Review Article

Histological assessment based on liver biopsy: the value and challenges in NASH drug development

Xiao-fei Tong1, Qian-yi Wang1, Xin-yan Zhao1, Ya-meng Sun1, Xiao-ning Wu1, Li-ling Yang1, Zheng-zhao Lu1, Xiao-juan Ou1, Ji-dong Jia1, Hong You1
1 Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing 100050, China
Correspondence to: Hong You:,
DOI: 10.1038/s41401-022-00874-x
Received: 5 September 2021
Accepted: 18 January 2022
Advance online: 14 February 2022


Nonalcoholic steatohepatitis (NASH) is increasingly recognized as a serious disease that can lead to cirrhosis, hepatocellular carcinoma (HCC), and death. However, there is no effective drug to thwart the progression of the disease. Development of new drugs for NASH is an urgent clinical need. Liver biopsy plays a key role in the development of new NASH drugs. Histological findings based on liver biopsy are currently used as the main inclusion criteria and the primary therapeutic endpoint in NASH clinical trials. However, there are inherent challenges in the use of liver biopsy in clinical trials, such as evaluation reliability, sampling error, and invasive nature of the procedure. In this article, we review the advantages and value of liver histopathology based on liver biopsy in clinical trials of new NASH drugs. We also discuss the challenges and limitations of liver biopsy and identify future drug development directions.
Keywords: nonalcoholic steatohepatitis; liver biopsy; value and challenges; new drug development

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