Serum alkaline phosphatase levels may remain elevated for up to 1 week after the resolution of biliary obstruction. The liver is the source in most patients with elevated enzyme levels.
Increased osteoblast activity seen in disorders of the bone or normally during periods of growth is the next likely contributor. The influx of placental alkaline phosphatase in the late third trimester contributes to the rise in pregnant women. The mechanism of the increase in alkaline phosphatase in hepatobiliary disorders has been a matter of debate. Research has convincingly shown that it is due to increased enzyme synthesis and not to reduced hepatobiliary excretion of the enzyme.
Increased hepatic enzyme activity demonstrably parallels the rise in serum alkaline phosphatase activity; this occurs primarily due to increased translation of the mRNA of alkaline phosphatase mediated by the rising bile acid concentration and increased secretion of alkaline phosphatase into serum via canalicular leakage into the hepatic sinusoid.
The mechanism that precipitates its release into the circulation has not been elucidated. Studies report that vesicles containing alkaline phosphatase, and many such enzymes bound to the sinusoidal membranes, are found in the serum of patients with cholestasis. Because alkaline phosphatase is newly synthesized in response to biliary obstruction, its serum level may be normal in the early phase of acute biliary obstruction even when the serum aminotransferases are already at their peak.
There are several clinical methods for the determination of serum alkaline phosphatase levels. The tests, in principle, rely on the ability of the enzyme to hydrolyze phosphate esters. In the most widely used international method, p-nitrophenol phosphate serves as the substrate, while an amino alcohol is used as a buffer. The different methods appear equally effective in the detection of abnormal values in various clinical diseases.
Using multiples of the upper limit of normal is a simple way of comparing results obtained via different tests. Electrophoresis does not reliably differentiate the isoenzymes as the electrophoretic mobility of bone and liver isoenzymes is only slightly different.
Electrophoresis on cellulose acetate, with the addition of heat inactivation, is a much reliable test than electrophoresis alone. Polyacrylamide gel slab-based separation provides accurate identification of the liver, bone, intestinal and placental isoenzymes; this test is, however, not widely available.
Patients with blood group O and B may need to fast before the test to avoid contribution from the intestinal isoenzyme if there is an unexplained elevation of alkaline phosphatase on routine tests. The phlebotomist uses a gold-top serum separator tube containing a clot activator and serum gel separator to collect the blood for analysis. There are many potential analytic sources of error. Factors such as concentrations of phosphate, magnesium, citrate, type, and concentration of buffer maintenance of the correct temperature may affect the result.
When alkaline phosphatase is the only liver biochemical test that presents as elevated i. In asymptomatic patients with isolated elevation of serum alkaline phosphatase, it is essential to identify the primary source of abnormality. Alkaline phosphatases derived from the liver, bone, placenta, and intestines have different physicochemical properties.
There are three general methods that have shown to be particularly used for discriminating between isoenzymes: thermostability studies; differential inhibition with various small peptides, amino acids, and other low molecular weight substances; and immunologic methods. These enzymes are not elevated in disorders of bone and correlate well with hepatobiliary disorders.
Serum GGT is very sensitive to biliary tract disease but is less specific for liver disorders. However, lack of an elevated 5NT in the presence of an elevated alkaline phosphatase does not rule out hepatobiliary disease as they do not rise concomitantly in early or mild hepatic injury.
The principal clinical value of measuring serum alkaline phosphatase lies in the diagnosis of cholestatic liver disease—some of the highest elevations in alkaline phosphatases present in patients with cholestasis. The degree of elevation does not help distinguish the two types. Similar elevations occur in biliary obstruction due to cancer cholangiocarcinoma, pancreatic head adenocarcinoma, or ampullary adenocarcinoma , choledocholithiasis, biliary stricture, sclerosing cholangitis, or causes of intrahepatic cholestasis such as primary biliary cholangitis, drug-induced liver injury, chronic rejection of liver allografts, infiltrative liver disease sarcoidosis, amyloidosis, tuberculosis, and liver metastasis , severe alcoholic hepatitis causing steatonecrosis.
Patients with AIDS may also have particularly high levels, either due to cholangiopathy from opportunistic infections such as cytomegalovirus, cryptosporidiosis, or granulomatous involvement of the liver from tuberculosis. Moderate elevation up to four times the upper limit of normal of serum alkaline phosphatase is nonspecific as it can occur in a variety of conditions affecting the liver including cirrhosis, chronic hepatitis, viral hepatitis, congestive heart failure, and ischemic cholangiopathy.
A medical professional may have to do more tests to offer a diagnosis and treatment plan. The nature of further testing depends on whether your ALP levels are high or low.
Follow-up tests might include:. You may experience some bruising around the puncture site, but this can be avoided by putting pressure on the wound. In rare cases, phlebitis inflammation of the vein may develop. If you experience this complication, apply a warm compress until the swelling goes down. Inform your doctor before your blood is taken if you have any bleeding disorders or take any blood thinners.
An alkaline phosphatase level test ALP test is a simple test to perform. It requires just a simple blood draw. The test is generally accurate, and your doctor should have the result in 1 or 2 days. Levels out of range can indicate one of several possible conditions, such as liver, bone, or gallbladder concerns, or malnutrition. Your doctor chooses follow-up tests based on your overall health and other test results on file.
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If you have ascites, you have fluid in the space between the abdominal lining and the organs. Lifestyle changes can help reduce your risk for fatty liver disease and damage. Learn what 10 foods you should eat and what 6 foods to avoid.
Fatty liver disease is best managed with lifestyle changes. Some of the best methods include weight loss, limiting sugar, and drinking coffee. Fatty tissue can build up in your liver even if you drink little or no alcohol. Learn more about the causes, complications, and how to manage it. P org and organic available P av P org are the compiled phosphorus fraction that better correlate with acid phosphatase activity Fig. Total P org correlates positively with acid phosphatase Fig. Acid phosphatase relationships.
Relationship between organic phosphorus and TN E and between acid phosphatase and Microbial C F are also shown for the mineral soils of our database. TP and different forms of available P were not considered for the SEM modeling because they showed no correlation to acid phosphatase patterns Table 1. In turn, P org was excluded from the predictors due to the insufficient number of site-data gathered in our database.
The total effect of MAP 0. The main contribution of MAP to phosphatase activity was indirect and positive by contributing to the explanation of Total Nitrogen and Carbon 0. Structural equation modeling. The effect of thermal amplitude AMP was negative, and Mean Annual Temperature MAT did not contribute significantly due to the opposite signals of its direct and indirect effects. Black arrows and bars represent positive effects, and red arrows and bars represent negative interactions.
The width of the arrows is proportional to the amount of the variance explained and P -values are in brackets. TN was a good predictor of acid phosphatase activity, better than P org Fig. The more TN, the higher the phosphatase activity in the soil.
A more complex model including acid phosphatase activity data from all biomes and adding mean AMP and TC produced an R 2 of 0. Partial residual plot. Partial residual plots permit the evaluation of the effect of each variable on a full model without interactions. Colorful areas indicate confidence band 0.
All variables were Ln-transformed. See Supplementary Table 1 Model 3 in the Supplementary Information for a summary of the linear model. Original pH of the soil was a significant explanatory variable for alkaline phosphatase, unlike in the modeling of acid phosphatase. Phosphatase activity in very low, low and intermediate weathered soils averaged 5. The phosphatase activity declined on the highly weathered soils Acid phosphatase activity on different Soil weathering, Community and Forest types.
Dependence of TN A and phosphatase activity D on the amount of soil weathering. Dependence of TN C and phosphatase activity F on forest class. Boxplot show median values solid horizontal line , 50 th percentile values box outline , 90 th percentile values whiskers , and outlier values.
The gradients in average phosphatase activity across biomes also match those of TN 9. Differences were found between angiosperm and gymnosperm forests. Both phosphatase and TN concentrations were higher in the angiosperm Total phosphorus was found to be a poor predictor of phosphatase activity because it comprises the phosphorus part of primary mineral and also occluded recalcitrant forms, both being reservoirs that cannot be substrate for phosphatase enzymatic activity Table 1 , Fig.
Our explanations for this result are 1 total P comprises mineral forms that are excluded from the loop of the cycle of P between soils and plants and 2 total P includes inorganic forms also not available for plants.
Phosphorus is present in soil in several organic and inorganic forms, and only a small fraction of P org is susceptible to release available phosphate after phosphatase reaction P Bray, Olsen, resin-P has been traditionally presented as a good proxy for P availability in ecosystems. However, av. P did not correlate with phosphatase activity Table 1 , Fig. P relates to the actual availability of P, but not to potential capacity of the system to release P with the help of phosphatases.
Instead, it can be considered an instantaneous picture of the immediately available P. Available P results from the balance between plant and microbial sinks, and sources from organic matter, itself partly of controlled by phosphatase activity.
Thus, phosphatase relate only to the source term, whereas available P is also controlled by the sink terms. No pattern emerges between av P and phosphatase from the data we collected. Nevertheless, soils with high av. P org and P org Fig. Organic fraction includes very recalcitrant and moderately labile forms, but as a natural potential substrate for phosphatase, it is a proper indicator of the capacity of the system to obtain labile phosphorus. This reinforces the idea that not only labile but also the moderately labile forms 24 are needed to quantify nutrient constraints in a soil-plant system.
Therefore, a combination of organic P reservoir and its access door phosphatase activity , can be a better indicator of P cycling capacity of the system than the direct measure of available forms. Unfortunately, despite we aimed to test statistically the robustness of P org as an indicator for acid phosphatase, the compilation availability of P fraction measurements was much lower in our database than for TC and TN. For this reason, P org was excluded from the structural equation modeling.
This clearly indicates that soils with higher nitrogen content also are wider reservoirs for P org , presumably because they accumulate more organic matter. Nevertheless, TN and TC can also be considered good proxies of soil P org , reinforcing the idea that the organic fraction of soil P, might be a good an indicator of the potential activity of acid phosphatase. The main large scale patterns of acid phosphatase activity distribution are explained by climatic conditions and soil nutrient concentrations.
Our analysis is in line with studies reporting the stimulation of phosphatase activity by N fertilization Microorganisms, and presumably plants, are thought to respond to elemental imbalances in their resources by producing of enzymes targeting the element in need P only becomes growth limiting when and where availability of other resources, e. Total Nitrogen has been considered an appropriate benchmark for determining N availability in natural and agricultural soils 27 , 28 , 29 , 30 , Since N is the main growth-limiting nutrient in many areas of the world, high N availability relative to P is required for organisms to start investing in the production of phosphatase, a protein, and therefore a N-rich molecule 32 , 33 , Hence, the observed pattern of increasing phosphatase activity with TN may arise from increased N investment by plants and microbes into P acquiring enzymes at higher N availability TN is often well correlated with microbial biomass and microbial C 36 , which in turn is related high acid phosphatase activity as is demonstrated in our database.
These patterns could, however, also be partly dependent on microbial community composition, as bacteria are thought to be more competitive than fungi in high-N environments 9.
Our analysis shows that the effect of N was modulated by climatic conditions. This conclusion is in line with most of the experiments studying enzymatic production under different levels of water availability, which showed lower phosphatase activity under drought conditions Some of these studies reported that soil drought decreased soil phosphatase activity, decreasing P mineralization and short-term available P and increasing the P content of litter A lack of water may be responsible for the extremely low levels of microbial biomass and phosphatase in arid and semiarid biomes.
Areas with harsh climatic conditions have been associated with lower litter input, decomposability, microbial and plant biomass and enzymatic activity On the other hand, effects of the other end of the water availability spectrum, like those found on flooded areas swamps, flooded forests are highly depending on reducing conditions and P speciation due to water saturation 39 see section 3. Our data shows how phosphatase is dependent on climate patterns, but also TN concentration in soil.
Our results suggest the coupling of different time-scale processes on the control of phosphatase activity. On one hand, several studies have reported enhanced phosphatase production under N fertilization experiments, revealing a short-term control of the enzymatic production. On the other hand, where climatic conditions are favorable and productivity higher, plants and microbes have modulated the nutrient pools.
It is known that the sum of organic P and occluded P becomes a larger P pool in soils with increasing weathering intensity In our database TN and organic P are also strongly correlated so we propose that the effect of TN over phosphatase activity is also strongly influenced by long-term ecosystem evolution.
Our SEM model also identified a positive direct effect of temperature MAT , which stimulates productivity, on phosphatase activity Fig.
Several studies on various types of biomes report increased plant productivity and microbial activity at higher temperatures 41 or increased phosphatase activity with atmospheric warming trends In contrast, cold temperatures and retarded decomposition are thought to lower N availability Several studies have suggested that the relationships among N and P availability and phosphatase activity should hold across biomes 43 , but evidence was thus far lacking.
The presence of N in soil is the main factor explaining phosphatase activity in temperate climates, but phosphatase activity was also found to be strongly reduced by harsh climatic conditions in other parts of the world.
Phosphatase activity is low in alpine environments database average of 1. A high P availability from direct apatite weathering on young soils could also lead to a little need for phosphatases. The low rates of precipitation in arid and semiarid areas were also associated with very low phosphatase activities database average of 4. Water availability is the main restriction in arid areas, but cold conditions can hamper production and decomposition in boreal areas.
Stagnant boreal wetland soils can become extremely rich in organic matter, in which organic P is trapped and thus unavailable to both plants and microbes. This would explain the extremely high phosphatase activity database average of Activity, however, can be very low in boreal areas with rocky soils, low weathering rates 46 and very high N limitation.
Given the low nitrogen, low carbon and short growing season climatic conditions, mean annual phosphatase activity would be expected to be low in soils of Mediterranean ecosystems. Nonetheless, high activities have been reported by studies at Mediterranean sites 37 , and the average activity for this biome was quite high in this study 9.
Mediterranean ecosystems have strong seasonality, and most measurements were collected in the spring or autumn when soil temperatures and water conditions are optimal for productivity 42 and therefore enzymatic activity may be higher than the yearly average.
The enzymatic content of the upper soil layers can vary 2-fold among seasons in communities that suffer from severe seasonality, such as those in the Mediterranean Basin Another hypothesis is that high phosphatase values in the soils of Mediterranean ecosystems are related to their low P content 15 , 47 , 48 , Also, more enzymes might be required because in these systems, sclerophyll woody vegetation represents an important fraction of the forest understory, which requires more energy to be degraded.
Phosphorus has been considered the main limiting nutrient in tropical ecosystems 50 , related to low P soil substrates. Our study suggests that phosphatase activity in tropical and subtropical ecosystems database average of 8. Tropical and subtropical sites in our data set had low TN values average of 3. In these sites with relatively poor soils, most important enzymatic activity occurs at the litter layer, promoting a very rapid nutrient cycling and fast mineralization rates.
In addition, the reduced conditions common in some flooded tropical forests, though, can lead to the release of previously unavailable P by the dissolution of iron oxides capable of binding P This process can be compensated by the formation of ferrous phosphate and an increased sorption capacity of iron hydroxides The labile P pathways in these environments are closely associated with the Fe and S cycles.
Temperate sites had higher phosphatase activities These ecosystems are frequently not water limited and commonly have well-developed soil horizons and high nitrogen content due to high atmospheric deposition Similar activities have been reported for temperate climax forests Phosphatases were related with TN in temperate and tropical sites Figure S3 , as well as alpine and arid sites not shown.
The effect of TN is not the main factor explaining phosphatase activity variance in Mediterranean sites due to the propensity of water availability and temperature to constrain nutrient cycling of the system. Our findings identified differences in phosphatase activity associated with the degree of soil weathering and ecosystem development. Phosphatase activity was highest in intermediately weathered soils in our dataset Fig. This pattern parallels those for TN Fig.
S2 , suggesting a relationship between enzymatic activity, microbial biomass and nutrient status 16 , Though chronosequences and weathering stages are not strictly comparable, both patterns of change share common trends.
Differences among low and high weathering status are comparable to differences between young and old soils described in chronosequences. Allison et al. Nevertheless, P content of the soil is depleted much faster than C, so that the C:P and N:P ratios constantly increase with soil age 53 , Peltzer et al. Microbial biomass progressively increases in first stages of Franz Joseph soil chronosequence, until becoming progressively the first pool of total biomass phosphorus plant and microbial 9.
This suggests an intense competition between plants and saprotrophic microbes for soil phosphorus in mature soils 9. Lower phosphatase activity with N limitation has been shown at retrogressed sites on volcanic islands 56 like in the highly weathered soils of our dataset, where a very important component of the enzymatic activity occurs on the litter layer before than the soil Fig.
Assessing the relative contributions of nutrient availability and alterations in soil microbiota to the rate of change is difficult A shift of microbial communities from bacterial to fungal dominance is common in N-limited acidic soils 9 , 52 , and such a shift can become an important driver of phosphatase activity.
Also, a positive feedback loop of intensifying nutrient limitation can occur: lower nutrient concentrations alter microbial communities, decrease decomposing activity and further intensify nutrient limitation.
Phosphatase activity and TN also differed significantly among communities Fig. Phosphatase activity was consistently higher in forests Wardle et al. Grasslands are systems composed of plant species that rapidly cycle nutrients, which benefits bacterial dominance more competitive under high-N conditions The control of plant composition over decomposers is context-dependent, but a higher proportion of fungi over bacteria are expected in forest soils.
Root symbiotic mycorrhizal fungi are efficient producers of phosphatase 58 and exert an important control over nutrient uptake 59 , This is because of the large surface area that mycorrhiza develops in contact with the soil, interacting more efficiently with the mineral and organic surroundings The abundances of mycorrhiza types in soil are dependent on the distribution of their host species and grassland and forest soils exhibit different diversity of mychorrhiza 59 , 62 , which may contribute to the final phosphatase production.
Soil communities, including root feeders and soil-engineering organisms, also determine the final specific enzymatic profiles. A good example are the epigeic earthworms and termites, whose mutualistic relationships can contribute to higher phosphatase activity However, we observe that despite forest and grassland soils showing differences in nutrient load capacity and primary productivity, a common pattern between TN and Acid Phosphatase underlies those disparities Figure S4.
Information from the forest communities gathered in our data set allowed us to identify differences between angiosperm and gymnosperm soils Fig. Soil phosphatase was significantly higher in the angiosperm forests This pattern was consistent for the Mediterranean and temperate biomes but not the tropical or subtropical sites where angiosperm dominance did not allow this comparison.
A disparity between these two tree classes would suggest that in forests a significant proportion of the phosphatase activity in soils may be produced by plant roots and mutualistic mychorrhiza. Lower biological activity could be expected in gymnosperm soils, which are better adapted to harsh conditions water stress in Mediterranean forests and lower temperatures in boreal ones in comparison with angiosperm forests.
However, we did not identify large differences in rainfall between both groups of forest compared in our database, fact that suggests that enzymatic differences depend on biological differences rather than climatic ones.
The higher phosphatase activity in angiosperm soil may be associated with TN values Fig. Some studies highlighted that low Nitrogen Use Efficiency NUE appears to be a significant disadvantage for gymnosperm plants under N limitation 64 that could prevent phosphatase exudation. Differences among microbial life, mycorrhiza dominances 65 or stoichiometry observed between angiosperm and gymnosperm classes 66 could be also behind these differences in phosphatase activity. Previous studies have reported higher tissue P contents in angiosperms than gymnosperms 66 , perhaps leading to a higher phosphatase requirement and thus higher enzyme activities.
This differential demand of P arises as an important biological trait that could have driven both separate evolutionary paths. Together with local land management, global processes such as atmospheric CO 2 enrichment or rising sea levels are transforming our world.
The effects of future climate and environmental change on soil-P cycling and enzymatic activities are hard to predict, because the feedbacks among soil chemical properties and above- and belowground life are still poorly understood. Higher levels of atmospheric CO 2 can stimulate phosphatase synthesis by changing litter quality and enhancing plant and microbial productivity 57 , 67 , from which we could expect a faster turnover of P.
Our data suggest that increasing temperatures could produce similar changes Fig. There is evidence that water limitation will strongly affect the stoichiometry of soil organic matter and various plant tissues.
Drought has been related to decreases in soluble organic C and P due to lower microbial biomass and activity 42 a pattern that is also seen at the arid and semiarid sites in our study. More available P org is released during drought by higher production of litter in the short-term, but available inorganic P and phosphatase activity decrease, leading to strong mid- and long-term P limitation Moreover, positive feedbacks can accelerate P loss by rapid leaching of soluble P during re-wetting, by an osmotic shock from microbes or from the leaching of nutrient aggregates Increasing water shortage and a higher likelihood of extreme events may decrease phosphatase activity, inducing the degradation of some ecosystems and the gradual change to communities that are less dependent on water and nutrients e.
Mediterranean forest towards shrublands. This change can be interpreted as a positive feedback on climate change, because less C is captured as biomass, and the ecosystem can become a source of CO 2. Various forms of P and phosphatase activity can be considerably lower after a fire 19 and microbial biomass becomes the main factor accounting for the P status and recovery.
In boreal forest, fire might increase the available P for the surviving and pioneer plants. Global change is predicted to bring a higher input of N due to anthropogenic fertilization Our model Fig. Enhancement of soil N availability, especially in poor-nutrient soils, is a common characteristic of invasive species, which will arise as an emerging driver of global change worldwide. Some systems that do not suffer from hydric stress are consequently expected to shift toward P limitation and higher phosphatase activity Our models and literature compilation suggest an uncertain scenario for the coming years: the effects of higher CO 2 levels, N fertilization and temperature are expected to increase phosphatase activity and the rate of turnover of P org in soils, but only if enough water is available.
In other areas, water restriction will induce P limitation and lower phosphatase activity, an effect that could be aggravated by recurrent fires. This study is the first to date to analyze global patterns of phosphatase activity in soil.
Soil TN is the main factor that we looked at, explaining spatial gradients of phosphatase activity at a global scale. Higher temperature and precipitation were further found to be positively associated with phosphatase activity. An important part of the effect of rainfall on phosphatase activity was indirect, occurring through the effect of water availability on soil TN. Where the climatic conditions are not specifically limiting -such as temperate and tropical forest-, soil N arises among the studied factors as the most determinant in limiting acid phosphatase activity.
However, on other sites that can undergo temperature or water limitations, the main control over phosphatase activity would be exerted by climate —such as arid or Mediterranean areas-. Mutualistic interactions between microbes and plants can guarantee P cycling, but chemical fixation, release and effective use of phosphatase can be an ultimately constrain for P uptake.
Soil geochemical conditions play an important role in determining phosphatase activity, and may be specifically important in tropical systems.
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