In a US multi-centre validation study including 139 NAFLD patients and 150 controls, Feldstein et al. demonstrated that plasma CK-18 levels measured using ELISA were significantly higher in patients with biopsy-proven NASH than in those with a borderline diagnosis and normal controls, with an AUROC of 0.83 for NASH diagnosis. This evidence concerns the gene KRT18 and metabolic dysfunction-associated steatotic liver disease.