Level 3 confirmation. Alpha-1-antichymotrypsin (AACT) is an acute phase protein synthesized in liver and induced during inflammation. Plasma levels of AACT are reduced with NASH (Hou et al., 2020) and with prediabetes, type 2 diabetes and abdominal obesity compared to normal (Kim et al., 2019). Here, SERPINA3 is linked to metabolic dysfunction-associated steatohepatitis.