NR1H4 and metabolic syndrome: Several approved or advanced experimental agents in MetS and MASH treatment like obeticholic acid, pioglitazone and resmetirom act as agonists of ligand-activated transcription factors (thyroid hormone receptor (THR), peroxisome proliferator-activated receptor (PPAR) γ, and farnesoid X receptor (FXR)), respectively.17–19 These nuclear receptors (NRs) regulate metabolic balance in different tissues and via different pathways.