Accumulation of Lipid Droplets as an Underlying Cause of the Progression of Fatty Liver Disease to Liver Cancer

Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the leading cause of chronic liver disease, accounting for an increasing burden of cirrhosis, hepatocellular carcinoma (HCC), and related mortality, thus representing a major emerging public health threat. Currently, the primary unmet clinical needs in progressive MASLD remain the development of non-invasive biomarkers and effective therapeutic options. The objective is to delineate the pathogenic mechanisms driving the transition from hepatic lipid accumulation to steatohepatitis, fibrosis, and HCC, based on the hypothesis that alterations in lipid droplet (LD) biology within hepatocytes and resident liver cells are early, decisive factors in disease progression. To test this, human genetic studies from well-characterized cohorts will be combined with human liver organoids (HLOs) and artificial intelligence (AI) tools. Specifically, common and rare genetic variants will be integrated into partitioned polygenic risk scores (pPRS) to link genetic predisposition to specific LD morphological and functional traits. Furthermore, an innovative high-throughput screening platform using multi-omic approaches will be developed to deconvolve the genetic diversity of MASLD through LD profiling. Finally, these data will be integrated via AI algorithms to refine risk stratification, develop new diagnostic and prognostic tools for cirrhosis and HCC, and identify novel therapeutic targets. Ultimately, the identification of high-risk MASLD subtypes through specific LD pathways will enable precision medicine strategies, significantly improving clinical management.