Identification of the genomic biomarkers of bosentan-induced liver dysfunction

[Background] Pulmonary arterial hypertension (PAH) is a progressive and devastating disease, ultimately leading to death from right heart failure if left untreated. Bosentan, an endothelin receptor antagonist, is used as a first-line drug for the treatment of PAH. Also, bosentan is the only drug having an insurance application for the onset suppression of the finger ulcer in systemic scleroderma. It's major adverse effect is a liver dysfunction, approximately 10% of patients treated with bosentan show dose-dependent increases in hepatic aminotransferases, which may lead to discontinuation of therapy. In the past two decades, the remarkable development of various disease-targeted medications, including prostanoids, phosphodiesterase-5 inhibitors, and endothelin receptor antagonists, has dramatically improved the management of patients with PAH. Therefore, we can avoid high risk pharmacotherapy if risk assessment is enabled before administration.