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Published on: October 31, 2025
Clinical implications of antimitochondrial antibody seropositivity in autoimmune hepatitis: a multicentre study
Paolo Muratori1, Cumali Efe, Luigi Muratori
1aDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna bCenter for the Study and Treatment of the Autoimmune Diseases of the Liver and Biliary System, S. Orsola-Malpighi, Bologna, Italy cDepartment of Gastroenterology, Hacettepe University Ankara dDepartment of Gastroenterology, Numune Education and Research Hospital, Ankara, Turkey eDepartment of Gastroenterology, Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, USA fDepartment of Gastroenterology, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada gDepartment of Hepato-Gastroenterology, CHU Reims, Reims, France hDepartment of Gastroenterology and Hepatology, Hepatology Division, Centre for Digestive Disease, Karolinska Institute, Stockholm, Sweden.
Background/Aim:
Antimitochondrial antibody (AMA) positivity is the serological marker of primary biliary cholangitis (PBC), but can also be sporadically detected in autoimmune hepatitis (AIH). Little is known about the clinical significance of AMA in AIH.
Patients And Methods:
We recruited 47 AMA-positive AIH cases from several centres and compared them with 264 well-characterized Italian AIH patients. Cases with any features of PBC were excluded.
Results:
In univariate analysis, AMA-positive AIH patients were older (46 vs. 36, P=0.002) and more responsive to immunosuppression (74 vs. 59%, P=0.05), but no differences were observed between the two groups after logistic regression using AMA as a dependent variable. None of the AMA-positive AIH patients showed signs of evolving PBC features after a median follow-up of up 47 months. AMA was detected in combination with all serological AIH markers except antiliver kidney microsome type 1 and antiliver cytosol type 1. AMA was the only marker of autoimmunity in eight cases.
Conclusion:
We found no differences between AIH with and without AMA. The groups had similar clinical, biochemical and histological features. AMA-positive AIH patients did not evolve towards PBC. In some cases, AMA was the only autoantibody.
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