title: Enhancing the utility of alanine aminotransferase as a reference standard biomarker for drug-induced liver injury.
abstract: Drug-induced liver injury (DILI) is the most frequent cause of discontinuation of new chemical entities during development. DILI can either be intrinsic/predictable or an idiosyncratic type. These two forms of DILI are contrasted in their manifestation and diagnosis. Even with regulatory guidance (FDA, 2009), there is still a gap in our ability to identify predictable DILI, both specifically and sensitively. Alanine aminotransferase (ALT) is the principal reference standard biomarker to diagnose DILI, yet its current application in preclinical to clinical translation for decision-making purposes has imperfections: (1) analytical ALT assay uniformity across industry would be aided by common analytical processes; (2) assessment of ALT toxicological performance in a large preclinical analysis would help to establish a true threshold of elevation for predictable DILI and improve translational use across various stages of pharmaceutical development and finally, (3) clinical evaluation of ALT elevations prospectively and retrospectively is recommended to define and manage variations in clinical study subjects including rising body mass index (BMI) range and ALT upper limit of normal (ULN) in the broader population over time. The emergence of new hepatotoxicity biomarkers necessitates a parallel and equivalent assessment to the aminotransferases in a regulatory qualification model.
authors.affiliation: Pfizer Global Research and Development, Pharmacokinetics, Dynamics, and Metabolism, 700 Chesterfield Parkway West, T2A, Chesterfield, MO 63017, USA. josef.ozer@pfizer.com
authors.forename: Josef S
authors.initials: JS
authors.lastname: Ozer
authors.forename: Raj
authors.initials: R
authors.lastname: Chetty
authors.forename: Gerry
authors.initials: G
authors.lastname: Kenna
authors.forename: Joe
authors.initials: J
authors.lastname: Palandra
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Anne
authors.initials: A
authors.lastname: Lanevschi
authors.forename: Nandan
authors.initials: N
authors.lastname: Koppiker
authors.forename: Bernard E
authors.initials: BE
authors.lastname: Souberbielle
authors.forename: Shashi K
authors.initials: SK
authors.lastname: Ramaiah
mesh_terms: D000410:Alanine Transaminase / Q000378:metabolism / Q000592:standards*; D015415:Biomarkers / Q000378:metabolism; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000201:enzymology; D006801:Humans; D012015:Reference Standards
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase