Hepatic Obstruction and Secretion of Alkaline Phosphatase

 4/15/02

Question: Why is an elevation in serum (liver) alkaline phosphatase seen in liver obstruction?

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Unique Identifier:9028630

Authors: Moss DW.

Institution: Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.

Title: Physicochemical and pathophysiological factors in the release of membrane-bound alkaline phosphatase from cells. [Review] [27 refs]

Source: Clinica Chimica Acta. 257(1):133-40, 1997 Jan 3.

Abstract: Alkaline phosphatase is bound to cell membranes by a glycan phosphatidylinositol anchoring domain. The structure of this domain and ways in which it may be cleaved by chemical and enzymatic means provide a basis for understanding the solubilization of alkaline phosphatase from tissues in vitro and in vivo and the generation of isoforms. [References: 27] CAS Registry/EC Number EC 3-1-3-1 (Alkaline Phosphatase).

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Unique Identifier:2178809

Authors: Alpers DH. Eliakim R. DeSchryver-Kecskemeti K.

Institution: Department of Medicine, Washington University, St. Louis, MO 63110.

Title: Secretion of hepatic and intestinal alkaline phosphatases: similarities and differences. [Review] [65 refs]

Source: Clinica Chimica Acta. 186(2):211-23, 1990 Jan 15.

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Unique Identifier:2300898

Authors: Hadjis NS. Blenkharn JI. Hatzis G. Adam A. Beacham J. Blumgart LH.

Institution: Department of Diagnostic Radiology, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.

Title: Patterns of serum alkaline phosphatase activity in unilateral hepatic duct obstruction: a clinical and experimental study.

Source: Surgery. 107(2):193-200, 1990 Feb.

Abstract: The levels of serum alkaline phosphatase (ALP) were measured in eight patients with bile duct obstruction limited to one lobe of the liver. Although an initial rise of enzyme concentration was documented in every patient, unrelieved biliary obstruction was associated with a gradual return of ALP to normal values. The return to normal levels coincided with the development of atrophy of that part of the liver deprived of its bile drainage. An animal model of experimental selective biliary obstruction supported a causative association between reduction of hepatocyte mass and a decrease in ALP activity. It appears that normal serum ALP levels can be expected with advanced obstructive biliary disease. Suspected lobar or segmental duct obstruction warrants investigation--even if liver function tests are normal. CAS Registry/EC Number 0 (Biological Markers). EC 3-1-3-1 (Alkaline Phosphatase).

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Unique Identifier:736012

Authors: McGill DB.

Title: Steatosis, cholestasis, and alkaline phosphatase in alcoholic liver disease.

Source: American Journal of Digestive Diseases. 23(12):1057-60, 1978 Dec.

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Unique Identifier:696683

Authors: Ellis G. Goldberg DM. Spooner RJ. Ward AM.

Title: Serum enzyme tests in diseases of the liver and biliary tree.

Source: American Journal of Clinical Pathology. 70(2):248-58, 1978 Aug.

Abstract: Eight serum enzyme tests were performed over a three-year period in 1,147 cases of patients with suspected hepatobiliary disease, of whom 580 had identifiable primary disease of the liver or biliary system. Individually, aminotransferase assays did not provide good discrimination among the various categories of hepatobiliary disease, but when expressed as a ratio a useful degree of discrimination was obtained. Isocitrate dehydrogenase, guanase and glutamate dehydrogenase alone were poor discriminants of the various disease categories studied; combination of the latter enzyme with the aminotransferases in various ratios did not achieve worthwhile improvement. Adenosine deaminase was normal in most patients with extrahepatic obstruction and abnormal in most patients with parenchymal hepatic disease, and is potentially a useful test additional to the aminotransferases in routine diagnosis. 5'-Nucleotidase was more sensitive and specific than alkaline phosphatase in diagnosing hepatobiliary disorders. Abnormalities of all these enzymes were encountered in patients who did not have hepatobiliary disease, most frequently among subjects with cancer, diabetes mellitus, and diseases of the respiratory and cardiovascular systems. CAS Registry/EC Number EC 1-1-1-41 (Isocitrate Dehydrogenase). EC 1-4-1-2 (Glutamate Dehydrogenase). EC 2-6-1-1 (Aspartate Aminotransferases). EC 2-6-1-2 (Alanine Transaminase). EC 3-1-3 (Nucleotidases). EC 3-1-3-1 (Alkaline Phosphatase). EC 3-5-4-3 (Guanine Deaminase). EC 3-5-4-4 (Adenosine Deaminase).

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Unique Identifier:908143

Authors: Whitaker KB. Whitby LG. Moss DW.

Title: Activities of bone and liver alkaline phosphatases in serum in health and disease.

Source: Clinica Chimica Acta. 80(1):209-20, 1977 Oct 1.

Abstract: A heat-inactivation method for determining absolute activities of liver and bone alkaline phosphatases in serum has been applied extensively in routine diagnosis. Values for each isoenzyme in healthy individuals of different ages are reported together with results obtained in various diseases. Data from normal subjects show that bone alkaline phosphatase contributes about half the total alkaline phosphatase activity in adults. Liver phosphatase shows a slight increase with age. The method is also able to detect reliably the presence of carcinoplacental isoenzymes. CAS Registry/EC Number EC 3-1-3-1 (Alkaline Phosphatase).

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Unique Identifier:18315

Authors: Wootton AM. Neale G. Moss DW.

Title: Enzyme activities of cells of different types isolated from livers of normal and cholestatic rats.

Source: Clinical Science & Molecular Medicine. 52(6):585-90, 1977 Jun.

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Unique Identifier:1002841

Authors: Price CP. Sammons HG.

Title: An interpretation of the serum alkaline phosphatase isoenzyme patterns in patients with obstructive liver disease.

Source: Journal of Clinical Pathology. 29(11):976-80, 1976 Nov.

Abstract: Earlier studies have identified two main isoenzymes of alkaline phosphatase in the sera of patients with obstructive liver disease. This paper reports on a study of these isoenzymes in specific types of liver disease where the pathology in relation to bile duct obstruction is known. The results have been used to support the theory that in biliary obstruction the increase in serum alkaline phosphatase is in part due to regurgitation of the biliary isoenzymes. CAS Registry/EC Number 0 (Isoenzymes). EC 3-1-3-1 (Alkaline Phosphatase).

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Unique Identifier:949244

Authors: Corlette MB. Mendes-Monteroi AC. Bismuth H. Morin J.

Title: Transient bile duct obstruction. Response of serum bilirubin and alkaline phosphatase levels in the rat.

Source: Archives of Surgery. 111(9):1017-20, 1976 Sep.

Abstract: The immediate evolution of changes in serum bilirubin and alkaline phosphatase levels during and after brief temporary occlusion (12 hours or less) of the main bile duct was studied in the rat. Transient obstruction of the main bile duct of more than one hour was characterized by a simultaneous increase in serum levels of both bilirubin and alkaline phosphatase. The time required for return to normal values was less for bilirubin than the duration of a brief obstruction and was more prolonged for alkaline phosphatase than the duration of obstruction. In obstruction of four or more hours, it was rare to find an isolated elevation of serum bilirubin; this occurred when the control value for alkaline phosphatase levels was low and their relative increase was obscured. Thus, an isolated increase in the serum bilirubin level is infrequently compatible with obstruction of the bile duct, even when transient and of brief duration. Conversely, isolated elevation of serum alkaline phosphatase levels in an acute abdominal syndrome may indicate relieved biliary obstruction. CAS Registry/EC Number 635-65-4 (Bilirubin). EC 3-1-3-1 (Alkaline Phosphatase).

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Unique Identifier:1093921

Authors: Brensilver HL. Kaplan MM.

Title: Significance of elevated liver alkaline phosphatase in serum.

Source: Gastroenterology. 68(6):1556-62, 1975 Jun.

Abstract: The serum alkaline phosphatase was fractionated by polyacrylamide gel electrophoresis in 317 patients with elevated serum alkaline phosphatase activity. In 253 patients the source of the elevation was the isoenzyme of presumed liver origin, band L. In 87 of these patients, there was either no obvious liver disease or the alkaline phosphatase elevation was inappropriately high. In 19 of the 87, liver disease was further excluded by liver biopsy or by laparotomy. Because of this, biochemical studies were done to verify the hepatic origin of band L. Band L and alkaline phosphatase extracted from human liver migrated together on polyacrylamide gel electrophoresis before and after digestion with Vibrio cholerae neuraminidase. They had identical pH optima, sedimentation coefficients, Michaelis constants, and rates of inactivation at 55.5 degrees C. They had different rates of inactivation in 3 M urea. Over-all, the data indicate that band L is of liver origin, and that elevation of the hepatic alkaline phosphatase isoenzyme may be a nonspecific finding in certain patients. CAS Registry/EC Number 0 (Isoenzymes). EC 3-1-3-1 (Alkaline Phosphatase).

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Unique Identifier:4443409

Authors: Afonija AO. Baron DN.

Title: Plasma alkaline phosphatase isoenzymes in hepatobiliary disease.

Source: Journal of Clinical Pathology. 27(11):916-20, 1974 Nov.

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Unique Identifier:4773450

Authors: Brohult J. Sundblad L.

Title: Isoenzyme patterns of serum alkaline phosphatase in ethanol-induced liver injury.

Source: Acta Medica Scandinavica. 194(6):497-9, 1973 Dec.

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Unique Identifier:4146084

Authors: Kryszewski A. Whitfield JB. Moss DW. Neale G.

Title: Enzyme changes in experimental biliary obstruction.

Source: Gut. 14(5):419, 1973 May.

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Unique Identifier:5087115

Authors: Warnes TW. Hine PM. Kay GH.

Title: Serum alkaline phosphatase isoenzymes in liver disease.

Source: Gut. 13(10):853, 1972 Oct.

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Unique Identifier:5415676

Authors: Kaplan MM. Righetti A.

Title: Induction of rat liver alkaline phosphatase: the mechanism of the serum elevation in bile duct obstruction.

Source: Journal of Clinical Investigation. 49(3):508-16, 1970 Mar.