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2014 ; 146
(4
): 914-28
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Pathogenesis of idiosyncratic drug-induced liver injury and clinical
perspectives
#MMPMID24389305
Fontana RJ
Gastroenterology
2014[Apr]; 146
(4
): 914-28
PMID24389305
show ga
Idiosyncratic drug-induced liver injury (DILI) is a rare disease that develops
independently of drug dose, route, or duration of administration. Furthermore,
idiosyncratic DILI is not a single disease entity but rather a spectrum of rare
diseases with varying clinical, histological, and laboratory features. The
pathogenesis of DILI is not fully understood. Standardization of the DILI
nomenclature and methods to assess causality, along with the information provided
by the LiverTox Web site, will harmonize and accelerate research on DILI. Studies
of new serum biomarkers such as glutamate dehydrogenase, high mobility group box
protein 1, and microRNA-122 could provide information for use in diagnosis and
prognosis and provide important insights into the mechanisms of the pathogenesis
of DILI. Single nucleotide polymorphisms in the HLA region have been associated
with idiosyncratic hepatotoxicity attributed to flucloxacillin, ximelagatran,
lapatinib, and amoxicillin-clavulanate. However, genome-wide association studies
of pooled cases have not associated any genetic factors with idiosyncratic DILI.
Whole genome and whole exome sequencing analyses are under way to study cases of
DILI attributed to a single medication. Serum proteomic, transcriptome, and
metabolome as well as intestinal microbiome analyses will increase our
understanding of the mechanisms of this disorder. Further improvements to in
vitro and in vivo test systems should advance our understanding of the causes,
risk factors, and mechanisms of idiosyncratic DILI.
|*Chemical and Drug Induced Liver
Injury/blood/classification/diagnosis/epidemiology/genetics
[MESH]