Aberrations of insulin-signaling cascades and glucose homeostasis are crucial in NASH progression; therefore, it has been hypothesized that s121Gln in the ENPP1/PC-1 gene and the 972Arg in the IRS-1 reduce cell survival and affect lipogenesis, contributing to hepatocellular damage and fibrogenesis [42]. This evidence concerns the gene ENPP1 and metabolic dysfunction-associated steatohepatitis.