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Title: Alkaline phosphatase forms in plasma : a clinical study
Author: Tibi, Laila
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1990
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The identification of the source of a raised total alkaline phosphatase activity in plasma, by the measurement of individual ALP forms, is of clinical value although many of the methods available for this purpose are complex, imprecise and non-specific. This thesis has validated, and in some cases modified, available methods for the measurement of the main forms of alkaline phosphatase (ALP; EC in plasma: liver, bone, intestinal and high-molecular-mass ALP. The following methods were selected on the basis of their reliability and specificity: polyacrylamide gel electrophoresis, with densitometric scanning, for liver and bone ALP, an enzyme-linked immunosorbent assay (ELISA) for intestinal ALP and ion-exchange chromatography for high-molccular-mass ALP. These methods were then used to quantify individual ALP forms in specific disease groups and compare activities to those found in healthy adults. The diseases studied (diabetes mellitus and hyperthryoidism) were those where the source of the raised total ALP activity has not been clearly established. Intestinal ALP activity was found to be an important source of the raised total ALP in diabetics of blood group B and O who were secretors. Abnormalities in liver ALP were also present, but these were found mainly in type 2 diabetics. Bone ALP and, to a lesser extent, liver ALP contributed to the raised total ALP activity in patients with hyper-thyroidism. These abnormalities were not present in euthyroid patients who were previously hyperthyroid, indicating that they were a temporary feature of the thyrotoxic state. Specific diseases (chronic renal failure and obstructive liver disease) where the measurement of an individual ALP form was likely to be of more value than total ALP measurement were also studied. In patients with chronic renal failure maintained on haemodialysis, measurements in plasma of activities of total ALP and gammaglutamyl-transferase identified bone abnormalities in most patients. However, measurement of bone ALP was essential in those patients (16% of the group) who had co-existent liver disease. In patients with obstructive liver disease, the measurement of plasma total ALP activity was of no value in determining the cause of obstruction (intra- or extrahepatic). In these patients, however, intestinal ALP activity, when measured by ELISA and related to blood group/secretor status category, showed absolute specificity for intrahepatic obstruction.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available