Drug-induced liver injury: present and future.

Sept 2012

Suk KT, Kim DJ.

Source

Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.

Abstract

Liver injury due to prescription and nonprescription medications is a growing medical, scientific, and public health problem. Worldwide, the estimated annual incidence rate of drug-induced liver injury (DILI) is 13.9-24.0 per 100,000 inhabitants. DILI is one of the leading causes of acute liver failure in the US. In Korea, the annual extrapolated incidence of cases hospitalized at university hospital is 12/100,000 persons/year. Most cases of DILI are the result of idiosyncratic metabolic responses or unexpected reactions to medication. There is marked geographic variation in relevant agents; antibiotics, anticonvulsants, and psychotropic drugs are the most common offending agents in the West, whereas in Asia, 'herbs' and 'health foods or dietary supplements' are more common. Different medical circumstances also cause discrepancy in definition and classification of DILI between West and Asia. In the concern of causality assessment, the application of the Roussel Uclaf Causality Assessment Method (RUCAM) scale frequently undercounts the cases caused by 'herbs' due to a lack of previous information and incompatible time criteria. Therefore, a more objective and reproducible tool that could be used for the diagnosis of DILI caused by 'herbs' is needed in Asia. In addition, a reporting system similar to the Drug-Induced Liver Injury Network (DILIN) in the US should be established as soon as possible in Asia.

PubMed

New method gives access to treasure trove of potential new antibiotics

New method gives access to treasure trove of potential new antibiotics

Scientists are reporting use of a new technology for sifting through the world's largest remaining pool of potential antibiotics to discover two new antibiotics that work against deadly resistant microbes, including the "super bugs" known as MRSA. Their report appears in the Journal of the American Chemical Society.

Sean Brady and colleagues explain that an urgent need exists for new medications to cope with microbes that shrug off the most powerful traditional antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) infections, for instance, are resistant to most known antibiotics. MRSA strikes at least 280,000 people in the U.S. alone every year, and almost 20,000 of those patients die. The typical way of discovering new antibiotics involves identifying and growing new bacteria from soil and other environmental samples in culture dishes in the laboratory. That environmental treasure-trove is the largest remaining potential source of new antibiotics. Researchers then analyse the bacteria to see if they make substances that could be used as antibiotics to kill other microbes. But most bacteria found in nature can't grow in the laboratory. That's why Brady and colleagues took a new approach to this problem.

The researchers removed DNA from soil bacteria that wouldn't grow in the lab. Then, they put this DNA into different bacteria that do grow well in culture dishes, and these bacteria acted like incubators for the new DNA. The approach enabled Brady's team to study the substances made by the soil bacteria's DNA in the lab. With this "metagenomics" method, they identified two new possible antibiotics called fasamycin A and fasamycin B that killed MRSA and vancomycin-resistant Enterococcus faecalis, which also is becoming more resistant to known antibiotics. They also determined how the new antibiotics work. "Metagenomics has the potential to access large numbers of previously inaccessible natural antibiotics," say the researchers.

Virtual Medicine