ATF4 and hepatocellular carcinoma: An increased incidence of inflammatory mediators, such as ATF4,1, 2 TLR4,3, 4 TREM-1,5, 6 have been linked to the development of HCC; other proteins, such as TIFA (TRAF-interacting protein with a Forkhead-associated (FHA) domain), are upregulated in response to hypoxia or other acute stress.7 The most frequent cause for chronic hepatic inflammation in humans is infection with hepatitis B virus or hepatitis C virus, which currently persist in approximately 500 million people worldwide, and fosters an increasing HCC patient population.