Metabolic links between metabolic dysfunction-associated steatotic liver disease and primary biliary cholangitis

Core Tip

Core Tip: The increase in metabolic disorders has led to the comorbidity of primary biliary cholangitis (PBC) and metabolic dysfunction-associated steatotic liver disease (MASLD) becoming increasingly common. Beyond simple comorbidity, these conditions cause complex immunometabolic cross-talk involving common pathways of immune dysregulation, lipid metabolism alterations, adipokine imbalance, and gut microbiota dysfunction. Recent data suggest that in patients with PBC, concomitant MASLD disrupts the characteristic hyperadiponectinemia associated with cholestasis, leading to a specific adipokine profile with an elevated leptin/adiponectin ratio. This Editorial summarizes current understanding of the pathogenetic relationships between PBC and MASLD, analyzes new clinical data on their bidirectional effects, and identifies critical gaps in knowledge. Understanding these interactions is important for developing personalized therapeutic approaches and improving treatment outcomes for patients with this increasingly recognized dual pathology.