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Review article: drug‐induced liver injury in the context of nonalcoholic fatty liver disease – a physiopathological and clinical integrated view

Bessone, Fernando, Dirchwolf, Melisa, Rodil, María Agustina, Razori, María Valeria, Roma, Marcelo G.·2018·Alimentary Pharmacology & Therapeutics
DOI 10.1111/apt.14952
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Abstract

Summary: Background: Nonalcoholic fatty disease ( NAFLD ) is the most common liver disease, since it is strongly associated with obesity and metabolic syndrome pandemics. NAFLD may affect drug disposal and has common pathophysiological mechanisms with drug‐induced liver injury ( DILI ); this may predispose to hepatoxicity induced by certain drugs that share these pathophysiological mechanisms. In addition, drugs may trigger fatty liver and inflammation per se by mimicking NAFLD pathophysiological mechanisms. Aims: To provide a comprehensive update on (a) potential mechanisms whereby certain drugs can be more hepatotoxic in NAFLD patients, (b) the steatogenic effects of drugs, and (c) the mechanism involved in drug‐induced steatohepatitis (DISH). Methods: A language‐ and date‐unrestricted Medline literature search was conducted to identify pertinent basic and clinical studies on the topic. Results: Drugs can induce macrovesicular steatosis by mimicking NAFLD pathogenic factors, including insulin resistance and imbalance between fat gain and loss. Other forms of hepatic fat accumulation exist, such as microvesicular steatosis and phospholipidosis, and are mostly associated with acute mitochondrial dysfunction and defective lipophagy, respectively. Drug‐induced mitochondrial dysfunction is also commonly involved in DISH. Patients with pre‐existing NAFLD may be at higher risk of DILI induced by certain drugs, and polypharmacy in obese individuals to treat their comorbidities may be a contributing factor. Conclusions: The relationship between DILI and NAFLD may be reciprocal: drugs can cause NAFLD by acting as steatogenic factors, and pre‐existing NAFLD could be a predisposing condition for certain drugs to cause DILI . Polypharmacy associated with obesity might potentiate the association between this condition and DILI .

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Metadata

Authors
Bessone, F., Dirchwolf, M., Rodil, M. A., Razori, M. V., & Roma, M. G.
Affiliations
  • Hospital Provincial del Centenario Facultad de Ciencias Médicas Servicio de Gastroenterología y Hepatología Universidad Nacional de Rosario Rosario Argentina
  • Unidad de Transplante Hepático Servicio de Hepatología Hospital Privado de Rosario Rosario Argentina
  • Instituto de Fisiología Experimental (IFISE‐CONICET) Facultad de Ciencias Bioquímicas y Farmacéuticas Universidad Nacional de Rosario Rosario Argentina
ORCID
Roma, Marcelo G.
Venue
Alimentary Pharmacology & Therapeutics
Publisher
Wiley
Published
2018-09-07
Volume
48
Issue
9
Pages
892-913
ISSN
  • 0269-2813
  • 1365-2036
DOI
10.1111/apt.14952
Cited by
102
References
19
Language
en
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)

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