Drug-induced liver injury from antibiotics can occur through several mechanisms: Direct hepatotoxicity dose-dependent cellular damage (rare with modern antibiotics) Idiosyncratic reactions unpredictable, immune-mediated responses unrelated to dose Metabolic idiosyncrasy genetic variations in drug-metabolising enzymes creating toxic intermediates Mitochondrial dysfunction interference with liver cell energy production Bile salt export pump inhibition causing cholestasis and bile acid accumulation The majority of antibiotic-related liver injury is idiosyncratic , meaning it cannot be predicted by dose or duration and likely involves complex interactions between drug metabolism, immune response, and individual genetic susceptibility
More importantly, accumulating evidence has established that c-Myc can modulate miRNA transcription by directly binding to their promoter regions [42,43,44,45,46,47]
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