Pathways of hepatic stellate cell activation and survival during NAFLD. Various factors, such as lipid mediators, free cholesterol accumulation, oxLDL, palmitic acid, LPS, and immune cell–derived profibrotic molecules and growth factors, promote hepatic stellate cell activation and survival during NAFLD. OPN, osteopontin; HH ligands, hedgehog ligands; ROS, reactive oxygen species; GM-CSF, granulocyte macrophage colony-stimulating factor; LPS, lipopolysaccharide; TLR4, toll like receptor-4; SHH, sonic hedgehog; IHH, Indian hedgehog; NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells; S1P, sphingosine-1-phosphate; oxLDL, oxidized low-density lipoprotein; LPA, lysophosphatidic acid; LPI, lysophosphatidylinositol; MSR1, macrophage scavenger receptor 1; miRNA, microRNA. Created with Biorender.com.