Autoantibodies and outcome of MASLD

Autoantibodies, specifically ANA (antinuclear antibodies) and ASMA (anti-smooth muscle antibodies), are immune system proteins that mistakenly target the body’s own tissues. These autoantibodies were studied in patients with metabolic dysfunction–associated steatotic liver disease (MASLD) to understand their impact on disease progression and outcomes. The research found that autoantibodies are relatively common in MASLD, with 17% of patients testing positive for ANA, 25% for ASMA, and 8% positive for both.

The presence of these autoantibodies significantly worsens the prognosis of MASLD. Patients who tested positive for ANA or ASMA had a nearly fourfold higher risk of liver decompensation and over twofold higher risk of death compared to those without autoantibodies. Autoantibody positivity independently predicted progression to advanced liver disease, even after accounting for other risk factors like obesity and diabetes.

The study suggests that these autoantibodies act as markers of systemic or liver inflammation rather than directly causing damage. Increased inflammation linked to autoantibodies reflects heightened immune activation, which contributes to disease severity. MASLD patients with autoantibodies often present with advanced fibrosis (F3–F4) and are at higher risk for complications like compensated advanced chronic liver disease (cACLD), hepatocellular carcinoma (HCC), and death. Screening for ANA and ASMA can help identify high-risk patients for closer monitoring and tailored treatment.