The inorganic pyrophosphatase activity associated with the forms of alkaline phosphatases isolated from human serum

The alkaline orthophosphatase and inorganic pyrophosphatase activities of fractions of human serum and of liver and intestinal tissue preparations have been determined. Low ratios between the activities were found in the form of phosphatase associated with S-β₂-globulin and in intestinal tissue extract whereas ratios, 3–4 fold higher, were found in the forms of alkaline phosphatase associated with other fractions of S-globulins investigated and in liver extract.The data signifies the close relation between alkaline phosphatases with slow moving mobilities in electrophoresis, the S-β₂-globulin zone, and the form present in intestine.The results also permit an evaluation of the estimation of the content of intestinal alkaline phosphatase in serum based on the ratio between orthophosphatase and inorganic pyrophosphatase of whole serum.     

Serum alkaline phosphatase in hypophosphatasia

It is recognized that serum alkaline phosphatase may reflect enzyme contributions from bone, liver, and intestine. We have investigated serum alkaline phosphatases in two siblings with hypophosphatasia. After administration of long-chain triglycerides, the major alkaline phosphatase component of their sera was shown to be of intestinal origin on the basis of inhibition by l-phenylalanine. Starch block electrophoresis suggested that there were other regions of l-phenylalanine-sensitive alkaline phosphatase in addition to the major slow-moving intestinal band. Medium-chain triglycerides which are absorbed by the portal route did not cause a similar augmentation of intestinal alkaline phosphatase activity. These studies indicate that serum levels of intestinal alkaline phosphatase are increased normally after long-chain fat feeding in hypophosphatasia and may be the major component of total serum alkaline phosphatase activity.     

Intestinal type alkaline phosphatase hyperphosphatasemia associated with liver cirrhosis.

Hyperphosphatasemia due to increased intestinal type serum alkaline phosphatase was noted in a 48-year-old male who had asymptomatic liver cirrhosis. The alkaline phosphatase activity in the serum was 828 U/l (our reference range in adults: 57-194 U/l), 94% of which was of the intestinal type as measured by an immunoprecipitation method. The intestinal component of alkaline phosphatase was separated into two major and some minor components using electrophoresis and isoelectrofocusing. One of the major components had similar mobility to that of a standard intestinal enzyme purified from adult intestine. The components were heat-labile and neuraminidase-resistant. Serial lectin affinity chromatography, however, indicated that sugar chain compositions of the alkaline phosphatase were different from those of the standard tissue intestinal enzyme. These results and further enzymological studies suggest that the patient's serum alkaline phosphatase basically consisted of several intestine-like isoforms.     

Immunological relationship between human placental and intestinal alkaline phosphatase.

Crystalline human alkaline phosphatase from placenta and intestine was isolated by butanol extraction, acetone precipitation, a heat step (for the placental enzyme), ammonium sulfate precipitation, anion exchange chromatography, gel filtration and crystallisation with ammonium sulfate. Rabbit antibodies showed a partial cross-reaction between both enzymes in double diffusion, quantitative precipitation experiments and in serial precipitin curves. There was no reaction with human alkaline phosphatases from liver, kidney and bone. Three phenotypes of placental alkaline phosphatase with different electrophoretical mobility exhibited identical immunological reactions with their respective antisera. Monospecific antisera were obtained by absorption with crystalline intestinal or placental alkaline phosphatase. These monospecific antisera against the placental or the intestinal alkaline phosphatase can be used for an immunological determination of these two alkaline phosphatases without contamination by other alkaline phosphatases in human serum.     

Chemical nature of intestinal-type alkaline phosphatase in human kidney.

Approximately 10% of the alkaline phosphatase activity in human kidney is derived from the intestinal-type alkaline phosphatase isoform, which can be differentiated from adult intestinal alkaline phosphatase by selective reactivity with monoclonal antibodies. The NH2-terminal sequence of the renal intestinal-type alkaline phosphatase was shown to be identical to sequences of the adult and meconial alkaline phosphatases except for the NH2-terminal valine residue, which is missing in the renal intestinal-type enzyme. Incubation of purified meconial alkaline phosphatase with kidney homogenate resulted in removal of the NH2-terminal valine residue, indicating the presence of aminopeptidases in kidney that catalyze this hydrolysis. Furthermore, the oligosaccharide chains of the renal intestinal-type alkaline phosphatase were shown to differ from those of meconial and adult intestinal alkaline phosphatases, as revealed by lectin affinity chromatography. The heterogeneity of the intestinal-type alkaline phosphatase can therefore be generated both by partial peptide bond hydrolysis and differences in glycosylation.     

A fetal intestinal-type alkaline phosphatase in hepatocellular carcinoma tissue.

We examined 19 hepatoma tissues for alkaline phosphatase isoenzyme and found that six have both the Kasahara isoenzyme and an alkaline phosphatase with a unique electrophoretic mobility, in addition to the liver-type enzyme. From two of six carcinoma tissues, the abnormal enzyme was partly purified and subjected to a detailed analysis, which clarified that the abnormal enzyme resembled a fetal intestinal alkaline phosphatase in most of its enzymic and immunologic properties and also in properties that reflect enzyme structure. This fetal intestinal-type alkaline phosphatase was not found in 24 specimens of normal liver from adults. The relevance of fetal intestinal-type alkaline phosphatase to Kasahara isoenzyme and adult intestinal alkaline phosphatase is discussed. The fetal and adult intestinal alkaline phosphatases differ in electrophoretic mobility, heat stability, and reactivity with concanavalin A. The adult-type enzyme has two components; only the electrophoretically slower, neuraminidase-resistant one is described here.     

A novel alkaline phosphatase isozyme in human adipose tissue

A novel alkaline phosphatase (AP) isozyme was found in human adipose tissue. Adipose tissue alkaline phosphatase differed in enzymatic properties from liver, placental and intestinal alkaline phosphatases. On electrophoresis it showed the same mobility as intestinal alkaline phosphatase, but after treatment with neuraminidase its mobility was decreased to the same as or slightly less than that of neuraminidase-treated liver alkaline phosphatase. Its inhibition by amino acids, inactivation by urea and activation by Mg2+ were almost the same to those of liver alkaline phosphatase. However, at 56 and 65 degrees C it was more stable than liver alkaline phosphatase. Alkaline phosphatase activity was demonstrated histochemically in adipose tissue with naphthol AS-MX phosphate as substrate. It was localized in the wall of blood capillaries, but not present in adipocytes.     

Association of high-molecular-mass and electrophoretically atypical alkaline phosphatases

Polyacrylamide gel electrophoresis of alkaline phosphatase may yield abnormally migrating fractions; these include high-molecular-mass alkaline phosphatase, which remains at the gel origin, and immunoglobulin-alkaline phosphatase complexes, which have a mobility approximately 1/3 that of liver isoenzyme. We performed a retrospective study of 19 patients whose sera exhibited atypical alkaline phosphatase fractions, defined as bands whose mobility was slower than bone, liver, or intestinal alkaline phosphatase; 17 had a mobility approximately 1/3 that of liver isoenzyme and 16 also exhibited gel origin enzyme activity or high-molecular-mass bands. The strong association of the atypical and high-molecular-mass alkaline phosphatases suggests that they may be structurally related, both consisting of either immunoglobulin-enzyme complexes or membrane-alkaline phosphatase complexes. This hypothesis is supported by (1) one serum available for investigation containing alkaline phosphatase-immunoglobulin complexes in both abnormally migrating fractions, but on detergent treatment showing no evidence of membrane-bound enzyme; (2) detergent treatment of serum from patients with only high-molecular-mass alkaline phosphatase creating bands with a mobility of approximately 1/3 that of the liver isoenzyme.     

Alkaline Phosphatase: Diagnostic Value of Isoenzyme Determination

Abstract. The isoenzyme pattern of the alkaline phosphatases was determined in the sera of 51 normal subjects, 28 patients with hepatobiliary diseases and 17 patients with bone diseases. Two quick and technically simple methods of differentiation were used for a semiquantitative determination: stereospecific sensitivity to L-phenylalanine, especially of the small intestine phosphatase, and the separation of the bone and liver/biliary tract phosphatases by a combination of heat inactivation and stereo-specific inhibition. The basic principles of these methods are described. The results, statistically evaluated, are discussed. The alkaline phosphatase activity in the serum of healthy adults stems from isoenzymes of the small intestine (about 20%), of bone and of hepatobiliary origin. In hepatobiliary diseases the proportion of bone to liver/biliary tract phosphatases changes significantly in favour of the latter. In diseases of the skeleton, however, which are accompanied by increased activity of serum alkaline phosphatase, there is a significant increase in the absolute fraction of bone phosphatase in the total activity. In addition to the demonstration of these qualitative and quantitative changes in the isoenzyme distribution patterns, limiting values were determined for a normal group; values outside these can be considered as pathognomonic for diseases of the liver and biliary tract and the skeleton respectively. Of particular importance for early diagnosis is the fact that changes in the isoenzyme distribution pattern are demonstrable not only when the total activity is increased, but at a time when the serum activity lies still within normal limits. The methods used are suitable for a rapid and reproducible semiquantitative determination of the isoenzymes of alkaline phosphatase, and for early differential diagnosis of diseases of the skeleton (especially metastatic tumours), the liver and biliary tract.     

Formation of an alkaline phosphatase-immunoglobulin G complex in human sera.

An electrophoretically slow-moving band of alkaline phosphatase (ALP) isoenzyme was found in four patients with chronic liver disease and in one with ulcerative colitis. Immunoelectrophoretic studies revealed that the slow band was a complex containing alkaline phosphatase and an immunoglobulin G of the lambda class. Its molecular weight was approximately 280 000. A complex molecule consisting of one molecule of immunoglobulin G and one molecule of alkaline phosphatase was proposed. The complex was similar to the liver and bone alkaline phosphatases in functional properties. Serum containing the complex was capable of binding liver and bone alkaline phosphatase isoenzymes but not the intestine or placenta alkaline phosphatase isoenzymes from normal controls. The presence of an abnormal immunoglobulin which binds liver and bone alkaline phosphatases appears to be responsible for the development of the complex. In one case of chronic liver disease, the complex disappeared after a few months.     

Diagnostic aspects of alkaline phosphatase and its isoenzymes

The changes in serum alkaline phosphatase that are of main diagnostic importance result from increased entry of enzyme into the circulation. This results from increased osteoblastic activity in bone disease, and increased synthesis of alkaline phosphatase by hepatocytes in hepatobiliary disease. The liver and bone forms of alkaline phosphatase are differently-glycosylated forms of a single gene product. The main value of their specific estimation is found in patients in whom bone and liver diseases co-exist, for example, as a result of cancer. Abnormal expression of genetically-distinct alkaline phosphatase isoenzymes is valuable in monitoring cancers, particularly germ-cell tumors. These isoenzymes include Regan and Nagao isoenzymes, which correspond respectively to normal placental and placental-like alkaline phosphatases, and the Kasahara isoenzyme which appears to result from re-expression of a fetal intestinal alkaline phosphatase gene.     

Alkaline phosphatase isoenzymes

The human alkaline phosphatases constitute a system of multiple molecular forms of enzymes in which heterogeneity is partly due to genetic factors and partly to posttranslational modifications. Recognition of the nature and occurrence of these multiple forms has made a significant contribution both to the understanding of changes in alkaline phosphatase values for serum in disease and to the use of alkaline phosphatase measurements in diagnosis. Many of the diagnostic advantages of alkaline phosphatase isoenzyme analysis can be obtained with the aid of qualitative methods such as zone electrophoresis. However, quantitative methods are needed to take full advantage of the potential benefits of isoenzyme analysis. Selective inactivation methods can be applied successfully to the quantitative analysis of bone and liver alkaline phosphatases in serum. However, the aim of future research should be to remove the limitations at present imposed on quantitative analysis by the close similarities of bone and liver alkaline phosphatases.     

Clinical and biological significance of an isozyme tumor marker—PLAP

In 1930 the determination of serum alkaline phosphatase in patients with bone or liver disease ushered in the era of clinical enzymology. The association of elevated (bone) alkaline phosphatase in serum of patients with osteogenic sarcoma was the first evidence that tumor cells themselves produced the enzyme. It became clear, however, in the 1960s that the serum alkaline phosphatase was not a single enzyme but consisted of a family of isozymes originating from liver, bone, intestine, and placenta. This was a consequence of the introduction of a combination of electrophoretic separations, heat inactivation, and organ-specific amino acid inhibitors. This combination of measurements made possible the demonstration of a serum alkaline phosphatase of lung cancer origin, as confirmed by the histochemical visualization in lung cancer of the Regan Isozyme (placental alkaline phosphatase-PLAP). At present, the measurement of PLAP has its greatest utility as a tumor marker in seminoma and ovarian cancer. A PLAP-like isozyme in normal testis and ovary is expressed in these and other neoplasias and appears to be related to rare alleles of placental alkaline phosphatase. Current studies have utilized a panel of monoclonal antibodies to detect useful epitopes that suggest that PLAP and PLAP-like isozymes are coded by different genes. The PLAP gene has now been cloned and sequenced by Millan and others. This fundamental new information is providing a base line that will make it possible to explain the overlapping specificities of intestinal and placental isozymes, the degree of uniqueness of the PLAP-like isozyme, the precise mechanism of uncompetitive inhibition by L-phenylalanine and the evolutionary history of the alkaline phosphatases. Tumor PLAP is an example of oncotrophoblast gene expression.     

Affinity electrophoresis of human serum alkaline phosphatase isoenzymes in agarose gel containing lectin

Separation of alkaline phosphatase isoenzymes using affinity electrophoresis in agarose gel containing lectin is described. The bone and biliary isoenzymes precipitate during electrophoresis and are clearly separated from the liver isoenzyme. The liver, intestinal and placental alkaline phosphatases are essentially not affected by the lectin. The migration distances of the precipitating bone and biliary fractions vary with their alkaline phosphatase activity. The bone isoenzyme is more heterogeneous than the biliary isoenzyme with respect to interaction with lectin forming both insoluble and soluble complexes. Affinity electrophoresis in agarose gel containing lectin can be used for quantitation by densitometry of liver and bone isoenzymes in sera containing only these two fractions but must be combined with conventional electrophoresis, preferably in agar gel, if biliary, intestinal, or placental isoenzymes are also present.     

Albumin preparations and placental alkaline phosphatase activity

A 68-year-old male with nephrotic syndrome due to diabetic glomerulosclerosis was found to have high serum alkaline phosphatase after albumin infusions. By examining several albumin preparations, certain products were found to contain as high as 200 Sigma units of alkaline phosphatase per ml. By disc electrophoresis and heat treatment (56 C for 30 min), all of the alkaline phosphatases in the albumin preparations were found to be heat stable and of placental origin. Since a high alkaline phosphatase activity in serum may mislead diagnosis, it is quite important to know whether the high level of the enzyme in patient's specimens is of exogenous or endogenous origin. It is recommended that sera obtained from patients who have been treated with albumin should be heat tested before determination of alkaline phosphatase. Most of the alkaline phosphatase activity of liver, intestine, and bone origins is inactivated by heat, whereas that of placental origin is not inactivated.     

The physical characteristics and enzymatic modification of fetal intestinal alkaline phosphatase in amniotic fluid

The predominant form of alkaline phosphatase in amniotic fluid at 16 to 18 weeks gestation has the inhibition characteristics of the isoenzymes from adult and fetal small intestine. These characteristics are shared by an alkaline phosphatase of presumed intestinal origin occasionally found in the sera of premature neonates. However, in contrast to the rapid anodal migration of the latter enzyme, amniotic fluid phosphatase is of low electrophoretic mobility in polyacrylamide gel, and it has a high molecular weight. Digestion of amniotic fluid with bromelain produces a rapidly-migrating active enzyme form, with a molecular weight of about 135,000, compared with 145,000 for the fetal intestinal phosphatase in serum. The bromelain-treated amniotic fluid phosphatase is similar in size to a Kasahara isoenzyme in the serum of a cancer patient, which is itself thought to result from re-expression of a fetal intestinal phosphatase gene.     

Serum levels of human alkaline phosphatase isozymes in relation to blood groups.

By use of sensitive immunocatalytic assays, based on isozyme specific monoclonal antibodies, the activities of the three main human alkaline phosphatases were determined in serum. The activities were related to ABO blood groups and secretor phenotypes. The activity of intestinal alkaline phosphatase was found to be strongly correlated with ABO blood groups and secretor phenotypes, while neither the placenta alkaline phosphatase activity nor the tissue unspecific alkaline phosphatase activity demonstrated any dependence on blood groups or secretor phenotypes. Non-secretors, independent of ABO blood groups, demonstrated low activities of intestinal alkaline phosphatase in serum, amounting to approximately 20% of the activities in the secretor groups. Within the secretor group, the lowest activities were observed for blood group A (2.8 +/- 1.1 IU/l; mean +/- SEM) and the highest for blood groups B and O (14.1 +/- 1.1 IU/l and 19.0 +/- 2.5 IU/l, respectively). These results confirm that the activities of intestinal alkaline phosphatase in serum have to be related both to ABO blood groups and to secretor phenotypes in order to be informative in clinical contexts.     

Further observations on the differential precipitation of alkaline phosphatase isoenzymes by ethanol

The proportions of the total activities of different isoenzymes of human alkaline phosphatase precipitated from serum by ethanol (20% v/v) were: liver phosphatase, 37%; placental phosphatase, 23%; bone phosphatase, 8.0%, and small-intestinal phosphatase, 3.7%. Treatment of the isoenzymes with neuraminidase reduced the percentages of non-intestinal phosphatases precipitated by ethanol to below 10%. Precipitation of intestinal alkaline phosphatase was unaffected by this treatment. The degree of solubility in ethanol therefore appears to be largely determined by the content of terminal sialic acid residues in the alkaline phosphatase molecules. In contrast the stabilities of the isoenzymes to heating at 56 degrees C were not significantly altered by neuraminidase digestion.     

Glutathione reductase activity in serum and liver tissue of human and rat with hepatic damage.

Glutathione reductase activity of both serum and liver tissue homogenates was measured in normal controls and in cases of hepatic parenchymatous diseases, and the results were compared with those from animal experiments in which hepatic damage was produced by CCl4 injection. Glutathione reductase showed a different attitude from those of transaminases and alkaline phosphatases under these clinical and experimental conditions. Glutathione reductase activity increased in both serum and liver in patients with hepatic damage, and this increase occurred earlier than the changes in alkaline phosphatase activity.     

A comparison of the transphosphorylating activities of human liver and intestinal alkaline phosphatases

The relative rates of transphosphorylation by human liver and intestinal alkaline phosphatases from p-nitrophenyl phosphate to Tris and diethanolamine have been measured. The maximum velocities of formation of diethanolamine phosphate by the two enzymes are nearly equal when preparations with equal hydrolytic activities in sodium carbonate—bicarbonate buffer are used. However, Tris phosphate is formed at a lower rate by liver alkaline phosphatase than by the intestinal enzyme. Consequently, the ratio of the activities of the solutions of liver and intestinal alkaline phosphatases varies with the nature and concentration of the buffer system.