The Pivotal Role of Liver Autoimmune Serology in the Diagnosis of Autoimmune Liver Disease

In their stimulating review, van Beers et al. describe the different tests to detect autoantibodies in autoimmune hepatitis, primary biliary cholangitis (PBC), and primary sclerosing cholangitis, and the potential pitfalls in interpreting the results of these tests (1). They appropriately point out that awareness of the different methods for autoantibody testing can optimize the diagnosis of patients with autoimmune liver disease but state that indirect immunofluorescence on HEp-2 cells is not specific for autoimmune hepatitis and PBC. In this regard, we would like to point out that several studies have demonstrated the high disease specificity of some antinuclear antibodies (ANA), such as the “homogeneous” antinuclear antibodies pattern for autoimmune hepatitis and “rim-like/membranous” or “multiple nuclear dots” antinuclear antibodies patterns for PBC (2–4). The latter patterns’ very high PBC specificity makes them surrogate diagnostic markers in PBC patients lacking antimitochondrial antibodies. As with other immunofluorescence tests, the high specificity of the test requires high operator experience. However, although operator-dependent, immunofluorescence offers the great advantage of detecting autoantibodies when the antigenic target is unknown.