Starting from MPR 4.0, the functions mpfr_set_float128 and mpfr_get_float128 can be used to convert from and to __f128 (see test cases here for usage: https://fossies.org/linux/misc/mpfr-4.1.0.tar.gz/mpfr-4.1.0/tests/tset_float128.c).
It would be great if mpreal supports these conversions as well.