{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:14:50Z","timestamp":1792419290193,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Lifestyle intervention is the mainstay of therapy for metabolic dysfunction\u2010associated steatohepatitis (MASH), and liver fibrosis is a key consequence of MASH that predicts adverse clinical outcomes. The placebo response plays a pivotal role in the outcome of MASH clinical trials. Second harmonic generation\/two\u2010photon excitation fluorescence (SHG\/TPEF) microscopy with artificial intelligence analyses can provide an automated quantitative assessment of fibrosis features on a continuous scale called qFibrosis. In this exploratory study, we used this approach to gain insight into the effect of lifestyle intervention\u2010induced fibrosis changes in MASH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We examined unstained sections from paired liver biopsies (baseline and end\u2010of\u2010intervention) from MASH individuals who had received either routine lifestyle intervention (RLI) (<jats:italic>n<\/jats:italic>\u2009=\u200935) or strengthened lifestyle intervention (SLI) (<jats:italic>n<\/jats:italic>\u2009=\u200917). We quantified liver fibrosis with qFibrosis in the portal tract, periportal, transitional, pericentral, and central vein regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>About 20% (7\/35) and 65% (11\/17) of patients had fibrosis regression in the RLI and SLI groups, respectively. Liver fibrosis tended towards no change or regression after each lifestyle intervention, and this phenomenon was more prominent in the SLI group. SLI\u2010induced liver fibrosis regression was concentrated in the periportal region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using digital pathology, we could detect a more pronounced fibrosis regression with SLI, mainly in the periportal region. With changes in fibrosis area in the periportal region, we could differentiate RLI and SLI patients in the placebo group in the MASH clinical trial. Digital pathology provides new insight into lifestyle\u2010induced fibrosis regression and placebo responses, which is not captured by conventional histological staging.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.16025","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T13:15:27Z","timestamp":1720098927000},"page":"2572-2582","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["<scp>AI<\/scp>\u2010based digital pathology provides newer insights into lifestyle intervention\u2010induced fibrosis regression in <scp>MASLD<\/scp>: An exploratory study"],"prefix":"10.1111","volume":"44","author":[{"given":"Hai\u2010Yang","family":"Yuan","sequence":"first","affiliation":[{"name":"MAFLD Research Center, Department of Hepatology The First Affiliated Hospital of Wenzhou Medical University  Wenzhou 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Liver Disease in Zhejiang Province  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4325-3900","authenticated-orcid":false,"given":"Giovanni","family":"Targher","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Verona  Verona Italy"},{"name":"Metabolic Diseases Research Unit IRCCS Sacro Cuore\u2014Don Calabria Hospital, Negrar di Valpolicella  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Southampton National Institute for Health and Care Research Biomedical Research Centre University Hospital Southampton and University of Southampton, Southampton General Hospital  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Wei","sequence":"additional","affiliation":[{"name":"Hepatopancreatobiliary Center Beijing Tsinghua Changgung Hospital, Tsinghua University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent W.\u2010S","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics Chinese University of Hong Kong, Hong Kong Special Administrative Region  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Tai","sequence":"additional","affiliation":[{"name":"HistoIndex Pte Ltd  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-5748","authenticated-orcid":false,"given":"Arun J.","family":"Sanyal","sequence":"additional","affiliation":[{"name":"Stravitz\u2010Sanyal Institute for Liver Disease and Metabolic Health Virginia Commonwealth University School of Medicine  Richmond Virginia 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