INS and metabolic dysfunction-associated steatotic liver disease: Although the direct impact of P. gingivalis OMVs in NAFLD has not been completely elucidated, P. gingivalis OMVs carrying gingipains can transfer to the liver and impair hepatic glycogen synthesis in a mouse model; they can also inhibit insulin-induced Akt/GSK-3β signaling in a gingipain-dependent manner in HepG2 cells (170), indicating a potential role of these gingipain-carrying OMVs in the development of NAFLD through negative regulation of glucose metabolism and insulin sensitivity.