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TXR is currently in Phase 2 trials for the treatment of non\u2010alcoholic steatohepatitis (NASH). Herein, we report the impact of TXR on in a piglet model in which cholestatic liver damage and fibrosis where induced by bile duct ligation (BDL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The piglets received BDL and TXR for 2\u00a0wk. Hepatic, portal and colonic bile acid and amino acid profiles and gut microbiome were analysed. Portal fibroblast growth factor (FGF) 19 levels were measured using an enzyme\u2010linked immunosorbent assay (ELISA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We first showed that bile acid metabolism and signalling are dysfunctional in patients with biliary atresia. Next, we observed that TXR potently suppresses BDL\u2010induced liver injury, fibrosis and ductular reaction in piglets. Within the ileum, TXR enhances FGF19 expression and subsequently increases portal FGF19 levels. In the liver, TXR promotes the expression of small heterodimer partner (SHP) and inhibits cholesterol 7\u03b1\u2010hydroxylase (CYP7A1). Additionally, TXR increases the abundance of bile acid\u2010biotransforming bacteria in the distal ileum and alters the composition of amino acids in the colon. Lastly, TXR ameliorates intestinal barrier injury in piglets subjected to BDL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TXR potently ameliorated cholestatic liver injury and fibrosis by modulating the gut\u2013liver axis in piglets. It supports the clinical evaluation of TXR as a therapeutic strategy for cholestatic liver diseases, such as biliary atresia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14906","type":"journal-article","created":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T17:42:03Z","timestamp":1619286123000},"page":"2117-2131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["A nonbile acid farnesoid X receptor agonist tropifexor potently inhibits cholestatic liver injury and fibrosis by modulating the gut\u2013liver axis"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0964-609X","authenticated-orcid":false,"given":"Yongtao","family":"Xiao","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology and Nutrition Xin Hua hosiptal School of Medicine, Shanghai Jiao Tong University Shanghai China"},{"name":"Department of Pediatric Surgery Xin Hua hospital School of 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