SPINK1 and metabolic dysfunction-associated steatotic liver disease: The SPINK 1 gene encodes serine peptidase inhibitor, Kazal type 1.9 This enzyme inhibits trypsin, and is a component of pancreatic juice, secreted by pancreatic acinar cells; mutations result in familial calcific pancreatitis.9 Oruc et al87 evaluated the SPINK1 N34S P555 polymorphism in 50 Turkish patients with NAFLD and 44 controls.