TGFB1 and Hepatic fibrosis: In contrast, BEVs can activate the cellular TGF-β signaling pathway through the bioactive substances they carry, activate HSCs, and promote the progression of hepatic fibrosis, and the persistent hepatic fibrous state is a major risk factor for the development of hepatocellular carcinoma (Dhar et al., 2020; Dorner et al., 2024).