Xiao Du,1,2,* Runyan Niu,1,3,* Xuexue Liu,4,* Fang Wu,1,3 Xian Yang,1 Xiaolong Ma,2 Jinping Zhang,1 Haihui Zhou,5 Lihua Shao,2 Siliang Wang1 

1Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China; 2Department of Colorectal Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China; 3Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210008, People’s Republic of China; 4Department of Hematology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, People’s Republic of China; 5Department of Pharmacy, Geriatric Hospital of Nanjing Medical University, Nanjing, 2100024, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Haihui Zhou; Siliang Wang, Email zhhhnj@126.com; wsl_dth@126.com

Abstract: Liver fibrosis is a reversible pathological process caused by chronic liver injury, which can lead to severe complications such as liver failure and cirrhosis. Current clinical treatments mainly focus on managing the underlying causes and complications, such as using antiviral regimens for HBV/HCV infections, combining alcohol abstinence with nutritional support for alcoholic fibrosis, and emphasizing weight reduction and exercise in metabolic associated steatolipodystrophy or non-alcoholic steatohepatitis. However, traditional therapies often have limited efficacy and significant side effects. With the deepening understanding of the pathophysiology of liver fibrosis, new therapeutic targets and investigational drugs are being continuously discovered. For example, lanifibranor and efruxifermin have shown promise in clinical trials. Although methods such as FXR and PPAR agonists, fibroblast growth factor 21 analogs, and mesenchymal stem cell therapies hold potential, they are limited by suboptimal delivery to the target site and systemic adverse reactions. Nanomedicine offers a solution by enabling the direct, precise, and efficient delivery of antifibrotic agents to fibrotic sites. This review explores the pathological mechanisms of liver fibrosis, the current state of clinical treatments, and the application of nanomedicine in the diagnosis and treatment of liver fibrosis. It also discusses the challenges in translating nanomedicines from laboratory research to clinical application and suggests potential improvements, aiming to enhance the understanding of liver fibrosis and provide new insights and approaches for its reversal and potential cure.

Keywords: nanomedicine, liver fibrosis, targeted therapy, drug delivery systems, combination therapy