Patient #4 had decompensated NASH and relatively low systemic RAS activity, and exhibited moderate and high hepatic activity of the classical (ACE activity: 116.0 (pg Ang II/μg protein)/h; chymase activity: 731.0 (pg Ang II/μg protein)/h) and alternative RAS (ACE2 activity: 130.0 (pg Ang 1–7/μg protein)/h; NEP activity: 403.0 (pg Ang 1–7/μg protein)/h), respectively. Here, ACE2 is linked to metabolic dysfunction-associated steatohepatitis.