Metabolic dysfunction-associated fatty liver disease (MASLD), previously called non-alcoholic fatty liver disease, is the most common cause of liver disease, affecting at least one in four adults worldwide. It is caused by a build-up of fat in the liver and is closely associated with obesity and type-2 diabetes.

Early-stage MASLD does not usually cause harm but it can sometimes lead to serious liver damage, including cirrhosis (where healthy cells are replaced by scar tissue) and liver cancer, if it gets worse.

Unfortunately, it is not known why some people’s disease get worse and others’ don’t. There are no good tests to predict this happening and there are no drug treatments for MASLD on the market.

To address these challenges, the team of researchers compiled a large group of 940 MASLD cases from across Scotland in a project called SteatoSITE.

The SteatoSITE project collected information about three key aspects of liver disease, including:

• the sort of liver damage that can develop in MASLD livers (pathology);
• which genes are present in the liver as MASLD gets more severe (RNA sequencing); and
• how this relates to the health of people with MASLD (electronic health record data collection).

The main objective of the project was to link this important information together to create a secure, searchable, open resource for MASLD research that could be used by the whole scientific community. The SteatoSITE resource is hosted by Precision Medicine Scotland-Innovation Centre (PMS-IC).

In a recent publication in Nature Medicine , the research team describe how SteatoSITE was created and detail its key features, including a web browser to look up genes of interest that were detected in the MASLD livers.

The team of researchers also conducted a comprehensive analysis of how liver pathology and different cells and molecules in the liver might cause severe outcomes in people with MASLD (such as death, cirrhosis and its complications, and liver cancer).

Professor Jonathan Fallowfield, Chair of Translational Liver Research, Centre for Inflammation Research, Institute for Regeneration and Repair & lead author of the Nature Medicine article said: ” Fatty liver caused by metabolic problems is now a major global public health challenge. SteatoSITE is a unique and powerful ‘big data’ project, including patients across the whole of Scotland, that will help to develop new prognostic tests and effective medicines that are urgently needed for this condition.”

Dr Tim Kendall, Senior Clinical Fellow in Pathology, Centre for Inflammation Research, Institute for Regeneration and Repair & first author of the Nature Medicine article added: ” SteatoSITE’s combination of histological images and long-term clinical follow-up data is a uniquely rich resource that will allow for the future development of artificial intelligence-based digital pathology clinical tools. These future AI tools could be able to discern subtle features that even the most experienced human eye could not.”

As more health data is added, SteatoSITE will evolve into a smarter, more comprehensive knowledge system that will be used to make new discoveries and will enable researchers and clinicians to better understand non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). From this point, SteatoSITE will play a vital role in the development and validation of new tests and therapies, and has the potential to transform the care of people living with NAFLD.

Twenty-five percent of the world’s population has non-alcoholic fatty liver disease (NAFLD), an umbrella term for a range of conditions characterised by a build-up of fat in the liver.

The Centre of Inflammation Research (CIR) is based within the Queen’s Medical Research Institute (QMRI) on Edinburgh BioQuarter, and has a multi-disciplinary approach to the research of mechanisms underlying inflammatory disorders with the aim of designing new treatments for and new methods to monitor and image these important conditions.