The chemical, genetic and immunological basis of idiosyncratic drug–induced liver injury

• Published in: Human & experimental toxicology Vol. 34; no. 12; pp. 1310 - 1317
• Main Authors: Tailor, A, Faulkner, L, Naisbitt, DJ, Park, BK
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.12.2015; Sage Publications Ltd
• Subjects: Amoxicillin-Potassium Clavulanate Combination - adverse effects; Animals; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - genetics; Chemical and Drug Induced Liver Injury - immunology; Floxacillin - adverse effects; Genomics; Humans; Immunology; Isoniazid - adverse effects; Liver; Pharmaceutical Preparations - metabolism; Pharmacology; Side effects; Toxicology; Idiosyncratic drug–induced liver injury; DILI; adduct; pharmacogenomics
• ISSN: 0960-3271; 1477-0903
• DOI: 10.1177/0960327115606529

Idiosyncratic drug reactions can be extremely severe and are not accounted for by the regular pharmacology of a drug. Thus, the mechanism of idiosyncratic drug–induced liver injury (iDILI), a phenomenon that occurs with many drugs including β-lactams, anti-tuberculosis drugs and non-steroidal anti-inflammatories, has been difficult to determine and remains a pressing issue for patients and drug companies. Evidence has shown that iDILI is multifactorial and multifaceted, which suggests that multiple cellular mechanisms may be involved. However, a common initiating event has been proposed to be the formation of reactive drug metabolites and covalently bound adducts. Although the fate of these metabolites are unclear, recent evidence has shown a possible link between iDILI and the adaptive immune system. This review highlights the role of reactive metabolites, the recent genetic innovations which have provided molecular targets for iDILI, and the current literature which suggests an immunological basis for iDILI.