ACTA1 and metabolic dysfunction-associated steatohepatitis: A recent study from the NASH Clinical Research Network (NASH CRN), found that positive serum autoantibodies, defined as antinuclear antibody (ANA) titer ≥1:160 or antismooth muscle antibody (ASMA) ≥1:40, were present in 21% of patients with biopsy-proven NAFLD and they were not associated with more advanced histologic features.57 However, if there are additional features suggestive of autoimmune hepatitis, such as markedly elevated aminotransferase, high γ-globulin, or high serum immunoglobulin G, then a liver biopsy may be considered necessary to firmly establish the diagnosis.