Mineralocorticoid Receptor Antagonists for Liver Fibrosis: Potential Mechanisms and Research Progress (IMAGE)
Caption
Reversing and treating liver fibrosis remain major challenges in hepatology, and currently, there is a lack of ideal antifibrotic drugs. Based on the pivotal role of the aldosterone–MR pathway in inflammation and fibrosis, MRAs constitute a novel therapeutic approach for antifibrotic treatment. Preclinical data consistently demonstrate that MRAs suppress HSC activation, oxidative stress, and inflammatory remodeling while restoring metabolic balance. New-generation nsMRAs, especially finerenone, combine potent antifibrotic and anti-inflammatory properties with superior receptor selectivity and safety. Although the current evidence is derived mainly from cardiorenal studies and small MASH trials, these findings underscore their translational potential in liver disease. Clinically, translating these findings will require careful patient stratification (e.g., metabolic vs. cholestatic etiologies), selection of appropriate endpoints (including histological improvement, validated noninvasive fibrosis markers, and portal pressure), and integration with existing standards of care. In addition, the use of MRAs in liver disease should include safety monitoring strategies, particularly for hyperkalemia, renal function, and drug–drug interactions, especially in patients with advanced fibrosis or cirrhosis.
In the future, more studies are needed to evaluate the use of nsMRAs in various liver disease settings, including investigations of their pharmacokinetics, efficacy, and safety in advanced fibrosis. Well-designed randomized controlled trials specifically targeting liver fibrosis are essential to define the therapeutic positioning of MRAs, including their potential role in combination regimens with metabolic, anti-inflammatory, or antifibrotic agents. In conclusion, MRAs, particularly finerenone, may become an important component of combination therapy strategies for liver fibrosis, offering a potential therapeutic option for patients with chronic liver disease.
Credit
Ye Feng
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