Moreover, portal endotoxin levels were elevated in HFD mice but were significantly elevated in HFD dextran sulfate sodium–administered mice.24 MASH has been associated with high blood endotoxin levels.25 Another report suggested that hyperleptinemia associated with obesity may increase hepatic KC reactivity to small amounts of endotoxins, inducing MASH development by means of inflammatory cytokines, among other factors.26 In this study, the levels of inflammatory cytokines, IL-6 and TNFα, were also elevated in the amylin MASH group, which may be related to hyperendotoxemia. This evidence concerns the gene CALCA and obesity due to melanocortin 4 receptor deficiency.