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Hepatology
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Hepatology
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Hepatology
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Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis

Authors: Taubert, Richard; Engel, Bastian; Diestelhorst, Jana; Hupa-Breier, Katharina; Behrendt, Patrick; Baerlecken, Niklas; Sühs, Kurt‐wolfram; +31 Authors

Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis

Abstract

Abstract Background and Aims Detection of autoantibodies is a mainstay of diagnosing autoimmune hepatitis (AIH). However, conventional autoantibodies for the workup of AIH lack either sensitivity or specificity, leading to substantial diagnostic uncertainty. We aimed to identify more accurate serological markers of AIH with a protein macroarray. Approach and Results During the search for more‐precise autoantibodies to distinguish AIH from non‐AIH liver diseases (non‐AIH‐LD), IgG antibodies with binding capacities to many human and foreign proteins were identified with a protein macroarray and confirmed with solid‐phase ELISAs in AIH patients. Subsequently, polyreactive IgG (pIgG) was exemplarily quantified by reactivity against human huntingtin‐interacting protein 1‐related protein in bovine serum albumin blocked ELISA (HIP1R/BSA). The diagnostic fidelity of HIP1R/BSA binding pIgG to diagnose AIH was assessed in a retrospective training, a retrospective multicenter validation, and a prospective validation cohort in cryoconserved samples from 1,568 adults from 10 centers from eight countries. Reactivity against HIP1R/BSA had a 25% and 14% higher specificity to diagnose AIH than conventional antinuclear and antismooth muscle antibodies, a significantly higher sensitivity than liver kidney microsomal antibodies and antisoluble liver antigen/liver pancreas antigen, and a 12%–20% higher accuracy than conventional autoantibodies. Importantly, HIP1R/BSA reactivity was present in up to 88% of patients with seronegative AIH and in up to 71% of AIH patients with normal IgG levels. Under therapy, pIgG returns to background levels of non‐AIH‐LD. Conclusions pIgG could be used as a promising marker to improve the diagnostic workup of liver diseases with a higher specificity for AIH compared to conventional autoantibodies and a utility in autoantibody‐negative AIH. Likewise, pIgG could be a major source of assay interference in untreated AIH.

Countries
Netherlands, Germany, Italy, France, Poland, Netherlands, United Kingdom
Keywords

Adult, Male, Adolescent, MESH: Biomarkers / blood, MESH: Diagnosis, [SDV]Life Sciences [q-bio], 610, MESH: Hepatitis, Diagnosis, Differential, Autoimmune / diagnosis, Young Adult, 80 and over, Humans, liver, autoimmunity, IgG, MESH: Autoantibodies / blood, Aged, Autoantibodies, Retrospective Studies, MESH: Adolescent, MESH: Aged, Aged, 80 and over, ddc:610, MESH: Humans, MESH: Middle Aged, MESH: Immunoglobulin G / blood, Autoimmune / immunology, MESH: Adult, MESH: Retrospective Studies, Middle Aged, Radboudumc 11: Renal disorders RIMLS: Radboud Institute for Molecular Life Sciences, MESH: Male, [SDV] Life Sciences [q-bio], Hepatitis, Autoimmune, MESH: Young Adult, Immunoglobulin G, Differential, Female, Gastroenterology - Radboud University Medical Center, MESH: Female, Autoimmune / blood, Biomarkers

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    influence
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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
37
Top 10%
Top 10%
Top 10%
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hybrid