Obeticholic acid is an FXR agonist that has entered clinical trials for non-alcoholic steatohepatitis (NASH) and NAFLD; however, this FXR agonist has the unwanted effect of increasing total cholesterol levels and increasing the HDL-c to non-HDL-c ratio (Mudaliar et al., 2013; Han, 2018). The gene discussed is NR1H4; the disease is metabolic dysfunction-associated steatohepatitis.