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So, an autoimmune disease is this special sort of disease, where your own immune cells have gone rogue and start to attack your own cells, right? Hepatitis happens to mean inflammation of the liver, so it’s reasonable to say that autoimmune hepatitis is this resulting inflammation of your liver tissue, because they’re being attacked by your own immune cells. Like many autoimmune diseases, the root cause of autoimmune hepatitis is, ultimately, not super clear, but some researchers think it’s a combination of environmental triggers and genetic predisposition. It tends to occur most often in young women, and the female to male ratio is about 4:1. Also though, an important piece of the genetic puzzle is the Human Leucocyte Antigen system, shortened to HLA, which is this location of genes on chromosome 6 that regulate our immune functions. Specifically, these genes control the proteins that are encoded and used on the cell’s surface to present foreign molecules to the immune system. But, although they present antigens, they’re also a form of antigen themselves. They aren’t, though, the same type of antigen as one on an infectious molecule, but actually alloantigens that vary from person to person, and are, actually, specific “self-proteins”. Usually, our thymus makes sure that the T-cells that attack these self proteins aren’t allowed to survive. In autoimmune disease, there may be some abnormality associated with specific self-proteins that lets the T-cells attack them. Based on studying people with autoimmune hepatitis, they often have HLA-DR3 and -DR4, which are both MHC class II surface receptors, The DR part refers to its location on the chromosome. For example, depending on the location, you could have HLA-A, HLA-B, HLA-C or HLA D, and HLA-D has three subregions: P, Q and R. So, this one is HLA-DR. So, specifically with autoimmune hepatitis, there seems to be some sort of connection between these particular “self-proteins”, the HLA-DR, and mounting an attack against your own liver. Autoimmune hepatitis also tends to be associated with other diseases, like Hashimoto’s thyroiditis, where your immune cells attack your thyroid, and Grave’s disease, where your thyroid overproduces thyroid hormones. Clinically, autoimmune hepatitis patients can sit anywhere on a spectrum from completely asymptomatic, to cirrhosis and fulminant hepatitis, also known as acute liver failure, or they might be somewhere in-between with debilitating symptoms like fever, jaundice, and hepatosplenomegaly, a condition where both the spleen and the liver are way larger than their normal size, probably caused by inflammation due to immune cell attack. Also, for symptomatic patients, there’ll be this increase in blood transaminases. Usually, there’s only a small amount of transaminases in the blood, which are these enzymes that help metabolise amino acids. Alanine aminotransferase, or ALT, is mostly found only in the liver, and aspartate aminotransferase, or AST, is found in both the liver as well as other tissues. So, if the liver cells are damaged by immune cells, both ALT and AST start leaking out into the blood from the liver, but typically since ALT is more associated with the liver, ALT will be higher than AST, even though they both will likely be elevated. Autoimmune hepatitis can be split into two types: Type 1 is the most common, accounting for about 80% of autoimmune hepatitis cases, and is characterised by several lab findings. First, we’ll look for antibodies to your own nuclei that are floating around in your blood. We also call these antinuclear antibodies, or ANAs, and these antibodies have failed to be able to tell the difference between self and non-self, and so they end up being against the proteins in the nuclei of your own cells. Also, along the same lines, we might find antibodies that are targeting your own smooth muscle proteins as well. Decreased serum albumin is also a marker for autoimmune hepatitis and damage to the liver. Usually, serum albumin is produced in the liver, but if the liver becomes damaged, serum albumin production may decrease. Finally, an elevated or prolonged prothrombin time, which is the time it takes your blood to clot, is a typical lab finding in more severe cases. Type 2 autoimmune hepatitis is way less common, and is defined by the presence of antibodies to the microsomes of the liver or your kidney, ALKM-1, or to a liver cytosol antigen, ALC-1. This type is most common in young girls, and usually happens alongside another autoimmune disease. As to treatment, initially, patients can be given immunosuppressant medications. They may be given corticosteroids, which help inhibit the immune responses that are mediated by both B- and T-cells. Another drug, azathioprine, has a similar immunosuppressing action and inhibits an enzyme that we need to synthesise DNA, and so it strongly inhibits cells, like T-cells and B-cells, that proliferate a lot during an immune response. If patients are resistant to these drug therapies, they might have to undergo a liver transplant.

55 thoughts on “Autoimmune hepatitis – causes, symptoms, diagnosis, treatment & pathology

  1. I'm glad to have found this video, a relative of mine has auto immune hepatitis & now I understand much more to this than I did. thank you!

  2. my sis is suffering in auto immune hepatitis and primary billiary cirrhosis so plzzzz tell me that she will be ok or not plzzzzzzzzzzzz text me on my gmail account. plzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz its request and help me plzzzzz i will always thanks full to u. i beg u plzzzzzzzzzzzz

  3. very informative. being told by specialist you might have autoimmune hepatitis is very saddening for me. learning more about it helps me manage it better. has there been any info if previous blood transfusion can also pre dispose a person to developing this?

  4. Could you explaine please, how MHC2 molecules appears on surface of hepatocytes? I thougt, that this molecules exist only on antigen-presenting cells, don't they?

  5. So I have extremely high liver enzymes. About 14x higher than they should be. BUT, they've been dropping now for a while. Doctors think it's this, or Primary Sclerosing Cholangitis. Even with the liver biopsy, it's still not clear.

  6. I myself have autoimmune hepatitis and I'm very worried about getting chicken pox as it can kill us so much easier!! I'm so scared of everything I know I'm being a baby but it's scary and I don't want to die 😥😭

  7. im a 16 year old boy and i was diagnosed with Autoimmune Hepatitis this year thank you for helping me understand my condition more

  8. I have non viral my suboxone clinic tests for Hep and THievery six months and I always come out NEG as I did last week but my liver was 72 AST. ALT 172 yes I.said 172. I'm a 33 year old non drinker or drug user, educated, and the only thing that ever came up in my blood that was abnormal was mono about 6 years ago. I am monotonous and eat healthy. I.called my psychologist he quickly said not to continue meds. I seedy PCP on th w 20th. How serious does these numbers sound should I cancelled my flight to visit my husband in Orlando on the 22 are they going to hospitalized me or give me a death sentence. I need some support I was also diagnosed with EDS (gullibility)

  9. Your videos are a huge blessing to me. Can't study without going through them first…. I'm a big fan of pathogenesis/pathophysiology of any disease condition and you do justice to that.

    Thanks alot. I hope all your heart desires are met with same level of kindness you've shown to us by providing us with such amazing videos for free.

  10. My sister was diagnosed with this and I never really understood what was going on till now. Really appreciate the effort put into this and how well you've explained all of this. Sincere gratitude all the way.

  11. i just cant get it🤔😕..how azathioprine used to treat hepatitis & in same time it's one of z drugs causing hepatitis!!!!!!!!!!!+!!

  12. azathioprine..is one of z most poweful drugs inducing lupus & hepatitis🤔in same time used to treat them😲it doesnt make any sense!!

  13. Hey everyone, I'm a medicine manufacturer and I've the best cure for hepatitis B & C. Let us fight hepatitis together and live happily with our family again <3

  14. I have AIH And turned into cirrhosis of the liver. I take Azathioprine only at this point. I was hoping to finally find the cause of it. Unfortunately nope The title was definitely misleading.🤔😔

  15. Thanks! I can't understand why I am also positive for SLE? Is it related? Are AIH and SLE related? I hope you can enlighten me. Thank you.

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