Positive alpha-1-foetoprotein tests in pyridoxine deprived baboons: relevance to liver carcinoma in Africans

Alpha-fetoprotein: a review

Alpha fetoprotein (AFP) is the major protein of fetal serum and most resembles albumen, which replaces it shortly after birth. It is produced by fetal liver and passes into the amniotic fluid (AF) via fetal urine. A small amount crosses the membranes into the maternal circulation. Excluding fetal blood contamination, elevated AF/AFP levels indicate fetal demise or one of several abnormalities. Maternal serum (MS) AFP measurement can be used as a screening procedure to identify neural tube defects providing a rigorous protocol is followed. This requires that a laboratory establish its normal range of MS/AFP levels between 15 and 20 weeks gestation, employ a reliable assay with adequate controls, and has recourse to genetic counseling as well as expert sonography, amniocentesis and amniography if necessary. Pregnancy is the only normal situation in which AFP is present after birth. It may be present in high levels in certain malignancies and has been useful in monitoring their recurrence. This article will review the history, biochemistry, and different assays of AFP in AF and blood as well as the indications and limitations for their use.

Alpha-fetoprotein and liver cell proliferation in rats fed choline-deficient diet

Liver 3H-thymidine labelling index and serum AFP were determined in rats fed a standard laboratory or choline deficient diet. A significant increase in the rate of liver cell proliferation was evidenced in animals on the deficient diet. Furthermore, elevated serum AFP levels were detected in a proportion of these rats. It is suggested that increased synthesis of AFP corresponds to liver cell regeneration secondary to hepatic damage.

Alpha-fetoprotein

Despite all the information about AFP presented, a great deal still needs to be discovered especially in pregnancy. Geographical and racial differences remain to be elucidated. Similarly, differences in obstetric population in Helsinki and Baltimore, for example, are only now being studied. Sex differences may exist; Lardinois and associates195 cited a higher level of AFP in male than female fetuses. The important questions that need to be answered are whether AFP assays can help improve the other half of prenatal care- that directed to the fetus- and whether the AFP model can help enhance our understanding of the similarities and differences of fetal and cancer cells.

Alpha-feto-protein during development and in disease

An alpha-feto-protein (AFP) is present in many mammals, in birds, and in sharks during development. The AFP present in different species have similar physicochemical properties and often have common antigenic determinants. Their study, both in health and disease, has provided a useful model for the understanding of other phase-specific antigens and the activation of the genes which control their synthesis. In the human fetus, the level of AFP falls with increasing maturity. The more sensitive methods of detection have disclosed that this fetal protein persists in trace amounts throughout life and its level increases in maternal blood during pregnancy. The principal sites of synthesis are the fetal liver and in some mammals, the yolk sac splanchnopleur. In humans as well as in mice and cows, it is notable that the synthesis of AFP is increased in liver cancer cells and that high levels of this protein are present in serum. Elevated values of AFP have also been detected in human subjects with undifferentiated tumours of the testis and ovary. A fall to normal levels has been noted in cases of complete remission after surgery and a return to high levels in patients who develop metastases. In some patients with hepatitis a temporary rise in the level of AFP has also been observed. In recent years, the detection of high levels of AFP in amniotic fluid has proved to be of great value for the prenatal diagnosis of neural-tube defects. Abnormal levels have also been found in the amniotic fluid or in maternal serum in cases of spontaneous abortion. Such measurements are now being assessed as a methodof monitoring abnormal pregnancy.

[Carcinofetal antigens. I. alpha-fetoprotein (author's transl)]

Alpha-fetoprotein (AFP) is an alpha1-glycoprotein (M.W. about 65000) appearing in the fetal serum of most mammals including man during the early stages of pregnancy; 4 weeks after birth it disappears altogether or exists at very low concentrations as in the normal adult. AFP is formed in the yolk sac, the fetal liver and the gastro-intestinal tract. One of its physiological functions in fetal life is supposed to be the protection of the fetus from maternal oestrogens (oestrophilic property). The clinical significance of AFP is based on the regular and increasing production in primary liver cell carcinoma, less frequently in teratogenetic tumors where it serves as a control of therapy and course of the disease. Less frequent, minor and temporary increases in the AFP serum level occur in several primary tumors with secondary liver involvement, and in inflammatory gastro-intestinal diseases, e.g. of the liver (hepatitis, cirrhosis). AFP has an increasing importance in gynecology (gestational age, fetal distress syndrom, malformations, hydatidiform mole/chorion carcinoma). The physico-chemical properties of AFP are widely known. Both fetal and tumor AFP appear to be immunologically and biochemically identical, as are that of tissue and biological fluids. The differences observed (variants, microheterogeneity) depend mainly on the different content of sialic acid. An antigenetic relationship exists, between the AFP of most species. The immunodiffusion (Ouchterlony) is the most frequently used but relatively insensitive test (1-5 mug/ml) in finding AFP, whereas the radioimmunoassay is the most sensitive one (up to 0,25 ng/ml) and permits the determination of normal serum levels in adults (below 20 ng/ml). The serum concentration in healthy pregnant women lies up to 500 ng/ml, in patients with hepatitis, liver cirrhosis and other liver diseases mostly under 3 mug/ml, whereas in those with primary liver cell carcinoma levels up to and above 600 mg-percent have been found.