Furthermore, Dasgupta et al. demonstrated that activation of XBP1-s enhances the transcription of serine palmitoyltransferase, a key enzyme in ceramide synthesis, in nonalcoholic steatohepatitis (NASH) model mice, leading to the release of extracellular vesicles (EVs) and the recruitment of macrophages, which ultimately cause inflammation and liver injury [85]. This evidence concerns the gene XBP1 and metabolic dysfunction-associated steatohepatitis.