NAFL progresses to NASH when evidence of hepatocellular injury characterized by the presence of lobular inflammation (mixture of CD4-(+), CD8-(+) lymphocytes, Kupffer cell aggregates, polymorphonuclear leukocytes, macrophages, T-cells), hepatocellular ballooning degeneration, apoptotic bodies, and Mallory-Denk bodies (eosinophilic intracytoplasmic inclusion composed of misfolded filaments of keratins, heat-shock proteins) [41] can be seen on histology samples [17]. Here, CD4 is linked to metabolic dysfunction-associated steatohepatitis.