To further investigate the effect of KAL on NASH, we found that the livers of 10-month-old KAL-Tg mice exhibited yellow and granular surfaces, and developed NASH with apparent inflammation, balloon-like degeneration of hepatocytes, and NAFLD activity score (NAS) greater than 5 (Fig. 2h-i, supplementary Fig. 2a-d). This evidence concerns the gene SERPINA4 and metabolic dysfunction-associated steatotic liver disease.