Current Therapeutic Targets for Alcohol-Associated Liver Disease.

Abstract

Alcohol-associated liver disease (ALD) is a liver disorder induced by chronic excessive alcohol consumption, affecting approximately 3.5% of the global population. The spectrum of ALD encompasses simple steatosis, alcoholic hepatitis, fibrosis, cirrhosis, and the potential development of hepatocellular carcinoma. The pathogenesis of ALD involves a complex interplay of factors, including direct cell damage caused by alcohol and its metabolites, hepatic inflammation, immune dysregulation, and oxidative stress. Additionally, dysbiosis and the subsequent imbalance of gut homeostasis further exacerbate the progression of ALD. While nutritional support and abstinence from alcohol remain the cornerstones of ALD management, increasing evidence highlights the therapeutic potential of targeting various pathologic processes, in particular, inflammation, cellular oxidative stress, lipid metabolism, and strategies that promote liver regeneration and inhibit fibrosis. Moreover, emerging treatment approaches aimed at modulating the gut-liver-brain axis and targeting innate immune cells offer promising new avenues for ALD therapy. For patients with end-stage ALD, liver transplantation remains the only viable option for improving prognosis. This review summarizes the current epidemiology, pathogenesis, pathophysiology, natural history, and recent advancements in the therapeutic management of ALD, aiming to provide further insight into the treatment of ALD and improve patient outcomes.