An updated overview of alkaloids for the prevention and treatment of metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as an increasingly formidable global public health challenge, characterized by a complex pathogenesis and a persistent scarcity of reliable and effective therapeutic interventions. In recent years, the multiple-hit hypothesis has provided novel mechanistic insights into the pathogenesis and progression of MASLD, paving the way for identifying viable therapeutic strategies. Due to their characteristic multi-target and multi-pathway regulatory profiles, natural products align closely with the core tenets of the multiple-hit hypothesis, demonstrating unique advantages and promising prospects in the research and development of MASLD therapeutics; consequently, they have become a prominent focal point in this field. This article provides a systematic review of the latest advances in the core pathogenesis of MASLD, summarizes key natural products with potential interventional efficacy, and highlights the critical targets, core signaling pathways, and therapeutic value of alkaloid compounds. This review aims to establish a theoretical framework and provide a scientific basis for developing innovative drugs to prevent and treat MASLD.