**3.7 Peroxisome Proliferator-Activated Receptors (PPAR)**

The only medication in this class that is currently in use is pioglitazone. It is regarded as an activator of the PPAR nuclear receptor of the PPARγ subgroup, which is mostly expressed in adipose tissue and associated with the reduction of inflammation, adipocyte differentiation, and lipid and glucose metabolism (**Figure 8**). Pioglitazone possibly increases peripheral insulin sensitivity by inducing the release of adipokines, promoting the storage of triglycerides in adipose tissue, and boosting insulin's inhibitory effect on lipolysis. These have the effect of decreasing plasma levels of free fatty acids and causing the liver to reabsorb lipids [25]. Throughout these pathways, it enhances hepatic and peripheral insulin sensitivity and influences the pathophysiology and development of NASH in a beneficial way [13, 26]. The PPARγ sensitizers were reported to improve the hepatic histologic findings of ballooning,

**Figure 8.** *Action of PPAR sensitizers in NAFLD/NASH.*
