MicroRNA Regulatory Networks in Alcohol-Associated Liver Disease: Mechanisms from Steatosis and Inflammation to Fibrosis.

Alcohol-associated liver disease (ALD) is a leading cause of liver-related morbidity and mortality worldwide and progresses through steatosis, alcohol-associated hepatitis, fibrosis, and cirrhosis. MicroRNAs (miRNAs) are established post-transcriptional regulators whose roles in ALD-associated signaling networks have been increasingly characterized. Recent high-throughput sequencing and functional studies have revealed dual regulatory roles of miRNA families, such as miR-122, miR-155, and miR-21, at different disease stages. However, most studies have focused on individual miRNAs, and network-level cooperative regulation and clinical translation remain underexplored. This narrative review examines the molecular mechanisms of miRNAs in alcohol-induced steatosis, inflammation, and fibrosis, with a particular focus on network-level cooperative regulation. Key findings indicate that miRNAs function as stage-specific and cell-type-specific regulators, with miR-122, miR-155, miR-21, miR-29, and miR-34a acting as central network nodes. These insights provide a framework for the identification of early diagnostic biomarkers and potential therapeutic targets in ALD.