In the context of cirrhosis, an advanced stage of NAFLD, outer-membrane vesicles from E. coli have been shown to induce C-type lectin domain family 4 member E (Clec4e) expression in hepatic macrophages and neutrophils, which influences hepatic immunity, activates hepatic M1 macrophages, and exacerbates cirrhosis development (Natsui et al., 2023). Here, CLEC4E is linked to metabolic dysfunction-associated steatotic liver disease.