ATF4 and metabolic dysfunction-associated steatotic liver disease: Indeed, the same study demonstrated that in human NAFLD/NASH patients, there is an increased level of hepatic endoplasmic reticulum (ER) stress markers such as ATF4 (activating transcription factor 4), GRP78 (glucose-regulated protein 78), CHOP (C/EBP homologous protein), and impaired autophagic marker p62/SQSTM1 (p62)[37].