Although the FXR agonist obeticholic acid (OCA) lowered hepatic fat in human subjects with non-alcoholic steatohepatitis (NASH), it had paradoxical effects on cholesterol levels, increasing LDL and decreasing high-density lipoprotein (HDL) cholesterol [152]. The gene discussed is NR1H4; the disease is metabolic dysfunction-associated steatohepatitis.