tl;dr: Efficiently maintaining authenticated state on disk is a research problem many blockchains are facing. Succinctly, Merkle trees do not fit in memory and maintaining them on-disk is rife with performance penalties. What can be done?
This blog discusses a few potential directions:
We could investigate on-disk, high-arity Verkle trees[^Kusz18].
We could make the problem obsolete by designing homomorphic authenticated data structures[^PSTY13] whose digest can be updated directly without going to disk.
We could investigate new state synchronization designs that rely not on Merkle trees, but on other cryptographic primitives such as multiset incremental hash functions[^BGG94],[^BM97].
We could borrow ideas from stateless validation[^RMCI17],[^CPZ18],[^BBF19],[^GRWZ20],[^PSB21].
We could design new databases optimized for storing Merkle trees.
We could authenticate a database like RocksDB directly, instead of storing a Merkle tree in the database[^RPK+18].