TNF and metabolic dysfunction-associated steatohepatitis: During the initial stages of NASH development, heightened hepatic LPS levels arise from increased intestinal permeability caused by gut dysbiosis induced by nutritional insults and fatty acids stimulate Kupffer cells (KCs) to secrete tumor necrosis factor α (TNFα) and interleukin (IL)-1β, initiating hepatic inflammation [10,11].