A recent study clearly demonstrated that adipocyte death predominantly induces liver injury and inflammation in a model of acute adipocyte death via activation of CCR2+ macrophages and elevation of epinephrine and norepinephrine levels to induce lipolysis.74 Current understanding of the role of adipose-derived EVs in metabolic homeostasis and diseases: communication from the distance between cells/tissues.201 The novel adipokine gremlin 1 antagonizes insulin action and is increased in type 2 diabetes and NAFLD/NASH.202. Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.