SERPINA4 and metabolic dysfunction-associated steatotic liver disease: KAL, encoded by the SERPINA4, is a secreted protein mainly expressed in hepatocytes.12 The previous studies, including ours’ showed that KAL levels in the peripheral blood of diabetic patients were significantly elevated13,14 and positively correlated with TG.14,15 Furthermore, we have reported that KAL could activate the nuclear factor κB (NF-κB) signaling pathway to cause inflammation in diabetic wound tissues.13 However, the relationship between lipid metabolic dysfunction, KAL, and NAFLD remains unclear.