Consistent with the key characteristics identified in the discovery cohort, there was a stepwise increase in the number of neutrophilic CLSs with positivity of NE (Fig. 3A and B) or PR3 (Fig. S2A and B), from no MASLD to MASLD, borderline MASH, and definite MASH, with a significant and positive correlation with biochemical markers of liver injury (ALT and AST) and histological features of MASH (Fig. 3C and D and Fig. S2C and D). Here, ELANE is linked to metabolic dysfunction-associated steatohepatitis.