Physiology In humans, alkaline phosphatase is present in all tissues throughout the body, but is particularly concentrated in the
liver,
bile duct,
kidney,
bone,
intestinal mucosa and
placenta. In the
serum, two types of alkaline phosphatase
isozymes predominate: skeletal and liver. During childhood the majority of alkaline phosphatase are of skeletal origin. Humans and most other mammals contain the following alkaline phosphatase isozymes: •
ALPI – intestinal (molecular mass of 150 kDa) •
ALPL – tissue-nonspecific (expressed mainly in liver, bone, and kidney) •
ALPP – placental (Regan isozyme) • ALPG – germinal tissues Four genes encode the four isozymes. The gene for tissue-nonspecific alkaline phosphatase is located on
chromosome 1, and the genes for the other three isoforms are located on
chromosome 2.
Intestinal alkaline phosphatase Intestinal alkaline phosphatase is secreted by
enterocytes, and seems to play a pivotal role in intestinal homeostasis and protection as well as in suppressing
inflammation via repression of the downstream Toll-like receptor
(TLR)-4-dependent and
MyD88-dependent inflammatory cascade. It dephosphorylates toxic/inflammatory microbial ligands like
lipopolysaccharides (LPSs), It also seems to regulate lipid absorption and bicarbonate secretion in the duodenal mucosa, which regulates the surface pH. Since the 1960s intestinal alkaline phosphatase has been utilized in
drug delivery. As it cleaves phosphate substructures from drugs, auxiliary agents, and even from the surface of nanocarriers, this
enzyme enables the design of drug delivery systems that can alter their properties in the body on demand. The solubility of many drugs can be substantially improved by the design of phosphate
prodrugs. On the intestinal
mucosa the phosphate substructures are cleaved off by alkaline phosphatase and the drug is absorbed. Furthermore, anionic nanocarriers exhibiting bioinert properties can alter their surface to interactive once having reached the intestinal epithelium as due to an alkaline phosphatase triggered cleavage of anionic phosphate groups from their surface charge converts to cationic improving for instance cellular uptake.
In cancer cells Studies show that the alkaline phosphatase protein found in cancer cells is similar to that found in nonmalignant body tissues and that the protein originates from the same gene in both. One study compared the enzymes of liver metastases of
giant-cell lung carcinoma and nonmalignant placental cells. The two were similar in
NH2-terminal sequence, peptide map, subunit molecular weight, and isoelectronic point. In a different study in which scientists examined alkaline phosphatase protein presence in a human colon cancer cell line, also known as HT-29, results showed that the enzyme activity was similar to that of the non-malignant intestinal type. However, this study revealed that without the influence of sodium butyrate, alkaline phosphatase activity is fairly low in cancer cells. A study based on
sodium butyrate effects on cancer cells conveys that it has an effect on androgen receptor co-regulator expression, transcription activity, and also on histone acetylation in cancer cells. This explains why the addition of sodium butyrate show increased activity of alkaline phosphatase in the cancer cells of the human colon. but levels are significantly higher in children and pregnant women. Blood tests should always be interpreted using the reference range from the laboratory that performed the test. High alkaline phosphatase levels can occur if the
bile ducts are obstructed. Also, the level of alkaline phosphatase increases if there is active bone formation occurring, as the enzyme is a byproduct of
osteoblast activity (such as the case in
Paget's disease of bone). The level of alkaline phosphatase is much more elevated in
metastatic prostate cancer cells than non-metastatic prostate cancer cells. High levels of ALP in prostate cancer patients is associated with a significant decrease in survival. Lowered levels of the level of alkaline phosphatase are less common than elevated levels. The source of elevated levels can be deduced by obtaining serum levels of
γ-glutamyltransferase. Concomitant increases of alkaline phosphatase with γ-glutamyltransferase should raise the suspicion of hepatobiliary disease. Some diseases do not affect the levels of alkaline phosphatase, for example, hepatitis C. A high level of this enzyme does not reflect any damage in the liver, even though high alkaline phosphatase levels may result from a blockage of flow in the biliary tract or an increase in the pressure of the liver.
Elevated levels As of 2020, normal ALP levels were "not well defined", and there tend to be variations by sex and racial background, and by age, with children and adolescents having markedly higher levels. There are many possible explanations for elevated ALP. When the cause is unclear,
isoenzyme studies using
electrophoresis can confirm the source of the increase. Skelphosphatase (which is localized in osteoblasts and extracellular layers of newly synthesized matrix) is released into circulation by a yet unclear mechanism. Placental alkaline phosphatase is elevated in
seminomas and active forms of
rickets, as well as in the following diseases and conditions: •
Biliary obstruction • Bone conditions • Osteoblastic bone tumors •
Osteomalacia •
Osteoporosis •
Hepatitis • Mononucleosis •
Cirrhosis • Acute
cholecystitis •
Myelofibrosis •
Leukemoid reaction • Congestive heart failure •
Lymphoma •
Paget's disease •
Sarcoidosis •
Hyperthyroidism •
Hyperparathyroidism •
Myocardial infarction • Cholangitis • Ischemic cholangiopathy •
Pregnancy Lowered levels The following conditions or diseases may lead to reduced levels of alkaline phosphatase: •
Hypophosphatasia, a
genetic disorder • Women receiving
estrogen therapy for
menopausal symptoms • Estrogen-containing
oral contraceptives • Men with recent
heart surgery,
malnutrition,
magnesium deficiency, or severe
anemia • Children with
achondroplasia and
congenital iodine deficiency • Children after a severe episode of
enteritis •
Pernicious anemia •
Aplastic anemia •
Wilson's disease •
Hypothyroidism •
Zinc deficiency •
Malnutrition • Steroid treatment • Colitis • Thyroid disease
Leukocyte alkaline phosphatase Leukocyte alkaline phosphatase is found within mature
white blood cells. White blood cell levels of LAP can help in the diagnosis of certain conditions. • Higher than typical levels are seen in the physiological response,
the leukemoid reaction, and in pathologies that include mature white blood cells, such as
polycythemia vera,
essential thrombocytosis, and in
primary myelofibrosis. • Lower than typical levels are found in pathologies that involve undeveloped leukocytes, such as
chronic myelogenous leukemia (CML),
paroxysmal nocturnal hemoglobinuria and
acute myelogenous leukaemia.
Structure and properties Alkaline phosphatase is homodimeric enzyme, meaning it is formed with two molecules. Three metal ions, two Zn and one Mg, are contained in the catalytic sites, and both types are crucial for enzymatic activity to occur. The enzymes catalyze the hydrolysis of monoesters in phosphoric acid which can additionally catalyze a transphosphorylation reaction with large concentrations of phosphate acceptors. While the main features of the catalytic mechanism and activity are conserved between mammalian and bacterial alkaline phosphate, mammalian alkaline phosphatase has a higher specific activity and
Km values thus a lower affinity, more alkaline pH optimum, lower heat stability, and are typically membrane bound and are inhibited by l-amino acids and peptides via a means of uncompetitive mechanism. These properties noticeably differ between different mammalian alkaline phosphatase isozymes and therefore showcase a difference in
in vivo functions. == See also ==