Xenobiotics-induced hepatotoxicity and an influence of HLA typisation

Introduction: The increased reporting of cases of drug-induced liver injuries, reflects the growing number of new agents introduced into clinical practice in the last decades. It should be added to the modernization of industries, and new chemicals which it applied. Drug-induced liver injuries make up a persisting and challenging problem for physicians, health agencies and pharmaceutical firms. Research objectives: The aim of the study is the determination of the most common causes of drug-induced liver injury in our surroundings. We compared the importance of hepatotoxic action of drugs in relation to other noxa in human environment. We determinated the importance of the body sensitivity on the acting agents. We also examined the importance of different drugs in the development of hepatotoxicity, regardless the dose. Materials and methods: We analyzed 52 patients with a diagnosis of hepa-totoxic liver injury (medical history, detailed clinical evaluation of patients, histopathological analysis of the liver, abdominal ultra sound, laboratory determination of standard liver function tests) and followed up for 12 months. In the period from 01.04. 2005 to 01.04.2009, in these patients of the Institute of Gastroenterology and Hepatology, Clinical Center of Serbia in Belgrade, we monitored liver functional tests and morphological findings. We used biological markers relevant for the differential diagnosis, monitoring of disease progression and response to therapy. The results of the patients with hepatotoxic liver injury were compared with the values of the findings of the 52 patients in the control group, with the diagnosis of chronic viral hepatitis, hospitalized in the same institution during the same time. Results: The causes of toxic liver damage in our study were following agents, classified into groups: Industrial toxins (8 patients), Food and beverages (9 pts), Antirheumatics and analgesics (6 pts), Antiarrhythmic drugs (4 pts) Antilipemic (4 pts), Antibiotics (4 pts), Vitamins (3 pts), Antihypertensive drugs (3 pts), Antiplatelet drugs (2 pts), Anticonvulsants (2 pts), Drugs for osteoporosis (2 pts), Antihipertireoidni drugs (1 pt), Oral antidiabetic agents (1 pt), Oral contraceptives (1 pt), Glucocorticoids (1 pt) and Antidepressants (1 pt). We got the results of HLA typing for 29 patients of the 52 patients with hepatotoxic liver injury and for 22 patients of 52 patients with chronic viral hepatitis. Conclusion: The paper points to hepatotoxicity, which is not rare in our population. Structure of xenobiotics causing liver toxicity in our environment is mainly industrial toxins, as well as food and beverages, more than drugs. It would be necessary to examine what are the ingredients of food causing hepatotoxicity. It would be very important to cover the wider population with HLA typing, in order to create a database with the frequency of certain HLA haplotypes in our population for the identification of patients at risk for developing hepatotoxicity