Case report: Kinetics of human leukocyte antigen receptor HLA-DR during liver injury induced by potassium para-aminobenzoate as assessed for causality using the updated RUCAM
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Clinical, biochemical, and serological features as well as searched for non-drug-related causes are investigated, and the updated Roussel Uclaf Causality Assessment Method (RUCAM) is applied confirming a highly probable causality of POTABA-induced liver injury.Abstract:
Potassium para-aminobenzoate (POTABA) is used to treat Peyronie’s disease by decreasing fibrosis and plaque size progression. Among potential side effects, drug-induced liver injury (DILI) attributed to POTABA administration has been reported in a few cases and inferred to immune hypersensitivity. In the present case, we investigated clinical, biochemical, and serological features as well as searched for non-drug-related causes, and applied the updated Roussel Uclaf Causality Assessment Method (RUCAM) confirming a highly probable causality of POTABA-induced liver injury. Moreover, we here observed specific activated CD3+ T lymphocytes during the acute phase of liver injury by monitoring of human leukocyte antigen receptor (HLA-DR) expression. Furthermore, improvement of biochemical markers of liver injury after POTABA withdrawal was associated with a rapid decline of CD3+ HLA-DR+ immune cells. In contrast, CD14+ monocytes expressing HLA-DR remained stable during recovery from liver injury. These observations implicate a specific involvement of activated T lymphocytes in liver injury mediated by POTABA. Clinicians should be aware of POTABA-induced liver injury, and measurement of activated immune cells by assessment of HLA-DR could provide pathomechanistic insights enabling biomonitoring of recovery from DILI.read more
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Journal ArticleDOI
Treatment of Drug-Induced Liver Injury
TL;DR: In this article , the authors evaluated pharmacotherapy options of drug-induced liver injury (DILI) and concluded that stopping the offending drug is still the first line of therapy for most instances of acute DILI, while various therapies are applied empirically and not based on good data from randomized controlled trials.
Journal ArticleDOI
Advances in Idiosyncratic Drug-Induced Liver Injury Issues: New Clinical and Mechanistic Analysis Due to Roussel Uclaf Causality Assessment Method Use
Rolf Teschke,Gaby Danan +1 more
TL;DR: In this article , the Roussel Uclaf Causality Assessment Method (RUCAM) was used to diagnose idiosyncratic drug-induced liver injury (iDILI) cases.
References
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Journal ArticleDOI
Causality assessment of adverse reactions to drugs--I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries.
Gaby Danan,Christian Bénichou +1 more
TL;DR: In this paper, a new method for drug causality assessment is described and applied to reports of acute liver injuries, using reports with positive rechallenge as external standard.
Journal ArticleDOI
Causality assessment of adverse reactions to drugs--II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge.
TL;DR: It is concluded that adverse drug reaction reports with a positive rechallenge can provide a standard for validation of causality assessment methods, and RUCAM applied to drug-induced liver injuries has been validated.
Journal ArticleDOI
RUCAM in drug and herb induced liver injury: The update
Gaby Danan,Rolf Teschke +1 more
TL;DR: The update of the well accepted original RUCAM scale is presented and its use for clinical, regulatory, publication, and expert purposes to validly establish causality in cases of suspected DILI and HILI is recommended, facilitating a straightforward application and an internationally harmonized approach of causality assessment as a common basic tool.
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Antigen presentation: comments on its regulation and mechanism.
Journal ArticleDOI
Acute Hepatitis E Infection Accounts for Some Cases of Suspected Drug-Induced Liver Injury
Timothy Davern,Naga Chalasani,Robert J. Fontana,Paul H. Hayashi,Petr Protiva,David E. Kleiner,Ronald E. Engle,Hanh Nguyen,Suzanne U. Emerson,Robert H. Purcell,Hans L. Tillmann,Jiezhun Gu,Jose Serrano,Jay H. Hoofnagle +13 more
TL;DR: HEV infection contributes to a small but important proportion of cases of acute liver injury that are suspected to be drug induced, andSerologic testing for HEV infection should be performed, particularly if clinical features are compatible with acute viral hepatitis.