Using spatial multi-omics, researchers reported shifting macrophage populations across MASLD progression and identified markers that may support patient stratification in clinical trials. The account describes the study as a way to map immune cell heterogeneity directly within tissue architecture. The results emphasize a move from bulk profiling toward spatially resolved immune characterization, targeting the question of which macrophage states align with disease stage and potentially influence response to interventions. For translational development, the immediate value is trial-enabling: biomarkers that distinguish subgroups can guide enrollment criteria and improve signal detection in studies testing therapies for metabolic dysfunction–associated steatohepatitis.