Metabolic remodeling during steatosis and lipotoxic stress is accompanied by lactate accumulation and altered substrate fluxes, and IGFBP-6 is responsive to metabolic signals such as lactate in immune cells, where it shapes transporter expression and inflammatory tone—suggesting a route by which hepatocellular and stromal metabolism could tune IGFBP-6 in the liver [61]. The gene discussed is IGFBP6; the disease is steatosis.