Additionally, genes associated with BA metabolism, including alternative BA synthetic enzymes (CYP7B1 and CYP27A1), BA conjugating enzyme (BAAT), BA importers (NTCP, OATP1B1, and OATP1B3), and BA exporters (BSEP, MDR2, and MDR3), were also upregulated, whereas the mRNA levels of alternative BA spillover exporters (OSTA and OSTB) showed no significant differences, indicating that the gene expression profile favors BA accumulation in patients with MASH. This evidence concerns the gene CYP27A1 and metabolic dysfunction-associated steatohepatitis.