It would be useful to evaluate how vildagliptin influences gut microbial activity and the gut–liver axis, since microbial metabolites that are prone to reach the liver through the portal vein, such as bile acids (via the farnesoid X receptor) or SCFA (like butyrate), modulate hepatic inflammation and thereby the occurrence of non-alcoholic fatty liver disease [48, 49]. The gene discussed is NR1H4; the disease is metabolic dysfunction-associated steatotic liver disease.