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). Here, NR1H4 is linked to metabolic dysfunction-associated steatotic liver disease.