The August 15, 2019 Department of Internal Medicine’s Medical Grand Rounds, “Bringing Autoimmune Hepatitis into the 21st Century – Challenges and Opportunities” was presented by David Assis, MD, assistant professor of medicine (digestive diseases).
In autoimmune hepatitis (AIH), the liver becomes inflamed from an immune attack due to a loss of tolerance. The condition is diagnosed by a liver biopsy along with clinical and laboratory features.
Assis discussed the history of AIH, which was first described in the literature in the early 1950s. “In some ways, I would argue that not a lot of things have changed,” said Assis. “Not only in terms of disease presentation, but also our tools and our expectations for management and I think in the 21st century we are challenged to do better.”
He cited the 2018 study by Renand et al which looked at the peripheral immune profiles of patients with AIH. “Even with long standing biochemical remission that these patients achieved, that autoimmune dysfunctional profile does not resolve. So when we talk about the fact that these patients have a very high rate of relapse, we should acknowledge that we are not really restoring that tolerigenic environment. We are just controlling it,” said Assis.
Assis cited the unmet needs for patients – finding new treatments with less side effects and assisting with quality of life issues caused by the disease.
He dove into his work into the treatment of AIH, specifically looking at the pro-inflammatory cytokine microphage migration inhibitory factor (MIF). Assis shared data from his 2014 paper in Hepatology, and 2016 paper in Digestive Diseases and Sciences, that suggest an important genetic and immunopathogenic role for MIF in AIH.
He also shared a new manuscript still in production that looks at the role of t-cells in AIH.
To learn more about Assis’s work and watch Medical Grand Rounds, Yale faculty can review the Grand Rounds video or review his bio.