Liver Viscosity Decreases Before the Onset of Fibrosis in Metabolic Dysfunction-Associated 1 Steatohepatitis (MASH)

Background and Aim: Metabolic dysfunction-associated steatohepatitis (MASH) is an increasingly prevalent condition worldwide, associated with biomechanical liver changes and detectable by magnetic resonance elastography (MRE). This study explored the pathophysiological features and their biomechanical manifestations at different stages of MASH in a mouse dietary model. Methods: Using MRE on a clinical 3 Tesla MRI scanner, we measured liver stiffness, viscosity, fat fraction and water diffusion in 45 male mice. These values were correlated with histopathology and proteomics analyses to further characterize the liver microstructural and metabolic changes during MASH progression. Results: We found in a high-fat, low amino-acid model that early MASH was marked by fat accumulation and increasing inflammatory activity, while later stages showed a reduction in fat despite persistent inflammation. These changes in microstructure were associated with biomechanical adaptations, including a progressive decrease in hepatic viscosity and the water diffusion. Notably, viscosity was inversely correlated with lobular inflammation, cell adhesion, antioxidant activity, and metabolic adaptations such as enhanced ketone body synthesis. These findings, which precede the onset of fibrosis and tissue stiffening, show that tissue viscosity is highly sensitive to early microstructural and metabolic alterations in MASH. Conclusion: Steatosis and inflammation significantly alter liver biophysical properties, particularly viscosity, in a mouse dietary model of MASH, even in the absence of fibrosis. These findings suggest that viscosity is a potential early and clinically translatable biomarker for the development and progression of MASH.