Figure 3. The pathogenesis of chemical liver injury is controlled by genetic, environmental, patho-physiological and dietary factors.

Other factors such as gender, race, age and lifestyle choices can be risk factors for certain forms of chemical liver injury. The interplay between these factors controls gene transcription and cell signalling events, leading to a myriad of interconnected outcomes such as imbalances between detoxification and toxification metabolic pathways, impaired organelle function, compromised ability to repair molecular damage and alterations in overall cellular homeostasis. With prominent shifts in normal cellular homeostasis, the ability of compensatory and adaptive responses to correct the detrimental effects of toxicants can be hampered. Similarly, repair mechanisms can be overwhelmed and incapable of correcting the cellular chemical injury. Green arrows indicate pathways leading to cell recovery; red arrows show pathways to cell damage or death; black arrows indicate pathways that contribute to chemical-induced liver injury.