Beyond the boundaries of these exciting preclinical findings, a placebo-controlled randomized clinical trial involving daily administration of ALA either alone or in combination with vitamin E for 6 months provided hepatoprotection in patients with NAFLD and NASH by reducing the levels of plasma triglyceride and tumor necrosis factor-alpha (TNF-α; a pro-inflammatory cytokine), and improved steatosis scores compared to placebo-control patients [19]. This evidence concerns the gene TNF and metabolic dysfunction-associated steatotic liver disease.