Clinical and Molecular Hepatology

"Fibrosis"

Review

Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions: Huapeng Lin, Haixia Wang, Kangsen Yang, Min Li, Yanting Wang, Terry Cheuk-Fung Yip, Seung Up Kim; Clin Mol Hepatol 2026;32(Suppl):e2026.0398.
Published online August 28, 2026; DOI: https://doi.org/10.3350/cmh.2026.0398

Abstract
PDF

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction and alcohol-related liver disease (MetALD) exist on a continuous spectrum in which fibrosis stage remains the dominant predictor of liver‑related complications. Contemporary non‑invasive risk stratification uses simple serum scores (e.g., Fibrosis‑4 index [FIB‑4]) as a first step, followed by vibration‑controlled transient elastography (VCTE) or liver‑specific blood tests (enhanced liver fibrosis [ELF], procollagen III N‑terminal propeptide [PRO‑C3]) to refine risk and triage referrals. Magnetic resonance elastography (MRE) provides higher accuracy than ultrasound‑based elastography, though limited by its availability. Composite models (Agile 3+/4, steatosis‑associated fibrosis estimator [SAFE]) can reduce indeterminate classifications but may require additional calibration for alcohol exposure for use in MetALD. Prognosis should incorporate dynamic, longitudinal measurement of non‑invasive tests, and integrate extrahepatic risks, particularly cardiovascular and kidney disease. In MetALD, quantitative alcohol assessment can be improved by incorporating objective biomarkers such as phosphatidylethanol (PEth) as part of a triangulation approach that integrates self‑reported alcohol intake, the Alcohol Use Disorders Identification Test‑Consumption (AUDIT‑C), and clinical history. Challenges remain, particularly for MetALD, and future research will focus on integrating dynamic biomarkers, predicting treatment response, and utilizing artificial intelligence (AI) for personalized risk and treatment prediction, combining genetic modifiers and polygenic risk scores with clinical and imaging data, with validation across diverse populations.

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Steatotic liver disease spectrum: From MASLD to MetALD and beyond - Clinical outcomes and precision medicine frontiers
Won Kim
Clinical and Molecular Hepatology.2026; 32(Suppl): e2026.1072. CrossRef

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Snapshot

The hepatic portal area in homeostasis and disease: Fanrong Kong, Sara Lemoinne, Chantal Housset, Xinwei Li, Lin Lei; Clin Mol Hepatol 2026;32(3):1467-1471.
Published online July 1, 2026; DOI: https://doi.org/10.3350/cmh.2026.0662

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Review

Cardiovascular and hepatic outcomes: prognostic differences across MASLD-MetALD-ALD continuum: Han Ah Lee, Gi-Ae Kim, Won Kim; Clin Mol Hepatol 2026;32(Suppl):e2026.0367.
Published online May 8, 2026; DOI: https://doi.org/10.3350/cmh.2026.0367

Abstract
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A paradigm shift in fatty liver disease nomenclature has introduced steatotic liver disease (SLD) as an umbrella term, encompassing metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcohol-associated liver disease (ALD). These SLD subtypes exist along a dynamic continuum shaped by the synergistic interplay of metabolic dysfunction and alcohol exposure. Accumulating evidence indicates that SLD exhibits distinct outcome-based clusters reflecting heterogeneity in pathogenic drivers and clinical trajectories. Cardiometabolic clusters, most prominently observed in MASLD, are characterized by systemic metabolic dysfunction and confer increased risks of cardiovascular disease (CVD). In contrast, liver-specific clusters demonstrate progressive fibrosis and cirrhosis, hepatic decompensation, and hepatocellular carcinoma. In large-scale cohorts, CVD accounts for 40-50% of deaths in MASLD, while liver-related mortality predominates in ALD (>60%). The relative dominance of cardiometabolic versus liver-specific clusters shifts progressively across the MASLD-MetALD-ALD spectrum. While CVD remains a major driver of mortality, particularly in MASLD, hepatic outcomes increase stepwise with advancing fibrosis and greater alcohol exposure. Advanced fibrosis is the predominant shared determinant amplifying both CVD and hepatic risks across subtypes. This review synthesizes cardiovascular and hepatic outcome patterns across the MASLD-MetALD-ALD spectrum, highlighting the prognostic reorientation across the continuum, in which hepatic outcomes rise stepwise with alcohol exposure while cardiovascular risk remains an important but less subtype-differentiated burden. These findings advocate outcome-oriented risk stratification integrating noninvasive fibrosis assessment, alcohol biomarkers (phosphatidylethanol), and cardiovascular risk calculators within the cardiovascular-kidney-metabolic framework. Understanding SLD as a modifiable continuum enables individualized management to optimize multisystem outcomes.

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Steatotic liver disease spectrum: From MASLD to MetALD and beyond - Clinical outcomes and precision medicine frontiers
Won Kim
Clinical and Molecular Hepatology.2026; 32(Suppl): e2026.1072. CrossRef
Alcohol-aware risk stratification and subtype-specific care pathways across metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and alcohol-associated liver disease, and alcohol-associated liver disease
Hyo Young Lee, Eileen Laurel Yoon, Dae Won Jun
Clinical and Molecular Hepatology.2026; 32(Suppl): e2026.0659. CrossRef

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Correspondences

The lean phenotype in metabolic dysfunction-associated steatotic liver disease: diagnostic challenges and prognostic implications: Correspondence to editorial on “Normal-weight metabolic dysfunction-associated steatotic liver disease: reclassification, characteristics, and adverse liver outcomes across diverse populations”: Sherlot Juan Song, Terry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Dae Won Jun; Clin Mol Hepatol 2026;32(3):e389-e391.
Published online February 5, 2026; DOI: https://doi.org/10.3350/cmh.2026.0143

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Rule-Out Cutoff of Two-Dimensional Shear Wave Elastography for Significant Fibrosis in Metabolic Dysfunction–Associated Steatotic Liver Disease: Systematic Review, Meta-Analysis, and External Validation
Joo Hyun Oh, Jonghyun Lee, Miyoung Choi, Kento Imajo, Masato Yoneda, Hideki Fujii, Hyo Young Lee, Eileen L. Yoon, Mimi Kim, Dae Won Jun
Clinical Gastroenterology and Hepatology.2026;[Epub] CrossRef

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1 Web of Science
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Incorporating chronic kidney disease into the cost-effectiveness of MASLD treatment: Correspondence to letter to the editor on “Evaluating treatment response thresholds for cost-effective treatment in metabolic dysfunction-associated steatotic liver disease”: Eileen L. Yoon, Jeong-Yeon Cho, Mimi Kim, Huiyul Park, Hye-Lin Kim, Dae Won Jun; Clin Mol Hepatol 2026;32(3):e415-e418.
Published online February 2, 2026; DOI: https://doi.org/10.3350/cmh.2026.0099

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Capturing systemic disease burden in MASLD: Toward integrated liver–kidney–cardiovascular economic models: Reply to correspondence on “Evaluating treatment response thresholds for cost-effective treatment in metabolic dysfunction-associated steatotic live
Anna Di Sessa, Gianmario Forcina, Emanuele Miraglia del Giudice
Clinical and Molecular Hepatology.2026; 32(3): e447. CrossRef

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Correspondence to editorial on “MicroRNA isomiRs reveal novel pathways linked to disease activity and fibrosis in MASLD”: David William Salzman, Stephen Aurelien Hoang, Arun Jayant Sanyal; Clin Mol Hepatol 2026;32(3):e387-e388.
Published online February 2, 2026; DOI: https://doi.org/10.3350/cmh.2026.0074

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Key challenges in cost-effectiveness analyses of emerging MASLD therapies: adherence, adverse events, cardiometabolic benefits, and age-related uncertainty: Correspondence to editorial on “Evaluating treatment response thresholds for cost-effective treatment in metabolic dysfunction-associated steatotic liver disease”: Eileen L. Yoon, Jeong-Yeon Cho, Mimi Kim, Huiyul Park, Hye-Lin Kim, Dae Won Jun; Clin Mol Hepatol 2026;32(3):e365-e368.
Published online January 27, 2026; DOI: https://doi.org/10.3350/cmh.2026.0059

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CHAIN Cohort: Prospective Multicenter Study of MASLD With Serial Liver Stiffness Assessments in Cardiovascular Care
Xiao‐Dong Zhou, Ren Cheng‐Han Fan, Jian‐Dong Chen, Xi‐Qiao Zhou, Qian Tong, Yan‐Hang Gao, Xiao‐Qi Wang, Ya‐Kun Jiang, Xiang‐Yuan Pu, Yu Shi, Ming‐Wei Wang, Jing Liu, Hai‐Bing Jiang, Li Ma, Xin‐Gang Zhang, Yi‐Ling Li, Su Lin, Hong‐Ju Yang, Yao‐Hong Song, Y
Liver International.2026;[Epub] CrossRef

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Correspondence to editorial on “Comparative risk of fibrosis progression with sodium-glucose cotransporter-2 vs. dipeptidyl peptidase-4 inhibitors in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes mellitus with low-to-intermediate fibrosis”: Jonggi Choi, Raymond T. Chung; Clin Mol Hepatol 2026;32(3):e372-e374.
Published online January 27, 2026; DOI: https://doi.org/10.3350/cmh.2026.0046

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Editorial

Discordant FIB-4 and liver stiffness in metabolic dysfunction-associated steatotic liver disease as related to histology and liver-related events in a global cohort: Editorial on “Histological severity and hepatic outcomes in patients with metabolic dysfunction-associated steatotic liver disease and discrepant FIB-4 and liver stiffness measurement”: Gurmehr Brar, Brian P. Lee; Clin Mol Hepatol 2026;32(3):1409-1412.
Published online January 9, 2026; DOI: https://doi.org/10.3350/cmh.2025.1484

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Nutritional-inflammatory indices optimize the diagnostic performance of FIB-4 for advanced fibrosis/cirrhosis in patients with benign liver disease
Jing Zhou, Daofeng Yang, Jun Lu
Annals of Medicine.2026;[Epub] CrossRef
Psychometric profiles and the phenotypic dissociation of imaging steatosis and elevated fibrosis risk in obesity
Nuryil Yilmaz, Enis Akca, Zeynep Ekinci, Melik Firat Fidan, Zeynep Pekel, Zelihan Kafadar, Barkin Yigitbasi, Huseyin Dongelli, Metin Ozgen, Demet Yalcin Kehribar
Current Medical Research and Opinion.2026; 42(7): 1347. CrossRef

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Correspondence

Reaffirming the role of SGLT2 inhibitors in slowing fibrotic progression in MASLD: Correspondence to editorial on “Comparative risk of fibrosis progression with sodium-glucose cotransporter-2 vs. dipeptidyl peptidase-4 inhibitors in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes mellitus with low-to-intermediate fibrosis”: Jonggi Choi, Raymond T. Chung; Clin Mol Hepatol 2026;32(3):e369-e371.
Published online January 9, 2026; DOI: https://doi.org/10.3350/cmh.2025.1476

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Original Article

MicroRNA isomiRs reveal novel pathways linked to disease activity and fibrosis in MASLD: Christian Brion, Stephen Aurelien Hoang, Guangliang Wang, Faridodin Mirshahi, Jessie Ang, Matthew Ray Long, Zheng Zhu, Bhanu Sakhamuri, Molly Anderson Srour, Mohammad Shadab Siddiqui, Amon Asgharpour, David John Hayes, Neal Charles Foster, David William Salzman, Arun Jayant Sanyal; Clin Mol Hepatol 2026;32(2):706-720.
Published online December 26, 2025; DOI: https://doi.org/10.3350/cmh.2025.0933

Background/Aims
MicroRNA (miRNA) isoforms (isomiRs) broaden the regulatory landscape of canonical miRNAs, but their role in metabolic dysfunction-associated steatotic liver disease (MASLD) remains unknown. We aimed to characterize the hepatic isomiR landscape in MASLD and define their association with disease activity and fibrosis.
Methods
Small RNA (sRNA) sequencing was performed on liver biopsies from 79 patients across the histological spectrum of MASLD. IsomiRs were annotated and quantified. Their association to disease activity and fibrosis score was assessed by differential expression, ordinal regression, and machine learning. Parallel mRNA sequencing and pathway enrichment were used to map isomiR–mRNA interactions and regulatory networks, which were validated against an independent dataset.
Results
MiRNAs accounted for 75% of sRNAs in liver tissue, of which 67% were isomiRs. Across MASLD severity, 173 isomiRs correlated with disease activity and 58 with fibrosis stage. Key findings included a miR-122 isomiR uniquely targeting INSIG1 (cholesterol metabolism) and a miR-21 isomiR targeting PPARA and HMGCS2 (lipid and fibrosis pathways). Integration with mRNA data revealed 33 dysregulated pathways, including PPAR signaling, insulin resistance, and TGF-β response. Several novel isomiRs from miR-26b, let-7c, and miR-32 families were also linked to lipid metabolism and fibrosis progression.
Conclusions
IsomiRs represent the majority of hepatic miRNAs and uncover novel regulatory networks masked by canonical miRNA analysis. These findings provide new insights into the molecular heterogeneity of MASLD, highlight candidate pathways driving disease progression, and identify potential biomarkers and therapeutic targets for precision hepatology.

Citations

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The Role of MicroRNAs in the Progression of Metabolic Dysfunction-associated Steatotic Liver Disease
Jang Hyun Choi
Journal of Digestive Cancer Research.2026; 14(1): 82. CrossRef
High Prevalence of Metabolic Dysfunction–Associated Steatohepatitis With Significant Fibrosis in Primary Care and Endocrinology Clinics
Srilaxmi Kalavalapalli, Eddison Godinez Leiva, Andrea Ortiz Rocha, Anu Sharma, Diana Barb, Nathaly Cuervo‐Pardo, Kelly Y. Chun, Toni R. Prezant, Margery A. Connelly, Jens T. Rosenberg, Joseph R. Grajo, Fernando Bril, Kenneth Cusi
Diabetes, Obesity and Metabolism.2026; 28(7): 6184. CrossRef
A Chemiluminescence Assay for Differentiating MicroRNA Isoforms with 3′-Terminal Single-Nucleotide Resolution
Yuelan He, Huizhu Song, Yingtung Lo, Zhipeng Fan, Yuhao Zhang, Jianzhong Lu
Analytical Chemistry.2026; 98(27): 20218. CrossRef

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Research Letter

Optimized MASH treatment eligibility cutoffs for MRE-measured liver stiffness and proton density fat fraction: Nana Owusu, Kyle Kalutkiewicz, Jiahui Li, Alina M. Allen, Rohit Loomba, Richard L. Ehman, Meng Yin; Clin Mol Hepatol 2026;32(1):e47-e51.
Published online December 8, 2025; DOI: https://doi.org/10.3350/cmh.2025.1267

2,266 View
91 Download

Original Articles

Histological severity and hepatic outcomes in patients with metabolic dysfunction-associated steatotic liver disease and discrepant FIB-4 and liver stiffness measurement: Joseph Rabbat, Boyu Yang, Hye Won Lee, Huapeng Lin, Emmanuel Tsochatzis, Salvatore Petta, Elisabetta Bugianesi, Masato Yoneda, Ming-Hua Zheng, Hannes Hagström, Jérôme Boursier, José Luis Calleja, George Boon-Bee Goh, Wah-Kheong Chan, Rocio Gallego-Durán, Arun J. Sanyal, Victor de Lédinghen, Philip N Newsome, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Céline Fournier-Poizat, Grace Lai-Hung Wong, Mirko Zoncape, Grazia Pennisi, Angelo Armandi, Atsushi Nakajima, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara-Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Clemence M Canivet, Manuel Romero-Gomez, Vincent Wai-Sun Wong, Seung Up Kim, Terry Cheuk-Fung Yip; Clin Mol Hepatol 2026;32(1):289-304.
Published online November 11, 2025; DOI: https://doi.org/10.3350/cmh.2025.0888

Background/Aims
Current guidelines recommend a 2-step approach for identifying advanced fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), using Fibrosis-4 index (FIB-4) followed by liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE). However, some patients may exhibit discordant results. This study evaluates the histological severity and outcomes in patients with discordant FIB-4 and LSM results.
Methods
This secondary analysis of the VCTE-Prognosis study included 12,950 patients evaluated for MASLD at 16 tertiary centers, of whom 2,915 underwent liver biopsy. Patients were categorized into four groups based on established FIB-4 (1.3) and LSM (8 kPa) cutoffs.
Results
F3–F4 fibrosis was observed in 6.4%, 13.7%, 30.6%, and 62.4% in low-FIB-4-low-LSM (n=6,403), high-FIB-4-low-LSM (n=3,017), low-FIB-4-high-LSM (n=1,363), and high-FIB-4-high-LSM (n=2,167) groups, respectively. During a median follow-up of 47.4 months, 248 patients experienced hepatic decompensation, hepatocellular carcinoma, liver transplantation, or liver-related death. The incidence rates of liver-related events (LREs) were 0.67, 1.19, 2.58, and 21.30 per 1,000 person-years, respectively. Compared to low-FIB-4-low-LSM patients, those with low-FIB-4-high-LSM (adjusted subdistribution hazard ratio [aSHR] 4.12) and high-FIB-4-high-LSM (aSHR 21.38) had a significantly higher risk of LREs, while high-FIB-4-low-LSM patients did not. Similar findings were observed when hepatic decompensation and hepatocellular carcinoma were analyzed separately.
Conclusions
Approximately 30% of patients in tertiary centers exhibit discordant FIB-4 and LSM results, with LSM more likely reflecting true severity. While some patients with discordant results may have advanced fibrosis, the overall incidence of LREs remains low.

Citations

Citations to this article as recorded by

Are FIB-4 and liver stiffness measurement interchangeable for HCC risk stratification in MASLD?
Yimeng Zhou, Xue Meng
JHEP Reports.2026; 8(8): 101852. CrossRef
High Prevalence of Metabolic Dysfunction–Associated Steatohepatitis With Significant Fibrosis in Primary Care and Endocrinology Clinics
Srilaxmi Kalavalapalli, Eddison Godinez Leiva, Andrea Ortiz Rocha, Anu Sharma, Diana Barb, Nathaly Cuervo‐Pardo, Kelly Y. Chun, Toni R. Prezant, Margery A. Connelly, Jens T. Rosenberg, Joseph R. Grajo, Fernando Bril, Kenneth Cusi
Diabetes, Obesity and Metabolism.2026; 28(7): 6184. CrossRef
The Evolution of MASLD Management: From Revised Nomenclature to Disease-Modifying Therapies
Karolina Kornatowska, Szymon Kopciał, Mateusz Wiekiera, Adrianna Wiekiera, Paweł Budzik, Mateusz Tyniec, Kamal Morshed
Gastroenterology Insights.2026; 17(2): 33. CrossRef
Hepatology: Emerging Paradigms in MASLD, Viral Hepatitis, Cholestatic Liver Disease, Portal Hypertension and Hepatocellular Carcinoma
Zobair M. Younossi, George Papatheodoridis, Emmanuel Tsochatzis, Maria Buti, Lorenza Rimassa, Massimo Pinzani, Ana Lleo, Debbie Shawcross, Frank Tacke, Vincent Wai‐Sun Wong, Shira Zelber‐Sagi, Andreas E. Kremer, David J. Pinato, Josep M. Llovet, Paolo Ang
Liver International.2026;[Epub] CrossRef
Device-Specific Cut-Offs of Canon Aplio i800 2D Shear Wave Elastography for Advanced Fibrosis in MASLD: A Histologically Validated Study
Wolfgang Kratzer, Andreas Binzberger, Stefan G. Kauschke, Finn Dolze, Markus Werner, Thomas F.E. Barth, Madeleine Feller, Heike Neubauer, Eric Simon, Andreas-David Brunner, Benedikt Haggenmüller, Mark M. Hänle
Ultraschall in der Medizin - European Journal of Ultrasound.2026;[Epub] CrossRef
Shear wave elastography demonstrates similar risk stratification performance to vibration-controlled transient elastography in FIB-4–based two-step algorithms for MASLD
Jaejun Lee, Hyun Yang, Si Hyun Bae, Sunhong Yoo, Soon Woo Nam, Jiwoon Yoon, Jung Hyun Kwon, Soon Kyu Lee
Hepatology.2026;[Epub] CrossRef
Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions
Huapeng Lin, Haixia Wang, Kangsen Yang, Min Li, Yanting Wang, Terry Cheuk-Fung Yip, Seung Up Kim
Clinical and Molecular Hepatology.2026; 32(Suppl): e2026.0398. CrossRef
EASL-EASD-EASO guidance on the use of resmetirom and semaglutide as MASH-targeted therapy
Frank Tacke, Paul Horn, Vincent Wai-Sun Wong, Vlad Ratziu, Elisabetta Bugianesi, Sven Francque, Shira Zelber-Sagi, Cyrielle Caussy, Michael Roden, Amalia Gastaldelli, Andreea Ciudin, Barbara McGowan
Journal of Hepatology.2026;[Epub] CrossRef
Cardiovascular and hepatic outcomes: prognostic differences across MASLD-MetALD-ALD continuum
Han Ah Lee, Gi-Ae Kim, Won Kim
Clinical and Molecular Hepatology.2026; 32(Suppl): e2026.0367. CrossRef

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Comparative risk of fibrosis progression with sodium-glucose cotransporter-2 vs. dipeptidyl peptidase-4 inhibitors in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes mellitus with low-to-intermediate fibrosis: Jonggi Choi, Daniel Fulop, Vy H. Nguyen, Eric Przybyszewski, Jiunn Song, Allison Carroll, Megan Michta, Erik Almazan, Tracey G. Simon, Raymond T. Chung; Clin Mol Hepatol 2026;32(1):305-317.
Published online November 11, 2025; DOI: https://doi.org/10.3350/cmh.2025.0825

Background/Aims
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing cause of cirrhosis and its complications. Given its close association with type 2 diabetes mellitus (T2DM), evaluating whether sodium-glucose cotransporter-2 inhibitors (SGLT2is) can mitigate the progression of liver fibrosis is clinically important. We examined the association between SGLT2i use and liver fibrosis progression in patients diagnosed with MASLD and T2DM.
Methods
We conducted a target trial emulation study using a retrospective, active comparator new-user design among adults with MASLD, T2DM, and low-to-intermediate Fibrosis-4 (FIB-4≤2.67) scores who initiated treatment with either SGLT2is or dipeptidyl peptidase-4 inhibitors (DPP-4is) at Mass General Brigham or Asan Medical Center from 2013 to 2023. The primary outcome was the progression to advanced fibrosis (FIB-4>2.67), confirmed on ≥2 occasions within 1 year. The secondary outcome was the development of major adverse liver outcomes (MALO), including incident cirrhosis, decompensation events, hepatocellular carcinoma, or liver transplantation.
Results
Among 16,901 eligible patients, 2,571 propensity score-matched pairs were identified with balanced baseline characteristics. During follow-up (median, 3.7 years), fibrosis progression occurred at a rate of 3.46/100 personyears in SGLT2i users and 4.44 in DPP4i users. SGLT2i use was associated with a lower risk of fibrosis progression (HR 0.78, 95% CI 0.67–0.89; P<0.001). No significant difference in MALO incidence was observed. Subgroup analyses showed a consistent association among users of metformin, statins, and aspirin.
Conclusions
SGLT2i use was associated with reduced risk of fibrotic progression compared to DPP4i use in adults with MASLD and T2DM.

Citations

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Reframing MASLD: A Hepatic Condition With Systemic Clinical Impact
Patricia S. Castillo-Flores, Itzayana Rodríguez-Antonio, Misael Uribe, Norberto C. Chávez-Tapia, Eduardo E. Montalvo-Javé, Natalia Nuño-Lámbarri
Journal of Clinical and Experimental Hepatology.2026; 16(6): 103631. CrossRef
Cardiovascular and hepatic outcomes: prognostic differences across MASLD-MetALD-ALD continuum
Han Ah Lee, Gi-Ae Kim, Won Kim
Clinical and Molecular Hepatology.2026; 32(Suppl): e2026.0367. CrossRef

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Editorial

Modulation of PRL-1 in placental MSCs: A novel therapeutic strategy for hepatic fibrosis: Editorial on “Modulation of phosphatase of regenerating liver-1 within placental mesenchymal stem cells instigates the transition between epithelial-to-mesenchymal transition and mesenchymal-to-epithelial transition subsequent to hepatic fibrosis”: Lihai Jiang, Wenjie Zheng; Clin Mol Hepatol 2026;32(1):377-380.
Published online March 12, 2025; DOI: https://doi.org/10.3350/cmh.2025.0264

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Letter to the Editor

Letter to the editor on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017–2023”: Sisi Yang, Zhenxuan Ma; Clin Mol Hepatol 2026;32(1):e4-e6.
Published online March 7, 2025; DOI: https://doi.org/10.3350/cmh.2025.0153

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Reply to Correspondence

Viral hepatitis

Reply to correspondence on “Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C”: Chen-Hua Liu, Yu-Ping Chang; Clin Mol Hepatol 2025;31(2):e232-e233.
Published online February 26, 2025; DOI: https://doi.org/10.3350/cmh.2025.0203

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Correspondence

Viral hepatitis

Correspondence to editorial on “Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C”: Tom Ryu, Young Chang, Seung Up Kim, Jae Young Jang; Clin Mol Hepatol 2025;31(2):e203-e205.
Published online February 24, 2025; DOI: https://doi.org/10.3350/cmh.2025.0179

Citations

Citations to this article as recorded by

Reply to correspondence on “Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C”
Chen-Hua Liu, Yu-Ping Chang
Clinical and Molecular Hepatology.2025; 31(2): e232. CrossRef

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1 Web of Science
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Original Article

Viral hepatitis

Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C: Tom Ryu, Young Chang, Soung Won Jeong, Jeong-Ju Yoo, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Seung Up Kim, Jae Young Jang; Clin Mol Hepatol 2025;31(2):548-562.
Published online January 9, 2025; DOI: https://doi.org/10.3350/cmh.2024.0904

Background/Aims
Direct-acting antivirals (DAAs) effectively eradicate hepatitis C virus. This study investigated whether metabolic dysfunction influences the likelihood of fibrosis regression after DAA treatment in patients with chronic hepatitis C (CHC).
Methods
This multicenter, retrospective study included 8,819 patients diagnosed with CHC who were treated with DAAs and achieved a sustained virological response (SVR) between January 2014 and December 2022. Fibrosis regression was defined as a 20% reduction in noninvasive surrogates for liver fibrosis, such as liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) and the fibrosis-4 (FIB-4) score. Hypercholesterolemia (h-TC) was defined as >200 mg/dL.
Results
The median age of the study population was 59.6 years, with a predominance of male patients (n=4,713, 57.3%). Genotypes 1, 2, and others were confirmed in 3,872 (46.2%), 3,487 (41.6%), and 1,024 (12.2%) patients, respectively. Diabetes mellitus (DM) was present in 1,442 (17.2%) patients and the median LS was 7.50 kPa (interquartile range, 5.30–12.50). Multivariate analysis revealed that the presence of DM and pre-DAA h-TC were independently associated with a decreased probability of fibrosis regression by VCTE. Additionally, pre-DAA h-TC was independently associated with a decreased probability of fibrosis regression by the FIB-4.
Conclusions
Metabolic dysfunction has an unfavorable influence on fibrosis regression in patients with CHC who achieve SVR after DAA treatment.

Citations

Citations to this article as recorded by

Longitudinal Changes in Lipid Profile After Sustained Virological Response in Patients with Chronic Hepatitis C Treated with Direct-Acting Antivirals
Oana Koppandi, Bogdan Miutescu, Iulia Ratiu, Alexandru Popa, Camelia Nica, Eyad Gadour, Bogdan Dan Totolici, Raluca Lupusoru, Ana Maria Ghiuchici, Eftimie Miutescu
Healthcare.2026; 14(4): 486. CrossRef
Impact of Cardiometabolic Risk Factors and Steatotic Liver Disease on Liver‐Related Outcomes in Patients With Chronic Hepatitis C After Curative Antiviral Therapy
Chung‐Feng Huang, Yi‐Hung Lin, Pei‐Chien Tsai, Ming‐Lun Yeh, Chih‐Wen Wang, Tyng‐Yuan Jang, Po‐Cheng Liang, Yu‐Ju Wei, Nai‐Jen Hou, Ming‐Yen Hsieh, Chao‐Kuan Huang, Tzu‐Chun Lin, Jee‐Fu Huang, Chia‐Yen Dai, Wan‐Long Chuang, Ming‐Lung Yu
The Kaohsiung Journal of Medical Sciences.2026;[Epub] CrossRef
Editorial: Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral‐Induced Cure of Hepatitis C Virus Infection—Authors' Reply
Yu‐Ping Chang, Jia‐Horng Kao, Chen‐Hua Liu
Alimentary Pharmacology & Therapeutics.2025; 61(9): 1553. CrossRef
Epidemiologic Characteristics of Chronic Hepatitis B and Coinfections with Hepatitis C Virus or Human Immunodeficiency Virus in South Korea: A Nationwide Claims-Based Study Using the Korean Health Insurance Review and Assessment Service Database
Hyunwoo Oh, Won Sohn, Na Ryung Choi, Hyo Young Lee, Yeonjae Kim, Seung Woo Nam, Jae Yoon Jeong
Pathogens.2025; 14(7): 715. CrossRef

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Correspondence

Steatotic liver disease

Age serves as the silent architect of FIB-4’s precision in unveiling advanced hepatic fibrosis in MASLD with T2DM: Correspondence to letter to the editor on “Diagnostic accuracy of the fibrosis-4 index for advanced liver fibrosis in nonalcoholic fatty liver disease with type 2 diabetes: a systematic review and meta-analysis”: Ji Won Han, Dae Won Jun; Clin Mol Hepatol 2025;31(2):e152-e154.
Published online December 30, 2024; DOI: https://doi.org/10.3350/cmh.2024.1160

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Non-invasive Risk-based Surveillance Strategy for Hepatocellular Carcinoma in Patients with Metabolic Dysfunction-associated Steatotic Liver Disease
Ji Won Han
The Korean Journal of Gastroenterology.2026; 86(1): 62. CrossRef

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Stem cell exosomes: new hope and future potential for relieving liver fibrosis: Lihua Li, Yongjie Liu, Kunpeng Wang, Jinggang Mo, Zhiyong Weng, Hao Jiang, Chong Jin; Clin Mol Hepatol 2025;31(2):333-349.
Published online November 7, 2024; DOI: https://doi.org/10.3350/cmh.2024.0854

Abstract
PDF

Liver fibrosis is a chronic liver injury resulting from factors like viral hepatitis, autoimmune hepatitis, non-alcoholic steatohepatitis, fatty liver disease, and cholestatic liver disease. Liver transplantation is currently the gold standard for treating severe liver diseases. However, it is limited by a shortage of donor organs and the necessity for lifelong immunosuppressive therapy. Mesenchymal stem cells (MSCs) can differentiate into various liver cells and enhance liver function when transplanted into patients due to their differentiation and proliferation capabilities. Therefore, it can be used as an alternative therapy for treating liver diseases, especially for liver cirrhosis, liver failure, and liver transplant complications. However, due to the potential tumorigenic effects of MSCs, researchers are exploring a new approach to treating liver fibrosis using extracellular vesicles (exosomes) secreted by stem cells. Many studies show that exosomes released by stem cells can promote liver injury repair through various pathways, contributing to the treatment of liver fibrosis. In this review, we focus on the molecular mechanisms by which stem cell exosomes affect liver fibrosis through different pathways and their potential therapeutic targets. Additionally, we discuss the advantages of exosome therapy over stem cell therapy and the possible future directions of exosome research, including the prospects for clinical applications and the challenges to be overcome.

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Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

Correspondence to letter to the editor on “Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis”: Hee Yeon Kim, Miyoung Choi, Dae Won Jun; Clin Mol Hepatol 2025;31(1):e105-e107.
Published online November 4, 2024; DOI: https://doi.org/10.3350/cmh.2024.0937

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Letters to the Editor

Steatotic liver disease

Prevalence of steatotic liver disease and associated fibrosis in the general population: An epidemiological survey: Letter to the editor on “Epidemiology of metabolic dysfunction-associated steatotic liver disease”: Lin Guan, Xinhe Zhang, Shanghao Liu, Xiaolong Qi, Yiling Li; Clin Mol Hepatol 2025;31(2):e145-e148.
Published online October 29, 2024; DOI: https://doi.org/10.3350/cmh.2024.0921

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Integrated serum metabolomics and MRI biomarkers for MASLD: a practical framework for noninvasive staging and monitoring
Hamzah M. Alghzawi, Sweta Sahu, Aditya Rana, Rhobi Mwita, Sri Gundapaneni, Dushyant Dahiya
Abdominal Radiology.2026;[Epub] CrossRef

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1 Web of Science
Crossref

Liver fibrosis, cirrhosis, and portal hypertension

Letter regarding “Prevalence of clinically significant liver fibrosis in the general population”: Wei Feng, Qile Wang, Qingwang Ye; Clin Mol Hepatol 2025;31(1):e21-e22.
Published online October 11, 2024; DOI: https://doi.org/10.3350/cmh.2024.0887

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Editorial

Steatotic liver disease

Essential tools for assessing advanced fibrosis in metabolic dysfunction-associated steatotic liver disease: Editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis”: Won Sohn; Clin Mol Hepatol 2025;31(1):277-280.
Published online October 11, 2024; DOI: https://doi.org/10.3350/cmh.2024.0823

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Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes
Na Tian, Tie Xiao, Tianyi Xia, Hai‐Yang Yuan, Michael D. Shapiro, Gregory Y. H. Lip, Cheng‐Han Fanren, Li‐You Lian, Chen‐Xiao Huang, Yi‐Xuan Wei, Giovanni Targher, Christopher D. Byrne, Cheng‐Lv Hong, Shenghong Ju, Ming‐Hua Zheng
Alimentary Pharmacology & Therapeutics.2026; 63(1): 70. CrossRef
Correspondence to editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: a systematic review and meta-analy
Young Eun Chon, Jung Hwan Yu, Seung Up Kim
Clinical and Molecular Hepatology.2025; 31(1): e61. CrossRef
Impact of Short-Term Liraglutide Therapy on Non-Invasive Markers of Liver Fibrosis in Patients with MASLD
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Bogdan-Ioan Stanciu, Marcela Iojiban, Andreea Morariu-Barb, Cosmin Caraiani, Bogdan Procopet, Horia Stefanescu, Monica Lupsor-Platon
World Journal of Hepatology.2025;[Epub] CrossRef

8,650 View
63 Download
4 Web of Science
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Letter to the Editor

Viral hepatitis

Contemporary awareness of viral hepatitis between 2012 and 2022 among Korean adults: Donghee Kim, Won Kim, Aijaz Ahmed; Clin Mol Hepatol 2025;31(1):e5-e7.
Published online October 8, 2024; DOI: https://doi.org/10.3350/cmh.2024.0849

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Correspondence to letter to the editor on “Contemporary awareness of viral hepatitis between 2012 and 2022 among Korean adults”
Chang Hun Lee, In Hee Kim, Sook-Hyang Jeong
Clinical and Molecular Hepatology.2025; 31(2): e149. CrossRef

8,170 View
59 Download
2 Web of Science
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Review

Artificial intelligence, epidemiology, methodology, or others

Roles of X-box binding protein 1 in liver pathogenesis: Jihoon Tak, Yun Seok Kim, Sang Geon Kim; Clin Mol Hepatol 2025;31(1):1-31.
Published online October 2, 2024; DOI: https://doi.org/10.3350/cmh.2024.0441

Abstract
PDF

The prevalence of drug-induced liver injury (DILI) and viral liver infections presents significant challenges in modern healthcare and contributes to considerable morbidity and mortality worldwide. Concurrently, metabolic dysfunctionassociated steatotic liver disease (MASLD) has emerged as a major public health concern, reflecting the increasing rates of obesity and leading to more severe complications such as fibrosis and hepatocellular carcinoma. X-box binding protein 1 (XBP1) is a distinct transcription factor with a basic-region leucine zipper structure, whose activity is regulated by alternative splicing in response to disruptions in endoplasmic reticulum (ER) homeostasis and the unfolded protein response (UPR) activation. XBP1 interacts with a key signaling component of the highly conserved UPR and is critical in determining cell fate when responding to ER stress in liver diseases. This review aims to elucidate the emerging roles and molecular mechanisms of XBP1 in liver pathogenesis, focusing on its involvement in DILI, viral liver infections, MASLD, fibrosis/cirrhosis, and liver cancer. Understanding the multifaceted functions of XBP1 in these liver diseases offers insights into potential therapeutic strategies to restore ER homeostasis and mitigate liver damage.

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Clinical and Molecular Hepatology.2026; 32(3): e349. CrossRef
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Delan Huang, Fan Gu, Jingzhi Ma, Zhi Chen
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Correspondences

Steatotic liver disease

Correspondence to editorial on “Optimal cutoffs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis”: Jung Hwan Yu, Seung Up Kim; Clin Mol Hepatol 2025;31(1):e52-e54.
Published online September 24, 2024; DOI: https://doi.org/10.3350/cmh.2024.0815

10,128 View
47 Download

Liver fibrosis, cirrhosis, and portal hypertension

Correspondence to editorial on “Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis”: Hee Yeon Kim, Miyoung Choi, Dae Won Jun; Clin Mol Hepatol 2025;31(1):e48-e51.
Published online September 11, 2024; DOI: https://doi.org/10.3350/cmh.2024.0777

7,468 View
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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

Spotting undiagnosed significant liver fibrosis in the general population: impact on subsequent clinical care: Editorial on “Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis”: Nana Peng, Mary Yue Wang, Sherlot Juan Song, Terry Cheuk-Fung Yip; Clin Mol Hepatol 2025;31(1):256-260.
Published online September 3, 2024; DOI: https://doi.org/10.3350/cmh.2024.0737

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Clinical and Molecular Hepatology.2025; 31(1): e48. CrossRef

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Original Articles

Autoimmune liver disease

Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver diseases: A systematic review and meta-analysis: Jihyun An, Young Eun Chon, Gunho Kim, Mi Na Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Miyoung Choi, Dae Won Jun, Seung Up Kim, Ji Won Han, Young-Joo Jin; Clin Mol Hepatol 2024;30(Suppl):S134-S146.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0586

Background/Aims
The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease.
Methods
Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, according to liver biopsy.
Results
Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87, 0.89, and 0.99 for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88, 0.88, and 0.92, respectively, while in PSC, they were 0.88, 0.95, and 0.92, respectively. The cutoff values for AF were 7.5–17.9 kPa in PBC, 8.18–12.1 kPa in AIH, and 9.6 kPa in PSC.
Conclusions
VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases. This non-invasive method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.

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Steatotic liver disease

Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: Young Eun Chon, Young-Joo Jin, Jihyun An, Hee Yeon Kim, Miyoung Choi, Dae Won Jun, Mi Na Kim, Ji Won Han, Han Ah Lee, Jung Hwan Yu, Seung Up Kim; Clin Mol Hepatol 2024;30(Suppl):S117-S133.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0392

Background/aims
Opinions differ regarding vibration-controlled transient elastography and magnetic resonance elastography (VCTE/MRE) cut-offs for diagnosing advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the diagnostic performance and optimal cut-off values of VCTE and MRE for diagnosing AF.
Methods
Literature databases, including Medline, EMBASE, Cochrane Library, and KoreaMed, were used to identify relevant studies published up to June 13, 2023. We selected studies evaluating VCTE and MRE regarding the degree of liver fibrosis using liver biopsy as the reference. The sensitivity, specificity, and area under receiver operating characteristics curves (AUCs) of the pooled data for VCTE and MRE for each fibrosis stage and optimal cut-offs for AF were investigated.
Results
A total of 19,199 patients from 63 studies using VCTE showed diagnostic AUC of 0.83 (95% confidence interval: 0.80–0.86), 0.83 (0.80–0.86), 0.87 (0.84–0.90), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. Similarly, 1,484 patients from 14 studies using MRE showed diagnostic AUC of 0.89 (0.86–0.92), 0.92 (0.89–0.94), 0.89 (0.86–0.92), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. The diagnostic AUC for AF using VCTE was highest at 0.90 with a cut-off of 7.1–7.9 kPa, and that of MRE was highest at 0.94 with a cut-off of 3.62–3.8 kPa.
Conclusions
VCTE (7.1–7.9 kPa) and MRE (3.62–3.8 kPa) with the suggested cut-offs showed favorable accuracy for diagnosing AF in patients with NAFLD. This result will serve as a basis for clinical guidelines for non-invasive tests and differential diagnosis of AF.

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Special Issue

Liver fibrosis, cirrhosis, and portal hypertension

KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease: Mi Na Kim, Ji Won Han, Jihyun An, Beom Kyung Kim, Young-Joo Jin, Seung-seob Kim, Minjong Lee, Han Ah Lee, Yuri Cho, Hee Yeon Kim, Yu Rim Shin, Jung Hwan Yu, Moon Young Kim, YoungRok Choi, Young Eun Chon, Eun Ju Cho, Eun Joo Lee, Sang Gyune Kim, Won Kim, Dae Won Jun, Seung Up Kim, on behalf of The Korean Association for the Study of the Liver (KASL); Clin Mol Hepatol 2024;30(Suppl):S5-S105.
Published online August 19, 2024; DOI: https://doi.org/10.3350/cmh.2024.0506

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Original Article

Hepatic neoplasm

Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-analysis: Han Ah Lee, Mi Na Kim, Hye Ah Lee, Miyoung Choi, Jung Hwan Yu, Young-Joo Jin, Hee Yeon Kim, Ji Won Han, Seung Up Kim, Jihyun An, Young Eun Chon; Clin Mol Hepatol 2024;30(Suppl):S172-S185.
Published online August 12, 2024; DOI: https://doi.org/10.3350/cmh.2024.0262

Backgrounds/Aims
Despite advances in antiviral therapy for hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC) still develops even after sustained viral response (SVR) in patients with advanced liver fibrosis or cirrhosis. This meta-analysis investigated the predictive performance of vibration-controlled transient elastography (VCTE) and fibrosis 4-index (FIB-4) for the development of HCC after SVR.
Methods
We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies examining the predictive performance of these tests in adult patients with HCV. Two authors independently screened the studies’ methodological quality and extracted data. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for HCC development using random-effects bivariate logit normal and linear-mixed effect models.
Results
We included 27 studies (169,911 patients). Meta-analysis of HCC after SVR was possible in nine VCTE and 15 FIB-4 studies. Regarding the prediction of HCC development after SVR, the pooled AUCs of pre-treatment VCTE >9.2–13 kPa and FIB-4 >3.25 were 0.79 and 0.73, respectively. VCTE >8.4–11 kPa and FIB-4 >3.25 measured after SVR maintained good predictive performance, albeit slightly reduced (pooled AUCs: 0.77 and 0.70, respectively). The identified optimal cut-off value for HCC development after SVR was 12.6 kPa for pre-treatment VCTE. That of VCTE measured after the SVR was 11.2 kPa.
Conclusions
VCTE and FIB-4 showed acceptable predictive performance for HCC development in patients with HCV who achieved SVR, underscoring their utility in clinical practice for guiding surveillance strategies. Future studies are needed to validate these findings prospectively and validate their clinical impact.

Citations

Citations to this article as recorded by

2025 KASL clinical practice guidelines for management of hepatitis C
Eun Sun Jang, Nae Yun Heo, Jae Yoon Jeong, Jung Gil Park, Do Seon Song, Eun Ju Cho, Chang Hun Lee, Jae Seung Lee, Jae Hyun Yoon, Seul Ki Han, Young Kul Jung
Clinical and Molecular Hepatology.2026; 32(1): 1. CrossRef
Editorial: Residual HCC Risk After Hepatitis C Cure—Can Polygenic Risk Scores Refine Surveillance?
Heechul Nam, Sung Won Lee
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Serum Agalactosyl IgG Predicts Hepatocellular Carcinoma and All‐Cause Mortality After SVR in Advanced Chronic Hepatitis C
Daisuke Sakon, Jumpei Kondo, Yuki Tahata, Hayato Hikita, Maki Iwaisako, Muya Matsumoto, Asuka Ogata, Shinji Takamatsu, Yasutoshi Nozaki, Naruyasu Kakita, Hisashi Ishida, Fumihiko Nakanishi, Yuichi Yoshida, Masanori Nakahara, Kazuho Imanaka, Mitsuru Sakaki
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Comment: Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus
Xinpu Miao, Haidong Wu, Jinrong Xu, Wei Cheng
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Hepatocellular carcinoma surveillance after sustained virological response in chronic hepatitis C: Editorial on “Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-ana
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Jung Hee Kim, Jae Hyun Yoon, Sung-Eun Kim, Ji-Won Park, Yewan Park, Gi-Ae Kim, Seong Kyun Na, Young-Sun Lee, Jeong Han Kim
Medicina.2025; 61(9): 1601. CrossRef
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Letter to the Editor

Viral hepatitis

Presence of liver fibrosis in chronic hepatitis B patients with varying serum hepatitis B virus DNA levels: Letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”: Jian Wang, Shaoqiu Zhang, Chuanwu Zhu, Yuanwang Qiu, Chao Wu, Rui Huang; Clin Mol Hepatol 2025;31(1):e27-e30.
Published online August 7, 2024; DOI: https://doi.org/10.3350/cmh.2024.0602

Citations

Citations to this article as recorded by

Correspondence to letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”
Gi-Ae Kim, Seung Won Choi, Young-Suk Lim
Clinical and Molecular Hepatology.2025; 31(1): e108. CrossRef

8,790 View
72 Download
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Correspondence

Viral hepatitis

Correspondence to letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”: Gi-Ae Kim, Seung Won Choi, Young-Suk Lim; Clin Mol Hepatol 2025;31(1):e108-e109.
Published online August 5, 2024; DOI: https://doi.org/10.3350/cmh.2024.0619

6,530 View
41 Download

Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis: Hee Yeon Kim, Jung Hwan Yu, Young Eun Chon, Seung Up Kim, Mi Na Kim, Ji Won Han, Han Ah Lee, Young-Joo Jin, Jihyun An, Miyoung Choi, Dae Won Jun; Clin Mol Hepatol 2024;30(Suppl):S199-S213.
Published online July 30, 2024; DOI: https://doi.org/10.3350/cmh.2024.0351

Background/Aims
Although important, clinically significant liver fibrosis is often overlooked in the general population. We aimed to examine the prevalence of clinically significant liver fibrosis using noninvasive tests (NITs) in the general population.
Methods
We collected data from four databases (MEDLINE, Embase, Cochrane Library, and KoreaMed) from inception to June 13, 2023. Original articles reporting the prevalence of clinically significant liver fibrosis in the general population were included. The Stata metaprop function was used to obtain the pooled prevalence of liver fibrosis with NITs in the general population.
Results
We screened 6,429 articles and included 45 eligible studies that reported the prevalence of clinically significant liver fibrosis in the general population. The prevalence of advanced liver fibrosis, using the high probability cutoff of the fibrosis-4 (FIB-4) index, was 2.3% (95% confidence interval [CI], 1.2–3.7%). The prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, assessed using vibration-controlled transient elastography (VCTE) among the general population, was 7.3% (95% CI, 5.9–8.8%), 3.5% (95% CI, 2.7–4.5), and 1.2% (95% CI, 0.8–1.8%), respectively. Region-based subgroup analysis revealed that the highest prevalence of advanced fibrosis using the high probability cutoff of the FIB-4 index was observed in the American region. Furthermore, the American region exhibited the highest prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, using VCTE.
Conclusions
Previously undiagnosed clinically significant liver fibrosis is found in the general population through NITs. Future research is necessary to stratify the risk in the general population.

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PREVALENCE OF VARIOUS ETIOPATHOGENIC VARIANTS OF CHRONIC DIFFUSE LIVER DISEASES
B. Sakhova, A. Oshibayeva, N. Nuskabayeva, E. Iskandirova, Zh. Rsalieva, N. Karabayev, L. Karimova, L. Ozbakyr
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Modified FIB-4 Index in Type 2 Diabetes Mellitus with Steatosis: A Non-Linear Predictive Model for Advanced Hepatic Fibrosis
Jonghyun Kim, Takanori Ito, Taeang Arai, Masanori Atsukawa, Miwa Kawanaka, Hidenori Toyoda, Takashi Honda, Ming-Lung Yu, Eileen L. Yoon, Dae Won Jun, Kyungjoon Cha, Mindie H. Nguyen
Diagnostics.2024; 14(22): 2500. CrossRef

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Viral hepatitis

Vibration-controlled transient elastography for significant fibrosis in treatment-naïve chronic hepatitis B patients: A systematic review and meta-analysis: Mi Na Kim, Jihyun An, Eun Hwa Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Young-Joo Jin, Young Eun Chon, Seung Up Kim, Dae Won Jun, Ji Won Han, Miyoung Choi; Clin Mol Hepatol 2024;30(Suppl):S106-S116.
Published online July 23, 2024; DOI: https://doi.org/10.3350/cmh.2024.0371

Backgrounds/Aims
Accurate diagnosis of significant liver fibrosis in patients with chronic hepatitis B (CHB) is crucial when determining whether to initiate antiviral treatment (AVT). We conduct a meta-analysis to assess the diagnostic performance of vibration-controlled transient elastography (VCTE) for significant liver fibrosis in AVT-naïve CHB patients with serum alanine transaminase (ALT) levels within 5-fold the upper limit of normal (ULN).
Methods
The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched to identify studies that compared the performance of VCTE and liver biopsy (reference standard) when diagnosing significant liver fibrosis (≥F2) in AVT-naïve CHB patients with ALT within 5-fold the ULN. A hierarchical summary receiver operating characteristic curve (HSROC) and bivariate model were performed to evaluate the diagnostic performance of VCTE in the meta-analysis.
Results
Eight studies (2,003 patients) were included. The summary sensitivity and specificity for diagnosis of significant liver fibrosis were 0.78 (95% confidence interval [CI], 0.66–0.86) and 0.72 (95% CI, 0.60–0.82), respectively. The HSROC for the diagnosis of significant liver fibrosis was 0.81 (95% CI, 0.72–0.86). The optimal cutoff value of VCTE for diagnosis of significant liver fibrosis was 7.7 kPa with a sensitivity of 0.64 (95% CI, 0.50–0.76) and specificity of 0.83 (95% CI, 0.72–0.90).
Conclusions
Our study demonstrated that VCTE has an acceptable diagnostic performance for significant liver fibrosis in AVT-naïve CHB patients with ALT within 5-fold the ULN.

Citations

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Chronic Hepatitis B Infection: Patient Guidance
Lung‐Yi Mak, Jimmy Che‐To Lai, Ken Liu, Rashid Lui, Sakkarin Chirapongsathorn, Kuo Chao Yew, Mara Teresa Panlilio, Cosmas Rinaldi Adithya Lesmana, Ruveena Bhavani Rajaram, Liang Shen, Desmond Cheung, Lung‐Fai Wong, Hye Won Lee, Madhumita Premkumar, Anand
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APASL clinical practice guidelines on the management of chronic hepatitis B infection: a 2026 update
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Hepatology International.2026; 20(4): 911. CrossRef
The Use of Ultrasound-Based Elastography Techniques in Liver Fibrosis: A Narrative Review
Arjuna Priyadarsin De Silva, Shashini Madushika Hathurusinghe, Madunil Anuk Niriella, Hithunadura Janaka De Silva
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Comparable Predictive Performance of Non‐VCTE–Based Machine Learning Model for HBV‐Infected Hepatocellular Carcinoma Risk
Hahn Yi, Hye Won Lee, Jae Il Shin, Hyung Woong Lee, Tae Seop Lim, Beom Kyung Kim, Namkug Kim
Journal of Gastroenterology and Hepatology.2026; 41(10): 3199. CrossRef
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Haizhen Chen, Gaixia Zhang, Yingwen Zhang, Li Li, Yuanyuan Che, Jing Huang
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Napoleon Bellua Sam, Saeed Folorunsho Majeed, Adams Dramani
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Nobuharu Tamaki, Daniel Q. Huang, Hyung Woong Lee, Soo Young Park, Yu Rim Lee, Dong Hyun Sinn, Tae Seop Lim, Hiroyuki Marusawa, Seng Gee Lim, Hironori Ochi, Masahiko Kondo, Yasushi Uchida, Haruhiko Kobashi, Koichiro Furuta, Masayuki Kurosaki, Beom Kyung K
Journal of Gastroenterology and Hepatology.2025; 40(6): 1595. CrossRef
Assessing Liver Fibrosis in Chronic Hepatitis B: Liver Biopsy or Non-Invasive Fibrosis Markers?
Deniz Borcak, Zuhal Yesilbag, Yusuf Emre Ozdemir, Adile Sevde Demir, Esra Salim Dogdas, Aysegul Inci Sezen, Esra Canbolat Unlu, Sevtap Senoglu, Hayat Kumbasar Karaosmanoglu, Kadriye Kart Yasar
Journal of Clinical Medicine.2025; 14(22): 8164. CrossRef
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Ho Soo Chun
Clinical Ultrasound.2025; 10(2): 69. CrossRef
Recent Trends in Noninvasive Tests for Assessing Hepatic Fibrosis in Patients with Chronic Liver Disease
Jung Hwan Yu
The Korean Journal of Medicine.2024; 99(5): 232. CrossRef
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Mi Na Kim
The Korean Journal of Gastroenterology.2024; 84(5): 201. CrossRef
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Han Ah Lee
Clinical Ultrasound.2024; 9(2): 70. CrossRef

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10 Web of Science
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Viral hepatitis

Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B: Gi-Ae Kim, Seung Won Choi, Seungbong Han, Young-Suk Lim; Clin Mol Hepatol 2024;30(4):793-806.
Published online July 19, 2024; DOI: https://doi.org/10.3350/cmh.2024.0252

Background/Aims
Serum hepatitis B virus (HBV) DNA levels and non-invasive liver fibrosis scores are significantly associated with hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) patients. Nonetheless, the relationship between HBV DNA levels and liver fibrosis scores is unclear.
Methods
A historical cohort comprising 6,949 non-cirrhotic Korean CHB patients without significant alanine aminotransferase elevation was investigated. The association of HBV DNA levels with the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis (FIB)-4 score at baseline was analyzed using general linear models.
Results
In HBeAg-negative patients (n=4,868), HBV DNA levels correlated linearly with both APRI and FIB-4 scores. In contrast, in HBeAg-positive patients (n=2,081), HBV DNA levels correlated inversely with both APRI and FIB-4 scores. Across the entire cohort, a significant non-linear parabolic relationship was identified between HBV DNA levels and fibrosis scores, independent of age and other covariates. Notably, moderate viral loads (6–7 log10 IU/mL) corresponded to the highest APRI and FIB-4 scores (p<0.001). Over a median 10-year follow-up, 435 patients (6.3%) developed HCC. Higher APRI scores ≥0.5 and FIB-4 scores ≥1.45 were significantly associated with elevated HCC risk (p<0.001 for both). HBV DNA level remained a significant predictive factor for HCC development, even after adjusting for APRI or FIB-4 scores.
Conclusions
HBV viral load is significantly correlated with APRI and FIB-4 scores, and is also associated with HCC risk independent of those scores in CHB patients. These findings suggest that HBV DNA level is associated with hepatocarcinogenesis through both direct and indirect pathways.

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Presence of liver fibrosis in chronic hepatitis B patients with varying serum hepatitis B virus DNA levels: Letter to the editor on “Non-linear association between liver fibrosis scores and viral load in patients with chronic hepatitis B”
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Clinical and Molecular Hepatology.2025; 31(1): e27. CrossRef
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Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

Correspondence to editorial on “Liver sinusoidal endothelial cell: An important yet often overlooked player in the liver fibrosis”: Jiaorong Qu, Le Wang, Xiaojiaoyang Li; Clin Mol Hepatol 2024;30(4):1002-1004.
Published online May 17, 2024; DOI: https://doi.org/10.3350/cmh.2024.0357

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Liver Fibrosis: Molecular Pathogenesis and Therapeutic Interventions
Jiaorong Qu, Wenqing Qin, Minghang Dong, Zhi Ma, Si Li, Runping Liu, Ranyun Chen, Changmeng Li, Xiaojiaoyang Li
MedComm.2026;[Epub] CrossRef

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Original Article

Hepatic neoplasm

Conventional and machine learning-based risk scores for patients with early-stage hepatocellular carcinoma: Chun-Ting Ho, Elise Chia-Hui Tan, Pei-Chang Lee, Chi-Jen Chu, Yi-Hsiang Huang, Teh-Ia Huo, Yu-Hui Su, Ming-Chih Hou, Jaw-Ching Wu, Chien-Wei Su; Clin Mol Hepatol 2024;30(3):406-420.
Published online April 11, 2024; DOI: https://doi.org/10.3350/cmh.2024.0103

Background/Aims
The performance of machine learning (ML) in predicting the outcomes of patients with hepatocellular carcinoma (HCC) remains uncertain. We aimed to develop risk scores using conventional methods and ML to categorize early-stage HCC patients into distinct prognostic groups.
Methods
The study retrospectively enrolled 1,411 consecutive treatment-naïve patients with the Barcelona Clinic Liver Cancer (BCLC) stage 0 to A HCC from 2012 to 2021. The patients were randomly divided into a training cohort (n=988) and validation cohort (n=423). Two risk scores (CATS-IF and CATS-INF) were developed to predict overall survival (OS) in the training cohort using the conventional methods (Cox proportional hazards model) and ML-based methods (LASSO Cox regression), respectively. They were then validated and compared in the validation cohort.
Results
In the training cohort, factors for the CATS-IF score were selected by the conventional method, including age, curative treatment, single large HCC, serum creatinine and alpha-fetoprotein levels, fibrosis-4 score, lymphocyte-tomonocyte ratio, and albumin-bilirubin grade. The CATS-INF score, determined by ML-based methods, included the above factors and two additional ones (aspartate aminotransferase and prognostic nutritional index). In the validation cohort, both CATS-IF score and CATS-INF score outperformed other modern prognostic scores in predicting OS, with the CATSINF score having the lowest Akaike information criterion value. A calibration plot exhibited good correlation between predicted and observed outcomes for both scores.
Conclusions
Both the conventional Cox-based CATS-IF score and ML-based CATS-INF score effectively stratified patients with early-stage HCC into distinct prognostic groups, with the CATS-INF score showing slightly superior performance.

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Ming-Ying Lu, Jacky Chung-Hao Wu, Henry Horng-Shing Lu, Mohammed Eslam, Ming-Lung Yu
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Review

Liver fibrosis, cirrhosis, and portal hypertension

Liver sinusoidal endothelial cell: An important yet often overlooked player in the liver fibrosis: Jiaorong Qu, Le Wang, Yufei Li, Xiaojiaoyang Li; Clin Mol Hepatol 2024;30(3):303-325.
Published online February 28, 2024; DOI: https://doi.org/10.3350/cmh.2024.0022

Abstract
PDF

Liver sinusoidal endothelial cells (LSECs) are liver-specific endothelial cells with the highest permeability than other mammalian endothelial cells, characterized by the presence of fenestrae on their surface, the absence of diaphragms and the lack of basement membrane. Located at the interface between blood and other liver cell types, LSECs mediate the exchange of substances between the blood and the Disse space, playing a crucial role in maintaining substance circulation and homeostasis of multicellular communication. As the initial responders to chronic liver injury, the abnormal LSEC activation not only changes their own physicochemical properties but also interrupts their communication with hepatic stellate cells and hepatocytes, which collectively aggravates the process of liver fibrosis. In this review, we have comprehensively updated the various pathways by which LSECs were involved in the initiation and aggravation of liver fibrosis, including but not limited to cellular phenotypic change, the induction of capillarization, decreased permeability and regulation of intercellular communications. Additionally, the intervention effects and latest regulatory mechanisms of anti-fibrotic drugs involved in each aspect have been summarized and discussed systematically. As we studied deeper into unraveling the intricate role of LSECs in the pathophysiology of liver fibrosis, we unveil a promising horizon that pave the way for enhanced patient outcomes.

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Snapshot

Steatotic liver disease

Immunopathogenesis of liver fibrosis in steatotic liver disease: Chaerin Woo, Won-Il Jeong; Clin Mol Hepatol 2024;30(2):299-302.
Published online February 19, 2024; DOI: https://doi.org/10.3350/cmh.2024.0113

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Correspondence

Steatotic liver disease

Correspondence on Letter regarding “Non-alcoholic fatty liver disease: Definition and subtypes”: Seul Ki Han, Soon Koo Baik, Moon Young Kim; Clin Mol Hepatol 2023;29(3):817-819.
Published online May 17, 2023; DOI: https://doi.org/10.3350/cmh.2023.0155

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Original Article

Viral hepatitis

Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis: Yu Jun Wong, Vy H. Nguyen, Hwai-I Yang, Jie Li, Michael Huan Le, Wan-Jung Wu, Nicole Xinrong Han, Khi Yung Fong, Elizebeth Chen, Connie Wong, Fajuan Rui, Xiaoming Xu, Qi Xue, Xin Yu Hu, Wei Qiang Leow, George Boon-Bee Goh, Ramsey Cheung, Grace Wong, Vincent Wai-Sun Wong, Ming-Whei Yu, Mindie H. Nguyen; Clin Mol Hepatol 2023;29(3):705-720.
Published online May 8, 2023; DOI: https://doi.org/10.3350/cmh.2023.0004

Background/Aims
Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients.
Methods
We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random- effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment.
Results
We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88–95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27–0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all p≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, p<0.0001).
Conclusions
IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.

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Editorials

Steatotic liver disease

Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: present and future: Lynna Alnimer, Mazen Noureddin; Clin Mol Hepatol 2023;29(2):394-397.
Published online April 1, 2023; DOI: https://doi.org/10.3350/cmh.2023.0104

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MAST versus FAST for active fibrotic MASH: a meta-analysis supporting risk-stratified diagnostic pathways
Shengfang Liu, Qingjuan Zhang, Lijing Wang, Qin Tang, Bingtao Hu
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Evolving B-mode ultrasound-based techniques for assessing metabolic dysfunction-associated steatotic liver disease: Now and beyond
Walaa Abdelhamed, Mohamed Elbadry, Mohamed El-Kassas
Liver Research.2026; 10(2): 109. CrossRef
Development of a machine learning model to identify individuals with VCTE-derived at-risk MASH in a Spanish Mediterranean region
Marta Cedenilla, David Marti-Aguado, Josep Redon, Inma Sauri-Ferrer, Jorge Navarro, Desamparados Escudero, Anton Gomez, Luis Cea-Calvo, Carlos J. Martos-Rodriguez, Javier Díaz Carnicero
Frontiers in Digital Health.2026;[Epub] CrossRef
Collagen fibers quantification for liver fibrosis assessment using linear dichroism photoacoustic microscopy
Yang Qiu, Honghui Li, Kun Yu, Jiali Chen, Li Qi, Yinghua Zhao, Liming Nie
Photoacoustics.2025; 42: 100694. CrossRef

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4 Web of Science
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Viral hepatitis

Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?: Joo Hyun Oh, Dong Hyun Sinn; Clin Mol Hepatol 2023;29(2):367-370.
Published online March 20, 2023; DOI: https://doi.org/10.3350/cmh.2023.0054; Correction in: Clin Mol Hepatol 2023;29(3):828

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Ping Wang, Tingting Zhu, Zhemin Cheng, Jiaping Huang
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Letter regarding “Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?”
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The Relationship between Mean Platelet Volume and Neutrophil–Lymphocyte Ratio and Liver Fibrosis in Patients with Chronic Hepatitis B
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Medicina.2023; 59(7): 1287. CrossRef

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Steatotic liver disease

Non-invasive biomarkers for liver inflammation in non-alcoholic fatty liver disease: present and future: Kee-Huat Chuah, Wah-Kheong Chan; Clin Mol Hepatol 2023;29(2):401-403.
Published online February 28, 2023; DOI: https://doi.org/10.3350/cmh.2023.0062

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Original Article

Cholestatic liver disease

Taurocholic acid promotes hepatic stellate cell activation via S1PR2/p38 MAPK/YAP signaling under cholestatic conditions: Jing Yang, Xujiao Tang, Zhu Liang, Mingzhu Chen, Lixin Sun; Clin Mol Hepatol 2023;29(2):465-481.
Published online February 20, 2023; DOI: https://doi.org/10.3350/cmh.2022.0327

Background/Aims
Disrupted bile acid regulation and accumulation in the liver can contribute to progressive liver damage and fibrosis. However, the effects of bile acids on the activation of hepatic stellate cells (HSCs) remain unclear. This study investigated the effects of bile acids on HSC activation during liver fibrosis, and examined the underlying mechanisms.
Methods
The immortalized HSCs, LX-2 and JS-1cells were used for the in vitro study. in vitro, the adeno-associated viruses adeno-associated virus-sh-S1PR2 and JTE-013 were used to pharmacologically inhibit the activity of S1PR2 in a murine model of fibrosis induced by a 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet. Histological and biochemical analyses were performed to study the involvement of S1PR2 in the regulation of fibrogenic factors as well as the activation properties of HSCs.
Results
S1PR2 was the predominant S1PR expressed in HSCs and was upregulated during taurocholic acid (TCA) stimulation and in cholestatic liver fibrosis mice. TCA-induced HSC proliferation, migration and contraction and extracellular matrix protein secretion were inhibited by JTE-013 and a specific shRNA targeting S1PR2 in LX-2 and JS-1 cells. Meanwhile, treatment with JTE-013 or S1PR2 deficiency significantly attenuated liver histopathological injury, collagen accumulation, and the expression of fibrogenesis-associated genes in mice fed a DDC diet. Furthermore, TCAmediated activation of HSCs through S1PR2 was closely related to the yes-associated protein (YAP) signaling pathway via p38 mitogen-activated protein kinase (p38 MAPK).
Conclusions
TCA-induced activation of the S1PR2/p38 MAPK/YAP signaling pathways plays a vital role in regulating HSC activation, which might be therapeutically relevant for targeting cholestatic liver fibrosis.

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Non-invasive biomarkers of liver fibrosis in non-alcoholic fatty liver disease: Maamon Basheer, Mohamed Naffaa, Nimer Assy; Clin Mol Hepatol 2023;29(2):398-400.
Published online February 13, 2023; DOI: https://doi.org/10.3350/cmh.2023.0045

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