Unveiling novel macrophage-specific biomarkers in MASH through single-cell sequencing for diagnostic modeling

Macrophages are pivotal in the progression of metabolic dysfunction-associated steatohepatitis (MASH), yet their specific markers remain elusive. Herein, we employed an integrated bioinformatics strategy, combining single-cell and bulk transcriptomic data from human MASH livers, to identify macrophage-related differentially expressed genes (Mϕ-DEGs). We pinpointed five core Mϕ-DEGs- FRMD4B, PTK2B, CPM, SPTLC2, and EPB41L2-that were predominantly expressed in macrophages and enriched within profibrotic M2 subsets. A diagnostic model constructed from these genes demonstrated high accuracy (area under the curve = 0.9865) and was robustly validated in an independent cohort. In human and murine MASH samples, FRMD4B and PTK2B were consistently downregulated, whereas CPM, SPTLC2, and EPB41L2 were upregulated. Protein-level validation by immunohistochemistry and immunofluorescence confirmed these expression patterns in human and mouse livers and in polarized THP-1-derived macrophages. Mendelian randomization analysis identified CPM as a significant causal protective factor, suggesting that its upregulation may represent a compensatory response. These genes correlated with altered immune cell infiltration (e.g., T follicular helper and regulatory cells) and were enriched in key MASH pathways, including fatty acid metabolism, sphingolipid signaling, and transforming growth factor beta/PI3K-Akt. Our findings were further corroborated through a multilevel validation framework encompassing clinical samples, a murine MASH model, and in vitro macrophage cultures. This study characterized a robust macrophage-specific gene signature for MASH diagnosis and offered genetic evidence regarding the causal protective role of CPM. The pronounced enrichment of these genes in M2 macrophages underscores their critical contribution to immunometabolic dysregulation, offering novel insights into MASH pathogenesis and potential diagnostic and therapeutic targets.