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Reply to: Diagnostic role of anti-dsDNA antibodies: do not forget autoimmune hepatitis

Nature Reviews Rheumatology volume 17, page 245 (2021)Cite this article

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As Granito and colleagues correctly highlight in their correspondence (Granito, A., Muratori, L., Tovoli, F. & Muratori, P. Diagnostic role of anti-dsDNA antibodies: do not forget autoimmune hepatitis. Nat. Rev. Rheumatol. https://doi.org/10.1038/s41584-021-00573-7 (2020))1 on our Review (Pisetsky, D. S. & Lipsky, P. E. New insights into the role of antinuclear antibodies in systemic lupus erythematosus. Nat. Rev. Rheumatol. 16, 565–579 (2020))2, anti-DNA antibodies, among other antinuclear antibodies (ANAs), occur prominently in autoimmune hepatitis. ANAs and other serological markers enable the division of autoimmune hepatitis into two types that differ in clinical course3,4,5,6,7. ANAs and anti-SMA antibodies are markers for type 1 autoimmune hepatitis, whereas anti-LKM1 antibodies are markers for type 2 autoimmune hepatitis8.

Patients with type 1 autoimmune hepatitis produce ANAs that recognize many nuclear antigens (including histones, centromeres and ribonucleoproteins), but the expression of anti-DNA antibodies is perhaps the most surprising. Anti-DNA antibodies are a serological criterion for classification for systemic lupus erythematosus (SLE) as well as a marker of disease activity, particularly renal disease9. In SLE, anti-DNA antibodies can form immune complexes that are deposited in the kidneys and induce nephritis; these complexes can also stimulate the production of cytokines, including type I interferons, that promote widespread immune abnormalities2. In autoimmune hepatitis, anti-DNA antibodies do not seem to have the same consequences8.

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References

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Authors and Affiliations

  1. Department of Medicine and Immunology, Duke University Medical Center and Medical Research Service, VA Medical Center, Durham, NC, USA

    David S. Pisetsky

  2. RILITE Research Institute, Charlottesville, VA, USA

    Peter E. Lipsky

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  1. David S. Pisetsky
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  2. Peter E. Lipsky
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Correspondence to David S. Pisetsky.

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Pisetsky, D.S., Lipsky, P.E. Reply to: Diagnostic role of anti-dsDNA antibodies: do not forget autoimmune hepatitis. Nat Rev Rheumatol 17, 245 (2021). https://doi.org/10.1038/s41584-021-00574-6

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