classified according to their amino acid sequence. The importance of these enzymes

can be seen in subgroups that lack particular genes. For example, in the case of

anaesthesia, codeine is metabolized to morphine by CYP2D6; therefore, the patients

having its deficiency find codeine ineffective (Vaja and Ghuman 2017). Cytochrome

P450s are also found in higher plants. The evolution of P450 family of isozymes in

plants is thought to occur through gene duplication and conversion due to the need of

plants to acclimatize in a harsh environment and also to protect themselves from

pathogens and predators (Werck-Reichhart and Feyereisen 2000).

29.2

Pharmacotherapies of Liver Disorders

The diseases associated with the liver are of major medical concern all over the

world. The main causes of liver diseases in Africa and Asia are parasitic and viral

infections, while alcohol abuse is a major cause in America and Europe. In addition,

viral hepatitis has also increased recently. So far, there is no established drug

available that could cure alcohol-associated liver disease (Subramaniyan et al.

2021). However, the currently used medications in the management of liver diseases

are discussed herein:

29.2.1 Corticosteroids

Corticosteroids allegedly are helpful in case of alcoholic hepatitis as they attenuated

the typical inflammatory response, decrease the production of cytokines, suppress

the acetaldehyde adduct formation and also inhibit the collagen production (Zhang

et al. 2005). Corticosteroids are also used for the short-term survival of patients with

severe alcoholic hepatitis (Mathurin et al. 2002). Steroidal treatment caused

improvement in some patients having severe alcoholic disease, and this short-term

histological improvement by steroids is due to decrease in the tumour necrosis factor

alfa (TNF-α), intercellular adhesion molecule-1 (ICAM-1) expression as well as

changes in the soluble intercellular adhesion molecule-1 (sICAM-1) in the hepatic

vein (Spahr et al. 2001). Notably, in a systematic review of Rambaldi et al. (2002),

neither beneficial effects nor any clinical outcomes such as liver histology,

complications or mortality of anabolic-androgenic steroids are demonstrated in

patients having alcoholic liver disease. In recent scenario, corticosteroids are con-

sidered to have poor but sure future in the management of liver disorders. Similar

conclusion is supported by a recent summary evaluating RCTs in this treatment

modality (Crabb et al. 2020).

29.2.2 Interferons

Interferons (IFNs) belong to cytokine family having pleiotropic effects on the target

cells including the antiviral state inhibition of cell growth and immune response

29

The Pathophysiology of Liver Disorders and Pharmacotherapy Options with. . .

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