Figure 7.

Potential mechanisms for drug-induced hepatic apoptosis. Pathogenesis of drug-induced liver injury (DILI) includes cell stress, mitochondrial impairment, and specific immune reactions. Parent drugs or their reactive metabolites can cause cell stress to produce cytokines, chemokines, ROS, and reactive nitrogen species (RNS). Current concepts emphasize the central role of mitochondria, which leads to apoptotic and/or necrotic cell death. Hepatocytes, Kupffer cells, and even endothelial cells all participate in DILI. Inflammatory mediators of innate immune system determine the outcome of DILI