The Role of Farnesoid X Receptor in Cholestasis.

Abstract

The nuclear receptor farnesoid X receptor (FXR) plays a significant role in physiological bile acid synthesis, secretion and transport. Defects in FXR regulation of these processes can cause cholestasis and subsequent pathologic changes. FXR regulates the reduction of synthesis and the uptake of bile acid via enzymes. It also increases bile acid solubility and elimination by promoting conjugation reactions and export pump expression in cholestasis. The changes in bile acid transporters are important causes of cholestasis, which can result from the mutations of transporter genes or acquired dysfunction of transport systems, such as inflammation induced intrahepatic cholestasis. The modulation function of FXR in extrahepatic cholestasis is not completely the same as that in intrahepatic cholestasis, but the discrepancy may be reduced over time. Under the extrahepatic cholestatic state, the increasing biliary pressure can induce bile duct proliferation and bile infarcts but the absence of FXR can ameliorate them. For the importance of FXR in cholestasis, the targets on it for the therapy of cholestatic disease have been extensively studied. This review will provide an update on the function of FXR on the regulation of bile acid metabolism, the role in the pathophysiologic process of cholestasis, and the therapeutic use of FXR agonists.

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