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2016 ; 81
(6
): 1030-6
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Mechanism of isoniazid-induced hepatotoxicity: then and now
#MMPMID26773235
Metushi I
; Uetrecht J
; Phillips E
Br J Clin Pharmacol
2016[Jun]; 81
(6
): 1030-6
PMID26773235
show ga
Isoniazid (INH) remains a mainstay for the treatment of tuberculosis despite the
fact that it can cause liver failure. Previous mechanistic hypotheses have
classified this type of drug-induced liver injury (DILI) as 'metabolic
idiosyncrasy' which was thought not to involve an immune response and was mainly
due to the bioactivation of the acetylhydrazine metabolite. However, more recent
studies support an alternative hypothesis, specifically, that INH itself is
directly bioactivated to a reactive metabolite, which in some patients leads to
an immune response and liver injury. Furthermore, there appear to be two
phenotypes of INH-induced liver injury. Most cases involve mild liver injury,
which resolves with immune tolerance, while other cases appear to have a more
severe phenotype that is associated with the production of anti-drug/anti-CYP
P450 antibodies and can progress to liver failure.