Drug-induced hepatic sinusoidal obstruction syndrome: current advances and future perspectives

Area of Science:

• Hepatology
• Toxicology
• Pharmacology

Background:

• Hepatic sinusoidal obstruction syndrome (HSOS) is a rare drug-induced liver injury (DILI).
• Knowledge from hematopoietic stem cell transplantation (HSCT)-associated HSOS has limited applicability to drug-induced HSOS due to different causes.
• Primary causes include pyrrolizidine alkaloid (PA)-containing plants, chemotherapy, and immunosuppressive drugs.

Purpose of the Study:

• To review the key aspects of drug-induced HSOS.
• To summarize etiologies, pathogenesis, clinical features, diagnosis, severity assessment, and treatment options.

Main Methods:

• Literature review of drug-induced HSOS.
• Summary of current understanding of pathological mechanisms.
• Analysis of diagnostic imaging modalities.

Main Results:

• Identified primary etiologies: PA-containing plants, chemotherapy, immunosuppressants.
• Highlighted the role of noninvasive imaging (ultrasound, CT, MRI) in diagnosis.
• Noted that pathogenesis is not fully understood and standardized grading/treatment are lacking.

Conclusions:

• Drug-induced HSOS requires further research for standardized severity grading and optimized treatment strategies.
• Understanding distinct etiologies is crucial for managing this rare DILI.