CYP7B1 has been demonstrated to be downregulated in NAFLD, NASH without fibrosis and T2DM but becomes up-regulated in NASH with fibrosis which may be due to an upregulation of the alternative BA pathway (Lake et al., 2013; Guillemot-Legris et al., 2016). This evidence concerns the gene CYP7B1 and metabolic dysfunction-associated steatohepatitis.