Abstract IN 1923 Robison1 discovered alkaline phosphatase (AP) in bone, and subsequent observations indicated that increased osteoblastic activity resulted in a rise of serum alkaline phosphatase (SAP). Seven years later, Roberts2 noted increased SAP in hepatobiliary disease. Although AP is found in other tissues of the body (intestine, kidney), diseases of the skeletal or hepatobiliary systems are the only ones consistently accompanied by elevated SAP. It has been assumed3-5 that the skeletal system is the chief source of AP, that the liver serves as the excretory organ for this enzyme, and that its rise in the serum is due to reduced excretion by the liver, but this assumption is contrary to experimental and clinical observations.6-8 One of us (M.A.S.) has demonstrated in dogs with biliary fistulas that biliary excretion of AP rises while the serum enzyme rises, an observation that cannot be correlated with the retention (or References 1. Robison, R.: The Possible Significance of Hexosephosphoric Esters in Ossification , Biochem J 17: 286-293, 1923. 2. Roberts, W.M.: Variation in the Phosphatase Activity of the Blood in Disease , Brit J Exp Path 11:90, 1930. 3. Gutman, A.B.: Serum Alkaline Phosphatase Activity in Diseases of the Skeletal and Hepatobiliary Systems , Amer J Med 27:875, 1959.Crossref 4. Dalgaard, J.B.: Serum and Bile Phosphatase in Biliary Fistula Dogs , Acta Physiol Scand 16:293, 1949.Crossref 5. Sherlock, S., and Walshe, V.: Hepatic Alkaline Phosphatase; Histological and Microchemical Studies on Liver Tissue in Normal Subjects and in Liver and Bone Disease , J Path Bact 59:615, 1947.Crossref 6. Polin, S.G., et al: The Origin of Elevated Serum Alkaline Phosphatase in Hepatic Disease , Gastroenterology 42:431, 1962. 7. Sebesta, D.G.; Bradshaw, F.J.; and Prockop, O.J.: Source of the Elevated Serum Alkaline Phosphatase Activity in Biliary Obstruction; Studies Utilizing Isolated Liver Perfusion , Gastroenterology 47:166, 1964. 8. Posen, S.; Neale, F.C.; and Clubb, J.S.: Heat Inactivation in the Study of Human Alkaline Phosphatases , Ann Intern Med 62:1234, 1965.Crossref 9. Flood, C.A.; Gutman, E.B.; and Gutman, A.B.: Serum and Urine Phosphatase Activity in the Cat After Ligation of the Common Bile Duct , Amer J Physiol 120:696, 1937. 10. Amador, E.; Zimmerman, T.S.; and Wacker, W.E.L.: Urinary Alkaline Phosphatase Activity , JAMA 185:133, 1963. 11. Gomori, G.: Determination of Phenol in Biological Material , J Lab Clin Med 34:275, 1949. 12. Leveen, H.H.; Talbot, L.J.; and Restuccio, M.: Metabolism and Excretion of Alkaline Phosphatase: Relation to Liver Function and Determination of Maximal Secretory Rates of Liver , J Lab Clin Med 26:192, 1950.
Archives of Internal Medicine – American Medical Association
Published: Dec 1, 1967