Table 1 Drugs under study or approved for the treatment of MAFLD

PPARα/γ/δ agonists

Elafibranor

Increased fatty acid beta oxidation, improves insulin resistance and inflammation

[154]

Thiazolidinediones (TZD)

[157, 159]

Pioglitazone

Rosiglitazone

Improves mitochondrial function, protects pancreatic beta cells and increases tissue sensitivity to insulin

MSDC-0602K

[168]

Biguanide hypoglycemic drugs

Dimethylbiguanide

Phenelzine

Targeted mitochondrial pyruvate carrier

[224]

Buformin

Improved insulin sensitivity of liver and peripheral tissues

[225, 226]

GLP-1 receptor agonist

Liraglutide

Exenatide

Lisiratide

Enhancement of mitochondrial structure, attenuation of ROS production and promotion of autophagy

[227]

Mitochondria-targeted antioxidants

Ursodeoxycholic acid (UDCA)

Elamipretide

Decoupling agent

Aramchol

Affects mitochondrial electron transport

[196]

Mito-quinone (Mito-Q)

MitoVitamin-E (MitoVit-E)

Reduction of SCD1 and maintenance of cellular redox homeostasis

[198]

Silymarin

Protects cells from peroxide-induced oxidative damage and apoptosis

[228]

Controlled Release Mitochondrial Protonin (CRMP)

Regulation of thioredoxin and nitric oxide (NO) derivatives to reduce lipid peroxidation

[229, 230]

Intravenous injection of functional mitochondria

Mitotherapy

Liver mitochondrial uncoupling, improving liver fibrosis and liver protein synthesis

Reduced lipid content, improve cellular redox balance

[216, 217]