PEPD and metabolic dysfunction-associated steatotic liver disease: Although several biochemical markers, such as TNF-a, IL-6, CRP, pentraxin, ferritin, serum prolidase enzyme activity, soluble receptor for advanced glycation end product, and cytokeratin-18, have been proposed as useful in predicting the severity of NAFLD/NASH in the past, none of these markers have shown sufficient sensitivity or specificity for routine clinical application for diagnosis35.