ER stress contributes to the progression of hepatic steatosis and insulin resistance by activating DNL (via the protein kinase RNA-like ER kinase (PERK)/activating transcription factor 4 (ATF4)/eukaryotic translation initiation factor 2alfa (eIF2alfa) pathway) and limiting the secretion of VLDL (via inositol-requiring signaling protein 1 (IRE1)) [69,74]. The gene discussed is ATF4; the disease is fatty liver disease.