Interestingly, six of the 20 most significant up-regulated genes in NASH encoded proteins involved in the extracellular matrix (MMP7, ITGBL1, LUM, CCDC80, CDH6, MUC6) consistent with fibrosis (Fig. 3C), whereas eight of the twenty top down-regulated genes (ORM1, SAA1, CRP, SAA2, LRG1, HAMP, SPINK1, FCN2) encode for secreted proteins suggesting impaired hepatocyte secretory function (Fig. 3D). The gene discussed is SPINK1; the disease is metabolic dysfunction-associated steatohepatitis.