Management and treatment of herb-induced liver injury

Xin SUN; Qiong LUO; Tao YANG; Chenghai. LIU

doi:10.12449/JCH240806

Volume 40 Issue 8

Aug. 2024

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Article Navigation > Journal of Clinical Hepatology > 2024 > 40(8): 1538-1542

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Management and treatment of herb-induced liver injury

DOI: 10.12449/JCH240806

Xin SUN^{1a, 2},
Qiong LUO^1a,
Tao YANG^{1b, 2},
Chenghai. LIU^{1a, 2, 3
,
,
,}

1a.
Institute of Liver Diseases，Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China
1b.
Institute of Cardiovascular Disease，Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China
2.
Shanghai Key Laboratory of Traditional Chinese Clinical Medicine，Shanghai 201203，China
3.
Key Laboratory of Liver and Kidney Diseases，Ministry of Education，Shanghai 201203，China

Research funding:

High-level Key Discipline Construction Project from State Administration of Traditional Chinese Medicine of China (zyyzdxk-2023060);

Shanghai TCM Development Three-Year Action Plan Project (ZY（2018-2020）-CCCX-5001);

Shanghai Science and Technology Innovation Action Plan Medical Innovation Research Special Project (20Z21900100);

Shanghai Key Specialty of Traditional Chinese Clinical Medicine (shslczdzk01201)

Received Date: 2024-06-15
Accepted Date: 2024-07-05
Published Date: 2024-08-25

Abstract

Abstract

Due to the diverse application forms of Chinese herbal medicine products， the wide range of users， and the complex conditions of medication in China， adverse events including herb-induced liver injury （HILI） occur frequently in recent years. In order to further understand HILI and standardize its risk management and prevention and treatment measures， this article discusses the risk management， clinical evaluation， prevention， and treatment of HILI based on related clinical research advances and experience in recent years. In the multiple links of traditional Chinese medicine including production and clinical application after marketing， the establishment of a comprehensive control system is of great importance for the prevention and treatment of HILI and other adverse events， involving product quality control， patient safety education， rational drug use by clinicians， regular monitoring， and graded and classified treatment， which provides a reference for the rational and safe clinical use of Chinese herbal medicine in the future.
- Drugs， Chinese Herbal,
- Chemical and Drug Induced Liver Injury,
- Therapeutics

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肝细胞癌（HCC）是临床常见的恶性肿瘤之一。HCC早期治疗以手术切除为主，但侵袭性HCC的治疗策略目前选择有限，索拉非尼、仑伐替尼及程序性细胞死亡受体1及其配体免疫抑制剂治疗HCC的效果不佳，临床有效率不足30%。因此，亟需进一步探究HCC的发病机制与治疗靶点。随着基因组学研究的发展，对HCC肿瘤生物学的认识逐渐深入，但HCC的泛素化特征尚不明晰。本研究旨在揭示HCC的泛素化特征，并探寻可指导侵袭性HCC临床诊断和治疗的潜在生物标志物。

陆军军医大学第一附属医院（重庆西南医院）谢传明教授、张雷达教授与重庆医科大学侯宇教授等通过对85例HCC患者肿瘤及相邻正常肝组织进行蛋白质组学、磷酸化修饰组学和泛素化修饰组学测序与分析发现，COL4A1、LAMC1和LAMA4在无病生存期较差患者中高表达。磷酸化与泛素化修饰在代谢和转移相关信号通路中存在关联。利用泛素化组学和蛋白质组学数据对HCC进行分子分型，发现具有不同临床特征的3个亚型：S-‍Ⅰ、S-‍Ⅱ和S-Ⅲ。S-‍Ⅰ亚型以代谢相关蛋白高表达为特征，预后最好；S-Ⅲ亚型与增殖/转移信号通路密切相关，预后最差，表现为总生存期最短和复发率最高；而S-‍Ⅱ亚型则介于两者之间。研究发现，生物标志物TUBA1A、BHMT2、BHMT和ACY1的表达表现出不同的泛素化水平，与HCC患者预后不良密切相关，表明靶向这些蛋白质或其泛素化修饰蛋白可能对临床治疗有益。此外，研究证实TUBA1A K370去泛素化可驱动HCC发生与转移，这主要归因于AKT介导的USP14激活。TUBA1A K370去泛素化标志着一类高侵袭性HCC亚型。值得注意的是，靶向AKT-USP14-TUBA1A复合物可促进TUBA1A降解，并在体内阻断HCC发生。

总之，本研究从泛素化组学、磷酸化组学和蛋白质组学角度对HCC进行了全面的整合分析，该研究不仅加深了对HCC中泛素化特征的了解，并为开发新的HCC生物标志物和潜在的治疗靶点提供了依据。

摘译自LIN XT, LUO YD, MAO C, et al. Integrated ubiquitomics characterization of hepatocellular carcinomas[J]. Hepatology, 2024. DOI: 10.1097/HEP.0000000000001096. [Online ahead of print]

(陆军军医大学第一附属医院肝胆外科谢传明报道）

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Management and treatment of herb-induced liver injury

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