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Xu M, Xie F, Qian G, Jing Y, Zhang S, Gao L, Zheng T, Wu M, Yang J, Wei L. Peritumoral ductular reaction: a poor postoperative prognostic factor for hepatocellular carcinoma. BMC Cancer 2014; 14:65. [PMID: 24495509 PMCID: PMC3916808 DOI: 10.1186/1471-2407-14-65] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/03/2014] [Indexed: 12/17/2022] Open
Abstract
Background The role of ductular reaction (DR) in hepatocellular carcinoma (HCC) remains to be elucidated. Methods In this study, we tried to uncover possible effect by correlating peritumoral DR in a necroinflammatory microenvironment with postoperative prognosis in HCC. The expression of peritumoral DR/CK19 by immunohistochemistry, necroinflammation and fibrosis were assessed from 106 patients receiving curative resection for HCC. Prognostic values for these and other clinicopathologic factors were evaluated. Results Peritumoral DR significantly correlated with necroinflammation (r = 0.563, p = 3.4E-10), fibrosis (r = 0.435, p = 3.1E-06), AFP level (p = 0.010), HBsAg (p = 4.9E-4), BCLC stage (p = 0.003), TNM stage (p = 0.002), multiple nodules (p = 0.004), absence of tumor capsule (p = 0.027), severe microscopic vascular invasion (p = 0.031) and early recurrence (p = 0.010). Increased DR was significantly associated with decreased RFS/OS (p = 4.8E-04 and p = 2.6E-05, respectively) in univariate analysis and were identified as an independent prognostic factor (HR = 2.380, 95% CI = 1.250-4.534, p = 0.008 for RFS; HR = 4.294, 95% CI = 2.255-8.177, p = 9.3E-6 for OS) in multivariate analysis. Conclusions These results suggested that peritumoral DR in a necroinflammatory microenvironment was a poor prognostic factor for HCC after resection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiamei Yang
- Tumor Immunology & Gene Therapy Center, Eastern Hepatobiliary Hospital, The Second Military Medical University, Changhai Road, Shanghai 200438, China.
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Pathophysiologie der Leberkrankheiten. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498791 DOI: 10.1007/978-3-642-24710-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In der sinusoidalen Membran beginnt die Gallebildung. Rezeptoren und Transporter erleichtern die Aufnahme und den Eintritt von Gallensäuren, Bilirubin, Fettsäuren und anderen Gallekomponenten in die Leberzelle. Diese enthält Rezeptoren für Glykoproteine, Asialoglykoprotein, Immunglobulin A (Ig A), vasoaktives intestinales Peptid (VIP), Insulin, Glukagon und „epidermal growth factor“ (EGF). Ein primär aktiver Transport erfolgt durch die Na+-K+-ATPase, die einen Ionengradienten an der Zellmembran aufbaut und innerhalb der Zelle ein negatives elektrisches Potenzial erzeugt (wodurch die Diffusion erleichtert wird). Dieser Ionengradient ermöglicht die Arbeit anderer Carrier gegen das Konzentrationsgefälle, z. B. von NTCP (Natrium-Taurocholsäure-Kotransport-Polypeptid), das auch für zahlreiche Medikamente, Östrogene und zyklische Oligopeptide spezifisch ist. Transporter für organische Anionen (OATP1) und anorganische Ionen wurden ebenfalls nachgewiesen.
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Azmaiparashvili E, Berishvili E, Kakabadze Z, Pilishvili O, Mikautadze E, Solomonia R, Jangavadze M, Kordzaia D. Ductular reaction at the early terms of common bile duct ligation in the rats. ACTA BIOLOGICA HUNGARICA 2012; 63:321-32. [PMID: 22963913 DOI: 10.1556/abiol.63.2012.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ductular reaction (DR) in bile duct ligated rats generally appears from 2nd day after biliary obstruction (BO). However, we show that increased amount of ductular profiles is evident already in 6 hours after BDL. The study aims to explain the origin of such an early DR in response to BO. Male Lewis rats were subjected to common bile duct ligation (CBDL) for 3, 6, 12 and 24 hours and sham operation. Liver samples were studied histologically, immunohistochemically (Ki67, pan-Cytokeratin /AE1 + AE3/ and OV-6) and by immunoblotting analyses. It appeared that number of ductular profiles increase in time-related manner after BO. These ductular profiles are formed by biliary epitheliocyte-like cells; No mitotic activity was revealed. Part of hepatocytes reveals pan-Cytokeratin positivity on 12 and 24 hours after BO. Total cytokeratins content at 24 hours after CBDL was 37% higher in comparison with control data. The significant increase was observed for the cytokeratins with molecular weights: 61, 56 and 40 KDa. Thus, early DR after BDL is mediated by widening of the existed finest biliary ramifications and is not associated with proliferation activities. This DR is accompanied by differentiation of hepatocytes toward bile duct-like cells.
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Affiliation(s)
- Elza Azmaiparashvili
- Faculty of Medicine, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Ductal plates in hepatic ductular reactions. Hypothesis and implications. III. Implications for liver pathology. Virchows Arch 2011; 458:271-9. [PMID: 21301864 DOI: 10.1007/s00428-011-1050-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/18/2011] [Accepted: 01/20/2011] [Indexed: 02/08/2023]
Abstract
This article discusses on the basis of the ductal plate hypothesis the implication of the concept for several liver abnormalities. The occurrence of ductal plates (DP) during liver growth in childhood would explain the paraportal and parenchymal localizations of von Meyenburg complexes in postnatally developed parts of the liver, and their higher incidence in adulthood versus childhood. It partly clarifies the lack of postnatal intrahepatic bile duct development in Alagille syndrome and the reduced number of portal tracts in this disease. Ductular reactions (DRs) in DP configuration are the predominant type of progenitor cell reaction in fulminant necro-inflammatory liver disease, when lack of sufficient parenchymal regeneration results in liver failure. The concept of dissecting DRs explains the micronodular pattern of advanced biliary and alcoholic cirrhosis. The concept explains the DP patterns of bile ducts in several cases of biliary atresia, with implications for diagnosis and prognosis. The hypothesis also has an impact on concepts about stem/progenitor cells and their niche.
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Desmet VJ. Ductal plates in hepatic ductular reactions. Hypothesis and implications. III. Implications for liver pathology. Virchows Arch 2011; 458:251-9. [PMID: 21301864 DOI: 10.1007/s00428-011-1048-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 01/18/2011] [Accepted: 01/20/2011] [Indexed: 01/09/2023]
Abstract
This article discusses on the basis of the ductal plate hypothesis the implication of the concept for several liver abnormalities. The occurrence of ductal plates (DP) during liver growth in childhood would explain the paraportal and parenchymal localizations of von Meyenburg complexes in postnatally developed parts of the liver, and their higher incidence in adulthood versus childhood. It partly clarifies the lack of postnatal intrahepatic bile duct development in Alagille syndrome and the reduced number of portal tracts in this disease. Ductular reactions (DRs) in DP configuration are the predominant type of progenitor cell reaction in fulminant necro-inflammatory liver disease, when lack of sufficient parenchymal regeneration results in liver failure. The concept of dissecting DRs explains the micronodular pattern of advanced biliary and alcoholic cirrhosis. The concept explains the DP patterns of bile ducts in several cases of biliary atresia, with implications for diagnosis and prognosis. The hypothesis also has an impact on concepts about stem/progenitor cells and their niche.
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Affiliation(s)
- Valeer J Desmet
- Department of Pathology, University Hospital K.U.Leuven, Leuven, Belgium,
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Hepatocellular transport in acquired cholestasis: new insights into functional, regulatory and therapeutic aspects. Clin Sci (Lond) 2008; 114:567-88. [PMID: 18377365 DOI: 10.1042/cs20070227] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The recent overwhelming advances in molecular and cell biology have added enormously to our understanding of the physiological processes involved in bile formation and, by extension, to our comprehension of the consequences of their alteration in cholestatic hepatopathies. The present review addresses in detail this new information by summarizing a number of recent experimental findings on the structural, functional and regulatory aspects of hepatocellular transporter function in acquired cholestasis. This comprises (i) a short overview of the physiological mechanisms of bile secretion, including the nature of the transporters involved and their role in bile formation; (ii) the changes induced by nuclear receptors and hepatocyte-enriched transcription factors in the constitutive expression of hepatocellular transporters in cholestasis, either explaining the primary biliary failure or resulting from a secondary adaptive response; (iii) the post-transcriptional changes in transporter function and localization in cholestasis, including a description of the subcellular structures putatively engaged in the endocytic internalization of canalicular transporters and the involvement of signalling cascades in this effect; and (iv) a discussion on how this new information has contributed to the understanding of the mechanism by which anticholestatic agents exert their beneficial effects, or the manner in which it has helped the design of new successful therapeutic approaches to cholestatic liver diseases.
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Bergasa NV, Liau S, Homel P, Ghali V. Hepatic Met-enkephalin immunoreactivity is enhanced in primary biliary cirrhosis. LIVER 2002; 22:107-13. [PMID: 12028403 DOI: 10.1034/j.1600-0676.2002.01458.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS In contrast to the normal adult liver, the fetal human and rat livers, and the liver of rats with cholestasis secondary to bile duct resection (BDR) express the preproenkephalin (ppENK) mRNA, which codes for the endogenous opioid peptide Met-enkephalin. In addition, Met-enkephalin immunoreactivity (MEIR) is detected in hepatocytes and in proliferating bile ductules in the cholestatic rat liver. These data suggest that cholestasis is associated with the resurgence of cells that produce Met-enkephalin. To explore further the status of opioids in cholestasis, we studied the expression of MEIR in liver tissue. METHODS The MEIR was sought in paraffin-preserved liver tissues from patients with primary biliary cirrhosis (PBC) (n = 10). RESULTS The MEIR was detected in all the PBC livers. Its intensity varied from weak to strong on hepatocytes and bile ducts and the strongest expression appeared as coarse granules. The MEIR was either absent or only faintly expressed by some hepatocytes from disease and nondisease control biopsies, but absent from bile ducts. CONCLUSION These results suggest that the human liver in cholestasis may be a source of endogenous opioids.
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Affiliation(s)
- Nora V Bergasa
- Division of Gastroenterology and Liver Disease, Beth Israel Medical Center, New York, USA.
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Rodriguez-Garay EA, Larocca C, Pisani G, del Luján Alvarez M, Rodriguez GP. Adaptive hepatic changes in mild stenosis of the common bile duct in the rat. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1999; 198:307-23. [PMID: 10369087 DOI: 10.1007/s004330050114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Adaptive hepatic changes were investigated in rats with mild stenosis of the common bile duct and in sham-operated controls. The studies were performed 24 h and 7-12 days postoperatively. A continuous intravenous infusion of taurocholic acid at stepwise-increasing rates was performed to explore the responses to bile acid effects. During the infusion, bile flow and the outputs of bile acids, phospholipids, cholesterol, alkaline phosphatase and gamma glutamyl transpeptidase were studied. At the end of the infusion, hepatic morphometric measurements were performed. In other experimental sets, biliary excretions of horseradish peroxidase, a marker of microtubule-dependent vesicular transport in the hepatocyte, and sulphobromophthalein, a well-known organic anion model, were studied. In other rats, bile acid pool size and composition were determined by depletion of bile. The results in rats with mild stenosis maintained for 24 h showed a greater susceptibility to the toxicity of taurocholic acid, as revealed by the abrupt decrement in bile flow at high rates of infusion, and increased outputs of phospholipids and canalicular enzymes. Conversely, rats with mild stenosis maintained for 7-12 days showed decreased bile acid maximum secretory rate and biliary outputs of phospholipids and canalicular enzymes, as well as hepatocyte hypertrophy. These findings may explain the limited hepatic and systemic repercussion of experimental mild stenosis of the common bile duct and help us to understand the early stages of constriction of the common bile duct in man.
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Affiliation(s)
- E A Rodriguez-Garay
- Instituto de Fisiología Experimental, Consejo Nacional de Investigaciones, Científicas y Técnicas, Universidad Nacional de Rosario, Argentina.
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Sanz N, Díez-Fernández C, Valverde AM, Lorenzo M, Benito M, Cascales M. Malic enzyme and glucose 6-phosphate dehydrogenase gene expression increases in rat liver cirrhogenesis. Br J Cancer 1997; 75:487-92. [PMID: 9052398 PMCID: PMC2063320 DOI: 10.1038/bjc.1997.85] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The cirrhogenic ability of thioacetamide has been used to induce a model of chronic generalized liver disease that resembles the preneoplastic state of human fibrosis. Malic enzyme (ME) and glucose-6-phosphate dehydrogenase (G6PDH) are two cytosolic NADPH-generating enzymes; their activities significantly increased in liver when macronodular cirrhosis was induced by long-term thioacetamide administration to rats. The progressive increase in G6PDH and ME activities during the cirrhogenic process is parallel to the induction in gene expression of both enzymes detected by the increase in their mRNAs. These data indicate that NADPH-consuming mechanisms such as the microsomal oxidizing system and the maintenance of the cell redox state could be involved. A relationship between the extent of G6PD and ME gene expression and oxidative stress generated by the oxidative metabolism of thioacetamide is proposed as the hepatic concentration of malondialdehyde, a metabolite derived from lipid peroxidation, underwent a progressive and significant enhancement during thioacetamide-induced cirrhogenesis. These results led us to suggest that the enhanced activities of G6PDH and ME might be related to microsomal mechanisms of detoxification as well as to the maintenance of the cellular redox state. Furthermore, the noticeable increase in the hepatocyte population involved in DNA replication parallel to G6PDH activity suggests that G6PDH, through ribose-5-phosphate, might also be involved in the processes of DNA synthesis and repair.
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Affiliation(s)
- N Sanz
- Instituto de Bioquímica (CSIC-UCM), Facultad de Farmacia, Madrid, Spain
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Azer SA, Stacey NH. Current concepts of hepatic uptake, intracellular transport and biliary secretion of bile acids: physiological basis and pathophysiological changes in cholestatic liver dysfunction. J Gastroenterol Hepatol 1996; 11:396-407. [PMID: 8713709 DOI: 10.1111/j.1440-1746.1996.tb01390.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hepatic sinusoidal uptake of bile acids is mediated by defined carrier proteins against unfavourable concentration and electrical gradients. Putative carrier proteins have been identified using bile acid photoaffinity labels and more recently using immunological probes, such as monoclonal antibodies. At the sinusoidal domain, proteins with molecular weights of 49 and 54 kDa have been shown to be carriers for bile acid transport. The 49 kDa protein has been associated with the Na(+)-dependent uptake of conjugated bile acids, while the 54 kDa carrier has been involved in the Na(+)-independent bile acid uptake process. Within the hepatocyte, cytosolic proteins, such as the glutathione S-transferase (also designated the Y protein), the Y binders and the fatty acid binding proteins, are able to bind bile acids and possibly facilitate their movement to the canalicular domain. At the canalicular domain a 100 kDa carrier protein has been isolated and it has been shown by several laboratories that this particular protein is concerned with canalicular bile acid transport. The system is ATP-dependent and follows Michaelis-Menten kinetics. Interference with bile acid transport has been demonstrated by several chemicals. The mechanisms by which these chemicals inhibit bile acid transport may explain the apparent cholestatic properties observed in patients and experimental animals treated with these agents. Several studies have shown that Na+/K(+)-ATPase activity is markedly decreased in cholestasis induced by ethinyloestradiol, taurolithocholate and chlorpromazine. However, other types of interference have been described and the cholestatic effects may be the result of several mechanisms. Cholestasis is associated with several adaptive changes that may be responsible for the accumulation of bile acids and other cholephilic compounds in the blood of these patients. It may be speculated that the nature of these changes is to protect liver parenchymal cells from an accumulation of bile acids to toxic levels. However, more detailed quantitative experiments are necessary to answer questions with regard to the significance of these changes and the effect of various hepatobiliary disorders in modifying these mechanisms. It is expected that the mechanisms by which bile acid transport is regulated and efforts to understand the molecular basis for these processes will be among the areas of future research.
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Affiliation(s)
- S A Azer
- Toxicology Unit, National Institute of Occupational Health and Safety, University of Sydney, New South Wales, Australia
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Parola M, Leonarduzzi G, Robino G, Albano E, Poli G, Dianzani MU. On the role of lipid peroxidation in the pathogenesis of liver damage induced by long-standing cholestasis. Free Radic Biol Med 1996; 20:351-9. [PMID: 8720905 DOI: 10.1016/0891-5849(96)02055-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previous studies have suggested a possible involvement of free radical reactions in the pathogenesis of cholestatic liver injury as well as in the modulation of hepatic fibrogenesis. In this study we investigated whether lipid peroxidation is involved in the development of chronic liver damage induced by long-standing cholestasis. For this purpose we have used the rat model of bile duct ligation (BDL), which leads to liver fibrosis and cirrhosis. Using this model we observed that the development of chronic liver damage was associated with the onset of lipid peroxidation, as pointed out by detection of carbonyl compounds, 4-hydroxynonenal (HNE) and malondialdehyde (MDA), in BDL livers and of fluorescent adducts between MDA and serum proteins. Lipid peroxidation was a relatively late event (starting after 1-2 weeks of BDL) and was unrelated to the early development of liver necrosis and cholestasis (already evident after 72 h after BDL). A positive significant linear correlation between the kinetic of infiltration of neutrophils and of a monocyte/macrophage population in BDL livers and MDA and HNE generation in the same organs is presented, indicating a close link between lipid peroxidation and the activation of inflammatory cells. We also observed that a positive linear correlation exists between collagen deposition in these livers and hepatic production of MDA and HNE. This event, which is accompanied by an increase in the number of fat storing cells (FSC, the cells that produce collagen in fibrotic liver), suggests that lipid peroxidation in this model may contribute to stimulate collagen synthesis by proliferating FSC.
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Affiliation(s)
- M Parola
- Department of Experimental Medicine and Oncology, University of Torino, Italy
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Affiliation(s)
- V Desmet
- Laboratory of Histo- and Cytochemistry, University Hospital St. Rafael, University of Leuven, Belgium
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Van Hoof VO, De Broe ME. Interpretation and clinical significance of alkaline phosphatase isoenzyme patterns. Crit Rev Clin Lab Sci 1994; 31:197-293. [PMID: 7818774 DOI: 10.3109/10408369409084677] [Citation(s) in RCA: 163] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Alkaline phosphatase (ALP, EC 3.1.3.1) is a membrane-bound metalloenzyme that consists of a group of true isoenzymes, all glycoproteins, encoded for by at least four different gene loci: tissue-nonspecific, intestinal, placental, and germ-cell ALP. Through posttranslational modifications of the tissue-nonspecific gene, for example, through differences in carbohydrate composition, bone and liver ALP are formed. Nowadays, most commercially available methods for separating or measuring ALP isoenzymes are easy to perform and sensitive and allow for reproducible and quantitative results. As more isoenzymes and isoforms have been characterized, confusion has arisen due to the many different names they were given. For the sake of simplicity and because of structural analogies, we propose an alternative nomenclature for the ALP isoenzymes and isoforms based on their structural characteristics: soluble, dimeric (Sol), anchor-bearing (Anch), and membrane-bound (Mem) liver, bone, intestinal, and placental ALP. Together with lipoprotein-bound liver ALP and immunoglobulin-bound ALP, these names largely fit the many forms of ALP one can encounter in human serum and tissues. The clinically relevant isoenzymes are sol-liver, Mem-liver, lipoprotein-bound liver, and Sol-intestinal ALP in liver diseases, and Sol-bone and Anch-bone ALP in bone diseases. Many different isoenzyme patterns can be found in malignancies and renal diseases. This test provides the clinician with valuable information for diagnostic purposes as well as for follow-up of patients and monitoring of treatment. However, ALP isoenzyme determination will only provide clinically useful information if the patterns are correctly interpreted. In this respect, care should be taken to use the proper reference ranges, taking into account the age and sex of the patient. A normal total ALP activity does not rule out the presence of an abnormal isoenzyme pattern, particularly in children. Separating ALP into its isoenzymes adds considerable value to the mere assay of total ALP activity.
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Affiliation(s)
- V O Van Hoof
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem/Antwerpen, Belgium
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