Nonalcoholic
steatohepatitis (NASH) is a severe form of nonalcoholic
fatty liver disease (NAFLD) characterized by liver steatosis, inflammation,
and hepatocellular damage. NASH is a serious condition that can progress
to cirrhosis, liver failure, and hepatocellular carcinoma. The association
of NASH with obesity, type 2 diabetes mellitus, and dyslipidemia has
led to an emerging picture of NASH as the liver manifestation of metabolic
syndrome. Although diet and exercise can dramatically improve NASH
outcomes, significant lifestyle changes can be challenging to sustain.
Pharmaceutical therapies could be an important addition to care, but
currently none are approved for NASH. Here, we review the most promising
targets for NASH treatment, along with the most advanced therapeutics
in development. These include targets involved in metabolism (e.g.,
sugar, lipid, and cholesterol metabolism), inflammation, and fibrosis.
Ultimately, combination therapies addressing multiple aspects of NASH
pathogenesis are expected to provide benefit for patients.