Autoimmune hepatitis (AIH) is one of causes of chronic liver diseases. It is an unresolving inflammation of liver tissue and characterized by elevated transaminases, hypergammaglobulinemia, and circulating autoantibodies. The disorder occurs mostly in females (F:M ratio is 3.6 to 1) and is a relatively uncommon disorder with point prevalence of 8-16.8 per 100 000 population in western countries. Hiostologic hallmarks are interface hepatitis (also called piecemeal necrosis), and portallymphoplasmacytic infiltration.Dignostic criteria are based on excluding other etiologies of chronic liver disease,such as viral hepatic (A, B, C), metabolic disorders eg Wilson disese,drug induced hepatitis and alcoholic liver disease. Conventional autoantibodies are Antinuclear antibody (ANA), Smooth muscle antibody (SMA) and Anti liver kidney microsomal 1 (Anti LKM1).Some cases have combined clinical, laboratory or histologic features of Primary Biliary Cirrhosis (PBC) or Primary Sclerosing Cholangitis (PSC) with AIH and are known as overlap syndrome. Standard treatments of AIH as the most successful treated form of chronic hepatitis are based on immunosuppression with corticosteroids alone or in combination with azathioprine.

Background and Objectives: Vitiligo is the most common acquired pigmentation disorder; which manifests as depigmented patches of skin; rarely mucosa and hair. The prevalence of vitiligo in different races is around 0.1-2%.Many factors have been proposed as possible etiologic factor including genetics, free radicals, autoimmune reactions, melanocytic growth factors deficiency, melatonic destruction. Here we studied the association between vitiligo and autoimmune diseases.Materials and Methods: In this prospective study 86 patients with vitiligo were questioned about the location of vitiligo, family history, treatment and therapeutic response. All patients were examined both clinically and with laboratory tests to detect the presence of autoimmune disorders including autoimmune thyroid disease, pernicious anemia, insulin dependent diabetes, systemic lupus erythematic (SLE) and Addison disease. The laboratory tests including TSH, T3, T4, Hg, Na, ANA, ESR and K were performed. We compared the prevalence of autoimmune disorder in vitiligo patients with that in a group of age-and gender-matched normal 11 years; 61% of ±population.Results: Average age of disease onset was 21.8 patients were female and 39% were male. The most common locations of vitiligo were hands (33.7%) and face (32.1%). The most common pattern of onset was vulgaris type (40%). Nearly one – fourth of patients had a positive family history of vitiligo. Prevalence of thyroid disorders in vitiligo patients and control group was 21.1% and 7%, respectively. The difference was statistically significant (P=0.008). Response to treatment in patients with positive family history was 20%, comparing with 37% in sporadic cases (P=0.01).Conclusion: The most common autoimmune disorder in patient with vitiligo was hypothyroidism (clinical and subclinical). Family history had a poor prognostic effect on response to therapy.Vitiligo, Autoimmunity, Thyroid Average age of disease onset was 21.8 patients were female and 39% were male. The most common locations of vitiligo were hands (33.7%) and face (32.1%). The most common pattern of onset was vulgaris type (40%). Nearly one-fourth of patients had a positive family history of vitiligo. Prevalence of thyroid disorders in vitiligo patients and control group was 21.1% and 7%, respectively. The difference was statistically significant (P=0.008). Response to treatment in patients with positive family history was 20%, comparing with 37% in sporadic cases (P=0.01).Conclusion: The most common autoimmune disorder in patient with vitiligo was hypothyroidism (clinical and subclinical). Family history had a poor prognostic effect on response to therapy.

Background: Advanced hepatic fibrosis and cirrhosis has generally been considered to be irreversible. The aim of this study was to determine whether cirrhosis is reversible.Methods: Seven patients with autoimmune hepatitis with histologic evidence of cirrhosis were enrolled. After treatment, they had follow-up liver biopsy while in clinical and biochemical remission. Biopsy specimens were randomly coded in unpaired manner according to patient and were read independently by two pathologists using the modified hepatitis activity index (with a maximum stage of 6).Results: Three patients still had extensive fibrosis in the second liver biopsy. But four patients had almost total regression of their liver fibrosis. In the latter patients, the mean alanine aminotransferase level decreased from 776.3 U/L to 23 U/L. The mean bilirubin level decreased from 5.85 mg/dL, to 0.98 mg/dL. Extensive fibrosis or cirrhosis were present in all patients at diagnosis but were not present on follow-up liver biopsy. The mean fibrosis score decreased from 5.88 to 0.5 (P=0.0002), and the mean grading score from 11.38 to 2.5 (P=0.0008.).Conclusion: Frank cirrhosis due to autoimmune hepatitis may be reversible in some patients who respond to treatment.

Background: Autoimmune lymphoproliferative syndrome (ALPS) is a congenital disorder that results in an apoptosis impairment of lymphocytes, leading to chronic lymphoproliferation and autoimmunity, mainly autoimmune cytopenia. Some of autoreactive T cells cannot become apoptosis in activation-induced cell death (AICD) pathway,therefore, they have accumulation of autoreactive TCRα, β, +CD4−, CD8−,doublenegative T (α, β,-DNT) cells, leading to cytopenia, splenomegaly, lymphadenopathy, autoimmune disorders and a greatly increased lifetime risk of lymphoma. FAS, FASL, CASP8 and CASP10 gene defects are often responsible for the disease, the phenotype of which can vary from asymptomatic/mild forms to severe disease. More rarely, defects are associated to other genes involved in ALPS-like phenotype. Methods: A systematic literature search was performed in Web of Science, PubMed and Scopus from the earliest available date to march 2021 with standard keywords to find patients with ALPS-like phenotypes. Demographic, clinical, immunological and molecular data were extracted. Results: In this systematic review we reported 61 patients with genetically determined ALPS-like. Most of ALPS-like cases carry mutations in the STAT3 (n=15), LRBA (n=11) and CARD11 (n=8) genes. The most common presentation was splenomegaly and lymphadenopathy followed by hepatomegaly. The most common autoimmunity was autoimmune hemolytic anemia and immune thrombocytopenic purpura followed by auto immune neutropenia. Elevated serum immunoglobulin was reported especially in IgG, IgM and IgA. Conclusion: In the present study, 61 patients with genetically determined ALPS-like were examined. Our results showed that most of ALPS-like cases carry mutations in the STAT3. We reported that the most common presentations were splenomegaly and lymphadenopathy. Elevated serum immunoglobulin, IL-10, vitamin B12 and increased proportion of DNT cells were reported.

Background Type one diabetes mellitus (Type 1 DM) is the most common type of diabetes in children and adolescents, arising through a complex interaction of immune, genetic and environmental factors. Autoimmune thyroid disease is the most frequent disorder associated with Type one diabetes mellitus. This study aimed to evaluate incidence of autoimmune thyroid disease in children and adolescents with type I diabetes mellitus.Materials and Methods Cross sectional case control study was made on forty diabetic children with regular attending to the Endocrinology clinic and patients from pediatric ward in Al-Imamain Al-Kadhimain Medical City, Eraq, and forty healthy children matching in aged (1-15 years) and gender were taken as control. History taking, clinical examination, measurement of hemoglobin A1C, serum thyroid peroxidase autoantibodies and serum thyroid stimulating hormone levels were carried out. Serum thyroxine and triiodothyronine were measured.Results Serum thyroid peroxidase antibodies was positive in 15 % of diabetic patients, while it was negative in controls. In those with positive thyroid peroxidase antibodies 100% had subclinical hypothyroidism, 50% had hyperthyroidism. Risk of autoimmune thyroid disease was more in patients older than 5 years and it was neither related to the degree of control of diabetes nor to the duration, but it was more common in females.Conclusion There is higher incidence of autoimmune thyroid disease in children and adolescents with type one diabetes compared with normal children and this risk is not related to duration of diabetes, but it is more common in those older than 5 years. The risk of hypothyroidism is double the risk of hyperthyroidism in these patients.

To tackle medication resistance in rheumatoid arthritis, type 1 diabetes, and Grave's disease, 32 compounds were chosen as new inhibitors of autoimmune disorders and underwent 2D-QSAR, 3D-QSAR, docking, ADMET, and molecular dynamics (MD) simulation experiments. Genetic approximation-multiple linear regression (GA-MLR) was used in the 2D-QSAR investigation. The experimental activities and those obtained by model 1 were shown to have a respectable connection (r2 = 0.7616 and q2 = 0.6327). The structure-activity relationships (SAR) were statistically studied using the 3D-QSAR technique, which produced strong statistical significance for one high predictive model, comparative molecular field analysis (CoMFA: Q2=0.785; R2=0.936; rext2= 0.818). The steric and electrostatic fields control the bioactivity, according to a thorough examination of the contour maps of the prediction models. This information is very useful in understanding the qualities that must be presented to create new and powerful inhibitors of autoimmune disorders. Through these discoveries, 70 new inhibitors with improved receptor-targeting activity were designed. The last lead compounds were compound 32 and designed compound D40, which were found by virtual screening and subsequent molecular docking. Compounds 32 and D40 have the ability to target proteins such as arginine deiminase 4 (PAD4), major histocompatibility complex (MHC) class II HLA-DQ-ALPHA chain, and thyrotropin receptor (or TSH receptor) proteins, according to the results of the MD simulation for each protein-ligand complex. Our studies suggest that compound 32 and designed compound D40 be studied in vitro and in vivo against some of the selected autoimmune disorders. The MM/GBSA binding free energies are also measured for the selected drugs. For pattern recognition, structural similarity, and hotspots binding energy prediction.