Reviewer's report
Title:Pediatric Primary Biliary Cirrhosis and Type 2 Autoimmune Hepatitis
Overlapping Features In A 3-Year-Old Girl: A Case Study And Review of the
Literature on AMA Positivity in Pediatric Age
Version: 2Date:30 April 2012
Reviewer: Gideon Hirschfield
Reviewer's report:
Interesting patient with interesting issues that help inform the debate on aetiology
of autoimmune liver disease. Helpful overview broadly.
My major issue is that I do not see evidence for PBC; I see evidence for
immunoserologic overlap. I would interpret the presentation as serologic overlap
with AMA in the context of severe acute autoimmune hepatitis, with biliary
overlap features. I do not see classic PBC and the AMA titre falls in keeping with
resolving acute liver injury. The images provided do not show convincing PBC
lesions.
Therefore I think this paper is useful and the review component helpful, but I
would favour that the title, abstract and emphasis is adjusted very clearly to
discuss the findings in the context as above. This is still interesting because Type
2 AIH is distinct precisely because of its recognised antigen specificity. Hence
the observation of AMA here is intriguing, although my personal opinion is that
this is serologic overlap in the context of severe liver injury and not true PBC.
The family history suggests certain shared risk across AIH/PBC/AMA production.
Do the authors have AMA-MIT3 results and gp210 or sp100 titres? Can they
stain tissue for AMA (biliary phenotype).
I would be happy to trust the authors to make the necessary changes without
re-review.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
No relevant disclosures; I have no competing interests.
Reviewer's report
Title:Pediatric Primary Biliary Cirrhosis and Type 2 Autoimmune Hepatitis
Overlapping Features In A 3-Year-Old Girl: A Case Study And Review of the
Literature on AMA Positivity in Pediatric Age
Version: 2Date:30 April 2012
Reviewer: Gideon Hirschfield
Reviewer's report:
Interesting patient with interesting issues that help inform the debate on aetiology
of autoimmune liver disease. Helpful overview broadly.
My major issue is that I do not see evidence for PBC; I see evidence for
immunoserologic overlap. I would interpret the presentation as serologic overlap
with AMA in the context of severe acute autoimmune hepatitis, with biliary
overlap features. I do not see classic PBC and the AMA titre falls in keeping with
resolving acute liver injury. The images provided do not show convincing PBC
lesions.
Therefore I think this paper is useful and the review component helpful, but I
would favour that the title, abstract and emphasis is adjusted very clearly to
discuss the findings in the context as above. This is still interesting because Type
2 AIH is distinct precisely because of its recognised antigen specificity. Hence
the observation of AMA here is intriguing, although my personal opinion is that
this is serologic overlap in the context of severe liver injury and not true PBC.
The family history suggests certain shared risk across AIH/PBC/AMA production.
Do the authors have AMA-MIT3 results and gp210 or sp100 titres? Can they
stain tissue for AMA (biliary phenotype).
I would be happy to trust the authors to make the necessary changes without
re-review.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
No relevant disclosures; I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Pediatric Primary Biliary Cirrhosis and Type 2 Autoimmune Hepatitis
Overlapping Features In A 3-Year-Old Girl: A Case Study And Review of the
Literature on AMA Positivity in Pediatric Age
Version: 2Date:30 April 2012
Reviewer: Gideon Hirschfield
Reviewer's report:
Interesting patient with interesting issues that help inform the debate on aetiology
of autoimmune liver disease. Helpful overview broadly.
My major issue is that I do not see evidence for PBC; I see evidence for
immunoserologic overlap. I would interpret the presentation as serologic overlap
with AMA in the context of severe acute autoimmune hepatitis, with biliary
overlap features. I do not see classic PBC and the AMA titre falls in keeping with
resolving acute liver injury. The images provided do not show convincing PBC
lesions.
Therefore I think this paper is useful and the review component helpful, but I
would favour that the title, abstract and emphasis is adjusted very clearly to
discuss the findings in the context as above. This is still interesting because Type
2 AIH is distinct precisely because of its recognised antigen specificity. Hence
the observation of AMA here is intriguing, although my personal opinion is that
this is serologic overlap in the context of severe liver injury and not true PBC.
The family history suggests certain shared risk across AIH/PBC/AMA production.
Do the authors have AMA-MIT3 results and gp210 or sp100 titres? Can they
stain tissue for AMA (biliary phenotype).
I would be happy to trust the authors to make the necessary changes without
re-review.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
No relevant disclosures; I have no competing interests.
assistant