Can Obeticholic Acid be Used for Liver Cirrhosis?

Obeticholic acid is a drug used to treat a chronic disease called primary biliary cholangitis (PBC). Primary biliary cholangitis is an autoimmune disease that causes damage to the small bile ducts in the liver and ultimately leads to liver fibrosis and cirrhosis.

Obeeticholic acid6α-ethylchenodeoxycholic acid (CCA) is a semi-synthetic derivative of chenodeoxycholic acid. It is a potent agonist of the farnesoid X receptor (FXR), 100 times more potent than CCA. Obeticholic acid binds and activates FXR, leading to increased secretion of ileal fibroblast growth factor-19 (FGF 19). This results in the formation of complexes. This complex inhibits bile acid synthesis by inhibiting CYP7A1. Obeticholic acid also increases the expression of bile salt export protein (BSEP) and multidrug resistance 3 (MDR3) protein, promoting the outflow of bile from hepatocytes.

However, the use of obeticholic acid in the treatment of non-alcoholic steatohepatitis (NASH) or other types of cirrhosis is unclear. NASH is a disease related to obesity and metabolic disorders, often accompanied by hepatic steatosis, hepatitis, and liver fibrosis. In NASH model, FXR agonists can reduce liver MCP-1 (monocyte chemoattractant protein-1) mRNA expression and significantly reduce inflammatory cell infiltration and fibrosis.

Overall, obeticholic acid is a synthetic cholic acid from the cholic acid family that has antifibrotic, anticholestasis, and anti-inflammatory properties. It binds to the nuclear receptor (FXR) in hepatocytes, regulates bile acid synthesis and excretion, and inhibits inflammatory responses, thereby improving liver pathological changes. Currently, the indications for obeticholic acid are limited to the treatment of primary biliary cholangitis (PBC). Ifthe patienthas other types of cirrhosis, such as non-primary biliary cirrhosis (NASH), it is recommended to consult with a medical professional to learn about the best treatment options for the situation.