GPT and hepatocellular carcinoma: These findings suggest that the transamination of pyruvate to alanine by alanine aminotransferase (ALT) and pyruvate to lactate by lactate dehydrogenase (LDH) is elevated throughout fibrosis progression, which is generally consistent with elevated serum ALT levels in a large retrospective observational study of 771 liver biopsies [90] and the correlation of LDH levels with the presence of fibrosis in HCC patients [91].