FGF21 reverses MASH through coordinated actions on the CNS and liver
Open accessAbstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), represent a growing public health burden with limited therapeutic options. Recent studies have revealed that fibroblast growth factor 21 (FGF21)-based analogs can significantly improve MASH, but the mechanisms for this effect are not well understood. Here, we demonstrate that the beneficial metabolic effects of FGF21 to reverse MASH are mediated through distinct mechanisms to independently lower hepatic triglyceride and cholesterol levels. Specifically, FGF21 signaling directly to glutamatergic neurons in the central nervous system (CNS) stimulates hepatic triglyceride reduction and reversal of fibrosis, whereas FGF21 signaling directly to hepatocytes is necessary and sufficient to reduce hepatic cholesterol levels in mice. Mechanistically, we show that FGF21 acts in the CNS to increase sympathetic nerve activity to the liver, which suppresses hepatic de novo lipogenesis. These results provide critical insights into a promising pharmacological target to treat MASH.
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The results extend current MASLD frameworks into an integrated mechanical-metabolic-inflammatory axis.
“our results extend current MASLD frameworks, traditionally centered on metabolic dysregulation and inflammation, into an integrated mechanical–metabolic–inflammatory axis [44, 45, 46, 47, 48]”
From Liver Stiffness Rises Early in MASLD and Drives Inflammation, Lipid Dysmetabolism, and Fibrosis via Piezo1–YAP Mechanotransduction (2026) · cites this paper as [45]
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Cited by
Sorted by citations
Ma, J., Xie, N., Wang, Z., Liang, X., Han, Y., Zhao, Q., Wang, M., Lu, H., Kou, W., Alazawi, W., et al. (2026) · Advanced Science · doi:10.1002/advs.202519109 · Cited by 14 · see citing works
- Authors
- Rose, J. P., Morgan, D. A., Sullivan, A. I., Fu, X., Inigo-Vollmer, M., Burgess, S. C., Meyerholz, D. K., Rahmouni, K., & Potthoff, M. J.
- Affiliations
- University of Iowa (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Potthoff, Matthew J.
- ORCID
- Venue
- Cell Metabolism
- Publisher
- Elsevier BV
- Published
- 2025-07
- Volume
- 37
- Issue
- 7
- Pages
- 1515-1529.e6
- ISSN
- 1550-4131 (ISSN-L)
- PMC
- PMC12409791
- OpenAlex
- W4410316023
- Cited by
- 75
- References
- 27
- Citations by year
- 2026: 54 · 2025: 21
- FWCI
- 22.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Cell Metabolism (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- US Department of Veterans Affairs (I01BX004634, IK6BX006040)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01HL162773, R01AA027654, R01DK106104, P30DK54759)
- Cystic Fibrosis Foundation
- National Institutes of Health
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fibroblast Growth Factor Research
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- FGF21, nonalcoholic steatohepatitis, non-alcoholic fatty liver disease, hepatic steatosis, liver fibrosis, hepatic triglycerides, liver cholesterol, glutamatergic neurons, central nervous system signaling, sympathetic activity, de novo lipogenesis, hepatocytes, diet-induced liver disease
- MeSH terms
- Animals, Central Nervous System, Cholesterol, Fatty Liver, Fibroblast Growth Factors, Humans, Liver, Male, Mice, Inbred C57BL, Triglycerides, Signal Transduction, Hepatocytes, Lipogenesis, Mice
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