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Updated: Mar 14, 2026

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Isoniazid metabolism and hepatotoxicity
Pengcheng Wang1, Komal Pradhan1, Xiao-Bo Zhong2
1Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Isoniazid (INH) effectively treats tuberculosis but can cause liver injury. This review explores how INH metabolism contributes to liver damage, aiding in understanding and preventing adverse effects.
Area of Science:
- Pharmacology
- Hepatology
- Infectious Diseases
Background:
- Tuberculosis (TB) treatment relies heavily on Isoniazid (INH), a cornerstone medication.
- INH, despite its efficacy, is associated with a significant risk of drug-induced liver injury (DILI), ranging from mild elevations in liver enzymes to acute liver failure.
- The precise mechanisms underlying INH-induced liver injury (HILI) are not fully elucidated but are strongly suspected to involve its metabolic pathways.
Approach:
- This review systematically examines the known metabolic pathways of Isoniazid.
- It critically analyzes the scientific literature linking specific INH metabolites and metabolic intermediates to the pathogenesis of liver injury.
- The review synthesizes current understanding of how variations in INH metabolism may predispose individuals to HILI.
Key Points:
- Isoniazid undergoes complex metabolism involving acetylation, hydrolysis, and oxidation.
- Key metabolites such as isoniazid acetylhydrazide and acetylisonicotinic acid have been implicated in hepatotoxicity.
- Reactive intermediates generated during INH metabolism can lead to oxidative stress and hepatocellular damage.
Conclusions:
- Understanding INH metabolic pathways is crucial for predicting and mitigating the risk of liver injury.
- Further research into INH metabolism may identify biomarkers for HILI susceptibility.
- Strategies targeting INH metabolism could enhance the safety profile of tuberculosis treatment.
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