Patient Test Information

Smooth Muscle Antibody

Also known as:

SMA; Anti-Smooth Muscle Antibody; ASMA; Actin Antibody; F-Actin Antibody; ACTA

Formal name:

Smooth Muscle Antibody

Related tests:

ANA; Autoantibodies; AST; Bilirubin; AMA; Liver Kidney Microsomal Type 1 (LKM-1) Antibodies

Why Get Tested?

To help diagnose autoimmune hepatitis and distinguish it from other causes of liver injury

When to Get Tested?

When you have hepatitis that your doctor suspects may be due to an autoimmune-related process

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?


How is it used?

The smooth muscle (SMA) or actin antibody test is primarily ordered along with antinuclear antibodies (ANA) and liver kidney microsomal type 1 (LKM-1) antibodies to help diagnose autoimmune hepatitis and to differentiate between the two major types of autoimmune hepatitis, type 1 and type 2. In type 1, a high level (titer) of SMA or actin antibodies and/or ANA are present in the blood. In people with type 2, the titer of LKM1 is increased. Type 2 is uncommon in the United States.

When is it ordered?

The SMA (or actin antibody), ANA, and rarely LKM1 tests are ordered when a doctor suspects that someone has autoimmune hepatitis. They are usually ordered when a person presents with symptoms such as fatigue and jaundice along with abnormal findings on routine liver tests such as aspartate aminotransferase (AST) and/or bilirubin.

These autoantibody tests may be ordered along with other testing when a doctor is investigating liver disease and wants to distinguish between different causes of liver injury, including viral infections, drugs, alcohol abuse, toxins, genetic conditions, metabolic conditions, and autoimmune disorders.

What does the test result mean?

A large increase in the blood titer of SMA or actin antibody is usually due to autoimmune hepatitis. A small increase in SMA or actin antibody may be present in up to 50% of patients with primary biliary cirrhosis (PBC). The SMA autoantibody may also be found in other conditions, such as infectious mononucleosis, hepatitis C, and some cancers.

If the SMA or actin antibody test is negative, then symptoms may be due to causes other than autoimmune hepatitis. However, most patients with autoimmune hepatitis who are negative for SMA or actin antibodies will be positive for ANA, LKM1, or other less frequently measured autoantibodies.

Is there anything else I should know?

Titers of SMA may be lower in children and in those with compromised immune systems. The levels may vary over the course of the disease and are not closely related to the severity of autoimmune symptoms or to a person's prognosis.

The presence of SMA, F-actin antibodies, and ANA are highly suggestive of autoimmune hepatitis but not diagnostic. When significant concentrations of both are present and the doctor suspects autoimmune hepatitis, then a liver biopsy may be performed to look for characteristic signs of damage and scarring in the liver tissue.

What is being tested?

Smooth muscle antibodies (SMA) are autoantibodies, proteins produced by the body's immune system that recognize and attack its own actin, a protein found in smooth muscle and other tissues, especially the liver. This test detects and measures the amount (titer) of SMA (or antibody against actin) in the blood.

The production of smooth muscle or actin antibodies is strongly associated with autoimmune hepatitis. It may also sometimes be seen in other forms of liver disease, such as primary biliary cirrhosis (PBC), but usually at lower antibody titers.

Autoimmune hepatitis occurs when the immune system attacks the body's liver cells. It presents as an acute or chronic inflammation of the liver that is not due to another cause, such as a viral infection, exposure to a drug or toxin, a hereditary disorder, or alcohol abuse. It can lead to liver cirrhosis and, in some cases, to liver failure. Autoimmune hepatitis can affect anyone at any age, but about 80% of patients are women. In the United States, more than 70% of people with this disorder will have SMA or actin antibodies, either alone or along with antinuclear antibodies (ANA).

The majority of smooth muscle antibodies produced with autoimmune hepatitis is specifically directed against a protein called actin or F-actin. Testing is available for specific actin autoantibodies, but it is not available in every laboratory. Tests for actin antibodies detect more cases of autoimmune hepatitis but, in some studies, give more false-positive results than tests for smooth muscle antibodies.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

  1. Will smooth muscle antibody (SMA) ever go away?

    If it is due to a temporary condition, such as infectious mononucleosis, SMA may drop below detectable levels once the condition has resolved. If SMA is produced because of autoimmune hepatitis, then it will be present throughout a person's life, although levels may vary over time.

  2. Can I have more than one cause of hepatitis?

    Yes. For instance, autoimmune hepatitis can co-exist with a viral hepatitis, such as hepatitis B or hepatitis C, and can be exacerbated by liver damage caused by alcohol abuse. Since the treatment of hepatitis depends on the cause, it is very important that your doctor understand the underlying cause(s) of your condition.

  3. How fast does autoimmune hepatitis progress?

    The course and severity of autoimmune hepatitis is hard to predict. It may be acute or chronic. Some people will have no or few symptoms for many years and are diagnosed when routine liver tests are abnormal. For more information, consult with your doctor and see the related links.