Although PREP-mediated transcriptional regulation seems to exert a permissive effect on inflammation, as signified by macrophage proinflammatory M1 polarization (Figs. 1 and 5) and our previous studies in NASH liver inflammation murine models25,26, the key pathological process underlying fibrosis progression is aberrant tissue repair (e.g., fibrogenesis and ECM remodeling) during intermissions of repetitive inflammation, but not inflammation episodes per se59. Here, PREP is linked to metabolic dysfunction-associated steatohepatitis.