Figure 3. Proposed role of abberant immunity in DILI pathogenesis.

Drugs are small molecules capable of binding to serum proteins under normal physiological circumstances for transport, metabolism, and elimination. In most instances, a drug-protein conjugate will not illicit a host immune response. However, a minority of individuals with specific class II HLA alleles that are ubiquitously expressed may be uniquely predisposed to have the native drug-protein or drug metabolite-protein conjugate activate an antigen presenting cell such as a dendritic cell or macrophage. The processing and handling of drug- protein conjugates in these individuals can then inadvertently activate T-Cell receptors which may proliferate and mediate end-organ damage.