Advanced materials for non-alcoholic fatty liver disease and cardiovascular disease comorbidity therapeutics.

Abstract

Non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) frequently co-occur, driven by inter-organ metabolic crosstalk that current single-target therapies fail to disrupt. This review reframes NAFLD-CVD comorbidity through a materials-first lens and advances a translational design framework that couples pathophysiology with engineering principles. We synthesize three major pathological axes, including lipid overflow and impaired reverse cholesterol transport, inflammation-oxidative stress amplification driven by Kupffer cell-NLRP3 and mitochondrial ROS/MAPK signaling, as well as gut-liver-vascular dysregulation involving bile acid FXR/TGR5 pathways and microbiota-derived metabolites, and further map these mechanisms to organ-selective and stimulus-responsive therapeutic interventions. Specifically, we highlight liver-heart co-targeting via GalNAc/ASGPR and VCAM-1 ligands, HDL-mimetic and exosome platforms that restore cholesterol efflux, ROS/pH/enzyme-responsive carriers that achieve microenvironment-triggered release and mitochondria-addressed nanodevices including antioxidant nanozymes, Mito-therapeutics, and optogenetically guided CRISPR/RNA payloads that recalibrate energy/redox homeostasis. We further outline macrophage-reprogramming strategies using cytokine mRNA and miRNA modulators to resolve chronic inflammation, and propose closed-loop systems that integrate AI-guided design with synthetic biology circuits for adaptive, multi-organ control. Across platforms, we distill actionable criteria covering clinical translation, biodistribution fidelity, barrier traversal, compensation-proof multi-pathway control, and safety-by-design. This materials-anchored roadmap moves the field from single-organ symptom control to systemic metabolic reprogramming, positioning advanced materials as catalysts for durable, precision therapy in NAFLD-CVD comorbidity.