International Journal of Clinical Case Reports 2024, Vol.14, No.2, 87-93 http://medscipublisher.com/index.php/ijccr 88 1 Types and Mechanisms of Drug Toxicity 1.1 Hepatotoxicity The liver, as one of the largest internal organs in the human body, has critical physiological functions, including drug metabolism and detoxification. However, it is precisely due to its complex and efficient metabolic mechanisms that the liver has become one of the main target organs for many drug induced adverse reactions. Hepatotoxicity refers to the damage caused by drugs or other chemicals to the structure and function of liver tissue, which involves multiple complex molecular and cellular level reactions (Figure 1). Figure 1 Depiction of factors responsible for causing hepatotoxicity upon doxorubicin treatment (Prasanna et al., 2020) This toxicity mechanism involves multiple aspects, including oxidative metabolism and the generation of toxic intermediate metabolites. In the liver, the cytochrome P450 enzyme family mediates the oxidative metabolism of many drugs, and the intermediate metabolites produced may directly damage liver cells. In addition, reactive metabolites generated during drug metabolism may bind to proteins in the liver, forming antigenic complexes that trigger immune responses, leading to damage to liver cells. The disruption of redox balance is also one of the mechanisms leading to hepatotoxicity. Drugs may interfere with redox balance, causing excessive generation of oxygen free radicals or reactive oxygen species, and causing damage to cell structure and function (Ma et al., 2023). Hepatotoxicity also involves complex mechanisms in multiple aspects such as cell apoptosis and necrosis, bile stasis, and immune response. These processes are intertwined to form a complex network, understanding these mechanisms is important for predicting and alleviating the adverse effects of drugs on the liver, as well as developing safer drug treatment plans. 1.2 Cardiovascular toxicity Cardiovascular toxicity refers to the damage caused by drugs or other chemicals to the structure and function of the cardiovascular system, which may involve the heart, blood vessels, and other related tissues. The mechanisms of cardiovascular toxicity are diverse, including direct damage to cardiac cells, impact on electrophysiological processes, leading to vascular damage, and affecting cardiac contractile function. These adverse effects may lead to abnormalities in the structure and function of the cardiovascular system through multiple pathways. Some antibiotics, especially aminoglycosides and quinolones, have been found to be associated with cardiovascular toxicity. This includes some antibiotics that may cause arrhythmia, such as quinine and azithromycin. At the same time, some anti-cancer drugs are also believed to have toxic effects on the heart, such as Xinde Bao and Doxorubicin, which may cause myocardial damage and even lead to heart failure (Zaki et al., 2022).
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