CASP9 and metabolic dysfunction-associated steatohepatitis: In NASH, Lipotoxicity-induced hepatocyte ballooning leads to downregulation of a key player in the apoptotic pathway, which is caspase 9, and along with reinforcement from a hedgehog autocrine survival signaling pathway produces an “undead hepatocyte” in which apoptosis has been initiated but fails to be executed driving a vicious pathway of inflammation (NASH) and fibrosis [27].