Chiglitazar Demonstrates Potential to Treat Metabolic Dysfunction–AssociatedSteatohepatitis <i>In Vitro</i> and In <i>Vivo</i>

Introduction: Chiglitazar was approved by the China National Medical Products Administration (NMPA) in 2021 for the treatment of patients with type 2 diabetes mellitus, and may also benefit from metabolic dysfunction-associated steatohepatitis (MASH). Methods: To characterise the role of Chiglitazar in MASH, in vitro experiments examining monocyte activation and migration were conducted, alongside liver and stellate cell proliferation assays. Three distinct MASH animal models (db/db mouse model, MCD model, CCl4 model) for conducting in vivo studies were established. Results: The results indicated that Chiglitazar reduced MCP-1-induced THP-1 migration and down-regulated TNF-α and MCP-1 expression. It also blocked TGF-β-driven proliferation in dermal fibroblasts and hepatic stellate cells while suppressing α-SMA and CTGF expression. In vivo, Chiglitazar alleviates hepatic steatosis and inflammation in the MCD model, whilst improving hepatic inflammation and fibrosis in both the CCL4 and HFD+CCL4 models. Discussion: In the study, it has been demonstrated that chiglitazar suppresses monocyte activation and chemotaxis, thereby attenuating chronic inflammation-elicited vascular and tissue damage. It also blocks fibroblast proliferation and differentiation, curbing toxin- or metabolite-induced inflammation and fibrosis. Although CCl4, MCD, and HFD+CCl4 models were used, they only partially reproduce human MASH pathology. Future work should employ more physiologically faithful systems. Conclusions: As the world's first pan-PPAR agonist approved for the treatment of Type 2 Diabetes Mellitus (T2DM), Chiglitazar has also demonstrated potential for treating MASH by modulating steatosis, inflammation, and fibrosis. This potential may be translatable into clinical treatments in the foreseeable future.