EWSR1 as a Regulatory Target in Hepatic Stellate Cell Apoptosis and Liver Fibrosis Therapy

Liver fibrosis is a progressive condition driven by hepatic stellate cell (HSC) activation and resistance to apoptosis, culminating in excessive extracellular matrix accumulation and organ dysfunction. Current antifibrotic therapies remain limited, as most target broad pathways such as TGF-β signaling or oxidative stress without addressing upstream regulators. Emerging evidence identifies the RNA-binding protein Ewing Sarcoma Breakpoint Region 1 (EWSR1) as a pivotal modulator of HSC fate. Through transcriptional regulation, non-coding RNA networks, and stress-granule dynamics, EWSR1 integrates TGF-β signaling, oxidative stress responses, and apoptosis resistance. Inhibition of EWSR1 has been shown to suppress fibrosis-related gene expression and restore apoptotic sensitivity in activated HSCs, highlighting its therapeutic potential. This review critically synthesizes recent insights into EWSR1 biology, its crosstalk with profibrotic pathways, and its regulatory influence on HSC activation. We further compare EWSR1 with conventional antifibrotic approaches, outline research gaps, and propose directions for translational development. By positioning EWSR1 as a novel molecular node in fibrogenesis, this article underscores its promise as a next-generation therapeutic target for halting or reversing liver fibrosis.