Sayak Banerjee, Amity University Kolkata
Autoimmune Hepatitis and Autoimmune sclerosing cholangitis
Autoimmune hepatitis (AIH) is a complex disease that occurs in patients of all ages present in both acute and chronic forms. Having no disease-specific test, it is a diagnosis of exclusion with one-third of patients suffering from advanced liver disease. Autoimmune sclerosing cholangitis (ASC) is the most common type of sclerosing cholangitis in children with strong autoimmune characteristics overlapping with AIH.
The diagnosis of ASC is similar to that of AIH but normally in combination with ursodeoxycholic acid (UDCA). AIH exhibits a higher median inflammatory activity index and ASC shows a higher frequency of cholangitis and associated inflammatory bowel disease (IBD). Nevertheless, the overall clinical presentation, histology, and blood markers in both conditions are alike. There are various open issues regarding the diseases because of their similar presentation and monitoring.
Non-invasive MRI Techniques in the evaluation of disease features:
Non-invasive techniques like Magnetic Resonance Cholangiopancreatography (MRCP) have a unique role in the assessment of treatment response, characterization of disease, and prediction of clinical outcome. MRCP is an MRI technique that depicts the health of the biliary tract and aids in the monitoring of the disease. Since it relies on qualitative evaluation, it might result in variable outcomes for more than one observer. This restricts its effectiveness in the accurate identification of disease features and detects change over time. Due to this, researchers from The Children’s Memorial Health Institute in Poland set forth to assess the utility and diagnostic performance of quantitative MRCP (MRCP+) to distinguish ASC from AIH in children and adolescents.
MRCP+ is a novel image processing tool that gives quantitative metrics derived from 3D MRCP images of the biliary tract acquired in a comparatively short imaging time. These metrics enable the evaluation of various features such as biliary tract volume, duct diameter, and length for the assessment of ductal anatomy. It is also used to visualize the presence of dilations and strictures in the biliary ducts that have been demonstrated to be reproducible and repeatable. It has been observed to have early utility in the monitoring of pediatric autoimmune liver disease. MRCP+ examines the disease progression by characterization of fibrosis and inflammation within the liver parenchyma.
Iron corrected T1 (cT1), a multiparametric MRI measure of fibrosis and inflammation has exhibited utility in the rapid assessment of treatment response in liver disease. cT1 is also observed to identify biochemically normal children and adolescents with active sub-clinical disease. It also determines the presence of radiologic portal hypertension in chronic progressive pediatric autoimmune liver diseases. From their findings, it was evident that cT1 did not show much difference between those with AIH and those with AIH. Therefore, its utility is more in the characterization and examination of parenchymal disease than in the differentiation of closely related autoimmune liver diseases.
Significance of the non-invasive technique- MRCP:
The biliary tract of patients with ASC is distinguished from those with AIH by its beaded look in MRCP, arising from the existence of biliary dilations and strictures. Dilations are known to increase in time in sclerosing cholangitis, and thus, this highlights the divergence between the two autoimmune liver diseases. So, it can be concluded that quantitative characterization of the biliary tract is essential in understanding the disparity between ASC and AIH.
The scientists said that there is no medical treatment for altering the progression of ASC. Hence, the information regarding the general worsening course followed by sclerosing cholangitis could be used by physicians to improve patient monitoring. Strengthening the utility of MRCP+ could provide clinically helpful information concerning the positive aid of patient management.
Also read: Nutritional treatment in liver transplantation!
Reference:
- Janowski, Kamil, et al. “Quantitative Multiparametric MRI as a Non-Invasive Stratification Tool in Children and Adolescents with Autoimmune Liver Disease.” Scientific Reports, vol. 11, no. 1, Dec. 2021, p. 15261. doi:10.1038/s41598-021-94754-9. https://doi.org/10.1038/s41598-021-94754-9
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Author info:
Sayak Banerjee is a 3rd year Biotechnology Engineering Student with great interest in Immunology and Molecular genetics. He is a creative scientific writer in BioXone with an inclination towards gaining knowledge regarding vast sections of Biotechnology and emphasizing himself in various wet lab skills.
Publications:
- https://bioxone.in/news/worldnews/car-t-cells-scientists-discover-on-off-switches-for-cell-immunotherapy/
- https://bioxone.in/news/worldnews/neutrophil-derived-nanovesicles-a-novel-drug-delivery-system/
- https://bioxone.in/news/worldnews/pig-to-human-heart-transplantation-a-solution-to-the-rarity-of-donor-organs/
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