Metabolomics at the cutting edge of risk prediction of MASLD
En Ying Tan, Mark Muthiah, Arun J. Sanyal
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health threat globally. Management of patients afflicted with MASLD and research in this domain are limited by the lack of robust well-established non-invasive biomarkers for diagnosis, prognostication, and monitoring. The circulating metabolome reflects both the systemic metabo-inflammatory milieu and changes in the liver in affected individuals. In this review we summarize the available literature on changes in the different components of the metabolome in MASLD with a focus on changes that are linked to the presence of underlying steatohepatitis, severity of disease activity, and fibrosis stage. We further summarize the existing literature around biomarker panels that are derived from interrogation of the metabolome. Their relevance to disease biology and utility in practice are also discussed. We further highlight potential direction for future studies particularly to ensure they are fit for purpose and suitable for widespread use. MASLD affects large swathes of the population, and a proportion develop advanced disease with resultant morbidity and mortality. Tan et al. review the metabolomic alterations in MASLD and its various phenotypes that pave the way for non-invasive diagnosis and risk assessment and provide insights into disease mechanisms and therapeutics development.