Table 2.

Biological effects of silymarin involved in its hepatoprotective action in patients with NAFLD.

Effect	Proposed Mechanism of Action
Antioxidant	Direct scavenger activity * Mitochondrial function optimization * Activation of protective molecules such as Heat Shock Proteins, thioredoxin and sirtuins
Anti-inflammatory	Inhibition of NF-κB activity Proinflammatory cytokine synthesis reduction (IL-1, IL-6, TNF-α, TNF-β) *
Anti-apoptotic	Modulation of caspase release and TNF-α effect
Antifibrotic	Inhibition of the conversion of stellate cells into fibroblasts Downregulation of the expression of profibrotic genes (procollagen III, TGF-β)
Endocrine-metabolic	Partial activation of estrogen receptors * Insulin-sensitizing action * PPAR-agonist action * Increased expression of GLUT4 on the cell surface * Inhibition of Hydroxy-Methyl-Glutaryl Coenzyme A reductase *
Choleretic	Upregulation of the bile salt export pump *

GLUT4 = glucose transporter type 4, IL = Interleukin, NF-κB = nuclear factor kappa-light-chain-enhancer of activated B cells, PPAR = peroxisome proliferator-activated receptor, TGF-β = transforming growth factor beta, TNF = tumor necrosis factor, * potentially positive effects on vascular health.