For example, in patients with non-alcoholic fatty liver disease (NAFLD) and diabetes, hepatocyte-derived fibrinogen-related protein 1 (HFREP1) induces IR by activating the ERK1/2 signaling pathway, inducing hepatocyte proliferation and disrupting insulin signaling in peripheral tissues (Wu H.-T. Here, FGL1 is linked to metabolic dysfunction-associated steatotic liver disease.