Abstract

This review analyzes the impact of the lipid-sensing nuclear receptors peroxisome proliferator activated receptors, farnesoid X receptor, and liver X receptors in the pathogenesis and treatment of nonalcoholic steatohepatitis. Agonists of peroxisome proliferator-activated receptors and farnesoid X receptor have been studied extensively in mouse models, and phase II and III clinical trials currently are ongoing to test the safety and efficacy of these nuclear-receptor–based drugs for treating nonalcoholic steatohepatitis. Nonalcoholic fatty liver disease comprises a wide spectrum of liver injuries from simple steatosis to steatohepatitis and cirrhosis. Nonalcoholic steatohepatitis (NASH) is defined when liver steatosis is associated with inflammation, hepatocyte damage, and fibrosis. A genetic predisposition and environmental insults (ie, dietary habits, obesity) are putatively responsible for NASH progression. Here, we present the impact of the lipid-sensing nuclear receptors in the pathogenesis and treatment of NASH. In detail, we discuss the pros and cons of the putative transcriptional action of the fatty acid sensors (peroxisome proliferator-activated receptors), the bile acid sensor (farnesoid X receptor), and the oxysterol sensor (liver X receptors) in the pathogenesis and bona fide treatment of NASH.