The role of quantitative systems pharmacology modeling in the prediction and explanation of idiosyncratic drug-induced liver injury

• Published in: Drug metabolism and pharmacokinetics Vol. 32; no. 1; pp. 40 - 45
• Main Authors: Woodhead, Jeffrey L., Watkins, Paul B., Howell, Brett A., Siler, Scott Q., Shoda, Lisl K.M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2017
• Subjects: Adaptive immune system; Animals; Benzazepines - adverse effects; Benzazepines - immunology; Benzazepines - therapeutic use; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - immunology; Chromans - adverse effects; Chromans - immunology; Chromans - therapeutic use; Computer modeling; Drug-Related Side Effects and Adverse Reactions; Humans; Idiosyncratic DILI; Liver injury; Models, Biological; Quantitative systems pharmacology; Thiazolidinediones - adverse effects; Thiazolidinediones - immunology; Thiazolidinediones - therapeutic use; Adaptive immune system; Idiosyncratic DILI; Quantitative systems pharmacology; Computer modeling; Liver injury
• ISSN: 1347-4367; 1880-0920
• DOI: 10.1016/j.dmpk.2016.11.008

Idiosyncratic drug-induced liver injury (iDILI) is a serious concern in drug development. The rarity and multifactorial nature of iDILI makes it difficult to predict and explain. Recently, human leukocyte antigen (HLA) allele associations have provided strong support for a role of an adaptive immune response in the pathogenesis of many iDILI cases; however, it is likely that an adaptive immune attack requires several preceding events. Quantitative systems pharmacology (QSP), an in silico modeling technique that leverages known physiology and the results of in vitro experiments in order to make predictions about how drugs affect biological processes, is proposed as a potentially useful tool for predicting and explaining critical events that likely precede immune-mediated iDILI, as well as the immune attack itself. DILIsym, a QSP platform for drug-induced liver injury, has demonstrated success in predicting the presence of delayed hepatocellular stress events that likely precede the iDILI cascade, and has successfully predicted hepatocellular stress likely underlying iDILI attributed to troglitazone and tolvaptan. The incorporation of a model of the adaptive immune system into DILIsym would represent and important advance. In summary, QSP methods can play a key role in the future prediction and understanding of both immune-mediated and non-immune-mediated iDILI.
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