Genetic, structural, and functional foundations of alkaline phosphatase measurement in clinical diagnostics

IF 3.9 3区医学 Q1 PATHOLOGY

Pathology Pub Date : 2026-03-01 Epub Date: 2025-12-15 DOI:10.1016/j.pathol.2025.11.003

Kenneth Andrew Sikaris , Karen Rankin

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Abstract

Alkaline phosphatase (ALP) is a membrane-bound ectoenzyme with critical diagnostic relevance in clinical medicine, particularly for bone and liver diseases. This review examines the genetic, structural, and functional foundations of ALP, highlighting its distribution across tissues such as bone, liver, intestine, placenta, and neutrophils. The article details the evolution of the ALP gene family, including tissue-non-specific and tissue-specific isoenzymes, and discusses how genetic variation and post-translational modifications influence ALP activity, serum levels, and clinical interpretation. Isoenzyme analysis, including electrophoretic and immunoassay techniques, enables differentiation of tissue origins in cases of elevated ALP, improving diagnostic precision for conditions such as Paget's disease, renal osteodystrophy, and malignancy. The review also explores the impact of ABO blood group on ALP levels, the functional roles of ALP in skeletal mineralisation and inflammation, and the importance of understanding molecular diversity for accurate measurement. The stability, clearance, and carbohydrate composition of ALP isoforms are discussed as key determinants in clinical assays. Overall, a comprehensive understanding of ALP's genetic and biochemical diversity is essential for interpreting serum ALP measurements, distinguishing between bone and liver pathology, and informing clinical decision-making. This knowledge enhances the utility of ALP as a diagnostic biomarker and supports its role in monitoring metabolic bone disease and other disorders.

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临床诊断中碱性磷酸酶测定的遗传、结构和功能基础。

碱性磷酸酶（ALP）是一种膜结合的外酶，在临床医学中具有重要的诊断意义，特别是在骨骼和肝脏疾病中。本文综述了ALP的遗传、结构和功能基础，强调了其在组织中的分布，如骨、肝、肠、胎盘和中性粒细胞。本文详细介绍了ALP基因家族的进化，包括组织非特异性和组织特异性同工酶，并讨论了遗传变异和翻译后修饰如何影响ALP活性、血清水平和临床解释。同功酶分析，包括电泳和免疫分析技术，能够在ALP升高的情况下区分组织来源，提高对Paget病、肾性骨营养不良和恶性肿瘤等疾病的诊断精度。该综述还探讨了ABO血型对ALP水平的影响，ALP在骨骼矿化和炎症中的功能作用，以及了解分子多样性对准确测量的重要性。ALP异构体的稳定性，清除率和碳水化合物组成被讨论为临床检测的关键决定因素。总的来说，全面了解ALP的遗传和生化多样性对于解释血清ALP测量、区分骨骼和肝脏病理以及为临床决策提供信息至关重要。这些知识增强了ALP作为诊断性生物标志物的效用，并支持其在监测代谢性骨病和其他疾病中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pathology 医学-病理学

CiteScore

6.50

自引率

2.20%

发文量

459

审稿时长

54 days

期刊介绍： Published by Elsevier from 2016 Pathology is the official journal of the Royal College of Pathologists of Australasia (RCPA). It is committed to publishing peer-reviewed, original articles related to the science of pathology in its broadest sense, including anatomical pathology, chemical pathology and biochemistry, cytopathology, experimental pathology, forensic pathology and morbid anatomy, genetics, haematology, immunology and immunopathology, microbiology and molecular pathology.