ATF4 and nutritional disorder: Furthermore, in the context of murine MAFLD, Gao et al., showed that hepatocyte iron deficiency, with iron being exported in extracellular vesicles to hepatic stellate cells (HSC), propagates hepatic insulin resistance and lipogenesis via Hypoxia-Induced factor 2α/Activating transcription factor 4 (HIF2α/ATF4) signalling, and the iron-overloaded HSC drive oxidative stress progression to MASH [42].