Terpenoids in the management of MASLD: Multi-target mechanisms, therapeutic potential, and future perspectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a highly prevalent chronic liver disorder characterized by a complex interplay of pathogenic factors, including excessive energy intake, insulin resistance, and genetic susceptibility. Given its multifactorial pathogenesis, therapeutic strategies targeting multiple pathways are particularly desirable. Terpenoids, a structurally diverse class of natural compounds derived from medicinal plants, have attracted increasing attention as potential therapeutic agents for MASLD because of their multi-target pharmacological properties. This review summarizes recent advances in the therapeutic potential and molecular mechanisms of representative terpenoids-including monoterpenoids, sesquiterpenoids, diterpenoids, triterpenoids, and tetraterpenoids-in the context of MASLD. These compounds exert therapeutic effects mainly by improving lipid metabolism, oxidative stress, inflammation, autophagy, fibrosis, and gut-liver axis dysfunction. We also summarize the limited clinical evidence and the major challenges for translation. Although terpenoids show considerable promise, more rigorous clinical validation is required.