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In vitro studies indicate that hepatic resident macrophages detect elevated free fatty acids and respond by increasing TNF- secretion that, in turn, promotes the progression of steatosis in hepatocytes ( Metabolic burden in hepatocytes activates multiple cell death pathways, including apoptosis, necroptosis, pyroptosis, and ferroptosis, which can further amplify the inflammatory and fibrogenic response ( Figure 1B )
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