Madrigal Pharmaceuticals signed a global license with Ribo Life Science (and Ribocure) to acquire six preclinical siRNA programs in a deal that could reach $4.4 billion in milestones. The upfront payment and milestone structure are designed to deepen Madrigal’s metabolic dysfunction‑associated steatohepatitis (MASH) portfolio alongside its approved drug Rezdiffra. Company executives framed the acquisition as a way to pair precise hepatic gene silencing with Rezdiffra’s thyroid hormone receptor‑beta activity to create combination regimens addressing multiple drivers of MASH. Madrigal has been active in dealmaking—recent buys include a DGAT2 inhibitor from Pfizer—seeking to build a multi‑program MASH franchise. The transaction reflects a broader industry push to assemble complementary modalities for complex liver disease; success will hinge on translating preclinical siRNA assets through IND enabling work and demonstrating meaningful additive benefit on top of Rezdiffra.