Exenatide (exendin-4) can improve hepatic steatosis via the SIRT1/heat shock factor 1/HSP pathway.327 SIRT2 regulated hepatic steatosis by HNF4α deacetylation.328 A natural chemical compound 2,3,5,4’-tetrahydroxy-stilbene-2-O-β-d-glucoside (TSG) reduces ROS formation and increases SIRT5 expression in mitochondria to ameliorate NAFLD.329 USP10 inhibits hepatic steatosis and inflammation by interacting with SIRT6.329 In mitochondria, MRG15 interacts with and deacetylates TUFM, which accelerates effects altogether and drives the progression from NAFLD to NASH with inflammation and fibrosis.330. This evidence concerns the gene HNF4A and metabolic dysfunction-associated steatotic liver disease.