Standardization of Autoantibody Testing in Autoimmune Hepatitis

  • Paolo MuratoriEmail author
  • Marco Lenzi
  • Luigi Muratori


It is a comment on a recent review published on the Journal.


Anti-smooth muscle antibodies Autoimmune hepatitis Anti-actin Autoantibodies 


We read with great interest the review by Tozzoli et al. [1] on the standardization of autoantibody testing. Particularly, we appreciated the paragraph on the harmonization in the diagnosis of autoimmune hepatitis. We agree with Tozzoli et al. about the lack of a standardized immunochemical method able to detect the anti-actin antibody in a convincing manner, and the speculative explanation of these discrepancy could be reside on the immunogenic conformational epitope that when linearized for immunochemical test misses its immunogenic properties. On the other hand, it is right to underline how the immunomorphological technique remains the reference method for anti-actin reactivity. The detection of a peculiar pattern such as smooth muscle antibodies (SMA) with peritubular positivity (IgG class) on rodent kidney tissue (the so called SMA T pattern) has been demonstrated to be strongly associated with anti-actin reactivity and with an autoimmune hepatitis diagnosis [2].

Differently the SMA-T IgA pattern is associated to celiac disease with anti-actin positivity [3].

Unfortunately, only few and selected laboratories differentiate the SMA pattern in V (vessel), G (glomeruli), and T peritubular on the basis of its first description [4], and this could complicate the reaching for an autoimmune hepatitis diagnosis, since the SMA diction alone is too simplistic and inclusive of many cases of a specific and clinical irrilevant seropositivity.

Bologna, September 2018


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Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Studies

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study formal consent is not required.


  1. 1.
    Tozzoli R, Villalta D, Bizzaro N (2017) Challenges in the standardization of autoantibody testing: a comprehensive review. Clin Rev Allergy Immunol 53:68–77CrossRefGoogle Scholar
  2. 2.
    Muratori P, Muratori L, Agostinelli D, Pappas G, Veronesi L, Granito A, Cassani F, Terlizzi P, Lenzi M, Bianchi FB (2002) Smooth muscle antibodies and type 1 autoimmune hepatitis. Autoimmunity 35:497–500CrossRefGoogle Scholar
  3. 3.
    Granito A, Muratori P, Cassani F, Pappas G, Muratori L, Agostinelli D et al (2004) Anti-actin IgA antibodies in severe coeliac disease. Clin Exp Immunol 137:386–392CrossRefGoogle Scholar
  4. 4.
    Bottazzo GF, Florin-Christensen A, Fairfax A, Swana G, Doniach D, Groeschel-Stewart U (1976) Classification of smooth muscle autoantibodies detected by immunofluorescence. J Clin Pathol 29:403–410CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Universita degli Studi di Bologna Scuola di Medicina e ChirurgiaBolognaItaly

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