Actin (Smooth Muscle) Antibodies (ASMA; anti-F-actin) are autoantibodies that target proteins in smooth muscle cells. They are most often linked to autoimmune hepatitis (AIH), especially type 1, but they can also appear in chronic active hepatitis and, less commonly, in primary biliary cholangitis (PBC, historically called “primary biliary cirrhosis”). Positivity is reported in about 52–85% of people with AIH or chronic active hepatitis and about 22% with PBC. ASMA often appears together with ANA (antinuclear antibodies) and high IgG levels, which form a typical autoimmune antibody pattern in AIH.
Helps identify autoimmune hepatitis (AIH): If liver enzymes (ALT, AST) are high and other causes are ruled out, ASMA can point toward immune-related liver inflammation.
Helps distinguish liver conditions: Along with ANA, anti-LKM-1, anti-SLA, AMA, and total IgG, this test helps doctors tell AIH apart from PBC and other chronic liver diseases.
Strengthens the autoimmune suspicion: Higher levels increase the likelihood of an autoimmune cause, though the test is not diagnostic on its own.
0–19 (Negative): Does not support autoimmune hepatitis by itself. If liver tests are abnormal, doctors will consider other causes (such as viral hepatitis, alcohol-related injury, metabolic disease, or medication effects) and may order other antibody or IgG tests.
20–30 (Weak positive): Borderline result suggesting possible autoimmune activity. Doctors interpret this together with liver enzyme patterns, other antibodies (ANA, AMA, anti-LKM-1, anti-SLA), IgG levels, liver-related symptoms (fatigue, itching, jaundice, joint pain), and imaging. Repeat testing or confirmation with an anti-F-actin ELISA test may sometimes be recommended.
Over 30 (Moderate to strong positive): Stronger evidence for AIH, particularly if IgG is elevated, ANA is also positive, and ALT/AST are high. Even then, diagnosis usually requires a combination of test results, scoring systems (such as IAIHG), and sometimes a liver biopsy to confirm characteristic inflammation and assess disease stage.
Specificity: ASMA is a useful piece of the diagnostic puzzle but not perfectly specific. It can also show up in PBC, viral hepatitis, or other autoimmune conditions.
Follow-up and monitoring: Antibody levels may fall with treatment, but changes in titers are not reliable for tracking disease activity. Doctors mainly monitor liver enzymes, bilirubin, IgG, symptoms, and may use imaging or biopsy.
Test methods differ: Some labs report ASMA qualitatively or as titers (such as 1:40, 1:80). These results correspond to the negative/weak/positive categories outlined above.
If positive: Your doctor may suggest a full evaluation, including liver blood tests (ALT, AST, ALP, GGT, bilirubin), IgG, antibody panels (ANA, AMA, anti-LKM-1, anti-SLA), a viral hepatitis panel, and imaging (ultrasound or elastography). A liver biopsy may be considered to confirm and stage the disease.
If negative but suspicion remains: If liver enzymes stay high or autoimmune features continue, your doctor may still order other antibody tests, IgG, or imaging, and may repeat ASMA testing.
Treatment implications: If autoimmune hepatitis is confirmed, treatment usually involves immunosuppressive medication (often corticosteroids and sometimes azathioprine) to reduce liver inflammation and prevent progression to fibrosis or cirrhosis.
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An elevated ASMA result means your immune system is producing higher levels of antibodies that mistakenly target proteins in smooth muscle. This test result is most often linked to autoimmune hepatitis (AIH), especially type 1, but it can also appear in chronic active hepatitis, primary biliary cholangitis (PBC), viral hepatitis, and other autoimmune conditions.
Moderate to strong positives (>30): Provide stronger evidence for an autoimmune cause of liver disease.
Typical in AIH: Found in more than half of people with autoimmune hepatitis.
Often paired with other markers: Elevated IgG, positive ANA, and high liver enzymes (ALT, AST) form a more complete autoimmune profile.
Not diagnostic on their own: A positive ASMA must be interpreted alongside other lab and clinical findings.
Additional blood tests: ANA, AMA, anti-LKM-1, anti-SLA, IgG, viral hepatitis panel.
Liver panel: ALT, AST, ALP, GGT, bilirubin to check for inflammation or damage.
Imaging: Ultrasound or elastography to look at liver health.
Liver biopsy: Sometimes required to confirm inflammation (“interface hepatitis”) and determine disease stage.
If autoimmune hepatitis is confirmed, treatment usually involves immunosuppressive therapy such as corticosteroids (often prednisone) with or without azathioprine. These medications help reduce immune activity, control liver inflammation, and prevent progression to fibrosis or cirrhosis. Regular monitoring of liver enzymes, IgG, and clinical symptoms is essential, since antibody titers alone are not reliable for tracking disease activity.
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Unlimited Plan Member since 2021
I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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Abnormal Protein Band 1, Actin (Smooth Muscle) Antibody, Actin (Smooth muscle) Antibody (IgG), Albumin (via Protein electrophoresis), Alpha-1-Globulin, Serum, Alpha-2-Globulin, Serum, baski sore, Beta Globulin, Serum, Beta-1-Globulin, Serum, Beta-2-Globulin, Serum, Bile Acid, Bile Acids, Bilirubin Direct, Bilirubin Indirect, Cholinesterase, Serum, FIB 4 Index, FIB-4 Index, FIBROSIS SCORE, FIBROSIS STAGE, Gamma Globulin, Serum, Gamma-Glutamyl Transferase (GGT), Mitochondrial (M2) Antibody, NECROINFLAMMAT ACT GRADE, NECROINFLAMMAT ACT SCORE, Pre-Albumin, Prealbumin
