Therapeutic horizons in metabolic dysfunction-associated steatohepatitis.

Philip N Newsome,Rohit Loomba
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Abstract

Metabolic dysfunction-associated steatohepatitis (MASH), the progressive inflammatory form of MASLD, is now a leading cause of chronic liver disease worldwide. Driven by obesity and type 2 diabetes, MASH significantly increases the risk of cirrhosis, hepatocellular carcinoma, and liver failure. While public health interventions remain essential, therapeutic strategies targeting metabolic dysfunction, inflammation, and fibrosis are urgently needed. This Review focuses on pharmacological treatments in advanced development, including incretin-based therapies (GLP-1, dual, and triple agonists), metabolic modulators (PPAR, FGF21, and THR-β agonists), and novel agents such as fatty acid synthase inhibitors. Current regulatory approval is based on histological end points, with increasing interest in noninvasive biomarkers and personalized treatment approaches. Recent trials with agents such as semaglutide, tirzepatide, survodutide, lanifibranor, pegozafermin, and resmetirom demonstrate substantial promise in resolving MASH and improving fibrosis, but unresolved issues remain regarding treatment duration, response heterogeneity, and long-term adherence. Genetic variants (e.g., PNPLA3 polymorphisms) and emerging molecular biomarkers may enhance stratification, while artificial intelligence is beginning to shape trial design and drug development. As the field moves toward combination therapies and precision medicine, the definition of therapeutic success will likely evolve to reflect both histological improvement and patient-reported outcomes. This Review provides a timely synthesis of the landscape, challenges, and future directions in MASH therapeutics.
代谢功能障碍相关脂肪性肝炎的治疗前景。
代谢功能障碍相关脂肪性肝炎(MASH)是MASLD的进行性炎症形式,目前是世界范围内慢性肝病的主要原因。在肥胖和2型糖尿病的驱动下,MASH显著增加肝硬化、肝细胞癌和肝功能衰竭的风险。虽然公共卫生干预仍然必不可少,但迫切需要针对代谢功能障碍、炎症和纤维化的治疗策略。这篇综述的重点是晚期药物治疗,包括基于肠促胰岛素的治疗(GLP-1,双重和三重激动剂),代谢调节剂(PPAR, FGF21和THR-β激动剂),以及脂肪酸合成酶抑制剂等新型药物。目前的监管批准是基于组织学终点,对无创生物标志物和个性化治疗方法的兴趣越来越大。最近的一些药物试验,如semaglutide, tizepatide, survodutide, lanifbranor, pegozafermin和resmetirom,在解决MASH和改善纤维化方面显示出了巨大的希望,但是关于治疗时间,反应异质性和长期依从性的问题仍然存在。遗传变异(如PNPLA3多态性)和新兴的分子生物标志物可能会加强分层,而人工智能正开始影响试验设计和药物开发。随着该领域向联合疗法和精准医学发展,治疗成功的定义可能会演变为反映组织学改善和患者报告的结果。这篇综述及时综合了MASH治疗方法的前景、挑战和未来方向。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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