Lactic acidosis fialuridine

Park, Y, Savarese, B., Kleiner, D. et al. (1995) Hepatic failure and lactic acidosis due to fialuridine (FIAU), an investigational nucleoside analogue for chronic hepatitis B. New England Journal of Medicine, 333, 1099-1105. 

Perhaps one of the most dramatic examples of hepatic failure and lactic acidosis associated with nucleoside analogues was that which occurred during the course of early clinical trials with an investigational nucleoside analogue fialuridine for treatment of chronic hepatitis B [95]. Seven of fifteen study patients developed progressive liver failure and lactic acidosis. Five of the patients died with severe lactic acidosis two patients underwent emergency liver transplantation and survived. Severe mitochondrial toxicity was proposed as the mechanism for this injury, based in part on the similarity of this presentation to that seen in individuals with inherited disorders of mitochondrial DNA and the presence of histopathological evidence of mitochondrial injury [94, 95]. 

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