Abstract
MicroRNAs (miRNAs) are short non-coding RNA molecules that are involved in metabolic dysfunction-associated steatotic liver disease (MASLD) either by promoting or inhibiting the transition from hepatic steatosis to steatohepatitis/fibrosis or even hepatocellular carcinoma. Mechanistically, miRNAs regulate the progression of MASLD through intercellular communication within hepatic tissues or remote transport into the liver from extrahepatic tissue. In comparison with conventional RNA-based therapeutics, miRNAs show irreplaceable advantages for MASLD treatment, including reduced immunogenicity, enhanced therapeutic precision, and improved structural stability. This review systematically summarizes the assignable roles of miRNA-mediated intrahepatic or extrahepatic communication in MASLD, and evaluates the existing miRNA-targeting therapeutic strategies for MASLD.