Idiosyncratic DILI: Immunology in Cases with Evidence Based on RUCAM
DOI:
https://doi.org/10.12970/2308-8044.2023.11.01Keywords:
Immunity, Autoimmunity, Hepatic immune cells, Idiosyncratic drug induced liver injury, RUCAM, Cytochrome P450, HLA B*57:01, Immune-mediated hypothesisAbstract
Idiosyncratic drug induced liver injury (iDILI) is a multifaceted and fairly well described liver disease, but there is yet some uncertainty on the role of immune systems triggering the liver injury and speculation on the cascade of immune events. Many conclusions were so far based on narratives or cases of iDILI, which did not receive the benefit of a robust causality assessment like by the Roussel Uclaf Causality Assessment Method (RUCAM). This analysis aims to clarify the cascade of immune events that lead to the liver injury by conventional drugs. For this approach, the search focused on iDILI cases with verified diagnosis by RUCAM. Most promising were parameters obtained from the blood as mirror of what happened in the liver during the injurious processes.The focus of this present analysis is on patients with RUCAM based iDILI and concomitant immune-related parameters in the blood. As an example, compelling evidence for a role of immune systems in iDILI was found for circulating mediators in the blood secreted by liver immune cells in patients under a therapy for tuberculosis, detected were also serum anti-cytochrome P450 (CYP) antibodies in patients after anesthesia with sevoflurane or desflurane and thereby reflecting their metabolism by the CYP 2E1 isoform, the occurrence of serum of autoantibodies in patients with drug induced autoimmune hepatitis (DIAIH) due to many drugs, and the role of blood and liver monocytes, which provide direct evidence for the activation of the hepatic innate immune system to the adapted immune system. In essence, patients with RUCAM based iDILI show various immunology features in the blood compatible with the role of the hepatic immune systems in patients with suspected iDILI caused by some but not all drugs.
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Bruno CD, Fremd B, Church RJ, Daly AK, Aithal GP, Björnsson ES, Larrey D, Watkins PB, Chow CR. HLA associations with infliximab-induced liver injury. Pharmacogenomics J 2020; 20: 681-686. https://doi.org/10.1038/s41397-020-0159-0
Li X, Jin S, Fan Y, Fan X, Tang Z, Cai W, Yang J, Xiang X. Association of HLA-C*03: 02 with methimazole-induced liver injury in Graves' disease patients. Biomed Pharmacother 2019; 117: 109095. https://doi.org/10.1016/j.biopha.2019.109095
Urban TJ, Nicoletti P, Chalasani N, Serrano J, Stolz A, Daly AK, Aithal GP, Dillon J, Navarro V, Odin J, Barnhart H, Ostrov D, Long N, Cirulli ET, Watkins PB, Fontana RJ; Drug-Induced Liver Injury Network (DILIN); Pharmacogenetics of Drug-Induced Liver Injury group (DILIGEN); International Serious Adverse Events Consortium (iSAEC). Minocycline hepatotoxicity: Clinical characterization and identification of HLA-B∗35: 02 as a risk factor. J Hepatol 2017; 67: 137. https://doi.org/10.1016/j.jhep.2017.03.010
Daly AK, Björnsson ES, Lucena MI, Andrade RJ. Drug-induced liver injury due to nitrofurantoin: Similar clinical features, but different HLA risk alleles in an independent cohort. J Hepatol 2023; 78: e165-e182. https://doi.org/10.1016/j.jhep.2022.11.022
Li YJ, Phillips EJ, Dellinger A, Nicoletti P, Schutte R, Li D, Ostrov DA, Fontana RJ, Watkins PB, Stolz A, Daly AK, Aithal GP, Barnhart H, Chalasani N; Drug-induced Liver Injury Network. Human Leukocyte Antigen B*14: 01 and B*35: 01 are associated with trimethoprim-sulfamethoxazole induced liver injury. Hepatology 2021; 73: 268-281. https://doi.org/10.1002/hep.31258
Daly AK. Genetics of drug-induced liver injury: Current knowledge and future prospectives. Clin Transl Sci 2023; 16: 37-42. https://doi.org/10.1111/cts.13424
Teschke R, Danan G. HLA genetics in idiosyncratic drug induced liver injury cases with evidence based on RUCAM. Int J Mol Sci 2023 in press.
