Expert consensus on clinical usefulness of M2BPGi for managing chronic liver diseases

Chronic liver disease is a major global health concern, leading to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Accurate fibrosis staging is essential for clinical management, yet liver biopsy remains invasive. Non-invasive tools such as transient elastography and serum biomarkers provide alternatives, but conventional markers like APRI and FIB-4 have limitations. Mac-2 binding protein glycosylation isomer (M2BPGi) has emerged as a novel biomarker for fibrosis assessment across various liver diseases. M2BPGi levels correlate with fibrosis severity in chronic hepatitis B, outperforming APRI and showing comparable performance to FIB-4, especially in patients with ALT flare-ups. Its predictive value for HCC has been shown in both untreated and treated CHB patients, with distinct cutoff values for risk stratification. In chronic hepatitis C, M2BPGi aids in fibrosis staging and predicts HCC occurrence post-sustained virologic response. In patients with metabolic dysfunction-associated steatotic liver disease, it correlates with advanced fibrosis and cirrhosis but requires further validation. While available literature supports the clinical utility of M2BPGi in managing chronic liver diseases, further research is needed to standardize cutoff values and expand validation across diverse populations, particularly in enhancing long-term HCC risk prediction for patients with MASLD and other chronic liver disease.