An insight into the role of telmisartan as PPAR-γ/α dual activator in the management of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most common hepatic disease. It is rapidly emerging as the frequent cause for liver transplantation with the risk of disease recurrence, even after transplantation. Clinical evidence showed an abnormally altered expression of different peroxisome proliferator-activated receptor (PPAR) isotypes (PPAR-alpha/gamma/delta) in NAFLD with an involvement in the induction of insulin resistance, hepatic steatosis, reactive oxygen species (ROS) formation, and hepatic inflammation. Recently, several dual PPAR-gamma/alpha agonists were developed to simultaneously achieve the insulin-sensitizing effect of PPAR-gamma as well as lipid catabolizing effect of PPAR-alpha. PPAR-alpha activation could counterbalance the steatogenic and adipogenic effects of PPAR-gamma. But most of the drugs were ended in the initial level itself due to harmful adverse effects. In the present review, we discuss the possible mechanism of telmisartan, a typical angiotensin receptor blocker with excellent safety and pharmacokinetic profile, as a PPAR-gamma/alpha dual agonist in the treatment of NAFLD.