Highlight
HTD1801 (berberine ursodeoxycholate) demonstrated significant histologic improvements in metabolic dysfunction-associated steatohepatitis (MASH) and associated fibrosis in both preclinical and clinical (Phase 2) studies. Its efficacy was reflected by biomarker improvements including liver fat content, fibrosis indices, and liver enzyme reductions. The findings suggest strong potential for HTD1801 as a therapeutic in MASH patients, particularly those with type 2 diabetes mellitus.
Study Background and Disease Burden
Metabolic dysfunction-associated steatohepatitis (MASH) represents a severe form of nonalcoholic fatty liver disease characterized by hepatic steatosis, inflammation, and progressive fibrosis. MASH poses a growing global health burden with strong associations to obesity, insulin resistance, and type 2 diabetes mellitus (T2DM). Despite its prevalence, effective pharmacologic therapies specifically improving liver histology and fibrosis in MASH remain limited, representing a significant unmet clinical need. Berberine ursodeoxycholate (HTD1801) is an investigational agent hypothesized to address this gap by targeting multiple pathophysiological pathways relevant to liver lipid metabolism and fibrosis.
Study Design
The efficacy and safety of HTD1801 were investigated via two complementary studies:
- Preclinical Study: A murine model of MASH/dyslipidemia was developed using golden hamsters fed a high-fat diet. Eight animals per group were treated daily with HTD1801 or placebo for six weeks. Histologic evaluation including fibrosis assessment and Nonalcoholic Fatty Liver Disease Activity Score (NAS) was performed to quantify liver changes.
- Phase 2 Clinical Study: This randomized, placebo-controlled, 18-week study included 100 patients with presumed MASH and T2DM. A secondary analysis focused on multiple noninvasive biomarkers related to fibrosis and disease resolution including MRI proton density fat fraction (MRIPDFF), iron-corrected T1 (cT1), alanine aminotransferase (ALT), weight loss, Fibrosis-4 (FIB-4) index, and the MASH resolution index.
Key Findings
Preclinical Results: Treatment with HTD1801 in the hamster MASH model resulted in significant histologic improvements. Fibrosis was notably reduced, and NAS scores improved to levels approaching those of normal controls. These findings provide mechanistic evidence of HTD1801’s effect on liver pathology.
Clinical Results: In the Phase 2 study, 52% of HTD1801-treated patients achieved the MRI-defined response criterion of at least 30% reduction in liver fat content, compared to 24% in the placebo group (P < 0.05). Additionally, dose-dependent improvements were seen across noninvasive markers including significant reductions in iron-corrected T1 times (suggesting fibrosis reduction), ALT levels, and shifts toward lower fibrosis scores (FIB-4 <1.3). Approximately half of treated patients met criteria consistent with MASH resolution, supporting histologic improvement inferred by noninvasive modalities.
Safety: HTD1801 was well tolerated, with no unexpected adverse safety signals reported in the Phase 2 cohort, indicating a favorable risk profile for further clinical development.
Expert Commentary
The dual demonstration of histologic improvement in an established preclinical MASH model and corroborating noninvasive biomarker responses in a Phase 2 trial highlights HTD1801 as a promising therapeutic candidate. The use of multiparametric MRI including proton density fat fraction and iron-corrected T1 enhances the confidence in fibrosis and steatosis assessment without invasive biopsy. Further large-scale, biopsy-proven trials are warranted to validate these findings and extend observations to broader patient populations.
Mechanistically, berberine derivatives are known to act via modulation of lipid metabolism, anti-inflammatory pathways, and cellular oxidative stress, which plausibly contribute to the histologic improvements observed. Integration into current treatment algorithms could benefit patients with MASH, especially those complicated by T2DM who are at higher risk for progressive liver disease.
Conclusion
This combined preclinical and clinical evidence supports the potential of HTD1801 to bring meaningful histological improvement in patients with metabolic dysfunction-associated steatohepatitis. The encouraging safety profile and biomarker efficacy signals merit advancement toward Phase 3 trials to confirm therapeutic benefit and long-term outcomes. HTD1801 may represent a novel pharmacologic option for a condition with significant unmet treatment needs.
References
Wong VW, Neff GW, Di Bisceglie AM, Bai R, Cheng J, Yu M, Liberman A, Liu L, Gunn N. HTD1801 demonstrates promising potential for histologic improvements in metabolic dysfunction-associated steatohepatitis in both a preclinical and phase 2 study. Clin Mol Hepatol. 2025 Jul;31(3):1071-1083. doi: 10.3350/cmh.2025.0145. Epub 2025 Apr 21. PMID: 40258699; PMCID: PMC12260645.
