This prevents phosphorylation of eukaryotic translation initiation factor 2 alpha, reduces levels of the transcription factor activating transcription factor 4 (ATF4), thereby downregulating TGF-β1 expression and decreasing extracellular matrix (ECM) accumulation, ultimately mitigating renal fibrosis in diabetic nephropathy (41). This evidence concerns the gene ATF4 and diabetic kidney disease.