GPT and metabolic dysfunction-associated steatohepatitis: Interestingly, Shavakhi et al. demonstrated that treatment with Metformin plus Protexin (L. acidophilus, L. casei, L. rhamnosus, L. bulgaricus, B. breve, B. longum, Streptococcus thermophilus) decreases ALT and AST activity, better than Metformin alone in patients with NASH [181].