A Systematic Review on Emerging Therapies for Liver Toxicity

Background: Liver toxicity, or hepatotoxicity, arises from diverse causes including metabolic syndromes, alcohol abuse, drug-induced injury, and immune dysregulation. This review aims to explore emerging therapeutic strategies for liver toxicity stemming from diverse etiologies, including metabolic disorders, drug-induced liver injury, and alcohol-related liver disease. By analyzing clinical evidence on probiotics, N-acetylcysteine (NAC), curcumin–galactomannoside complex (CGM), and macrophage-based cell therapy, the article highlights their efficacy, mechanisms, and translational potential. Methodology: A systematic review was conducted using PubMed and Google Scholar to identify human clinical trials, randomised control trials (RCTs), and observational studies published between January 2015 and June 2025. After screening 11,020 initial articles and applying rigorous inclusion and exclusion criteria, four high-quality studies were selected for final analysis. Results: Probiotics showed subgroup-specific improvements in liver markers among patients with depressive episodes, suggesting a role for the gut-liver-brain axis. NAC significantly reduced alanine transaminase (ALT), alkaline phosphatase (ALP), and bilirubin in drug-induced liver injury, with sustained benefits and good tolerability. CGM led to pronounced improvements in liver enzymes, oxidative stress, and inflammation of alcohol-induced liver dysfunction. Lastly, infusion of alternatively activated macrophages in paracetamol-induced liver injury showed a favorable safety profile and potential regenerative effects, though efficacy data remain preliminary. Conclusion: Targeted therapies such as NAC and CGM exhibit strong clinical potential for managing hepatotoxicity, while probiotics and macrophage therapy may benefit specific populations. Personalized, mechanism-driven approaches, validated by larger multicenter trials, are essential for improving outcomes in liver toxicity.