TLR4 and steatosis: Phase II trial (2018 [165]): JKB-121 (oral TLR4 antagonist) in NASH patients (24 weeks) was well-tolerated but showed no significant improvement over placebo in liver fat, ALT, or fibrosis markers. A high placebo response rate was observed, and JKB-121 did not further reduce liver inflammation or steatosis compared to the placebo. Other approaches: A bovine-derived anti-LPS antibody (IMM-124/ASX-100) and gut-selective antibiotics (rifaximin) have been explored to lower endotoxemia; however, clinical efficacy in NASH remains unproven.