Polygenic Risk Score for Metabolic Dysfunction-Associated Steatotic Liver Disease and Steatohepatitis: A Narrative Review

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are spreading worldwide as the most critical causes of cirrhosis and hepatocellular carcinoma (HCC). Thus, improving the screening and managing strategies for patients with MASLD or MASH is necessary. A traditional non-systemic review provided this narrative. Genetic variations associated with the development of MASLD and MASH, such as PNPLA3, TM6SF2, GCKR, MBOAT7, MERTK, and HSD17B13, were initially reviewed. PNPLA3 genetic variants appeared to be strongly associated with the increased pathogenesis of MASLD, MASH, cirrhosis, and HCC. We also reviewed the useful polygenic risk score (PRS) for the development of MASLD, MASH, their related cirrhosis, and the occurrence of HCC. PRSs appeared to be better predictors of MASLD, MASH, the development of cirrhosis, and the occurrence of HCC in patients with MASLD or MASH than any single-nucleotide polymorphisms. RNA interference and antisense nucleotides against the genetic variations of PNPLA3 and HSD17B13 are also being developed. Multidisciplinary collaboration and cooperation involving hepatologists, geneticists, pharmacologists, and pathologists should resolve complicated problems in MASLD and MASH. This narrative review highlights the importance of the genetic susceptibility and PRS as predictive markers and personalized medicine for patients with MASLD or MASH in the future.

Keywords: MASH; MASLD; PNPLA3; PRS; cirrhosis; fat accumulation; liver cancer; liver fibrosis.

Figure 1

Effects of genetic variations in PNPLA3, TM6SF2, GCKR, MBOAT7, MERTK, HSD17B13, etc., on the liver. Fat deposition into hepatocytes, apoptotic hepatocyte death, and the activation of hepatic stellate cells occur, causing hepatic steatosis, fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) [8,110]. PNPLA3, patatin-like phospholipase domain-containing protein 3; TM6SF2, transmembrane 6 superfamily member 2; GCKR, glucokinase regulator; MBOAT7, membrane-bound O-acyltransferase domain-containing 7; MERTK, myeloid–epithelial–reproductive tyrosine kinase; HSD17B13, hydroxysteroid 17-beta dehydrogenase 13.