The field of liver disease is undergoing significant evolution, particularly in the understanding and management of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD). This shift in nomenclature, highlighted in a multisociety Delphi consensus statement, reflects a move towards recognizing metabolic dysfunction as the central driver of the disease.
Understanding MASLD Pathogenesis
Research continues to unravel the complex mechanisms underlying MASLD. Key areas of focus include the genetic architecture of the disease, with studies exploring the implications of genes like PNPLA3. A recent Phase 1 trial investigated PNPLA3 siRNA in I148M homozygous patients with MAFLD, demonstrating the potential of targeting specific genetic factors.
Another emerging area is the role of senescent cells in MASLD progression. Studies have identified phenotypes and ontogeny of senescent hepatic stellate cells in metabolic dysfunction-associated steatohepatitis (MASH), suggesting that targeting these cells could ameliorate disease progression. For example, research has shown that targeting senescent hepatocytes using the thrombomodulin-PAR1 inhibitor vorapaxar can improve NAFLD outcomes.
The intersection between alcohol-related liver disease and MASLD is also receiving increased attention, recognizing the complex interplay of metabolic and lifestyle factors in liver health.
Diagnostic Advancements
Non-invasive diagnostic tools are becoming increasingly important in the management of MASLD. Vibration-controlled transient elastography (VCTE) is used to predict liver-related events in steatotic liver disease. Studies have shown that VCTE scores can effectively monitor patients and identify those at higher risk.
Clinical care pathways are being developed to improve risk stratification and management of patients with MASLD, particularly in high-risk groups such as those with type 2 diabetes. Automated fibrosis score calculation and electronic reminder messages have been shown to improve the detection of advanced liver disease in these patients.
Emerging Therapies
Several new therapies are showing promise in clinical trials. Resmetirom, a thyroid hormone receptor-β agonist, has demonstrated efficacy in a Phase 3 trial for NASH with liver fibrosis. Tirzepatide, a dual GIP and GLP-1 receptor agonist, has also shown significant benefits in patients with metabolic dysfunction-associated steatohepatitis and liver fibrosis.
These advancements represent a significant step forward in addressing the growing global burden of MASLD and its associated complications.
