,30 Specifically, transforming growth factor-βI (TGF-βI) binds to the TGF-βI receptor (TGF-βRI) on HSCs, initiating a complex phosphorylation cascade involving R-Smad, Smad4, and Co-Smad (a complex with Smad2, Smad3, and Smad4), which subsequently regulates the expression of fibrosis-related genes and influences ECM composition.31, 32, 33, 34 As shown in Table 1 and Figure 1, Numerous miRNAs modulate liver fibrosis progression through the TGF-β/Smad signaling pathway, such as miR-122, miR-150, miR-155, miR-181-5p, and miR-214. Here, SMAD4 is linked to Hepatic fibrosis.