Identification of a macro-alkaline phosphatase complex in a patient with inflammatory bowel disease

McTaggart, Malcolm P; Rawson, Catherine; Lawrence, David; Raney, Barbara S; Jaundrill, Linnet; Miller, Lorna A; Murtinho-Braga, Joseph; Kearney, E.

doi:10.1258/acb.2011.011224

Cited by 9 publications

(4 citation statements)

References 10 publications

(11 reference statements)

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“…Maekawa et al [8] suggested that ALP was attached through the F (ab′) 2 fragment of IgA and that the molecular weight of the complexes suggested that 2 molecules of ALP was associated with one molecule of divalent IgA. Characterisation of the macro-ALP was performed by gel filtration [7], immunoelectrophoresis [7], PEG precipitation [11], and proteolytic digestion [9]. Protein A/G agarose affinity chromatography was used to demonstrate the presence of macro-ALP [12].…”

Section: Discussionmentioning

confidence: 99%

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Persistent Increase in Serum Alkaline Phosphatase in a Patient with Monoclonal Gammopathy of Undefined Significance

Ramasamy

2020

Case Reports in Hematology

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We report the finding of alkaline phosphatase-immunoglobulin complex (macro-alkaline phosphatase (macro-ALP)) in a patient with persistently increased ALP activity. The identification of macro-ALP is important to rule out pathological causes of increased ALP activity and to avoid unnecessary diagnostic investigation. The patient was subsequently diagnosed with vitamin D deficiency, gallstone pancreatitis, and monoclonal gammopathy of undefined significance (MGUS). Macro-ALP can coexist with disease that can increase serum ALP activity. We report, for the first time, a case of macro-ALP in a patient with a monoclonal protein (M-protein).

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Section: Discussionmentioning

confidence: 99%

“…Macro-ALP has been reported in patients with ulcerative colitis [11], carcinoma of prostate [10], bronchopneumonia and recurrent infections [9], and liver cirrhosis and cholestasis [6]. Atypical ALP with posttranslational modification has been described in a patient with Hodgkin's disease [14].…”

Section: Discussionmentioning

confidence: 99%

Persistent Increase in Serum Alkaline Phosphatase in a Patient with Monoclonal Gammopathy of Undefined Significance

Ramasamy

2020

Case Reports in Hematology

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“…Macro-ALP (e.g. immunoglobulin-ALP complexes) have also been described in several case reports, although such cases specifically refer to human Abs bound to human ALP [[18], [19], [20]].…”

Section: Discussionmentioning

confidence: 99%

Detection and characterization of estradiol (E2) and unconjugated estriol (uE3) immunoassay interference due to anti-bovine alkaline phosphatase (ALP) antibodies

Maharjan

Wyness

Ray

et al. 2019

Practical Laboratory Medicine

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ObjectivesCompetitive immunoenyzmatic assays for estradiol (E2) and unconjugated estriol (uE3) on UniCel DxI 800 Access immunoassay systems (Beckman Coulter) utilize bovine alkaline phosphatase (ALP) for amplification. In these assays, rare ‘IND’ error flags indicate that a relative light unit (RLU) raw result is past the high or low end of the calibration curve but cannot be differentiated from an instrument error or analytical interference. The present studies were conducted to establish a protocol to identify analytical interference and to characterize its mechanism when present.Design and methodsMatrix and recovery studies were conducted to establish a protocol for interference identification. Spiking experiments with inactivated calf intestinal ALP were performed to determine whether interference could be blocked. Commercial anti-ALP antibodies (Abs) were spiked into human serum to model assay interference. Three E2 immunoassays which do not include ALP as a reagent component (cobas e602, Roche; Centaur XP, Siemens; ARCHITECT i2000SR, Abbott) were tested for comparative purposes.Results1:2 dilution of specimen into Access Sample Diluent A (Beckman) differentiated IND error flags due to true low results (e.g. less than the analytical measurement range; AMR) from those due to assay interference. Interferences were reduced by pre-incubation with inactivated ALP and could be replicated by spiking with commercial anti-ALP Abs.ConclusionsPatient anti-bovine ALP Abs can cause interference on DxI 800 E2 and uE3 assays. This model can be used to investigate interference risk with other ALP-dependent assays.

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“…There is however still a smattering of interesting papers describing novel isoforms, the most recent appearing in 2012. 20 It is good to see that this enzyme still interests clinical biochemists today, but the heady days of Barron's 'new magic', when many of the old academic departments were led by enzymologists who could claim an almost apostolic line of descent from Earl King, are well and truly gone.…”

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confidence: 99%

A history of clinical biochemistry through the eye of an enzyme

Day

2013

Ann Clin Biochem

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Identification of a macro-alkaline phosphatase complex in a patient with inflammatory bowel disease

Cited by 9 publications

References 10 publications

Persistent Increase in Serum Alkaline Phosphatase in a Patient with Monoclonal Gammopathy of Undefined Significance

Persistent Increase in Serum Alkaline Phosphatase in a Patient with Monoclonal Gammopathy of Undefined Significance

Detection and characterization of estradiol (E2) and unconjugated estriol (uE3) immunoassay interference due to anti-bovine alkaline phosphatase (ALP) antibodies

A history of clinical biochemistry through the eye of an enzyme

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