Chronic liver injury caused by HBV, HCV, chronic alcohol consumption, nonalcoholic steatohepatitis (NASH), hereditary hemochromatosis, primary biliary cirrhosis (PBC), and alpha-1 antitrypsin deficiency leads to permanent hepatocyte damage followed by a massive compensatory cell proliferation and regeneration in response to cytokine stimulation (Table 1). The gene discussed is SERPINA1; the disease is metabolic dysfunction-associated steatohepatitis.