A Severe Case of Drug-Induced Liver Injury after Gemcitabine Administration: A Highly Probable Causality Grading as Assessed by the Updated RUCAM Diagnostic Scoring System

Histological Effect of Gemcitabine on the Liver and Kidney of Male Rat with and without Melatonin

Background: the aim of this study is to identify the toxic effect of gemcitabine on the kidney and liver tissues of rat and whether melatonin has any protective effect on these tissues. MATERIALS AND METHODS: 32 adults male Wistar rats were selected and divided into four groups. Group A was the control group that received normal saline. Group B received gemcitabine alone in a dose of 25mg/kg body weight intraperitoneally once per week for four successive weeks. Group C received gemcitabine intraperitoneally in a dose of 25mg/ kg and melatonin orally in a dose of 10mg/kg once per week for four successive weeks. Group D received only melatonin 10mg/kg once per week for four weeks. RESULTS: The histological changes of liver of group B showed disorganization of hepatic tissue with congestion in the portal area and chronic inflammatory cells infiltration in the periportal area. Nuclei of some hepatocytes were vesicular with steatosis. In group C liver sections showed inflammatory cell infiltration with mild pyknosis of some hepatocytes. Liver sections of group D were limited to degeneration of some hepatocyte. Renal sections of group B showed degeneration and necrosis of epithelial cells with thickening of blood vessel wall, congestion and thrombus formation with cystic appearance in the interstitial tissue were detected. While in group C the histological sections showed swelling of epithelial cells lining renal tubules with congestion of blood vessels. Renal sections of group D were more or less normal. CONCLUSION:   the present study concluded that gemcitabine induced toxic effect on liver and kidney of male rats and melatonin may play protective effect on the tissue of these organs. Key wards: gemcitabine, melatonin, liver, kidney, rat

Drug-Induced Liver Injury: Highlights and Controversies in the Recent Literature

Drug-induced liver injury (DILI) remains an important, yet challenging diagnosis for physicians. Each year, additional drugs are implicated in DILI and this year was no different, with more than 1400 articles published on the subject. This review examines some of the most significant highlights and controversies in DILI-related research over the past year and their implications for clinical practice. Several new drugs were approved by the US Food and Drug Administration including a number of drugs implicated in causing DILI, particularly among the chemotherapeutic classes. The COVID-19 pandemic was also a major focus of attention in 2020 and we discuss some of the notable aspects of COVID-19-related liver injury and its implications for diagnosing DILI. Updates in diagnostic and causality assessments related to DILI such as the Roussel Uclaf Causality Assessment Method are included, mindful that there is still no single biomarker or diagnostic tool to unequivocally diagnose DILI. Glutamate dehydrogenase received renewed attention as being more specific than alanine aminotransferase. There were a few new reports of previously unrecognized hepatotoxins, including immune modulators and novel gene therapy drugs that we highlight. Updates and new developments of previously described hepatotoxins, such as immune checkpoint inhibitors and anti-tuberculosis drugs are reviewed. Finally, novel technologies such as organoid culture systems to better predict DILI preclinically may be coming of age and determinants of hepatocyte loss, such as calculating P_ALT are poised to improve our current means of estimating DILI severity and the risk of acute liver failure.