# Pharmacotherapies for Drug-Induced Liver Injury: A Current Literature Review

**Authors:** Meng Li, Qiong Luo, Yanyan Tao, Xin Sun, Chenghai Liu

PMC · DOI: 10.3389/fphar.2021.806249 · Frontiers in Pharmacology · 2022-01-05

## TL;DR

This paper reviews current pharmacotherapies for drug-induced liver injury and highlights treatment options and research gaps.

## Contribution

The paper systematically categorizes and evaluates existing drug treatments for DILI based on clinical evidence.

## Key findings

- Hepatoprotective drugs like N-acetylcysteine and Silymarin are commonly used for DILI.
- Anticholestatic and immunosuppressant drugs are also part of the treatment regimen.
- The review identifies unmet needs and limitations in current clinical studies on DILI therapies.

## Abstract

Drug-induced liver injury (DILI) has become a serious public health problem. For the management of DILI, discontinuation of suspicious drug or medicine is the first step, but the treatments including drugs and supporting approaches are needed. Reference to clinical patterns and disease severity grades of DILI, the treatment drugs were considered to summarize into hepatoprotective drugs (N-acetylcysteine and Glutathione, Glycyrrhizin acid preparation, Polyene phosphatidylcholine, Bicyclol, Silymarin), anticholestatic drug (Ursodeoxycholic acid, S-adenosylmethionine, Cholestyramine), immunosuppressants (Glucocorticoids) and specific treatment agents (L-carnitine, Anticoagulants). The current article reviewed the accumulated literature with evidence-based medicine researches for DILI in clinical practice. Also the drawbacks of the clinical studies involved in the article, unmet needs and prospective development for DILI therapy were discussed.

## Linked entities

- **Chemicals:** N-acetylcysteine (PubChem CID 12035), Glutathione (PubChem CID 124886), Bicyclol (PubChem CID 9821754), Silymarin (PubChem CID 5213), Ursodeoxycholic acid (PubChem CID 31401), S-adenosylmethionine (PubChem CID 34755), L-carnitine (PubChem CID 288)
- **Diseases:** Drug-induced liver injury (MONDO:0005359)

## Full-text entities

- **Genes:** ABCB11 (ATP binding cassette subfamily B member 11) [NCBI Gene 8647] {aka ABC16, BRIC2, BSEP, PFIC-2, PFIC2, PGY4}, CYP3A4 (cytochrome P450 family 3 subfamily A member 4) [NCBI Gene 1576] {aka CP33, CP34, CYP3A, CYP3A3, CYPIIIA3, CYPIIIA4}, Cxcl9 (C-X-C motif chemokine ligand 9) [NCBI Gene 17329] {aka CMK, Mig, MuMIG, Scyb9, crg-10}, SOD1 (superoxide dismutase 1) [NCBI Gene 6647] {aka ALS, ALS1, HEL-S-44, IPOA, SOD, STAHP}, NT5E (5'-nucleotidase ecto) [NCBI Gene 4907] {aka CALJA, CD73, E5NT, NT, NT5, NTE}, CYP2C9 (cytochrome P450 family 2 subfamily C member 9) [NCBI Gene 1559] {aka CPC9, CYP2C, CYP2C10, CYPIIC9, P450-2C9, P450IIC9}, Gpt (glutamic pyruvic transaminase, soluble) [NCBI Gene 76282] {aka 1300007J06Rik, 2310022B03Rik, ALT, ALT1, Gpt-1, Gpt1}, SLC17A5 (solute carrier family 17 member 5) [NCBI Gene 26503] {aka AST, ISSD, NSD, SD, SIALIN, SIASD}, LMNA (lamin A/C) [NCBI Gene 4000] {aka CDCD1, CDDC, CMD1A, CMT2B1, EMD2, FPL}, ATHS (atherosclerosis susceptibility (lipoprotein associated)) [NCBI Gene 470] {aka ALP}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, Cxcr3 (C-X-C motif chemokine receptor 3) [NCBI Gene 12766] {aka Cd183, Cmkar3}, IL18 (interleukin 18) [NCBI Gene 3606] {aka IGIF, IL-18, IL-1g, IL1F4}, NFKB1 (nuclear factor kappa B subunit 1) [NCBI Gene 4790] {aka CVID12, EBP-1, KBF1, NF-kB, NF-kB1, NF-kappa-B1}, SNCA (synuclein alpha) [NCBI Gene 6622] {aka NACP, PARK1, PARK4, PD1}, TGFB1 (transforming growth factor beta 1) [NCBI Gene 7040] {aka CAEND1, CED, DPD1, IBDIMDE, LAP, TGF-beta1}, Hmox1 (heme oxygenase 1) [NCBI Gene 15368] {aka D8Wsu38e, HO-1, HO1, Hemox, Hmox, Hsp32}, IL1B (interleukin 1 beta) [NCBI Gene 3553] {aka IL-1, IL1-BETA, IL1F2, IL1beta}, GGTLC5P (gamma-glutamyltransferase light chain 5 pseudogene) [NCBI Gene 653590] {aka GGT}
- **Diseases:** convulsive (MESH:D012640), IPH (MESH:D000094724), fatigue (MESH:D005221), infected (MESH:D007239), BCS (MESH:D006502), hepatic encephalopathy (MESH:D006501), PA (MESH:C535387), poisoning (MESH:D011041), cholestatic liver injury (MESH:D017093), autoimmune symptoms (MESH:D001327), shock (MESH:D012769), portal sclerosis (MESH:D006975), jaundice (MESH:D007565), neuropathy (MESH:D009422), thrombophilia (MESH:D019851), SOS (MESH:D006504), anti (MESH:D006679), Inflammatory (MESH:D007249), Reye's syndrome (MESH:D012202), Anti-TB (MESH:D014376), fever (MESH:D005334), acute (MESH:D000208), itchy skin symptoms (MESH:D012871), weight-loss (MESH:D015431), liver cirrhosis (MESH:D008103), ADRs (MESH:D064420), Hepatocellular type (MESH:D006528), VBDS (MESH:D001649), death (MESH:D003643), NSD (MESH:D029461), inflammatory damage (MESH:D018746), hepatocyte injury (MESH:D014947), immune injury (MESH:D007154), coagulation disorders (MESH:D001778), Anti-TB DILI (MESH:D056486), hyperbilirubinemia (MESH:D006932), necrosis (MESH:D009336), pruritus (MESH:D011537), intrahepatic cholestasis (MESH:D002780), PBC (MESH:D008105), acute-on-chronic liver failure (MESH:D065290), rashes (MESH:D005076), cirrhosis (MESH:D005355), drug (MESH:D000081015), psoriasis (MESH:D011565), Cholestatic (MESH:D002779), bone-diseases (MESH:D001847), TB (MESH:D014390), Chinese Clinical Medicine (MESH:C562377), PH (MESH:D010382), allergic (MESH:D004342), cancer (MESH:D009369), ALF (MESH:D017114), abnormalities in liver- (MESH:D008107), gastritis (MESH:D005756), overdose (MESH:D062787)
- **Chemicals:** MDA (MESH:D008315), triterpenoid (MESH:D014315), APAP (MESH:D000082), cholesterol (MESH:D002784), flavonols (MESH:D044948), PA (MESH:D011478), bilirubin (MESH:D001663), glucuronic acid (MESH:D020723), NO (MESH:D009569), Leflunomide (MESH:D000077339), defibrotide (MESH:C036901), GSH (MESH:D005978), silydianin (MESH:C015505), L-Carnitine (MESH:D002331), flavonoid (MESH:D005419), MgIG (MESH:C521270), chlorpromazine (MESH:D002746), Bile acid (MESH:D001647), ROS (MESH:D017382), lignin (MESH:D008031), pyrrolizidine alkaloids (MESH:D011763), silychristin (MESH:C015504), terbinafine (MESH:D000077291), Valproic acid (MESH:D014635), norfloxacin (MESH:D009643), Cholestyramine (MESH:D002792), free radicals (MESH:D005609), lipid (MESH:D008055), Glycyrrhizic acid (MESH:D019695), cephalexin (MESH:D002506), UDCA (MESH:D014580), Irinotecan (MESH:D000077146), prednisolone (MESH:D011239), cholic acid (MESH:D019826), Polyene Phosphatidylcholine (MESH:C029449), cysteamine (MESH:D003543), Amoxicillin-clavulanate (MESH:D019980), isosilybin (MESH:C075820), fatty acids (MESH:D005227), Oxaliplatin (MESH:D000077150), Flupirtine (MESH:C034161), phospholipids (MESH:D010743), Imatinib (MESH:D000068877), warfarin (MESH:D014859), styrene (MESH:D020058), Tyrosine (MESH:D014443), alcohols (MESH:D000438), Bicyclol (MESH:C477843), Prednisone (MESH:D011241), L-Cys (MESH:D003545), L-methionine (MESH:D008715), N-Acetylcysteine (MESH:D000111), taurolithocholate (MESH:D013658), Silymarin (MESH:D012838), low molecular weight heparin (MESH:D006495), ATP (MESH:D000255), tiopronin (MESH:D008625), acetyl-CoA (MESH:D000105), sulfur (MESH:D013455), Silybin (MESH:D000077385)
- **Species:** Mus musculus (house mouse, species) [taxon 10090], Gynura segetum (species) [taxon 210888], Glycyrrhiza glabra (species) [taxon 49827], Homo sapiens (human, species) [taxon 9606]

## Full text

_Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC8766857/full.md

## References

119 references — full list in the complete paper: https://tomesphere.com/paper/PMC8766857/full.md

---
Source: https://tomesphere.com/paper/PMC8766857