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The abnormal signal pathways will lead to excessive production of FFAs and ROS in adipocytes and hepatocytes, which is a milestone of the first step to develop MASH ( 4 Mechanisms of hepatoprotection by GLP-1RAs as immune-metabolic modulators 4.1 Immunomodulatory mechanism of hepatic injuries by GLP-1RAs GLP-1RAs reduce inflammation, downregulate pro-inflammatory cytokines, and influence immune cell differentiation via the GLP-1 receptor, which alters macrophage polarization and inhibits fibrosis ( 4.1.1 GLP1-RAs attenuate the inflammation in MASLD by downregulating multiple inflammatory factors In animal models, GLP-1RAs have shown promising results in decreasing the expression of various inflammatory markers, including TLR2 and C-X3-C chemokine receptor 1 (CX3CR1), as well as reducing the expression of genes related to liver fibrosis and fat accumulation