Introduction to drug-induced liver injury

Abstract

This chapter provides an overview of the emerging drugs, herbs and health supplements associated with drug-induced liver injury (DILI). We first review three distinct categories of DILI: direct, idiosyncratic and indirect. We then review the mechanisms of DILI, the methods for diagnosing DILI including liver function tests, tests to exclude alternative causes, imaging, biopsy, genetic testing, tests of novel biomarkers, and in vitro tool. We describe the epidemiology and the methodology of the assessment for DILI as they relate to causality assessment scale, adverse event self-reporting system, and electronic healthcare database. We describe the current and future directions in the treatment & prevention of DILI, including Chinese medicines and hepatotoxicity, focusing on understanding adverse effects of Chinese medicine including toxic effects, determining the safe doses of specific Chinese medicines, determining the toxicity of Chinese medicine induced by inappropriate combinations, determining the target organs and mechanism of toxicity of Chinese medicine, and developing new therapeutic applications from toxic herbs. We identify Chinese Medicines associated with hepatotoxicity, including Polygonum multiflorum, Fructus xanthii, Pyrrolizidine alkaloids, and Aristolochic acid. We emphasize that large scale and rigorous basic and clinical research studies for systematic toxicological evaluation remains a priority to inform the safe and effective use of Chinese Medicine for hepatitis management.