Alkaline phosphatase isozymes in non-malignant intestinal and hepatic diseases

Human alkaline phosphatase isozymes--the tissue-unspecific, the intestinal, and the placental alkaline phosphatases--were determined in sera by use of isozyme-specific monoclonal antibodies. The clinical utility of serum determinations of alkaline phosphatase isozymes was evaluated in patients with diseases of the gastrointestinal tract and the liver. No elevations of the different serum isozymes were observed in the intestinal diseases investigated (active Crohn's disease and ulcerative colitis). For non-malignant diseases of the liver the alkaline phosphatase isozymes presented characteristic patterns. Patients with cirrhosis due to hepatocellular diseases had markedly elevated levels of intestinal alkaline phosphatase and moderate serum activities of tissue-unspecific and placental alkaline phosphatases. In patients with liver disease with cholestatic features tissue-unspecific and placental isozyme levels were high, but the intestinal isozyme remained normal, whereas primary biliary cirrhosis was associated with high levels of the tissue-unspecific enzyme and moderate elevations of intestinal and placental alkaline phosphatases. It can be concluded that, in addition to tissue-unspecific alkaline phosphatase, intestinal and placental isozymes contribute to the total alkaline phosphatase activity for patients with liver disease. The results suggest that specific methods for the identification of alkaline phosphatase isozymes could be of value.