Published online Dec 8, 2015. doi: 10.4254/wjh.v7.i28.2811
Peer-review started: July 17, 2015
First decision: September 2, 2015
Revised: November 5, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: December 8, 2015
Processing time: 143 Days and 12.1 Hours
With the high prevalence of obesity, diabetes, and other features of the metabolic syndrome in United States, nonalcoholic fatty liver disease (NAFLD) has inevitably become a very prevalent chronic liver disease and is now emerging as one of the leading indications for liver transplantation. Insulin resistance and derangement of lipid metabolism, accompanied by activation of the pro-inflammatory response and fibrogenesis, are essential pathways in the development of the more clinically significant form of NAFLD, known as nonalcoholic steatohepatitis (NASH). Recent advances in the functional characterization of bile acid receptors, such as farnesoid X receptor (FXR) and transmembrane G protein-coupled receptor (TGR) 5, have provided further insight in the pathophysiology of NASH and have led to the development of potential therapeutic targets for NAFLD and NASH. Beyond maintaining bile acid metabolism, FXR and TGR5 also regulate lipid metabolism, maintain glucose homeostasis, increase energy expenditure, and ameliorate hepatic inflammation. These intriguing features have been exploited to develop bile acid analogues to target pathways in NAFLD and NASH pathogenesis. This review provides a brief overview of the pathogenesis of NAFLD and NASH, and then delves into the biological functions of bile acid receptors, particularly with respect to NASH pathogenesis, with a description of the associated experimental data, and, finally, we discuss the prospects of bile acid analogues in the treatment of NAFLD and NASH.
Core tip: Bile acids and bile acid receptors play important roles in modulation of feature of the metabolic syndrome, hepatic steatosis, and hepatic inflammation. Development of bile acid analogues specifically targeting farnesoid X receptor and transmembrane G protein-coupled receptor 5 provide potential novel classes of drugs for the treatment of nonalcoholic steatohepatitis.