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With regard to the increased secretion of EVs during the progression of NAFLD, experimental studies demonstrated that toxic lipids significantly increase the production of hepatocyte-derived EVs, which act as mediators of paracrine signaling, causing hepatic stellate cell activation, angiogenesis and activation of macrophages leading to inflammation and chemotaxis [103,104,105]

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As the major source of plasma GPx is the kidney, the mentioned authors suggested that the inflammatory injury in the intestine elicits an increase in E-GPx in the plasma that is associated with an increase in E-GPx mRNA in the kidney

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While these findings are promising, current clinical research still has several limitations