As detailed above, FXR is the intracellular sensor for BAs in the liver and intestines, and its activation decreases hepatic gluconeogenesis, de novo lipogenesis and steatosis.322,323 Obeticholic acid (OCA), a modified BA, is a potent FXR agonist that has been studied in patients with NASH. The gene discussed is NR1H4; the disease is steatosis.