ATF4 and Insulin resistance: This also contributes to the progression of hepatic steatosis and of insulin resistance [33]: ER stress further interferes with lipid metabolism in the liver by activating DNL, via the protein kinase activated by dsRNA (PKR)-related Endoplasmic Reticulum Kinase (PERK)/eukaryotic translation Initiation Factor 2α (eIF2α)/Activating Transcription Factor 4 (ATF4) pathway and by limiting the formation and secretion of VLDL, via Inositol Requiring Enzyme 1 (IRE1) pathway.