Overexpression of TGF-β in NAFLD or NASH activates the Smad signaling pathway, leading to apoptosis, hepatic stellate cells (HSCs) activation and proliferation, and myofibroblast (MFB) transformation, resulting in increased extracellular matrix (ECM) deposition (80). This evidence concerns the gene TGFB1 and metabolic dysfunction-associated steatotic liver disease.