Environment May Play Role in Autoimmune Liver Disease



VIENNA -- Evidence of spatial clustering of autoimmune liver disease cases was observed in certain parts of England, suggesting environmental factors may be at play, a researcher here said.

Significant spatial clustering -- meaning that disease cases occurred together in space more than expected by chance -- was observed in cases of primary biliary cholangitis, autoimmune hepatitis, and primary sclerosing cholangitis in northeastern England and North Cumbria (in northwestern England), reported Jessica Dyson, MD, of Newcastle University in Newcastle upon Tyne, England.

"The etiology of autoimmune liver disease is complex. There are certain genetic components, but [there is] increasingly believed to be interplay with genetics and environmental factors," she said during her presentation at the annual meeting of the European Association for the Study of the Liver (EASL).

Dyson noted that while disease clustering for primary biliary cholangitis has been previously reported in Northern England and New York, there have been no equivalent studies done in autoimmune hepatitis or primary sclerosing cholangitis.

In a statement, Marco Marzioni, MD, of the Università Politecnica delle Marche, Ancona, Italy, and an EASL Governing Board Member, said that autoimmune diseases of the liver are "infrequent, but have an increasing incidence overall."

"Environmental factors have been considered, but no solid data have emerged so far. [This] study ... has sufficient scientific rigor to reinforce the idea that environmental exposure may play a major role in triggering autoimmune diseases of the liver," he said.

Dyson's group set out to examine if there was spatial and/or temporal clustering of these diseases in a cohort of patients in northeast England and North Cumbria. The areas were described as a "stable population" of approximately 3 million people with low migration rates, which Dyson noted is "important when thinking about the validity of epidemiological research."

Cases were identified from a variety of different sources, including existing cohorts, data from hospital records, as well as a review of clinical case notes. Overall, researchers identified:

  • 2,150 primary biliary cholangitis cases (median age at diagnosis 58, 88.7% were women)
  • 963 autoimmune hepatitis cases (median age at diagnosis 57, 80.2% were women)
  • 472 primary sclerosing cholangitis cases (median age at diagnosis 51, 32.0% were women)

Point prevalence estimates per 100,000 population were highest for primary biliary cholangitis (41.7%), followed by autoimmune hepatitis (21.2%) and primary sclerosing cholangitis (8.6%). Researchers used spatial point analyses (K-function) to "investigate for the presence and patterns of disease clustering (using postal addresses) after controlling for population size."

All three diseases had evidence of "significant spatial clustering" at about 1-2 km, with further clustering for autoimmune hepatitis and primary sclerosing from 7.5-12 km, the authors said -- adding that in primary biliary cholangitis, there was clustering at all distances above 7.5 km.

Temporal clustering was confined to patients with a known post code and year of diagnosis, but there was no evidence of temporal clustering in cases of either primary biliary cholangitis and autoimmune hepatitis. Dyson said there was "suggestion" of temporal clustering for primary sclerosing cholangitis, though it was not statistically significant.

She said that there might be "something developing here" with a bigger cohort, commenting that this cohort was "somewhat smaller" than the other two diseases.

Dyson said that one would expect to see this type of clustering if there were contagious or infectious causes or transient environmental risk.

"However, if an environmental trigger is a persistent, low-level exposure, we wouldn't expect to see temporal clustering," she said, adding that the findings of varying distances of peak clustering between diseases "suggests many different environmental factors at play."

Dyson noted that point-based analyses confirmed clustering, but not the location or size of the clusters, and those would be subjects for future study.

This study was funded by the National Institute for Health Research Newcastle Biomedical Research Centre, which Dyson received support from.

Source: https://www.medpagetoday.com/meetingcoverage/easl/79188

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