The bile acid 6-ethyl-chenodeoxycholic acid (obeticholic acid, or OCA), is a synthetic version of chenodeoxycholic acid and serves as a potent farnesoid X nuclear receptor (FXR) activator.[12] Initially approved by the FDA to treat primary biliary cholangitis,[12] OCA gained attention in 2016 when a study suggested that OCA treatment has the potential to lower NASH patients’ NAFLD activity scores (NAS), and improve fibrosis, steatosis, hepatic lobule inflammation, and hepatocellular ballooning, which may reverse the severity of NASH-related liver fibrosis. This evidence concerns the gene NR1H4 and primary biliary cholangitis.