Comprehensive Review on Biomarkers in Hepatotoxicity: From Conventional Indicators to Omics‑Driven Discoveries

ABSTRACT: The liver plays crucial role in metabolic homeostasis, detoxification, and biosynthesis, yet it is highly susceptible to damage from xenobiotics, alcohol, metabolic disorders, and infections. Hepatotoxicity, a major contributor to liver disease, progresses from reversible steatosis to irreversible cirrhosis, driven by genetic, environmental, and metabolic factors. Early detection and monitoring of liver injury rely heavily on biomarkers, with conventional options such as aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, bilirubin, and gamma-glutamyl transferase being widely used but limited in specificity. Recent advances in omics technologies have uncovered novel biomarkers, including microRNAs, high-mobility group box 1 (HMGB1), keratin-18, and glutamate dehydrogenase that provide enhanced sensitivity and earlier detection. This review consolidates current knowledge on conventional, emerging, and omics-based biomarkers, exploring their mechanistic roles and clinical potential. Broader adoption of validated biomarker panels could enhance diagnostic accuracy, guide treatment strategies, and ultimately enhance results for liver disease patients.