Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines

“…Baseline abnormal liver function test results were defined as elevated ALT ≥ 2 times the upper limit of normal (ULN) before the commencement of anti-TB therapy. When abnormal liver function panels were noted during follow-up, patients were screened for viral hepatitis (HAV, HEV, and reactivation of HBV), autoimmune hepatitis and enquiry on the use of other hepatotoxic drugs or complementary and alternative medicine [ 7 ]. DILI is defined as ≥5× ULN for ALT or ≥2.6× ULN of total bilirubin, based on the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Paediatric Adverse Events [ 13 ] and causality assessment by using RUCAM (Roussel Uclaf Causality Assessment Method) [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…Significant concern about developing DILI during anti- tuberculous (TB) treatment has been raised because it can result in the modification or discontinuation of anti-TB treatment in about one-sixth of TB patients [ 5 , 6 ] and is difficult to manage, rendering further dissemination of Mycobacterium tuberculosis . DILI under anti-TB treatment (anti-TB DILI) is the most common cause of DILI and drug-induced acute liver failure in many Asian countries [ 7 ] and the second most common cause of drug-induced acute on chronic liver failure in Asia [ 7 ]. The incidence of anti-TB DILI varies depending on the definition used to define DILI and varies from 3.4% to 7.3% [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…DILI under anti-TB treatment (anti-TB DILI) is the most common cause of DILI and drug-induced acute liver failure in many Asian countries [ 7 ] and the second most common cause of drug-induced acute on chronic liver failure in Asia [ 7 ]. The incidence of anti-TB DILI varies depending on the definition used to define DILI and varies from 3.4% to 7.3% [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Circulatory Inflammatory Mediators in the Prediction of Anti-Tuberculous Drug-Induced Liver Injury Using RUCAM for Causality Assessment

Chen

Chang

et al. 2021

Biomedicines

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Background: Anti-tuberculous (TB) medications are common causes of drug-induced liver injury (DILI). Limited data are available on systemic inflammatory mediators as biomarkers for predicting DILI before treatment. We aimed to select predictive markers among potential candidates and to formulate a predictive model of DILI for TB patients. Methods: Adult active TB patients from a prospective cohort were enrolled, and all participants received standard anti-tuberculous treatment. Development of DILI, defined as ≥5× ULN for alanine transaminase or ≥2.6× ULN of total bilirubin with causality assessment (RUCAM, Roussel Uclaf causality assessment method), was regularly monitored. Pre-treatment plasma was assayed for 15 candidates, and a set of risk prediction scores was established using Cox regression and receiver-operating characteristic analyses. Results: A total of 19 (7.9%) in 240 patients developed DILI (including six carriers of hepatitis B virus) following anti-TB treatment. Interleukin (IL)-22 binding protein (BP), interferon gamma-induced protein 1 (IP-10), soluble CD163 (sCD163), IL-6, and CD206 were significant univariable factors associated with DILI development, and the former three were backward selected as multivariable factors, with adjusted hazards of 0.20 (0.07–0.58), 3.71 (1.35–10.21), and 3.28 (1.07–10.06), respectively. A score set composed of IL-22BP, IP-10, and sCD163 had an improved area under the curve of 0.744 (p < 0.001). Conclusions: Pre-treatment IL-22BP was a protective biomarker against DILI development under anti-TB treatment, and a score set by additional risk factors of IP-10 and sCD163 employed an adequate DILI prediction.

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“…Drugs and drug metabolites are capable of damaging the liver, resulting in a spectrum of symptoms ranging from mild to acute liver failure. The most common drugs inducing liver injury are antimicrobials [ 72 , 73 , 74 ]. Despite the rare incidence and uncommon cause of acute liver failure, DILI poses a threat to morbidity and mortality.…”

Section: Drug-induced Liver Injury (Dili) In Personalized Medicinementioning

confidence: 99%

Progress and Challenges in the Use of a Liver-on-a-Chip for Hepatotropic Infectious Diseases

Kulkeaw

Pengsart

2021

Micromachines

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The liver is a target organ of life-threatening pathogens and prominently contributes to the variation in drug responses and drug-induced liver injury among patients. Currently available drugs significantly decrease the morbidity and mortality of liver-dwelling pathogens worldwide; however, emerging clinical evidence reveals the importance of host factors in the design of safe and effective therapies for individuals, known as personalized medicine. Given the primary adherence of cells in conventional two-dimensional culture, the use of these one-size-fit-to-all models in preclinical drug development can lead to substantial failures in assessing therapeutic safety and efficacy. Advances in stem cell biology, bioengineering and material sciences allow us to develop a more physiologically relevant model that is capable of recapitulating the human liver. This report reviews the current use of liver-on-a-chip models of hepatotropic infectious diseases in the context of precision medicine including hepatitis virus and malaria parasites, assesses patient-specific responses to antiviral drugs, and designs personalized therapeutic treatments to address the need for a personalized liver-like model. Second, most organs-on-chips lack a monitoring system for cell functions in real time; thus, the review discusses recent advances and challenges in combining liver-on-a-chip technology with biosensors for assessing hepatocyte viability and functions. Prospectively, the biosensor-integrated liver-on-a-chip device would provide novel biological insights that could accelerate the development of novel therapeutic compounds.

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Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines

Cited by 74 publications

References 164 publications

Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic - A Case Series

Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic - A Case Series

Circulatory Inflammatory Mediators in the Prediction of Anti-Tuberculous Drug-Induced Liver Injury Using RUCAM for Causality Assessment

Progress and Challenges in the Use of a Liver-on-a-Chip for Hepatotropic Infectious Diseases

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