F573 injection for treating liver injury and failure

Inclusion Criteria:

（1）The first stage:

Participants who meet all of the following criteria will be enrolled in the study:

1. Age ≥18 and ≤60 years old, gender is not limited;
2. Patients with liver injury clinically diagnosed with hepatocyte injury or mixed liver injury or CHB patients with hepatitis B virus infection for more than 6 months (refer to the "Chronic Hepatitis B Prevention and Treatment Guidelines (2019 edition)"). Screening patients with CHB may provide etiological (HBsAg positive and/or HBV DNA positive) or clinical or pathological evidence (liver tissue biopsy results) that HBV infection has been present for more than 6 months.
3. Serum ALT: 2\~ 10× upper limit of normal (ULN), TBil: \<5×ULN;
4. DILI patients: the abnormal duration of liver biochemical indexes \[ALT, AST, ALP, gamma-glutamyltranspeptides (GGT), TBil, albumin, prothrombin time\] does not exceed 90 days;
5. The subject (including the partner) is willing to take effective contraceptive measures from the screening until 6 months after the last test drug administration;
6. Sign informed consent and be able to comply with the requirements of the program; If the subject is unable to sign the informed consent form, it must be signed by a legal guardian or witness as required by the regulations.

(2)The second stage:

Subjects meeting all of the following criteria will be included in the study:

1. Age ≥ 18 and ≤ 65 years old, with no gender restrictions;
2. According to the "Chinese Guidelines for the Diagnosis and Treatment of Drug-Induced Liver Injury (2023 Edition)", patients diagnosed with drug-induced liver injury (DILI) or those diagnosed with intrahepatic cholestasis type liver injury. Patients with DILI and intrahepatic cholestasis type liver injury need to meet the following criteria separately;

   1. Patients with DILI need to simultaneously meet the following conditions: ① Serum ALT \> 3 times the upper limit of normal (ULN), and TBil \> 2 times the ULN (the ULN of TBil refers to 17.1 μmol/L according to international standards); ② Abnormal liver biochemical indicators (ALT, AST, ALP, TBil) persist for no more than 60 days;
   2. Patients with intrahepatic cholestasis type liver injury need to simultaneously meet the following conditions: ① TBil \> 2 times the ULN (the ULN of TBil refers to 17.1 μmol/L); ② ALP \> 1.5 times the ULN; ③ALT\>1×ULN;
3. The subjects (including their partners) are willing to voluntarily adopt effective contraceptive measures from the time of the initial screening until 6 months after the last administration of the investigational drug;
4. They have signed the informed consent form and can comply with the requirements of the protocol; if the subjects are unable to sign the informed consent form, it must be signed by a legal guardian or a witness as required by the regulations.

The third stage:

Subjects who meet all of the following criteria will be enrolled in the study:

1\. Age ≥18 and ≤70 years old, gender is not limited; 2. Patients diagnosed with chronic and acute liver failure with TBil≥5×ULN according to the "Guidelines for Diagnosis and Treatment of Liver Failure (2018 Edition)" may have hepatic encephalopathy (Grade 1-2) or ascites (grade 1-2) 4 weeks before subject screening. And 5≤AARC score ≤10 (AARC rating I-II); 3. The subject (including the partner) is willing to take effective contraceptive measures from the screening until 6 months after the last trial drug administration; 4. Sign informed consent and comply with the requirements of the program; If the subject is unable to sign the informed consent form, it must be signed by a legal guardian or witness as required by the regulations.

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Exclusion Criteria:

The first stage:

Subjects meeting one of the following conditions will not be included in the trial:

1. According to the investigator's judgment, the subjects were patients with cholestatic liver injury;
2. Previous diagnosis of cirrhosis or liver hardness determination (LSM) at screening ≥ 12.4kPa;
3. Patients with severe or life-threatening heart, lung, brain, kidney, gastrointestinal and systemic diseases, and patients with malignant tumors;
4. There are the following laboratory test values or abnormal test values:

   1. Blood routine: platelet (PLT) \<75× 109/L, hemoglobin (HGB) \<90 g/L;
   2. Prothrombin activity \<40%, prothrombin time (PT) extended \>5 s;
   3. Left ventricular ejection fraction (LVEF) \<50%;
5. Allergic or intolerant to the investigational drug, or allergic;
6. The subject is unable to express his main complaint, such as mental illness and severe neurosis;
7. Poor compliance can not partner;
8. Pregnant women, breastfeeding women or women of childbearing age who are trying to conceive;
9. Participants in other clinical trials within 3 months;
10. Patients who had used liver protection drugs other than ursodeoxycholic acid or adenosylmethionine within 3 days before randomization;
11. The researcher considers any circumstances unsuitable for inclusion.

The second stage:

Subjects meeting one of the following conditions will not be included in the trial:

1. The diagnosis is advanced liver cirrhosis (with complications such as ascites and hepatic encephalopathy), or liver cancer, or when liver stiffness measurement (LSM) is ≥ 18.0 kPa during screening.
2. Patients with severe or life-threatening heart, lung, brain, kidney, gastrointestinal and systemic diseases are malignantTumor patients;
3. There are the following laboratory test values or abnormal test values:

   1. Blood routine: platelet (PLT) \<100×109/L, hemoglobin (HGB) \<100 g/L;
   2. INR\>1.4, or as determined by the investigator to meet the criteria for severe hepatitis;
   3. Left ventricular ejection fraction (LVEF) \<50%;
4. Allergic or intolerant to the investigational drug, or allergic;
5. The subject is unable to express his main complaint, such as mental illness and severe neurosis;
6. Poor compliance can not partner;
7. Pregnant women, breastfeeding women or women of childbearing age who are trying to conceive;
8. Participants in other clinical trials within 3 months;
9. Patients who had used liver protection drugs other than ursodeoxycholic acid or adenosylmethionine and basic therapeutic drugs (polyene phosphatidylcholines and glutathione drugs) within 3 days before randomization;
10. Patients who had used glucocorticoids or interferon drugs within 3 days before randomization;
11. The researcher considers any circumstances unsuitable for inclusion.

The third stage:

Subjects meeting one of the following conditions will not be included in the trial:

1. Patients who have completed liver transplantation or plan to undergo liver transplantation within 1 month;
2. Severe grade 3 ascites or stubborn ascites;
3. Patients with ≥ grade 3 hepatic encephalopathy;
4. Patients who received artificial liver treatment within 1 week before screening;
5. Patients with severe underlying diseases, such as respiratory system, digestive system, circulatory system, endocrine and other diseases and malignant tumors, and patients with severe infections that cannot be controlled by drugs;
6. During the screening period or within 1 month before screening, the results of gastroscopy or imaging (abdominal B-ultrasound, CT or MRI) examination suggest severe varicose veins with bleeding risk;
7. Patients with acute kidney injury (AKI), defined as meeting one of the following conditions:

   1. Serum creatinine (Scr) increased ≥26.5 μmol/L (0.3 mg/dL, 1 mg/dL=88.4 μmol/L) within 48 h;
   2. The Scr increase exceeds 1.5 times or more of the base value within 7 days;
   3. Decreased urine volume (\<0.5 mL/kg/h) for more than 6 hours;
8. Allergic or intolerant to the investigational drug, or allergic;
9. The subject is unable to express his main complaint, such as mental illness and severe neurosis;
10. Poor compliance can not partner; 11 Pregnant women, breastfeeding women or women of childbearing age who are trying to conceive;

12\. Participants in other clinical trials within 3 months; 13. The researcher considers any circumstances unsuitable for inclusion.