The liver is known for its remarkable regenerative capacity to restore liver architecture and re-establish specific functions after various types of liver injury. However, in patients with end-stage liver disease, the regenerative capacity is inhibited and liver transplantation is the only option. Considering the limitations of liver transplantation and the prevalence of liver regeneration in liver injury, promoting liver regeneration is suggested as an effective strategy for treating patients with liver disease. Liver regeneration is a complex process involving the regulation of cytokines, growth factors, and metabolic signals. Traditional Chinese medicine (TCM) has been practiced for thousands of years due to its comprehensive intervention advantages with multi-component and multi-pathway. Recent studies have described that TCM can effectively promote liver regeneration. In this review, we provide an overview of the molecular mechanisms involved in the process and regulation of liver regeneration. Subsequently, we first summarize the pro-regenerative activity and mechanism of TCM formulas, extracts and active ingredients, which reveal the potential of TCM in promoting liver regeneration and provide reasonable evidence for TCM in the prevention and treatment of patients with clinical liver disease.

Aims This study aimed to explore the relationship between voriconazole trough concentration (Ctrough) and toxicity, identify the factors significantly associated with voriconazole pharmacokinetic parameters and propose an optimised dosing regimen for patients with liver dysfunction. Methods The study prospectively enrolled 51 patients with 272 voriconazole concentrations. Receiver operating characteristic (ROC) curves were used to explore the relationship between voriconazole Ctrough and toxicity. The pharmacokinetic data was analysed with nonlinear mixed-effects method. Dosing simulations stratified by TBIL (TBIL-1: TBIL < 51 μmol/L; TBIL-2: 51 μmol/L ≤ TBIL < 171 μmol/L; TBIL-3: TBIL ≥ 171 μmol/L) were performed. Results ROC curve analysis revealed that voriconazole Ctrough of ≤ 5.1 mg/L were associated with significantly lower the incidence of adverse events. A one-compartment pharmacokinetic model with first-order absorption and elimination was used to describe the data. Population pharmacokinetic parameters of clearance (CL), the volume of distribution (V) and oral bioavailability (F) were 0.88 L/h, 148.8 L and 88.4%, respectively. Voriconazole CL was significantly associated with total bilirubin (TBIL) and platelet count. The V increased with weight. Patients with TBIL-1 could be treated with loading dose of 400 mg every 12 hours (q12h) for first day and maintenance dose of 100 mg q12h intravenously or orally. TBIL-2 and TBIL-3 patients could be treated with loading dose of 200 mg q12h and maintenance doses of 50 mg q12h or 100 mg once daily (qd) and 50 mg qd orally or intravenously, respectively. Conclusions TBIL-based dosing regimens provide a practical strategy for voriconazole maximizing treatment outcomes.