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Tarantino G, Di Minno MND, Capone D. Drug-induced liver injury: Is it somehow foreseeable? World J Gastroenterol 2009; 15(23): 2817-2833 [PMID: 19533803 DOI: 10.3748/wjg.15.2817]
World J Gastroenterol. Jun 21, 2009; 15(23): 2817-2833 Published online Jun 21, 2009. doi: 10.3748/wjg.15.2817
Drug-induced liver injury: Is it somehow foreseeable?
Giovanni Tarantino, Matteo Nicola Dario Di Minno, Domenico Capone
Giovanni Tarantino, Matteo Nicola Dario Di Minno, Department of Clinical and Experimental Medicine, Section of Hepatology in Internal Medicine, Federico II University, Medical School of Naples, 5 80131 Napoli, Italy
Domenico Capone, Department of Neurosciences, Unit of Clinical Pharmacology, Federico II University, Medical School of Naples, 5 80131 Napoli, Italy
Author contributions: All the authors equally contributed towards writing and editing the manuscript; All authors approved the final version of the manuscript.
Correspondence to: Giovanni Tarantino, MD, Professor, Department of Clinical and Experimental Medicine, Section of Hepatology in Internal Medicine, Federico II University, Medical School of Naples, Via S. Pansini, 5 80131 Napoli, Italy. tarantin@unina.it
Telephone: +39-81-7462024
Fax: +39-81-5466152
Received: April 22, 2009 Revised: May 13, 2009 Accepted: May 20, 2009 Published online: June 21, 2009
Abstract
The classic view on the pathogenesis of drug-induced liver injury is that the so-called parent compounds are made hepatotoxic by metabolism (formation of neo-substances that react abnormally), mainly by cytochromes P-450 (CYP), with further pathways, such as mitochondrial dysfunction and apoptosis, also playing a role. Risk factors for drug-induced liver injury include concomitant hepatic diseases, age and genetic polymorphisms of CYP. However, some susceptibility can today be predicted before drug administration, working on the common substrate, by phenotyping and genotyping studies and by taking in consideration patients’ health status. Physicians should always think of this adverse effect in the absence of other clear hepatic disease. Ethical and legal problems towards operators in the health care system are always matters to consider.
