Review on clinical diagnosis, pathogenesis and therapeutic strategies of drug-induced liver injury

Drug-induced liver injury (DILI) is a severe adverse reaction caused by various drugs and their metabolites, with complex clinical manifestations, and severe cases may progress to acute liver failure (ALF) or even death. Currently, the pathogenesis of DILI has not been fully elucidated, and specific diagnostic indicators and effective therapeutic strategies are lacking, so it is crucial to deeply analyze its pathogenesis and develop precise intervention strategies. This review explores key pathogenic mechanisms in the development of DILI, with a focus on mitochondrial dysfunction, ferroptosis, immune responses and the gut-liver axis. It further systematically summarizes the clinical diagnostic approaches for DILI, including common diagnostic methods and potential biomarkers. Additionally, the review discusses therapeutic strategies for DILI, encompassing western medical treatments, ethnomedical treatments and non-pharmacological treatments. Although N-acetylcysteine (NAC) remains the FDA-approved standard treatment for acetaminophen (APAP) overdose, superior therapeutic options for DILI need to be explored urgently due to its therapeutic limitations and side effects. In the future, the prevention and treatment strategy of DILI will rely on deeper mechanistic investigations, development of novel biomarkers, and further exploration of multi-targeted traditional Chinese medicine (TCM) therapies.