“…Alkaline phosphatase is named as such because it enhances hydrolysis of monophosphate esters at alkaline pH. The accumulation of natural substances of TNSALP causes musculoskeletal and neurocognitive symptoms: inorganic pyrophosphate (PPi), pyridoxal 5’ phosphate (PLP), adenosine triphosphate (ATP), di-phosphoryl lipopolysaccharide (LPS), phosphoethanolamine (PEA) and phosphorylated osteopontin [ 3 ]. TNSALP isoforms by alternative splicing or posttranslational modification from liver, kidney and bone, and the isozymes, which is encoded by different genes on chromosome 2q34-37 but catalyze same reaction, are all measured and reported as total serum alkaline phosphatase [ 4 ].…”