Insight into the regulatory mechanism of m6A modification: From MAFLD to hepatocellular carcinoma

In recent years, there has been a significant increase in the incidence of metabolic-associated fatty liver disease (MAFLD), which has been attributed to the increasing prevalence of type 2 diabetes mellitus (T2DM) and obesity. MAFLD affects more than one-third of adults worldwide, making it the most prevalent liver disease globally. Moreover, MAFLD is considered a significant risk factor for hepatocellular carcinoma (HCC), with MAFLD-related HCC cases increasing. Approximately 1 in 6 HCC patients are believed to have MAFLD, and nearly 40 % of these HCC patients do not progress to cirrhosis, indicating direct transformation from MAFLD to HCC. N6-methyladenosine (m 6 A) is commonly distributed in eukaryotic mRNA and plays a crucial role in normal development and disease progression, particularly in tumors. Numerous studies have highlighted the close association between abnormal m 6 A modification and cellular metabolic alterations, underscoring its importance in the onset and progression of MAFLD. However, the specific impact of m 6 A modification on the progression of MAFLD to HCC remains unclear. Can targeting m 6 A effectively halt the progression of MAFLD-related HCC? In this review, we investigated the pivotal role of abnormal m 6 A modification in the transition from MAFLD to HCC, explored the potential of m 6 A modification as a therapeutic target for MAFLD-related HCC, and proposed possible directions for future investigations. • It analyzes how aberrant m 6 A modifications contribute to the progression of MAFLD to HCC. • It explores the potential of m 6 A modification as a therapeutic target and biomarker for MAFLD-HCC. • It elucidates paradoxical m 6 A regulation and proposes a new model for future research.