Duoliv™ is a preparation of Obeticholic Acid. Obeticholic Acid is an agonist for Farnesoid X receptor (FXR), a nuclear receptor expressed in the liver and intestine. FXR is a key regulator of bile acid, inflammatory, fibrotic and metabolic pathways. FXR activation decreases the intracellular hepatocyte concentrations of bile acids by suppressing de novo synthesis from cholesterol as well as by increased transport of bile acids out of the hepatocytes. These mechanisms limit the overall size of the circulating bile acid poo! while promoting choleresis, thus reducing hepatic exposure to bile acids.