Metabolomics and Liver Disease

This chapter reviews recent advances in metabolomics for studying liver diseases, including viral hepatitis, cirrhosis, hepatocellular carcinoma (HCC), drug- and toxininduced injury, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), and autoimmune conditions. Metabolomics enables the identification of characteristic metabolites and disrupted pathways—such as amino acid, bile acid, lipid, and energy metabolism—that reflect disease progression from hepatitis to fibrosis, cirrhosis, and cancer. It facilitates early diagnosis, non-invasive staging, differentiation of etiologies (e.g., HBV vs. ALD), and prediction of treatment outcomes. For example, distinct urinary and serum metabolite panels can distinguish early HCC from cirrhosis, even in patients with low AFP. Metabolomics also helps evaluate interventions like artificial liver support systems and reveals metabolic shifts underlying liver failure and recurrence after therapy. Furthermore, it shows promise for differentiating traditional Chinese medicine syndromes. Despite current limitations in comprehensive metabolic detection, metabolomics offers a powerful systems-level approach to understand pathogenesis, monitor disease evolution, and support precision medicine in hepatology. Future expansion to diverse biospecimens will further enhance its clinical utility.