Steatotic liver disease induces YAP/TAZ-driven cell competition that can suppress tumor initiation.

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are leading risk factors for liver cancer. While inflammation and fibrosis are known to promote tumorigenesis in advanced MASH, it remains unclear how earlier stages of MASLD contribute to cancer initiation. Here, we investigated how steatosis alone, in the absence of significant fibrosis and inflammation, influences liver cancer development in mouse models.

Methods: We fed mice a Western diet to induce early-stage MASLD, characterized by steatosis and mild hepatitis without fibrosis. We triggered liver tumorigenesis by hydrodynamic tail vein injection of plasmids encoding oncogenes. We combined this with genetic manipulation of Hippo signaling and assessed tumor development by histology and single-nucleus RNA-sequencing.

Results: Western diet suppressed liver tumor development by promoting the elimination of tumor-initiating cells. This effect was not due to a direct impact on oncogene-expressing cells, but rather to increased competitiveness of the surrounding hepatocytes. Mechanistically, the Western diet activated the Hippo pathway effectors Yap and Taz in steatotic hepatocytes, enhancing their cellular fitness and enabling them to outcompete tumor-initiating cells. The progression to advanced MASH abrogated this tumor-suppressing mechanism thus allowing tumor development.

Conclusions: These findings reveal that steatotic hepatocytes in early MASLD can activate endogenous cell competition programs to suppress tumor initiation, a process that depends on Yap/Taz activity. This adds a new layer to our understanding of how fitness landscapes and cell-to-cell interactions within the tissue microenvironment shape cancer risk. It also shows that progression of chronic liver disease not only promotes tumorigenesis through effects of inflammation and fibrosis on tumor cells but also by disrupting the competitive defenses of normal surrounding cells. We found that early stages of steatotic liver disease (MASLD) can suppress tumor initiation in mouse models of liver cancer by triggering Yap/Taz-mediated cell competition. This reveals an unexpected tumor-suppressive role for early MASLD and highlights the importance of non-cell autonomous mechanisms during tumor initiation. Since Hippo-YAP/TAZ signaling is deregulated in many cancers, similar cell competition-based mechanisms may operate in other tissues.