Search Results (1,031)

Background: Metabolic dysfunction-associated steatohepatitis (MASH), the progressive stage of metabolic dysfunction-associated steatotic liver disease (MASLD), is characterized by hepatic steatosis, inflammation, and fibrosis, yet no specific therapy has been established. This study evaluated the therapeutic potential of Andrias davidianus liver-derived peptides (ALPs) in a mouse model of MASH. Methods: ALPs were prepared by enzymatic hydrolysis of fresh Andrias davidianus liver. A MASH model was induced in mice using a methionine- and choline-deficient diet (MRCD). ALP was administered via oral gavage, and its effects were assessed through histological staining (H&E, Oil Red O, and Sirius Red), immunofluorescence (Ki67), apoptosis detection (TUNEL), serum biochemistry, and RNA-sequencing of liver tissues. Gut microbiota composition was also analyzed. Results: ALP treatment significantly alleviated hepatic histopathological features, including steatosis, inflammation, and fibrosis. It reduced aberrant proliferation and apoptosis of hepatocyte-like cells, and markedly improved serum biochemical markers of liver function. RNA-seq analysis revealed that ALP modulated the expression of lipid metabolism-related genes, an effect associated with suppression of the PPARγ signaling pathway. Furthermore, ALP selectively modulated MRCD-induced gut microbiota dysbiosis, particularly by reducing the Firmicutes-to-Bacteroidota (F/B) ratio and enriching Akkermansia. No overt toxicity was observed in other organs. Conclusions: Our findings demonstrate that ALP exerts protective effects against MASH by improving lipid metabolism, partially through suppression of the PPARγ signaling pathway, and by selectively modulating specific gut microbial taxa. ALP represents a promising natural therapeutic candidate for MASH. Full article

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. In the U.S., HCC incidence is highest among Hispanic populations. With the exception of well-known PNPLA3 variants, the genetic risk factors underlying HCC in Hispanic individuals, particularly rare germline variants, are largely unexplored. Methods: We performed whole-exome sequencing in 719 Hispanic Americans, including 455 HCC cases and 264 controls. We analyzed rare to low frequency, putatively deleterious variants in 86 genes previously implicated in HCC susceptibility. Genetic associations were assessed at single-variant, gene, and cumulative multi-variant burden levels using Fisher’s exact tests and weighted burden tests. Results: We identified 29 rare deleterious variants across 16 genes enriched in HCC cases compared with controls. Single-variant tests identified statistically robust associations in pathways related to lipids metabolism, TM6SF2 R138W, immune regulation, HLA-DRB1 W38X, and Wnt signaling pathway, WNT9A R375H. Exploratory analyses showed that TM6SF2 R138W was further enriched among cases with alcohol and metabolic dysfunction-associated steatotic liver disease. Gene-based burden tests revealed five associated genes, including TM6SF2 and HLA-DRB1. A strong dose-effect relationship was observed, with HCC risk increasing ~4-fold per candidate variant carried (odds ratio, 3.84; 95% confidence interval, 2.40–6.53). Conclusions: Rare deleterious germline variants across lipid metabolism and immune pathways contribute to increased HCC risk in Hispanic individuals. These findings provide a genetic framework for understanding HCC disparities and support future mechanistic and epidemiologic studies in this high-risk population. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD), a leading cause of chronic liver disease, encompasses a continuum from steatosis to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma. This review aimed to synthesize current evidence on how metabolomic, lipidomic, and spatial multi-omic approaches illuminate MASLD pathogenesis and support precision hepatology. Methods: A structured narrative review was conducted through searches of PubMed, Scopus, and Web of Science, complemented by manual screening of key references. Studies were prioritized when they addressed MASLD biology, metabolic rewiring, lipid remodeling, mitochondrial dysfunction, inflammatory and fibrogenic pathways, gut–liver–adipose crosstalk, biomarker development, or therapeutic monitoring. Results: The reviewed evidence identifies MASLD as a systemic metabolic disorder shaped by excess lipid flux, enhanced de novo lipogenesis, impaired mitochondrial adaptation, oxidative and endoplasmic reticulum stress, sterile inflammation, and hepatic stellate-cell activation. Recurrent metabolomic signatures include altered amino acid, fatty acids, bile acid, and microbial co-metabolite pathways. Lipidomic studies consistently implicate depletion of protective polyunsaturated fatty acids, lysophosphatidylcholines, and phosphatidylcholines, in association with accumulation of diacylglycerols and ceramides, in the transition from steatosis to MASH and fibrosis. Emerging spatial and multi-omic analyses further resolve cell-specific metabolic niches involving hepatocytes, macrophages, endothelial cells, and stellate cells. Conclusions: Metabolomics provides a mechanistic and translational bridge between molecular injury, histological progression, and non-invasive risk stratification in MASLD. Future progress requires standardized analytical workflows, longitudinal validation, causal pathway interrogation, and integration with imaging, genetics, microbiome profiling, and treatment-response phenotyping. Clinical implementation will require standardized platforms, transparent metabolite identification, external validation across diverse populations, cost-effectiveness analyses, and regulatory-grade evidence of clinical utility. Full article

Background and Purpose: Ultra-processed food (UPF) intake is a risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD) development, and fibroblast growth factor 21 (FGF21) is a key regulator of hepatic lipid metabolism, but its role in this association remains unclear. We aimed to investigate whether FGF21 mediates the UPF-MASLD relationship in a population-based cohort and whether berry extract (BE) protects against UPF-related liver injury through FGF21 signaling. Methods: This study included 29,386 participants with magnetic resonance imaging (MRI)-derived proton density fat fraction (PDFF) and iron-corrected T1 (cT1) from the UK Biobank. UPF intake was classified according to the NOVA system. Log-binomial and generalized linear regression models were used to estimate the associations of UPF with MASLD, PDFF, and cT1, respectively. In vivo, nine-month-old male C57BL/6J mice were fed a baked Western diet (BWD) with bilberry extract (BE, 200 mg/kg/day) or vehicle for 16 weeks. In vitro, the role of FGF21 was examined by knockdown experiments in AML12 hepatocytes. Results: UPF consumption was linearly associated with a higher risk of MASLD, with per 10% increment associated with 9% higher risk of MASLD (RR 1.09 [95% CI 1.07–1.10]), as well as dose-dependent increases in PDFF and cT1. Among the 283 plasma proteins associated with PDFF, FGF21 showed the strongest association with UPF intake and accounted for the largest proportion of mediation in the UPF-PDFF association. A significant interaction between UPF and berry intake was observed in MASLD risk (p for interaction = 0.018). In the animal model, BE supplementation for 16 weeks alleviated BWD-induced hepatic steatosis, inflammation, and glucose intolerance, while upregulating hepatic FGF21, FGFR1c, and β-Klotho expression and improving mitochondrial function. FGF21 knockdown abrogated BE’s protective effect against lipid accumulation in vitro. Conclusions: FGF21 emerged as a potential mediator of the association between UPF consumption and liver fat accumulation. Anthocyanin-rich dietary interventions may offer a promising strategy to prevent MASLD progression. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and is characterized by excessive hepatic lipid accumulation and metabolic dysfunction. Although microRNA-34a (miR-34a) has been implicated in hepatic lipid metabolism, the molecular mechanisms underlying its contribution to MASLD remain incompletely understood. Here, we investigated the role of miR-34a in FFA-induced hepatic steatosis using HepG2 cells and explored RXR-associated signaling as a potential therapeutic strategy. RT-qPCR quantified miR-34a expression; direct target interactions were validated using dual-luciferase reporter assays; proteomic alterations were characterized by iTRAQ-based proteomics followed by Ingenuity Pathway Analysis (IPA); and transcriptomic responses to 9-cis-retinoic acid (9-cis-RA) were analyzed by RNA sequencing. FFA treatment significantly increased miR-34a expression, and dual-luciferase assays confirmed that miR-34a directly targets the 3′-UTRs of RXRα, PPARα, and SIRT1. Integrated proteomic and transcriptomic analyses consistently identified LXR/RXR signaling as one of the principal pathways associated with miR-34a dysregulation and 9-cis-RA treatment. Pharmacological activation of RXR-associated signaling with the pan-RXR agonist 9-cis-RA attenuated intracellular lipid accumulation and reduced the expression of key regulators of lipogenesis and fatty acid uptake, including FASN, SCD1, FABP4, and CD36. Collectively, these findings support the miR-34a–RXRα axis as one regulatory component within a broader nuclear receptor network associated with hepatic lipid homeostasis and support further investigation of RXR-associated signaling as a potential therapeutic strategy for MASLD. Nevertheless, confirmation of receptor-specific mechanisms and validation in more physiologically relevant experimental models will be required. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a systemic metabolic disorder associated with an elevated risk of cardiovascular disease. Mac-2 binding protein glycosylation isomer (M2BPGi), a noninvasive serum biomarker of hepatic fibrosis, has also been linked to adverse metabolic and cardiovascular outcomes. However, the association between serum M2BPGi levels and subclinical coronary atherosclerosis in individuals with MASLD remains unclear. We investigated the association between serum M2BPGi levels and coronary artery calcium score (CACS), an established imaging marker of subclinical atherosclerosis, in individuals with MASLD. Methods: This retrospective cross-sectional study included 6514 adults with MASLD who underwent health screening examinations between 2020 and 2025. Participants were categorized into quartiles according to serum M2BPGi levels: Q1 (<0.48), Q2 (0.48–0.61), Q3 (0.62–0.80), and Q4 (≥0.81). Coronary artery calcification (CAC) was defined as CACS > 0. Multivariable logistic regression analysis was performed after adjustment for age, sex, smoking status, liver enzymes, adiposity, dysglycemia, blood pressure, and lipid profile. Multivariable ordinal logistic regression analysis was additionally performed to evaluate the association between M2BPGi levels and CAC severity. Results: The prevalence of CAC increased progressively across M2BPGi quartiles (39.4%, 45.3%, 48.5%, and 57.4% for Q1–Q4, respectively; p < 0.001). In multivariable logistic regression analysis, participants in the highest M2BPGi quartile had significantly higher odds of CAC presence than those in the lowest quartile (OR, 1.32; 95% CI, 1.10–1.58; p = 0.0035). Higher M2BPGi quartiles were also independently associated with greater CAC severity in multivariable ordinal logistic regression analysis (OR, 1.33; 95% CI, 1.13–1.57; p = 0.0007 for Q4 vs. Q1). Conclusions: Higher serum M2BPGi levels were independently associated with both the presence and severity of CAC in individuals with MASLD. These findings suggest that M2BPGi may serve as a potential biomarker for identifying individuals with MASLD at increased risk of subclinical atherosclerosis and may complement conventional cardiovascular risk assessment. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) has traditionally been conceptualized as a predominantly metabolic disorder driven by obesity and insulin resistance. However, recent advances in human genetics have revealed a more complex picture that encompasses germline susceptibility variants, protective loss-of-function alleles, polygenic risk models, and somatic clonal evolution. Since the discovery of PNPLA3 (patatin-like phospholipase domain-containing 3) I148M, multiple loci—including TM6SF2, MBOAT7, GCKR, HSD17B13, MTARC1, GPAM, and CIDEB—have substantially expanded the mechanistic understanding of disease heterogeneity and hepatocellular vulnerability. Recent studies integrating partitioned polygenic risk scores and unsupervised phenotypic clustering suggest that MASLD may be organized into at least two predominant subtypes: a liver-specific subtype characterized by intrinsic hepatocellular susceptibility, and a cardiometabolic subtype associated with systemic metabolic dysfunction and increased cardiovascular risk. Analyses of cirrhotic liver tissue have, in turn, demonstrated somatic clonal expansion of hepatocytes harboring adaptive metabolic mutations, adding an evolutionary dimension to advanced disease. On this basis, we propose an integrated LS/CM/C framework encompassing liver-specific (LS), cardiometabolic (CM), and clonal (C) components. This model offers a conceptual structure that links germline genetics, metabolic heterogeneity, somatic adaptation, and emerging pharmacogenomic strategies. The recent development of genotype-directed therapies targeting PNPLA3 and HSD17B13, together with the approval of resmetirom and semaglutide, further supports the transition toward biologically stratified hepatology. Although prospective validation remains necessary, the convergence of genetics, clonal biology, and targeted therapeutics suggests that MASLD is moving toward an era of precision medicine. Full article

Various high-fat diets have been used to create animal models of metabolic dysfunction-associated steatotic liver disease (MASLD) and to evaluate the effect of various therapeutic drugs. We determined the effects of PPARα/δ/γ subtype-selective agonists (pemafibrate, seladelpar, and pioglitazone, respectively) on the hepatic triglyceride (TG) profile using LC–MS in a MASLD mouse model established by administering a high-fat/high-cholesterol/high-cholic acid (HFCC) diet combined with cyclodextrin-containing water, which is thought to induce fatty liver over a short period. The livers of mice fed the HFCC/CDX diet for four weeks exhibited an approximately fivefold increase in the summed TG LC–MS signal per unit liver weight and altered TG composition compared with normal livers of mice administered a standard diet/water. Specifically, the proportion of TG54 (TG with 54 carbon atoms) species doubled, whereas the proportion of TG52 decreased by 38%. Pemafibrate did not alter the relative total TG signal but decreased the proportion of some TG58/TG56 species and increased the proportion of some TG56/TG52 species. Seladelpar did not alter the relative total TG signal, while only slightly altering TG composition. Pioglitazone reduced the relative total TG signal by 44%, which included a decrease in the proportion of polyunsaturated fatty acid-rich TG54 and an increase in the proportion of TG58/TG56 with 1–3 unsaturated bonds. We are the first to demonstrate that selective activation of PPARα/δ/γ has different effects on the TG profile in fatty liver. Full article

Background/Objectives: Psoriatic disease (PsD) is a chronic cutaneous and systemic inflammatory condition associated with an increased risk of metabolic-dysfunction-associated steatotic liver disease (MASLD) and its complications. Our objective was to determine the prevalence of MASLD in our overall cohort and to analyze it across PsO, PsA, and healthy control groups. The secondary objective was to describe hepatic steatosis and fibrosis using transient elastography (FibroScan^®) and to characterize hepatic scores within each study group. The third objective was to assess whether specific cardiovascular risk factors were associated with the development of hepatic steatosis or fibrosis in individuals with PsD and healthy controls. Methods: A cross-sectional study was conducted at a single tertiary care center, enrolling consecutive patients from the Dermatology and Rheumatology Departments. Individuals with pre-existing liver disorders were excluded. The control cohort comprised 102 healthy volunteers without chronic inflammatory or hepatic conditions. All participants underwent comprehensive clinical assessments, serum biomarker analysis, and FibroScan^®. Results: A total of 330 participants were included, 228 with PsD (101 with psoriasis (PsO) and 127 with psoriatic arthritis (PsA)) and 102 healthy controls. MASLD was present in 39% of the overall cohort, with a prevalence of 47.5% in PsO, 32.2% in PsA, and 8.8% in healthy controls (p < 0.001). FibroScan^® measurements indicated a tendency toward increased liver stiffness and higher controlled attenuation parameter (CAP) values in patients with PsD. Both PsO and PsA groups showed a higher prevalence of cardiometabolic risk factors compared with controls (p < 0.05). Non-invasive fibrosis indices were also significantly altered in both patient groups. Conclusions: Patients with PsD demonstrated a higher prevalence of MASLD, hepatic fibrosis, and cardiometabolic abnormalities compared with healthy controls in our cohort. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects nearly one-fourth of the world population and is closely linked to obesity, metabolic syndrome, and poor diet. We conducted a systematic review and meta-analysis to evaluate the impact of exercise on key clinical outcomes in MASLD patients. Methods: A systematic literature search was conducted until 202 September 5, to identify randomized controlled trials (RCTs), post-hoc analyses, and quasi-experimental designs comparing exercise versus standard therapy in MASLD. A random-effects model pooled data as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). Analyses were conducted using R (version 4.5.1). Results: Our meta-analysis included 21 RCTs, 4 post-hoc analyses, and 1 quasi-experimental study (1124 patients; mean age 52.24 ± 7.24 years). Exercise reduced BMI (MD −0.82), serum cholesterol (MD −14.31), ALT (MD −6.56), AST (MD −5.32), FIB-4 (MD −0.19), and NAFLD fibrosis score (MD −0.59), and increased HDL (MD 4.36) versus standard therapy. Weight (MD −2.11) and HOMA-IR (MD −0.59) were not significantly different. Meta-regression showed age increased HOMA-IR (estimate 0.032) and higher BMI reduced HDL (estimate −0.71). Conclusions: Exercise significantly improves key clinical outcomes in MASLD, including BMI, cholesterol, liver enzymes, and fibrosis markers, supporting physical activity as a core component of MASLD management. Full article

Background/Objectives: Obesity can cause metabolic disorders and hepatic steatosis. Continuous hepatic influx of dietary lipids leads to adaptive metabolic changes, including increased fatty acid oxidation (FAO) and ketogenesis. However, these adaptations are not enough to counter the detrimental accumulation of lipids, resulting in hepatic steatosis. Apabetalone is a clinical-stage Bromodomain and Extra-Terminal domain inhibitor (BETi) that attenuated the increase in hepatic fibrosis score (FS) and reduced the rate of ischemic major adverse cardiovascular events and hospitalizations for heart failure in a subgroup of patients having a high likelihood of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in the phase 3 clinical trial, BETonMACE. Methods: To analyze apabetalone’s effects on lipid and ketone metabolism, RNA seq, Oil Red staining and triglyceride quantification were performed in livers from a mouse model of diabetes-induced obesity and ketones were measured in plasma. Results: Mice fed a high-fat diet (HFD) were obese and demonstrated liver steatosis. Apabetalone treatment maintained the beneficial metabolic adaptation induced by HFD (increased FAO) and decreased hepatic triglycerides and lipid droplets. This inhibition of lipid anabolism redirected substrates to FAO and ketogenesis, resulting in increased plasma ketones, showing for the first time the role of BETi in ketogenesis. In the heart, apabetalone treatment reduced cardiac oxidative stress and plasma NT-proBNP levels. Conclusions: Apabetalone improves hepatic lipid handling, favoring ketogenesis. As ketones have demonstrated beneficial effects on cardiac function, increased ketones induced by apabetalone may not only contribute to the observed attenuation of FS in patients, but also a reduction in cardiac events among patients with high likelihood of MASLD, as well as in the overall trial population. Full article

Background: Dysregulation of innate immune pathways is an important contributor to the progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Inflammasomes serve as key regulators of innate immunity. Emerging evidence suggests that nutrient status, particularly choline, may play an important role in inflammasome activation. However, there is no systematic study across different in vitro and in vivo experiments to demonstrate the same. Methods: Hepatic expression of canonical inflammasomes such as NLRP3, NLRC4, and AIM2 and downstream inflammatory cytokines was analyzed in the high-fat-high-fructose (HF-HF) and methionine-choline-deficient (MCD) diet-induced mouse models of MASLD, along with liver biopsies from MASLD patients (n = 20). Moreover, in vitro experiments were performed to analyze the potential of choline to modulate inflammasome activation under obesogenic conditions. Results: Our data suggest increased hepatic expression of IL-1β and IL-18, at both mRNA and protein levels, in both models. While MCD-fed mice showed elevated hepatic mRNA expression of all three inflammasomes, the HF-HF diet induced a selective upregulation of NLRP3. Consistently, MCD-fed mice showed stronger induction of IL-1β and IL-18. MASLD patients also demonstrated increased hepatic expression of inflammasomes and both cytokines. In vitro, choline supplementation attenuated free fatty acid- and fructose-induced cytokine elevation. Conclusions: Our data suggest the differential activation of canonical inflammasomes across experimental MASLD models. We also observed that choline availability can serve as a potential modulator of metabolic stress-induced inflammation, highlighting the importance of nutrient status in metabolic liver disease. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents the hepatic manifestation of systemic metabolic dysfunction and has become one of the leading causes of chronic liver disease worldwide. Although obesity is a major determinant of MASLD, the metabolic and lifestyle context in which the disease develops may vary across different geographical and dietary environments. The present study aimed to evaluate the prevalence of MASLD among adults with metabolic dysfunction from two European cohorts, to compare the clinical, metabolic, lifestyle, and psychological characteristics of participants with MASLD from Romania and Italy, and to explore differences according to MASLD status within each cohort. In addition, intestinal permeability was exploratorily assessed in a subgroup of the Italian cohort. Methods: This prospective multicentre observational study included 132 adults undergoing metabolic and hepatic evaluation in Romania (n = 52) and Italy (n = 80). Hepatic steatosis was assessed using SteatoTest in the Romanian cohort and ultrasonography in the Italian cohort. Anthropometric and metabolic parameters were recorded in all participants. Dietary quality was evaluated using the MEDI-LITE questionnaire, physical activity using the International Physical Activity Questionnaire (IPAQ), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life using the 36-Item Short Form Health Survey (SF-36). Intestinal permeability was evaluated in the Italian cohort using the lactulose/mannitol absorption test. Results: MASLD was identified in 80.8% of participants from the Romanian cohort and in 66.3% of participants from the Italian cohort. Among patients with MASLD, Italian participants exhibited significantly higher body mass index, waist circumference, fasting insulin, total cholesterol, LDL cholesterol, and diastolic blood pressure compared with Romanian participants, whereas HDL cholesterol levels were significantly higher in the Romanian cohort. Sex-stratified analyses revealed significant sex-related differences in anthropometric and metabolic parameters within both cohorts. In both geographical populations, participants with MASLD demonstrated lower adherence to the Mediterranean diet, lower physical activity levels, higher depressive symptom burden, and less favorable quality-of-life indicators compared with participants without MASLD. Exploratory analyses of intestinal permeability in the Italian cohort did not reveal significant differences according to MASLD or obesity status. Conclusions: MASLD was highly prevalent in both Romanian and Italian adults with metabolic dysfunction. Patients with MASLD exhibited distinct metabolic and lifestyle profiles across the two geographical cohorts, supporting the potential contribution of environmental and lifestyle-related factors to MASLD heterogeneity. Lower adherence to the Mediterranean diet, reduced physical activity, and increased psychological burden were consistently associated with MASLD in both populations. Exploratory intestinal permeability analyses did not demonstrate significant differences according to MASLD or obesity status in the Italian cohort. Full article

Peroxisome proliferator-activated receptors (PPARα, PPARβ/δ, and PPARγ) are ligand-activated nuclear transcription factors that orchestrate key metabolic and immuno-inflammatory networks governing hepatic homeostasis. By regulating fatty acid oxidation, insulin signaling, bile acid metabolism, and hepatic stellate cell activation, PPARs integrate metabolic and inflammatory cues central to the pathogenesis of chronic liver disorders. Chronic liver diseases (CLDs) constitute a major and growing global health burden. Metabolic dysfunction-associated steatotic liver disease (MASLD), now affecting up to one-third of the adult population worldwide, is closely linked to type 2 diabetes, cardiovascular disease, and major liver-related events. In parallel, chronic immune-mediated cholestatic liver diseases continue to pose important therapeutic challenges. Although ursodeoxycholic acid remains the standard first-line therapy for primary biliary cholangitis (PBC), and several second-line therapeutic options are now available, a substantial proportion of patients exhibit an incomplete biochemical response, while effective disease-modifying therapies for primary sclerosing cholangitis (PSC) remain lacking. Across etiologies, persistent metabolic stress, immune-mediated injury, and maladaptive fibrogenesis represent convergent pathogenic pathways. In MASLD, PPAR agonists have shown promising effects on steatosis, necroinflammatory activity, and fibrosis regression in randomized clinical trials, positioning them among the most advanced pharmacological strategies currently under investigation. In cholestatic liver diseases, selective and dual PPAR agonists have demonstrated significant improvements in cholestasis, pruritus, and markers of disease activity, supporting their role as second-line or adjunctive therapy. This review critically appraises the current preclinical and clinical evidence on the role of PPARs in CLDs, delineates the underlying molecular mechanisms, and discusses future therapeutic perspectives. Although the available evidence is encouraging, most clinical studies have primarily demonstrated improvements in surrogate biochemical and histological endpoints rather than hard clinical outcomes. Ongoing phase III trials and long-term outcome studies will be essential to define the role of PPAR agonists within future therapeutic algorithms for CLDs. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most common chronic liver disorder in the pediatric population, closely paralleling the global rise in childhood obesity. Increasing evidence highlights the gut–liver axis as a key contributor to MASLD pathogenesis, with gut microbiota dysbiosis influencing hepatic steatosis through multiple interconnected mechanisms, including increased intestinal permeability, endotoxemia, altered bile acid metabolism, and modulation of host energy homeostasis. In children, the characterization of microbiota signatures associated with MASLD remains challenging due to heterogeneity across studies, age-related microbial dynamics, and methodological variability. This review synthesizes current evidence regarding the role of the gut microbiota in pediatric MASLD, focusing on pathogenetic pathways, reported microbial patterns, and microbiota-targeted therapeutic strategies, while incorporating relevant mechanistic evidence from adult studies where pediatric data remain limited. Although several taxa have been repeatedly associated with pediatric MASLD, findings are not yet sufficiently consistent for clinical application. Interventions such as probiotics, prebiotics, and dietary modulation show promising but still preliminary results, with limited high-quality pediatric trials available. A deeper mechanistic understanding and standardized study designs are needed to clarify causality and to support microbiota-based precision approaches in pediatric MASLD management. Full article