Idiosyncratic Drug-Induced Liver Injury (IDILI): Potential Mechanisms and Predictive Assays

Figure 1

Simplified mechanisms of drug metabolism in liver cells with potential pathways towards toxicity. Abbreviations are used as follows: Na⁺-taurocholate cotransporting polypeptide (NTCP), organic cation transporter (OCT), organic anion transporting polypeptide (OATP), bile salt export pump (BSEP), breast cancer resistance protein (BCRP), multidrug resistance protein (MDR), multidrug resistance-associated protein (MRP), cytochrome P450 (CYP), flavin-containing monooxygenase (FMO), monoamine oxidase (MAO), UDP-glucuronosyltransferases (UGT), sulfotransferase (SULT), glutathione S-transferase (GST), N-acetyl transferase (NAT), reactive oxygen species (ROS), reactive nitrogen species (RNS), nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), nuclear factor erythroid 2-related factor 2 (Nrf2), glutathione (GSH), superoxide dismutase (SOD), glutathione peroxidase (GPx), mitochondrial pore transition (MPT), mitochondrial DNA (mtDNA), receptor-interacting serine/threonine protein kinase (RIPK), phosphoglycerate mutase (PGAM), c-Jun N-terminal kinase (JNK), B-cell lymphoma 2 (Bcl2), antigen-presenting cell (APC), and Kupffer cell (KC) [12].