Drug-Induced Liver Injury - Types and Phenotypes

Enhanced hepatic exposure and toxicity from concurrent administration of coumarin and bakuchiol in psoralea corylifolia L. under LPS-induced immune stress

ETHNOPHARMACOLOGICAL RELEVANCE

Psoralea corylifolia L., known as "Bu Gu Zhi" in traditional Chinese medicine, is widely used for its antioxidant and anti-inflammatory properties. It is traditionally employed to treat conditions such as vitiligo, osteoporosis, and various skin diseases. Despite its therapeutic benefits, there are safety concerns due to reports of liver injury associated with its use, especially under conditions of immune stress.

AIM OF THE STUDY

This study aimed to investigate the hepatotoxic effects of coumarin and bakuchiol-the key bioactive components of Psoralea corylifolia L.-under lipopolysaccharide (LPS)-induced immune stress in mice.

MATERIALS AND METHODS

Mouse models were used to evaluate liver injury. coumarin (139.91 mg/kg), bakuchiol (280.00 mg/kg), and LPS (6.00 mg/kg) were administered individually and in combination. Liver toxicity was assessed through histopathological examinations and liver enzyme assays. Transcriptomic analyses were performed to identify dysregulated genes and pathways. Pharmacokinetic studies measured hepatic exposure, and molecular dynamics simulations examined intermolecular interactions between the compounds.

RESULTS

While coumarin and bakuchiol alone did not induce significant liver toxicity at the administered doses, their concurrent administration under immune stress significantly exacerbated liver injury. This was evidenced by pronounced histopathological changes and elevated liver enzyme levels. Transcriptomic analysis revealed dysregulation of genes related to inflammation, oxidative stress, and metabolic processes, with significant overlap in affected pathways, suggesting shared mechanisms underlying the enhanced liver injury. Pharmacokinetic studies demonstrated increased hepatic exposure during co-administration, with coumarin enhancing the solubility and absorption of bakuchiol. Molecular dynamics simulations supported these findings by illustrating enhanced intermolecular interactions between the two compounds.

CONCLUSIONS

The study demonstrates that co-administration of coumarin and bakuchiol under immune stress conditions exacerbates hepatotoxicity, highlighting potential risks associated with the use of Psoralea corylifolia L. in individuals with underlying inflammation. These findings emphasize the need for cautious therapeutic use and consideration of immune status when prescribing this traditional medicine, as well as the development of safer combination strategies.

Super-Resolution Mitochondrial Fluorescent Probe for Accurate Monitoring of Drug-Induced Liver Injury

Drug-induced liver injury (DILI) has emerged as an urgent clinical challenge. It is characterized by mitochondrial dysfunction in liver cells, which leads to abnormal changes in H2O2 levels within the mitochondria. Super-resolution imaging allows for the observation of the fine structure of mitochondria at the nanometer scale, potentially enabling the detection of mitochondrial H2O2 levels during DILI at the subcellular organelle level. Here, we report the design and synthesis of a novel H2O2-activated probe for the detection of mitochondrial H2O2 levels. SML is a near-infrared (NIR) fluorescent probe with a large Stokes shift (260 nm) and a sensing mechanism based on intramolecular charge transfer (ICT) switching. Super-resolution imaging of mitochondrial H2O2 was conducted using structured illumination microscopy (SIM). The improved accuracy in observing periods of mitochondrial dysfunction allows the SML probe to be effectively utilized for the rapid monitoring nanoscale upregulation of H2O2 during DILI and hepatic fibrosis, thus providing SML with the capability to screen for effective therapeutic candidates.

Primary sclerosing cholangitis in children with inflammatory bowel disease: An ESPGHAN position paper from the Hepatology Committee and the IBD Porto group

OBJECTIVE

We aimed to provide an evidence-supported approach to diagnose, monitor, and treat children with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC).

METHODS

The core group formulated seven PICO-structured clinical questions. A systematic literature search from inception to December 2022 was conducted by a medical librarian using MEDLINE and EMBASE. Core messages from the literature were phrased as position statements and then circulated to a sounding board composed of international experts in pediatric gastroenterology and hepatology, histopathology, adult gastroenterology and hepatology, radiology, and surgery. Statements reaching at least 80% agreement were considered as final. The other statements were refined and then subjected to a second online vote or rejection.

RESULTS

Regular screening for gamma-glutamyltransferase (GGT) is essential for detecting possible biliary disease in children with IBD. MR cholangiopancreatography is the radiological modality of choice for establishing the diagnosis of PSC. Liver biopsy is relevant in the evaluation of small duct PSC or autoimmune hepatitis. Children who do not have known IBD at the time of PSC diagnosis should undergo initial screening with fecal calprotectin for asymptomatic colitis, and then at least once yearly thereafter. Children with a cholestatic liver enzyme profile can be considered for treatment with ursodeoxycholic acid and can continue if there is a meaningful reduction or normalization in GGT. Oral vancomycin may have a beneficial effect on GGT and intestinal inflammation, but judicious use is recommended due to the lack of long-term studies. Children with PSC-IBD combined with convincing features of autoimmune hepatitis may benefit from corticosteroids and antimetabolites.

CONCLUSIONS

We present state-of-the-art guidance on the diagnostic criteria, follow-up strategies, and therapeutic strategies and point out research gaps in children and adolescents with PSC-IBD.

Advances in liver organoids: replicating hepatic complexity for toxicity assessment and disease modeling

The lack of in vivo accurate human liver models hinders the investigation of liver-related diseases, injuries, and drug-related toxicity, posing challenges for both basic research and clinical applications. Traditional cellular and animal models, while widely used, have significant limitations in replicating the liver's complex responses to various stressors. Liver organoids derived from human pluripotent stem cells, adult stem cells primary cells, or tissues can mimic diverse liver cell types, major physiological functions, and architectural features. Recent advancements in the field have shown that some liver organoids have sufficient accuracy to replicate specific aspects of the human liver's complexity. This review highlights recent progress in liver organoid research, with a particular emphasis on their potential for toxicity assessment and disease modeling. The intrinsic advantages of liver organoids include higher sensitivity and suitability for long-term studies, which enhance the predictive value in drug and nanomaterial toxicity testing. The integration of liver organoids with microfluidic devices enables the simulation of the liver microenvironment and facilitates high-throughput drug screening. The liver organoids also serve as ideal platforms for studying liver diseases such as hepatitis, liver fibrosis, viral liver diseases, and monogenic diseases. Additionally, this review discusses the advantages and limitations of liver organoids along with potential avenues for future research.

Cholestasis Linked to Bodybuilding Supplements: Exploring the Risks of Contamination

Drug-induced liver injury resulting from herbal and dietary supplement use is increasingly common and underrecognized. We report a case of a 34-year-old male recreational bodybuilder who presented with muscle cramping, fatigue, and diffuse itching in the setting of bodybuilding supplement use. Labs showed cholestatic liver injury, and liver biopsy revealed bland cholestasis and sinusoidal dilation. He was diagnosed with anabolic-androgenic steroid-induced liver injury. He was symptomatically managed with plasmapheresis for debilitating pruritus. This case highlights drug-induced liver injury as a complication of bodybuilding supplement use containing unlabeled anabolic-androgenic steroids. Sports medicine providers should inquire on herbal and dietary supplement use and be aware of potential contaminants.

Substantial Elevation of Liver Enzymes During Ketamine Infusion: A Case Report

Intravenous infusion of a subanesthetic dose of ketamine has been shown to improve neuropathic pain. However, ketamine-induced liver injury can occur. Reported here are 2 cases with substantial liver enzyme elevations less than 2 days after initiation of repeat ketamine infusion at least 7 months after the last infusion. Although their liver enzymes normalized within a few weeks, it is unclear what the long-term consequences are. Furthermore, drug-induced liver injury can cause acute liver failure. Therefore, we recommend close monitoring of liver enzymes every 1 to 2 days during ketamine infusions.