Figure 2.

APAP and liver injury. APAP is metabolized into NAPQI, which covalently binds to proteins and causes hepatocellular damage. Binding of APAP to protein has been found to correlate with APAP-induced liver injury. Damaged cells produce DAMPs, which activate antigen-presenting cells and may increase the risk of IDILI caused by co-administered drugs. Using PD-1^–/– mice and anti-CTLA-4, the inhibitory signal can be blocked, leading to activation of T cells. Damaged hepatocytes can release additional DAMPs that lead to a cascade of events that may potentiate the drug-mediated liver injury.