Liver disease is one of the most under-discussed health crises of our time. Globally, it affects hundreds of millions of people, and conditions like non-alcoholic fatty liver disease (NAFLD), metabolic-associated steatohepatitis (MASH), liver fibrosis and liver cancer are all on the rise. What makes this particularly difficult is that liver disease rarely announces itself early. By the time symptoms appear, the condition is often already advanced.
That gap between early disease and late diagnosis is exactly where technology is starting to make a real difference. A growing number of healthtech startups are building solutions that target liver disease at every stage, from drug development and diagnostics to tissue engineering and gene therapy. Here is a look at five of the most active ones right now.
Why Hepatology Needs a Technology Push
The liver is one of the most complex organs in the human body. It handles over 500 functions, from filtering toxins and metabolising drugs to producing proteins and regulating blood sugar. When something goes wrong, the consequences ripple across almost every other system in the body.
Part of what makes liver disease so hard to manage is how quietly it progresses. Fatty liver disease, for example, can develop over years with no obvious symptoms. By the time a patient feels unwell, liver damage may already be significant. Clinicians often rely on blood markers like liver enzymes to catch early warning signs, and tools like a fatty liver ast/alt level chart can help patients and doctors track how enzyme levels correspond to disease severity. Even so, early detection remains a major challenge, and effective treatments for conditions like MASH and liver fibrosis are still limited. That is the problem these startups are trying to solve.
1. Akero Therapeutics
Location: USA | Focus: MASH treatment
Akero Therapeutics is one of the most closely watched companies in liver disease research right now. The company has been developing efruxifermin, a drug that mimics the FGF21 protein, which plays a central role in how the body manages fat and inflammation. What makes efruxifermin notable is its multi-pronged approach: it works to reduce liver fat, bring down inflammation, reverse fibrosis and restore healthy lipid metabolism in the liver all at once.
MASH, formerly called NASH, is a condition where fat accumulation in the liver leads to inflammation and scarring. It is strongly tied to obesity and metabolic syndrome, and it has no widely approved treatments. Akero’s clinical programme has been advancing through trials, with its Phase 3 data drawing significant attention from both clinicians and investors. The company has raised over $950 million to date, reflecting just how much is riding on this approach.
2. Madrigal Pharmaceuticals
Location: USA | Focus: Fatty liver disease
Madrigal Pharmaceuticals has been making headlines since the FDA approved its drug Rezdiffra in 2024, making it the first approved treatment for MASH with liver fibrosis. That approval was a landmark moment for hepatology, a field that had spent decades without a licensed therapy for this condition.
Rezdiffra works by targeting a thyroid hormone receptor in the liver, which helps reduce fat accumulation and inflammation without the systemic side effects that come with activating thyroid receptors elsewhere in the body. Madrigal continues to build on this foundation, expanding its research into other stages and subtypes of fatty liver disease. For patients who have been waiting years for a treatment option, this is a significant step forward.
3. Alentis Therapeutics
Location: Switzerland | Focus: Liver fibrosis and liver cancer
Alentis Therapeutics is taking a different approach to liver disease, targeting a protein called claudin-1, which plays a key role in how fibrosis and certain liver cancers develop. The company has built a pipeline of antibody-drug conjugates and monoclonal antibodies that specifically bind to claudin-1, either to block disease signals in fibrosis or to selectively destroy tumour cells in cancer.
Its lead clinical candidate for liver fibrosis, lixudebart, is currently in trials, and early signals have been encouraging. Alentis has raised over $365 million, largely from European investors, and its science is considered one of the more novel approaches in the hepatology space right now. The company’s work on liver cancer is particularly relevant given that hepatocellular carcinoma remains the third leading cause of cancer-related death worldwide.
4. Enyo Pharma
Location: France | Focus: Chronic Hepatitis B
While much of the attention in hepatology has shifted to metabolic liver disease, chronic Hepatitis B remains a massive global problem. Around 296 million people are estimated to be living with it, and current treatments can suppress the virus but rarely clear it completely. Enyo Pharma is trying to change that.
The company uses a drug discovery engine inspired by how viruses interact with human cells. By studying viral biology and then turning those mechanisms against the virus itself, Enyo has developed a pipeline of compounds aimed at achieving a functional cure for Hepatitis B. The company has raised over €103 million and is currently advancing its lead candidate through clinical testing. If successful, it would represent a meaningful shift in how one of the world’s most common chronic infections is managed.
5. Pandorum Technologies
Location: India | Focus: Liver tissue engineering
Pandorum Technologies sits at the more experimental end of the hepatology spectrum, but its work could eventually have a profound impact on how liver disease is treated. The company builds functional three-dimensional living human liver tissues using its own bioengineering platforms. These lab-grown tissues are designed for use in medical research, drug testing and, ultimately, therapeutic applications.
One of the biggest bottlenecks in liver disease research is the lack of accurate human models to test drugs in. Animal models often don’t translate well to humans, which is part of why so many liver disease drugs fail in late-stage trials. Pandorum’s technology could help close that gap by giving researchers a more accurate stand-in for human liver tissue, reducing the chance of late-stage failures and speeding up the path to new treatments.
The company also fits into a wider conversation about liver health and metabolic disease. For patients managing conditions like fatty liver disease, metabolic factors like body weight and energy balance play a big role. Tools that help patients calculate total daily energy expenditure can support better lifestyle management alongside whatever clinical treatment they receive. Pandorum’s work operates at a different level entirely, but it sits within the same ecosystem of innovation that is trying to make liver disease more manageable from every angle.
What This Means for the Field
Taken together, these five companies represent the range of approaches being applied to liver disease right now: drug development, precision biology, antiviral therapy, tissue engineering and targeted oncology. No single approach is going to solve everything, but the pace of progress over the last few years, particularly since Madrigal’s approval in 2024, suggests that hepatology is finally getting the attention it has long needed.
For patients, clinicians and investors alike, this is a space worth watching closely.
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