{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T23:12:43Z","timestamp":1789081963364,"version":"build-2803163510"},"reference-count":85,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Approximately 30 million people worldwide consume new psychoactive substances (NPS), creating a serious public health issue due to their toxicity and potency. Drug-induced liver injury is the leading cause of liver disease, responsible for 4% of global deaths each year.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Content<\/jats:title>\n                  <jats:p>A systematic literature search revealed 64 case reports, in vitro and in vivo studies on NPS hepatotoxicity. Maximum elevated concentrations of aspartate aminotransferase (136 to 15 632\u2005U\/L), alanine transaminase (121.5 to 9162\u2005U\/L), total bilirubin (0.7 to 702\u2005mg\/dL; 0.04 to 39.03\u2005mmol\/L), direct (0.2\u201315.1\u2005mg\/dL; 0.01\u20130.84\u2005mmol\/L) and indirect (5.3\u2005mg\/dL; 0.29\u2005mmol\/L) bilirubin, alkaline phosphatase (79\u2013260\u2005U\/L), and gamma-glutamyltransferase (260\u2005U\/L) were observed as biochemical markers of liver damage, with acute and fulminant liver failure the major toxic effects described in the NPS case reports. In vitro laboratory studies and subsequent in vivo NPS exposure studies on rats and mice provide data on potential mechanisms of toxicity. Oxidative stress, plasma membrane stability, and cellular energy changes led to apoptosis and cell death. Experimental studies of human liver microsome incubation with synthetic NPS, with and without specific cytochrome P450 inhibitors, highlighted specific enzyme inhibitions and potential drug\u2013drug interactions leading to hepatotoxicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>Mild to severe hepatotoxic effects following synthetic NPS exposure were described in case reports. In diagnosing the etiology of liver damage, synthetic NPS exposure should be considered as part of the differential diagnosis. Identification of NPS toxicity is important for educating patients on the dangers of NPS consumption and to suggest promising treatments for observed hepatotoxicity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/clinchem\/hvad210","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T21:13:06Z","timestamp":1709327586000},"page":"597-628","source":"Crossref","is-referenced-by-count":7,"title":["Exposure to Synthetic Psychoactive Substances: A Potential Cause for Increased Human Hepatotoxicity Markers"],"prefix":"10.1093","volume":"70","author":[{"given":"Aurora","family":"Balloni","sequence":"first","affiliation":[{"name":"Department of Excellence-Biomedical Sciences and Public Health, Section of Legal Medicine, Universit\u00e0 Politecnica delle Marche , Ancona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasio","family":"Tini","sequence":"additional","affiliation":[{"name":"Department of Excellence-Biomedical Sciences and Public Health, Section of Legal Medicine, Universit\u00e0 Politecnica delle Marche , Ancona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Prospero","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine, and Public Health, Universit\u00e0 Politecnica delle Marche , Ancona , Italy"},{"name":"School of Nursing Science, Universit\u00e0 Politecnica delle Marche , Ancona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Paolo","family":"Busard\u00f2","sequence":"additional","affiliation":[{"name":"Department of Excellence-Biomedical Sciences and Public Health, Section of Legal Medicine, Universit\u00e0 Politecnica delle Marche , Ancona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2137-4645","authenticated-orcid":false,"given":"Marilyn Ann","family":"Huestis","sequence":"additional","affiliation":[{"name":"Institute of Emerging Health Professions, Thomas Jefferson University , Philadelphia, PA , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo Fabrizio","family":"Lo Faro","sequence":"additional","affiliation":[{"name":"Department of Excellence-Biomedical Sciences and Public Health, Section of Legal Medicine, Universit\u00e0 Politecnica delle Marche , Ancona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"key":"2024040223561890700_hvad210-B1","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.jhep.2023.03.017","article-title":"Global burden of liver disease: 2023 update","volume":"79","author":"Devarbhavi","year":"2023","journal-title":"J Hepatol"},{"key":"2024040223561890700_hvad210-B2","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1017\/S0020818300011620","article-title":"The single convention on narcotic drugs, 1961","volume":"16","author":"Lande","year":"1961","journal-title":"Int Organ"},{"key":"2024040223561890700_hvad210-B3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0364-7722(79)90064-X","article-title":"Convention on psychotropic substances, 1971. 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