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23 October 2017

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Int J Med Sci 2009; 6(4):177-183. doi:10.7150/ijms.6.177

Research Paper

IMMUNE RESPONSES IN AUTOIMMUNE HEPATITIS: EFFECT OF PREDNISONE AND AZATHIOPRINE TREATMENT: CASE REPORT

Martin H. Bluth1, Stephan Kohlhoff2,4, Kevin B. Norowitz2, Jonathan I Silverberg3,4, Seto Chice3, M Nowakowski3,4, Helen G. Durkin3,4, Tamar A. Smith-Norowitz 2,4 ✉

1. Deptartment of Pathology, Wayne State University School of Medicine, Detroit, MI 48201, USA;
2. Departments of Pediatrics, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA;
3. Departments of Pathology, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA;
4. Center for Allergy and Asthma Research, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.

Abstract

The role of the immune response in autoimmune hepatitis has not been studied before and after prednisone and azathioprine treatment. Distributions of blood lymphocytes (CD4+, CD8+, CD19+, CD23+, CD16/56+), levels of serum immunoglobulins (IgM, IgG, IgE, IgA) and cytokines (IFN-γ, IL-4, IL-12, TNFα ) were studied in a child (f/14 y/o) with autoimmune hepatitis before and after prednisone (20 mg/d) and azathioprine (50 mg/d) treatment (nephelometry, UniCAP Total IgE Fluoroenzymeimmunoassay, flow cytometry, cytokine ELISA). Patient was studied for 0-2.5 yrs; treatment was initiated 12 weeks post diagnosis. Numbers of CD4+ T cells increased (50%), while CD19+ and CD23+ cells decreased (>50%) post treatment; other lymphocyte subsets were unaffected by treatment. Serum IgG and IgE levels decreased (>50%) after treatment; serum IgM and IgA were within normal range and were not affected by treatment High levels of IFN-γ (5-23 pg/ml) were initially detected in serum, which decreased after treatment (<0.1 pg/ml). Furthermore, low levels of IL-4 (0.2 pg/mL) were detected before treatment, which were not detected after treatment (<0.1 pg/ml). In contrast, before treatment, IL-12 and TNFα were not detected in serum; however after treatment the levels of IL-12 and TNFα dramatically increased. Prednisone and azathioprine treatment decreased total serum IgG, IgE, IFN-γ and IL-4 levels, and blood CD19+ and CD23+ cells; however serum IL-12, TNFα and blood CD4+ T cells increased with treatment. Understanding immunomodulation in autoimmune hepatitis will provide better insight and mechanisms of this disease and may tailor more effective therapeutic intervention.

Keywords: autoimmune hepatitis, Immunoglobulin E (IgE), azathioprine treatment

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How to cite this article:
Bluth MH, Kohlhoff S, Norowitz KB, Silverberg JI, Chice S, Nowakowski M, Durkin HG, Smith-Norowitz TA. IMMUNE RESPONSES IN AUTOIMMUNE HEPATITIS: EFFECT OF PREDNISONE AND AZATHIOPRINE TREATMENT: CASE REPORT. Int J Med Sci 2009; 6(4):177-183. doi:10.7150/ijms.6.177. Available from http://www.medsci.org/v06p0177.htm