Precision treatment and frontier advances of glycyrrhizin preparations in drug-induced liver injury (DILI)

Abstract

Drug-induced liver injury (DILI) is an important drug-induced disease in clinical practice, with a complex pathogenesis and challenges in diagnosis and treatment. Glycyrrhizin preparations are a class of hepatoprotective agents derived from the traditional Chinese medicinal plant Glycyrrhiza uralensis, and have shown significant efficacy in the treatment of DILI due to their multi-target and multi-pathway pharmacological effects. Currently, they have been recommended as core therapeutic drugs for DILI in multiple domestic and international guidelines. This review delves into the advanced evidence-based medical evidence for the treatment of DILI with glycyrrhizin preparations and their recommended status in various guidelines. It also systematically expounds the precise treatment strategies of glycyrrhizin preparations based on DILI classification, severity, and special populations, and elaborately analyzes their cutting-edge mechanisms of action such as regulation of the gut-liver axis and epigenetic modifications. It discusses the challenges in clinical application, such as adverse reactions and predictive markers of efficacy, and their optimization solutions, and looks forward to future research directions. This article aims to promote the precise application of glycyrrhizin preparations in the treatment of DILI, providing practical diagnostic and therapeutic references for clinicians.