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Updated: Mar 10, 2026

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Drug-Induced Liver Injury
Leslie A Hamilton1, Angela Collins-Yoder1, Rachel E Collins1
1Leslie Hamilton is Associate Professor of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee. Angela Collins-Yoder is Clinical Professor, Capstone College of Nursing, and Critical Care Nurse Specialist, Sacred Heart Pensacola Hospital, 8370 Foxtail Loop, Pensacola, FL 32526 (acollins-yoder@ua.edu). Rachel E. Collins is a PharmD candidate, Auburn University Harrison School of Pharmacy, Auburn, Alabama.
Drug-induced liver injury (DILI) has both predictable (intrinsic) and unpredictable (idiosyncratic) causes from medications and supplements. Identifying patient risk factors and understanding DILI mechanisms are crucial for effective management and future research.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Toxicology
Background:
- Drug-induced liver injury (DILI) presents significant clinical challenges, arising from both intrinsic and idiosyncratic mechanisms.
- A wide array of medications, alongside herbal and dietary supplements, are implicated in DILI.
- Understanding the multifactorial nature of DILI is essential for patient care and risk assessment.
Purpose of the Study:
- To provide a comprehensive overview of the clinical impact of DILI.
- To discuss the risk factors and mechanisms associated with idiosyncratic DILI (IDILI).
- To highlight treatment strategies and future research directions in DILI.
Main Methods:
- Review of clinical literature on DILI.
- Discussion of specific drug classes and supplements associated with DILI.
- Analysis of mechanisms and risk factors for IDILI.
Main Results:
- IDILI is influenced by host, environmental, and compound factors, with common triggers in critical care including antibiotics, antiepileptics, and statins.
- IDILI mechanisms vary, leading to cholestatic, hepatocellular, or mixed liver damage.
- Acetaminophen-induced DILI is intrinsic and dose-dependent, with established treatments like N-acetylcysteine.
Conclusions:
- Discontinuation of the causative agent is the primary treatment for IDILI.
- Further research is needed to identify mitochondrial stress biomarkers and high-risk patient populations for DILI.
- A thorough understanding of DILI is critical for improving patient outcomes and developing targeted interventions.
Related Concept Videos
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
Drug Toxicity: Overview
Drug toxicity: Idiosyncratic Reactions
Drug Toxicity: Dose-Dependent Reactions
Drug toxicity: Drug–Drug Interaction

