In this article,we discuss the article recently published by Zhao et al.This study focused on the intersection of metabolic dysfunction-associated steatotic liver disease(MASLD)and drug-induced liver injury(DILI),two ...In this article,we discuss the article recently published by Zhao et al.This study focused on the intersection of metabolic dysfunction-associated steatotic liver disease(MASLD)and drug-induced liver injury(DILI),two major contributors to the global burden of liver disease.By analyzing clinical characteristics,metabolic parameters,immune profiles,and liver pathology,Zhao et al comprehensively explored how MASLD influences the presentation,severity,and prognosis of DILI.Additionally,this study underscores the importance of structured diagnostic tools,such as the Roussel Uclaf Causality Assessment Method,to accurately assess the causality of DILI within the MASLD population.Although this study provides valuable insights,limitations such as its retrospective design and cohort heterogeneity underscore the need for future prospective research to refine diagnostic approaches and therapeutic strategies.展开更多
AIM To analyze liver tests before and following treatment with herbal Traditional Chinese Medicine(TCM) in order to evaluate the frequency of newly detected liver injury.METHODS Patients with normal values of alanine ...AIM To analyze liver tests before and following treatment with herbal Traditional Chinese Medicine(TCM) in order to evaluate the frequency of newly detected liver injury.METHODS Patients with normal values of alanine aminotransferase(ALT) as a diagnostic marker for ruling out pre-existing liver disease were enrolled in a prospective study of a safety program carried out at the First German Hospital of TCM from 1994 to 2015. All patients received herbal products, and their ALT values were reassessed 1-3 d prior to discharge. To verify or exclude causality for suspected TCM herbs, the Roussel Uclaf Causality Assessment Method(RUCAM) was used.RESULTS This report presents for the first time liver injury data derived from a prospective, hospital-based and largescale study of 21470 patients who had no liver disease prior to treatment with herbal TCM. Among these, ALT ranged from 1 × to < 5 × upper limit normal(ULN) in 844 patients(3.93%) and suggested mild or moderate liver adaptive abnormalities. However, 26 patients(0.12%) experienced higher ALT values of ≥ 5 × ULN(300.0 ± 172.9 U/L, mean ± SD). Causality for TCM herbs was RUCAM-based probable in 8/26 patients, possible in 16/26, and excluded in 2/26 cases. Bupleuri radix and Scutellariae radix were the two TCM herbs most commonly implicated. CONCLUSION In 26(0.12%) of 21470 patients treated with herbal TCM, liver injury with ALT values of ≥ 5 × ULN was found, which normalized shortly following treatment cessation, also substantiating causality.展开更多
Drug induced liver injury is responsible for 50% of acute liver failure in developed countries. Ayurvedic and homeopathic medicine have been linked to liver injury. This case describes the first documented case of Pun...Drug induced liver injury is responsible for 50% of acute liver failure in developed countries. Ayurvedic and homeopathic medicine have been linked to liver injury. This case describes the first documented case of Punarnava mandur and Kanchnar guggulu causing drug induced liver injury. Drug induced liver injury may be difficult to diagnosis, but use of multi-modalities tools including the ACG algorithms, causative assessment scales, histological findings, and imaging, is recommended. Advanced imaging, such as magnetic resonance cholangiopancreatography, may possibly have a greater role than previously reported in literature.展开更多
Herbal-induced liver injury(HILI)is an important and increasingly concerning cause of liver toxicity,and this study presents recent updates to the literature.An extensive literature review was conducted encompassing S...Herbal-induced liver injury(HILI)is an important and increasingly concerning cause of liver toxicity,and this study presents recent updates to the literature.An extensive literature review was conducted encompassing September 2019 through March 2021.Studies with clinically significant findings were analyzed and included in this review.We emphasized those studies that provided a causality assessment methodology,such as Roussel Uclaf Causality Assessment Method scores.Our review includes reports of individual herbals,including Garcinia cambogia,green tea extract,kratom as well as classes such as performance enhancing supplements,Traditional Chinese medicine,Ayurvedic medicine and herbal contamination.Newly described herbals include ashwagandha,boldo,skyfruit,and‘Thermo gun’.Several studies discussing data from national registries,including the United States Drug-Induced Liver Injury(DILI)Network,Spanish DILI Registry,and Latin American DILI Network were incorporated.There has also been a continued interest in hepatoprotection,with promising use of herbals to counter hepatotoxicity from anti-tubercular medications.We also elucidated the current legal conversation surrounding use of herbals by presenting updates from the Federal Drug Administration.The highlights of the literature over the past year indicate interest in HILI that will continue as the supplement industry in the United States grows.展开更多
Drug-induced liver injury(DILI)is a common and serious adverse drug reaction.At present,DILI is perfectly diagnozed in clinical settings using Roussel Uclaf causality assessment method(RUCAM)in its original version pu...Drug-induced liver injury(DILI)is a common and serious adverse drug reaction.At present,DILI is perfectly diagnozed in clinical settings using Roussel Uclaf causality assessment method(RUCAM)in its original version published 1993 and its updated version published 2016,well established worldwide as a diagnostic algorithm with a high sensitivity and specificity.Nevertheless,the search for additional detection methods supporting RUCAM continues.In recent years,with the development of optical imaging technology,fluorescent probes have gradually shown great advantages in the detection and diagnosis of DILI markers such as high sensitivity,anti-interference,real-time monitoring and non-invasive measurement.In this review,the recent advances of fluorescent probes for evaluation of DILI in experimental studies were summarized according to various markers of DILI.We believe that learning about the design and practical application of these probes will contribute to the further development of detection sensors for DILI markers.展开更多
Sterculia gum,the dry exudate of Sterculia versicolor and other members of the same genus,is used as a thickener and emulsifier in foods.It is generally considered safe as a food or drug,and its adverse reactions,such...Sterculia gum,the dry exudate of Sterculia versicolor and other members of the same genus,is used as a thickener and emulsifier in foods.It is generally considered safe as a food or drug,and its adverse reactions,such as Sterculia-induced liver injury,have never been reported.A 46-year-old woman was admitted to hospital with fatigue,nausea,abdominal distension,jaundice and a>16-fold increase in transaminase and bilirubin level.The patient had used Sterculia gum prior to the onset of her symptoms.Her symptoms and clinical indicators improved after treatment.The possibility of acute viral hepatitis,autoimmune hepatitis,and metabolic liver disease was excluded.After discharge from hospital,the patient had a severe liver injury again when re-exposed to Sterculia gum.And the Roussel Uclaf Causality Assessment Method score was updated from 5 to 7,which was consistent with probable drug-induced liver injury.This is the first report of Sterculia-induced liver injury.Clinicians need to be aware of the potential hepatotoxicity of Sterculia.展开更多
Liver injury in Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)is a multifaceted disorder,lacking cohort homogeneity due to a variety of potential causes,including drugs,arsenic and other heavy metals...Liver injury in Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)is a multifaceted disorder,lacking cohort homogeneity due to a variety of potential causes,including drugs,arsenic and other heavy metals,glyphosate,infections,and ultraviolet radiation.The goals of this review were(1)to analyze the role of diagnostic algorithms in assessing causality for potential culprits involved in the development of liver injury associated with immune-mediated SJS and TEN,which represent immune-based variant disorders within a continuous spectrum.Milder forms are classified as SJS or SJS/TEN overlap,while TEN is known as the most serious form;and(2)to interpret the findings that allow for the characterization of the different types of these disorders.The manuscript is based on an extensive literature search for single case reports,case cohorts,and review articles.Search terms included:Stevens-Johnson Syndrome,Toxic Epidermal Necrolysis,and specific diagnostic algorithms such as the Roussel Uclaf Causality Assessment Method(RUCAM)and the Algorithm of Drug Causality for Epidermal Necrolysis(ALDEN).For the purpose of basic feature description,the uniform term SJS/TEN is used in the current analysis.SJS/TEN presents with five different cohort types:SJS/TEN type(1),which refers to a cohort of SJS/TEN caused by drugs,as assessed by both ALDEN and RUCAM;type(2),representing SJS/TEN due to drugs and assessed by ALDEN only,but not by RUCAM;type(3),which includes a cohort of SJS/TEN caused by drugs,assessed by non-ALDEN and non-RUCAM tools;type(4),which focuses on a cohort of SJS/TEN caused by non-drug culprits,assessed by various tools;and type(5),which considers a cohort of SJS/TEN caused by unknown culprits.Using this new SJS/TEN typology will help better characterize individual features,personalize treatment,and clarify pathogenetic specifics for each of the five disease types.This new SJS/TEN typology provides clarity by replacing issues of inhomogeneity with cohort homogeneity.展开更多
Cases of suspected herb-induced liver injury(HILI)caused by herbal Traditional Chinese Medicines(TCMs)and of druginduced liver injury(DILI)are commonly published in the scientific literature worldwide.As opposed to th...Cases of suspected herb-induced liver injury(HILI)caused by herbal Traditional Chinese Medicines(TCMs)and of druginduced liver injury(DILI)are commonly published in the scientific literature worldwide.As opposed to the multiplicity of botanical chemicals in herbal TCM products,which are often mixtures of several herbs,conventional Western drugs contain only a single synthetic chemical.It is therefore of interest to study how HILI by TCM and DILI compare with each other,and to what extent results from each liver injury type can be transferred to the other.China is among the few countries with a large population using synthetic Western drugs as well as herbal TCM.Therefore,China is well suited to studies of liver injury comparing drugs with TCM herbs.Despite some concordance,recent analyses of liver injury cases with verified causality,using the Roussel Uclaf Causality Assessment Method,revealed major differences in HILI caused by TCMs as compared to DILI with respect to the following features:HILI cases are less frequently observed as compared to DILI,have a smaller proportion of females and less unintentional rechallenge events,and present a higher rate of hepatocellular injury features.Since many results were obtained among Chinese residents who had access to and had used Western drugs and TCM herbs,such ethnic homogeneity supports the contention that the observed differences of HILI and DILI in the assessed population are well founded.展开更多
文摘In this article,we discuss the article recently published by Zhao et al.This study focused on the intersection of metabolic dysfunction-associated steatotic liver disease(MASLD)and drug-induced liver injury(DILI),two major contributors to the global burden of liver disease.By analyzing clinical characteristics,metabolic parameters,immune profiles,and liver pathology,Zhao et al comprehensively explored how MASLD influences the presentation,severity,and prognosis of DILI.Additionally,this study underscores the importance of structured diagnostic tools,such as the Roussel Uclaf Causality Assessment Method,to accurately assess the causality of DILI within the MASLD population.Although this study provides valuable insights,limitations such as its retrospective design and cohort heterogeneity underscore the need for future prospective research to refine diagnostic approaches and therapeutic strategies.
文摘AIM To analyze liver tests before and following treatment with herbal Traditional Chinese Medicine(TCM) in order to evaluate the frequency of newly detected liver injury.METHODS Patients with normal values of alanine aminotransferase(ALT) as a diagnostic marker for ruling out pre-existing liver disease were enrolled in a prospective study of a safety program carried out at the First German Hospital of TCM from 1994 to 2015. All patients received herbal products, and their ALT values were reassessed 1-3 d prior to discharge. To verify or exclude causality for suspected TCM herbs, the Roussel Uclaf Causality Assessment Method(RUCAM) was used.RESULTS This report presents for the first time liver injury data derived from a prospective, hospital-based and largescale study of 21470 patients who had no liver disease prior to treatment with herbal TCM. Among these, ALT ranged from 1 × to < 5 × upper limit normal(ULN) in 844 patients(3.93%) and suggested mild or moderate liver adaptive abnormalities. However, 26 patients(0.12%) experienced higher ALT values of ≥ 5 × ULN(300.0 ± 172.9 U/L, mean ± SD). Causality for TCM herbs was RUCAM-based probable in 8/26 patients, possible in 16/26, and excluded in 2/26 cases. Bupleuri radix and Scutellariae radix were the two TCM herbs most commonly implicated. CONCLUSION In 26(0.12%) of 21470 patients treated with herbal TCM, liver injury with ALT values of ≥ 5 × ULN was found, which normalized shortly following treatment cessation, also substantiating causality.
文摘Drug induced liver injury is responsible for 50% of acute liver failure in developed countries. Ayurvedic and homeopathic medicine have been linked to liver injury. This case describes the first documented case of Punarnava mandur and Kanchnar guggulu causing drug induced liver injury. Drug induced liver injury may be difficult to diagnosis, but use of multi-modalities tools including the ACG algorithms, causative assessment scales, histological findings, and imaging, is recommended. Advanced imaging, such as magnetic resonance cholangiopancreatography, may possibly have a greater role than previously reported in literature.
文摘Herbal-induced liver injury(HILI)is an important and increasingly concerning cause of liver toxicity,and this study presents recent updates to the literature.An extensive literature review was conducted encompassing September 2019 through March 2021.Studies with clinically significant findings were analyzed and included in this review.We emphasized those studies that provided a causality assessment methodology,such as Roussel Uclaf Causality Assessment Method scores.Our review includes reports of individual herbals,including Garcinia cambogia,green tea extract,kratom as well as classes such as performance enhancing supplements,Traditional Chinese medicine,Ayurvedic medicine and herbal contamination.Newly described herbals include ashwagandha,boldo,skyfruit,and‘Thermo gun’.Several studies discussing data from national registries,including the United States Drug-Induced Liver Injury(DILI)Network,Spanish DILI Registry,and Latin American DILI Network were incorporated.There has also been a continued interest in hepatoprotection,with promising use of herbals to counter hepatotoxicity from anti-tubercular medications.We also elucidated the current legal conversation surrounding use of herbals by presenting updates from the Federal Drug Administration.The highlights of the literature over the past year indicate interest in HILI that will continue as the supplement industry in the United States grows.
基金supported by National Natural Science Foundationof China(No.U1804136)。
文摘Drug-induced liver injury(DILI)is a common and serious adverse drug reaction.At present,DILI is perfectly diagnozed in clinical settings using Roussel Uclaf causality assessment method(RUCAM)in its original version published 1993 and its updated version published 2016,well established worldwide as a diagnostic algorithm with a high sensitivity and specificity.Nevertheless,the search for additional detection methods supporting RUCAM continues.In recent years,with the development of optical imaging technology,fluorescent probes have gradually shown great advantages in the detection and diagnosis of DILI markers such as high sensitivity,anti-interference,real-time monitoring and non-invasive measurement.In this review,the recent advances of fluorescent probes for evaluation of DILI in experimental studies were summarized according to various markers of DILI.We believe that learning about the design and practical application of these probes will contribute to the further development of detection sensors for DILI markers.
基金the support of Yunnan (Kunming) Zhang Wenhong expert workstation (YSZJGZZ-2020051)
文摘Sterculia gum,the dry exudate of Sterculia versicolor and other members of the same genus,is used as a thickener and emulsifier in foods.It is generally considered safe as a food or drug,and its adverse reactions,such as Sterculia-induced liver injury,have never been reported.A 46-year-old woman was admitted to hospital with fatigue,nausea,abdominal distension,jaundice and a>16-fold increase in transaminase and bilirubin level.The patient had used Sterculia gum prior to the onset of her symptoms.Her symptoms and clinical indicators improved after treatment.The possibility of acute viral hepatitis,autoimmune hepatitis,and metabolic liver disease was excluded.After discharge from hospital,the patient had a severe liver injury again when re-exposed to Sterculia gum.And the Roussel Uclaf Causality Assessment Method score was updated from 5 to 7,which was consistent with probable drug-induced liver injury.This is the first report of Sterculia-induced liver injury.Clinicians need to be aware of the potential hepatotoxicity of Sterculia.
文摘Liver injury in Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)is a multifaceted disorder,lacking cohort homogeneity due to a variety of potential causes,including drugs,arsenic and other heavy metals,glyphosate,infections,and ultraviolet radiation.The goals of this review were(1)to analyze the role of diagnostic algorithms in assessing causality for potential culprits involved in the development of liver injury associated with immune-mediated SJS and TEN,which represent immune-based variant disorders within a continuous spectrum.Milder forms are classified as SJS or SJS/TEN overlap,while TEN is known as the most serious form;and(2)to interpret the findings that allow for the characterization of the different types of these disorders.The manuscript is based on an extensive literature search for single case reports,case cohorts,and review articles.Search terms included:Stevens-Johnson Syndrome,Toxic Epidermal Necrolysis,and specific diagnostic algorithms such as the Roussel Uclaf Causality Assessment Method(RUCAM)and the Algorithm of Drug Causality for Epidermal Necrolysis(ALDEN).For the purpose of basic feature description,the uniform term SJS/TEN is used in the current analysis.SJS/TEN presents with five different cohort types:SJS/TEN type(1),which refers to a cohort of SJS/TEN caused by drugs,as assessed by both ALDEN and RUCAM;type(2),representing SJS/TEN due to drugs and assessed by ALDEN only,but not by RUCAM;type(3),which includes a cohort of SJS/TEN caused by drugs,assessed by non-ALDEN and non-RUCAM tools;type(4),which focuses on a cohort of SJS/TEN caused by non-drug culprits,assessed by various tools;and type(5),which considers a cohort of SJS/TEN caused by unknown culprits.Using this new SJS/TEN typology will help better characterize individual features,personalize treatment,and clarify pathogenetic specifics for each of the five disease types.This new SJS/TEN typology provides clarity by replacing issues of inhomogeneity with cohort homogeneity.
基金the Specialized Research Fund of National Traditional Chinese Medicine Clinical Research and Base Construction Project(No.JDZX2015188):The study of the pathogenesis of herb-induced liver injury
文摘Cases of suspected herb-induced liver injury(HILI)caused by herbal Traditional Chinese Medicines(TCMs)and of druginduced liver injury(DILI)are commonly published in the scientific literature worldwide.As opposed to the multiplicity of botanical chemicals in herbal TCM products,which are often mixtures of several herbs,conventional Western drugs contain only a single synthetic chemical.It is therefore of interest to study how HILI by TCM and DILI compare with each other,and to what extent results from each liver injury type can be transferred to the other.China is among the few countries with a large population using synthetic Western drugs as well as herbal TCM.Therefore,China is well suited to studies of liver injury comparing drugs with TCM herbs.Despite some concordance,recent analyses of liver injury cases with verified causality,using the Roussel Uclaf Causality Assessment Method,revealed major differences in HILI caused by TCMs as compared to DILI with respect to the following features:HILI cases are less frequently observed as compared to DILI,have a smaller proportion of females and less unintentional rechallenge events,and present a higher rate of hepatocellular injury features.Since many results were obtained among Chinese residents who had access to and had used Western drugs and TCM herbs,such ethnic homogeneity supports the contention that the observed differences of HILI and DILI in the assessed population are well founded.
