Persistence of active fibrogenesis in advanced fibrotic liver disease might, for example, explain clinical observations such as the recent report that the clinical response to obeticholic acid (OCA), a farnesoid-X-receptor agonist, in non-alcoholic steatohepatitis (NASH) patients was more pronounced in advanced fibrotic disease than in early disease [23]. Here, NR1H4 is linked to metabolic dysfunction-associated steatohepatitis.