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Advances in biomarkers of hepatotoxicity of drugs and herbal medicines Volume 25, issue 6, Juin 2018

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Authors
1 Hôpital Saint-Eloi, Service d’hépato-gastroentérologie et transplantation, 80 avenue Fliche, 34295 Montpellier Cedex 5, France
2 INSERM 1183
* Tirés à part

Drug hepatotoxicity is the main cause of the withdrawal of drugs of the market and of the discontinuation of clinical trials. The detection, the characterization, the prognosis and the diagnosis of drug-induced liver injury largely rely on blood biochemical and biological markers (liver enzymes, bilirubin, blood clotting tests, albumin). The causality assessment of a drug may be facilitated by using a scoring system combining biomarkers with chronological and clinical characteristics as illustrated by the « Roussel-Uclaf Causality Assessment Method » (RUCAM). There are rare instances in which drug-induced liver injury is associated with the presence of specific serum autoantibodies or the possibility to detect the causative drug or its toxic metabolites in the blood. To improve the management of drug-induced liver injury, various new biomarkers are developing. They allow an early detection of liver injury (microARN 122 and 192, cytokeratin 18), the characterization of a type of liver injury (HMGB-1, MCSFR-1 GLDH) or the prediction of the prognosis (MCSFR-1, ostéopontine, cytokératine 18 et bile acids). A standard utilization is still not fully validated. The role of pharmacogenetics in drug-induced liver injury is increasingly recognized and some significant associations have been recently identified with specific HLA haplotypes.

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