PPAR agonists show strong preclinical efficacy but mixed clinical translation in NASH/MASH; while the pan–PPAR agonist lanifibranor improved histology and fibrosis in recent trials, historical α/δ/γ-targeted agents produced variable results and safety trade-offs, highlighting isoform- and tissue-selective actions and off-target liabilities that complicate bedside translation [32,51]. Here, PPARA is linked to metabolic dysfunction-associated steatohepatitis.