Deletion of hepatic FXR leads to more severe MASH development in female mice

The farnesoid X receptor (FXR) has been identified as a therapeutic target for metabolic dysfunction-associated steatohepatitis (MASH). FXR is the major homeostatic regulator of bile acids (BAs) with dysregulation of BAs and/or FXR implicated in the pathogenesis of MASH. Synthetic whole-body FXR agonists have been developed to treat MASH. Although beneficial for MASH treatment, these whole-body modulators contribute to unfavorable side effects such as pruritus and an elevation in low-density liporoteins, thereby highlighting the importance of tissue and cell-restricted modulation of FXR in the development of novel therapeutics for MASH to negate potential harmful off-target effects.

The objective of this study was to determine the tissue-specific role of FXR in MASH development using male and female wild-type (WT), liver FXR KO (FXRhep-/-), intestinal FXR KO (FXRint-/-), and whole body FXR KO (FXR KO) mice fed either a low-fat control diet (CTL) or a MASH "Fast Food" (FF) diet.

The results showed, in females, hepatic, but not intestinal, deficiency of FXR was associated with severe liver injury, through increased ALT, ALP, and genes indicative of inflammation and fibrosis when comparing FXRhep-/- versus FXRint-/-. Regardless of sex, hepatic FXR deficiency triggered the activation of neuroinflammation and neurodegenerative canonical pathways.

These data suggest that hepatic FXR is more critical in suppressing liver injury during MASH development in female mice. However, this same trend was not clear in the male cohorts, highlighting sex differences and potential roles for sexual dimorphism in MASH development.