Tillförlitliga referensintervall krävs för värdering av P-ALP - Nya pediatriska referensintervall för alkaliskt fosfatas har klinisk betydelse för att hitta rätt till diagnosen.
[Article in Swedish]
Abstract
Age-
and gender-specific reference intervals are pivotal to ensure
appropriate interpretation of plasma alkaline phosphatase activities in
the lower range Hypophosphatasia (HPP) is an inborn error of metabolism
caused by loss-of-function mutations of the ALPL gene that mainly express alkaline phosphatase (ALP)
in bone and liver. The clinical expression of HPP is highly variable
and is classified into six different forms mainly affecting bone and
tooth mineralization. The prognosis for each of these HPP forms depends
upon the severity of the skeletal disease which reflects the age at
presentation. The biochemical hallmark of HPP is low plasma ALP
activity (hypophosphatasemia); however, HPP is often misdiagnosed
because of low awareness and sometimes absence of age- and
gender-specific ALP reference intervals. Children and adolescents have higher ALP
levels in comparison with adults. Reliable reference intervals are
pivotal for any clinical laboratory test. Harmonized age- and
gender-specific plasma ALP reference intervals ought to be used to ensure appropriate interpretation of plasma ALP activities in the lower range.
http://www.lakartidningen.se/Klinik-och-vetenskap/Kommentar/2017/10/Tillforlitliga-referensintervall-kravs-for-vardering-av-P-ALP/
http://www.socialstyrelsen.se/ovanligadiagnoser/hypofosfatasi#anchor_5
Tästä huomaa että kriittinen kohta
fosfaattiaineenvaihdunnassa on sekin että P-ALP käyttää
substraattina pyrofosfaatin lisäksi
aktiivia B6 vitamiinia jolla on
varsin suuri tarve esim myeliinisynteesin aloituksessa. Myeliinin
huonosta muodostuksesta tietysti tulee sitä epilepsiaa, johon
sitten tehoaa B6- anto jolloin myeliinisynteesi saa alkuainetta
aktiivi B6 ja aktiivi seriini kondensoituvat ketosfinganiiniksi jne
myeliinitielle se vaatii energiaa tämä synteesitie käsittääkseni.
Ilmeisesti tässä on pahin metabolinen kuoppa koska kyse on samlla
keskushermoston kehittymisestä luuston muun fyysisen kehittymisen
ohella. Ei tarvitsisi odottaa epileptista kohtausta B6 annon
aloitukseen, jos tämä tauti on diagnosoitu.
Siis yksinkertaisesti myeliinia ei muodostu de novo ilman aktiivia
B6 vitamiinia.
https://www.ncbi.nlm.nih.gov/pubmed/28072448
https://www.ncbi.nlm.nih.gov/pubmed/22696173
https://www.ncbi.nlm.nih.gov/pubmed/26219720
The Role of Tissue Non-specific Alkaline Phosphatase (TNAP) in Neurodegenerative Diseases: Alzheimer's Disease in the Focus.
Abstract
Tissue non-specific alkaline phosphatase
(TNAP) is present on neuronal membranes and induces neuronal toxicity
via tau dephosphorylation; a mechanism which could play a role in the
neuronal loss seen in Alzheimer's disease (AD). TNAP increases in the
plasma following brain injury and cerebrovascular disease. In this
chapter we summarise our previous work which looked at changes in TNAP
activity in the brain and plasma of AD individuals and discuss whether
these changes may be reflective of neuronal loss. Our data demonstrate
that TNAP activity is significantly increased in the brain in both the
sporadic and familial forms of AD and that TNAP activity is
significantly increased in the plasma in AD patients. In addition, we
describe a significant inverse correlation between plasma TNAP activity
and cognitive function in AD. Using these data we propose a model for
TNAP-induced neurodegeneration in AD resulting from tau dephosphorylation following secretion of tau from neuronal cells.