Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading chronic liver disease worldwide in the past decade.1 The spectrum of liver diseases in MASLD ranges from metabolic dysfunction-associated simple steatosis to steatohepatitis (MASH), advanced fibrosis, cirrhosis and hepatocellular carcinoma. The pathophysiology of MASLD involves many diverse pathways, including lipotoxicity, insulin resistance, gut dysbiosis, dietary factors, and innate and adaptive immunity, all reflecting the critical aspects of the disease process.2 3 Liver inflammation and progressive fibrosis, as observed in many patients with MASH, are considered crucial driving forces of disease progression, and therefore patients with MASH are the key target population for the development of new therapeutic drugs.2 4 Identification of patients with MASH has historically been dependent on liver biopsy and analysis of liver histology, although promising biomarker panels have recently been developed5 that might replace the need for liver biopsy in the diagnosis and monitoring of treatment responses in the near future. MASLD reflects a prototypic multisystem disorder whereby extrahepatic complications, such as cardiovascular events and malignancies, dominate mortality.6 Although many clinical trials have been performed in people with MASLD/MASH in the past two decades, there is currently no licensed therapy for this highly prevalent metabolic liver disease.