic and Therapeutic Strategies. J Immunol Res [Internet]. 2019 [Citado 17/06/2021];2019:9437043. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899271/

Aizawa Y, Hokari A. Autoimmune hepatitis: current challenges and future prospects. Clinical Experimental Gastroenterology [Internet]. 2017;10:9-18.

Fischer HP, Goltz D. Autoimmune liver diseases. Der Pathologe [Internet]. 2020 [Citado 17/06/2021];41(5):444-56. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32749523

Terrabuio D, Porta G, Cancado E. Particularities of Autoimmune Hepatitis in Latin America. Clinical Liver Disease [Internet]. 2020 [Citado 22/06/2021];16(3):101-7. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33005390

Fernández MIC, Hernandez DR, Cabrera Eugenio DE, Palanca W, Guridi ZD, Gonzalez Fabian L. Diagnosis and Treatment of Autoimmune Liver Diseases in a Tertiary Referral Center in Cuba. Current Therapeutic Research Clinical Experimental [Internet]. 2017 [Citado 21/06/2021];85:8-14. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/29158853

Engel B, Taubert R, Jaeckel E, Manns MP. The future of autoimmune liver diseases – Understanding pathogenesis and improving morbidity and mortality. Liver International [Internet]. 2020 [Citado 17/06/2021];40(S1):149-53. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/liv.14378

Kovalic AJ, Bonkovsky HL. The Pathogenesis of Autoimmune Liver Diseases. En: Russo MW. Diagnosis and Management of Autoimmune Hepatitis: A Clinical Guide [Internet]. Switzerland: Springer; 2020 .p.9-50. Disponible en: https://doi.org/10.1007/978-3-030-33628-8_2

Lee BT, Tana MM, Kahn JA, Dara L. We Are Not Immune: Racial and Ethnic Disparities in Autoimmune Liver Diseases. Hepatology [Internet]. 2021 [Citado 21/06/2021];19:[Aprox. 2 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/34056734

Doherty DG. Immunity, tolerance and autoimmunity in the liver: A comprehensive review. Journal Autoimmunity [Internet]. 2016;66:60-75.

Chen C, Ke R, Yang F, Cai Q, Liu J, Huang X, et al. Risk factors for recurrent autoimmune liver diseases after liver transplantation: A meta-analysis. Medicine [Internet]. 2020 [Citado 01/10/2020];99(20):[e20205 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32443344

Lamba M, Ngu JH, Stedman CAM. Trends in Incidence of Autoimmune Liver Diseases and Increasing Incidence of Autoimmune Hepatitis. Clinical Gastroenterology Hepatology [Internet]. 2021 [Citado 21/06/2021];19(3):573-9. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32526342

Bischoff S, Yesmembetov K, Antoni C, Sollors J, Evert M, Ebert M, et al. Autoimmune Hepatitis: a Review of Established and Evolving Treatments. Journal Gastrointestinal Liver Diseases [Internet]. 2020 [Citado 17/06/2021];29(3):429-43. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32919424

Vierling JM, Kerkar N, Czaja AJ, Mack CL, Adams D, Assis DN, et al. Immunosuppressive Treatment Regimens in Autoimmune Hepatitis: Systematic Reviews and Meta-Analyses Supporting American Association for the Study of Liver Diseases Guidelines. Hepatology [Internet]. 2020 [Citado 17/06/2021]; 72(2):753-69. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32500593

Czaja AJ. Review article: opportunities to improve and expand thiopurine therapy for autoimmune hepatitis. Alimentary Pharmacology & Therapeutics [Internet]. 2020 [Citado 17/06/2021];51(12):1286-304. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32363674

Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology [Internet]. 2020 [Citado 17/06/2021];72(2):671-722. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/31863477

Tunio NA, Mansoor E, Sheriff MZ, Cooper GS, Sclair SN, Cohen SM. Epidemiology of Autoimmune Hepatitis (AIH) in the United States Between 2014 and 2019: A Population-based National Study. Journal Clinical Gastroenterology [Internet]. 2020 [Citado 17/06/2021];54:[Aprox. 2 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33074948

Tanaka A. Autoimmune Hepatitis: 2019 Update. Gut Liver [Internet]. 2020 [Citado 17/06/2021];14(4):430-8. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32301319

Kerkar N, Mayo MJ. Autoimmune Hepatitis: Highlights for Liver Transplant Providers From the American Association for the Study of Liver Diseases 2019 Guidelines. Liver Transplantation [Internet]. 2020 [Citado 17/06/2021];26(8):973-6. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32133751

Bozward A, Ce M, Dell'oro L, Oo YH, Ronca V. Breakdown in hepatic tolerance and its relation to autoimmune liver diseases. Minerva Gastroenterology [Internet]. 2021 [Citado 17/06/2021];42:[Aprox. 2 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33793157

Duarte Rey C, Pardo AL, Rodriguez Velosa Y, Mantilla RD, Anaya JM, Rojas Villarraga A. HLA class II association with autoimmune hepatitis in Latin America: a meta-analysis. Autoimmunity Reviews [Internet]. 2009 [Citado 17/06/2021];8(4):325-31. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19041429

Arvaniti P, Giannoulis G, Gabeta S, Zachou K, Koukoulis GK, Dalekos GN. Belimumab is a promising third-line treatment option for refractory autoimmune hepatitis. JHEP Reports: Innovation in Hepatology [Internet]. 2020 [Citado 16/06/2021];2(4):100123. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32671332

Buitrago Molina LE, Pietrek J, Noyan F, Schlue J, Manns MP, Wedemeyer H, et al. Treg-specific IL-2 therapy can reestablish intrahepatic immune regulation in autoimmune hepatitis. Journal Autoimmunity [Internet]. 2021 [Citado 17/06/2021];117:102591. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33387980

Qian Q, He W, Tang R, Ma X. Implications of gut microbiota in autoimmune liver diseases. Minerva Gastroenterology [Internet]. 2021 [Citado 17/06/2021];42:[Aprox. 2 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33793160

Wei Y, Li Y, Yan L, Sun C, Miao Q, Wang Q, et al. Alterations of gut microbiome in autoimmune hepatitis. Rheumatology, Allergy, and Clinical Immunology [Internet]. 2020 [Citado 17/06/2021];69(3):569-77.Disponible en: https://ucdavis.pure.elsevier.com/en/publications/alterations-of-gut-microbiome-in-autoimmune-hepatitis

Li L, Xu P, Zhou Q, Xu J. The Function of T Follicular Helper Cells in the Autoimmune Liver Diseases. Journal Immunology Research [Internet]. 2020 [Citado 17/06/2021];2020:5679254. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33294464

He C, Yang Y, Zheng K, Chen Y, Liu S, Li Y, et al. Mesenchymal stem cell-based treatment in autoimmune liver diseases: underlying roles, advantages and challenges. Therapeutic Advances Chronic Disease [Internet]. 2021 [Citado 17/06/2021];12:2040622321993442. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33633826

Fan X, Men R, Huang C, Shen M, Wang T, Ghnewa Y, et al. Critical roles of conventional dendritic cells in autoimmune hepatitis via autophagy regulation. Cell Death & Disease [Internet]. 2020 [Citado 17/06/2021];11(1):23. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/31932577

Wang H, Feng X, Yan W, Tian D. Regulatory T Cells in Autoimmune Hepatitis: Unveiling Their Roles in Mouse Models and Patients. Frontiers in Immunology [Internet]. 2020 [Citado 17/06/2021];11:575572. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33117375

Liu Z, Gu J, Qin Z, Yang C, Yu S, Dai X, et al. Decreased Foxp3 and function of Tregs caused immune imbalance and liver injury in patients with autoimmune liver diseases post-liver transplantation. Annals of Translational Medicine [Internet]. 2020 [Citado 17/06/2021];8(8):534. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32411757

Horst AK, Kumashie KG, Neumann K, Diehl L, Tiegs G. Antigen presentation, autoantibody production, and therapeutic targets in autoimmune liver disease. Cellular & Molecular Immunology [Internet]. 2021 Jan [Citado 17/06/2021];18(1):92-111. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33110250

Zhou G, Ding ZC, Fu J, Levitsky HI. Presentation of acquired peptide-MHC class II ligands by CD4+ regulatory T cells or helper cells differentially regulates antigen-specific CD4+ T cell response. Journal Immunology [Internet]. 2011 Feb [Citado 17/06/2021];186(4):2148-55. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21242518

French SW. Change in nomenclature for the immunologic synapse from Troxis Necrosis to trogocytosis. Experimental Molecular Pathology [Internet]. 2017 Oct [Citado 17/06/2021];103(2):162. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/28843649

Elsherbiny NM, Rammadan M, Hassan EA, Ali ME, El Rehim ASA, Abbas WA, et al. Autoimmune Hepatitis: Shifts in Gut Microbiota and Metabolic Pathways among Egyptian Patients. Microorganisms [Internet]. 2020 [Citado 16/06/2021];8(7):7409351. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32640728

Granito A, Muratori P, Muratori L. Editorial: gut microbiota profile in patients with autoimmune hepatitis-a clue for adjunctive probiotic therapy?. Alimentary Pharmacology & Therapeutics [Internet]. 2020 [Citado 17/06/2021];52(2):392-4. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32592252

Liu SP, Bian ZH, Zhao ZB, Wang J, Zhang W, Leung PSC, et al. Animal Models of Autoimmune Liver Diseases: a Comprehensive Review. Clinical Reviews Allergy & Immunology [Internet]. 2020 [Citado 17/06/2021];58(2):252-71. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32076943

Huang C, Xing X, Xiang X, Fan X, Men R, Ye T, et al. MicroRNAs in autoimmune liver diseases: from diagnosis to potential therapeutic targets. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie [Internet]. 2020 [Citado 17/06/2021];130:110558. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32781357

Hoffmanova I, Sanchez D, Tuckova L, Tlaskalova Hogenova H. Celiac Disease and Liver Disorders: From Putative Pathogenesis to Clinical Implications. Nutrients [Internet]. 2018 Jul [Citado 17/06/2021];10(7):6073476. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/30002342

Arizaga G, Castiella A, Zubiaurre L, Zapata E. Hepatitis autoinmune y enfermedad celiaca. Aparición simultánea de las 2 enfermedades. Gastroenterología y Hepatología [Internet]. 2019 [Citado 17/06/2021];42(6):391-2. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=7349447

Narciso Schiavon JL, Schiavon LL. To screen or not to screen? Celiac antibodies in liver diseases. World Journal Gastroenterology. 2017;23(5):776-91.

Taylor SA, Assis DN, Mack CL. The Contribution of B Cells in Autoimmune Liver Diseases. Seminars Liver Disease [Internet]. 2019;39(4):422-31.

Richardson N, Ng STH, Wraith DC. Antigen-Specific Immunotherapy for Treatment of Autoimmune Liver Diseases. Frontiers in Immunology [Internet]. 2020 [Citado 17/06/2021];11:1586. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32793226

Wei Q, Jiang Y, Xie J, Lv Q, Xie Y, Tu L, et al. Analysis of antinuclear antibody titers and patterns by using HEp-2 and primate liver tissue substrate indirect immunofluorescence assay in patients with systemic autoimmune rheumatic diseases. Journal Clinical Laboratory Analysis [Internet]. 2020 [Citado 17/06/2021];34(12):e23546. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/33047841



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