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Diagnostic Approach to Abnormal Alkaline Phosphatase Value.

Salvatore Minisola1, Cristiana Cipriani1, Luciano Colangelo1

  • 1Department of Clinical, Internal, Anesthesiologic, and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy.

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Alkaline phosphatase (ALP) is a vital enzyme measured in blood for diagnosing skeletal and liver diseases. Understanding ALP levels and its various forms aids in identifying and managing numerous medical conditions.

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Area of Science:

  • Biochemistry and Clinical Diagnostics
  • Enzymology
  • Medical Biomarkers

Background:

  • Alkaline phosphatase (ALP) is a crucial enzyme with fundamental roles, notably in skeletal mineralization.
  • Its involvement in disease pathogenesis is increasingly recognized, making serum ALP a valuable clinical biomarker.
  • Abnormal ALP levels are commonly linked to skeletal and biliary tract diseases.

Purpose of the Study:

  • To provide a comprehensive overview of alkaline phosphatase (ALP) and its clinical significance.
  • To outline a clinical approach for identifying diseases associated with abnormal ALP values.
  • To explore the diagnostic and therapeutic roles of ALP, including its use in hypophosphatasia.

Main Methods:

  • A narrative review based on a comprehensive PubMed search from inception to July 2024.
  • Keywords included alkaline phosphatases, isozymes, isoforms, ALP variants (bone, liver, intestinal, placental), liver function tests, and related diseases.
  • Emphasis on English-language articles, prioritizing those detailing differential diagnoses.

Main Results:

  • Serum total ALP measurement is a standard part of initial patient biochemical evaluation.
  • Electrophoretic assays are useful for visualizing increased ALP activity, while bone ALP immunoassays aid in bone/mineral disorder assessment.
  • Abnormal ALP levels indicate various conditions, primarily affecting the skeleton and biliary system.

Conclusions:

  • Alkaline phosphatase (ALP) is a fundamental enzyme with significant diagnostic utility in clinical practice.
  • Specific assays can differentiate ALP isoforms to pinpoint disease causes.
  • Emerging therapeutic applications, such as in hypophosphatasia, highlight the expanding role of ALP.