Alkaline Phosphatase In Patients Research Articles

Assessment of Testosterone Levels, Kidney Function and Alkaline Phosphatase in Patients with Benign Prostatic Enlargement in Kirkuk City/Iraq

The present study is designed to evaluate the concentration of Testosterone, Creatinine, Urea urea, and alkaline phosphatase levels in patients with benign prostatic hyperplasia. This study was conducted for the period from the beginning of October 2023 to the end of February 2024 at Kirkuk Hospital. General and specialized medical clinics in the city of Kirkuk. The study included (70) males with benign prostatic hyperplasia, ages (45-75) years, and average weight (82) kg. In addition to 20 samples of healthy people with the same rate of ages and weights of patients, study samples were distributed as follows: The first group: the control group and included (20) healthy males, and the second group: the patient group and distributed to three groups according to the age groups first category ( 45-55) years and included 25 patients, the second age group (56-65) years and included 20 patients, the third age group (66-75) years and included 25 patients. The results of the current study showed a significant increase (p ≤ 0.05) in the concentration of urea, creatinine and alkaline phosphatase enzyme in patients with benign prostatic hyperplasia compared to healthy people, and the current study showed a significant decrease (P ≤ 0.05) in testosterone concentration in patients with benign prostatic hyperplasia compared to healthy people. According to age groups, the results showed no significant differences (p ≤ 0.05) in the concentrations of urea, creatinine and alkaline phosphatase enzyme in patients with prostatic hyperplasia, and the results showed a significant decrease (p≤ 0.05) in the concentration of testosterone according to the age groups of patients with benign prostatic hyperplasia.

A Study of Certain Physiological Characteristics of Infected Children with Diarrhea Owing to Entamoeba Histolytica and Related Bacteria in Children of Thi-Qar Province

The present study aims to evaluate the physiological characteristics of E. histolytica and common pathogenic bacteria in children under the age of five who are experiencing diarrhoea. The present investigation was carried out at Bint Al-Huda Teaching Hospital for Women and Children and Al-Mousawi Hospital under the jurisdiction of Thi-Qar Province. The present study observed a significant decrease in the count of red blood cells, haemoglobin blood, and hematocrite in patients infected with E. histolytica and pathogenic bacteria, as well as in patients infected with E. histolytica alone, compared to the control groups. However, there was no significant difference within patients for both males and females. The blood parameters of male and female patients with diarrhoea (plate late test) exhibited a statistically significant increase (P ≥ 0.05) in comparison to the control group. There was no statistically significant difference (P ≥ 0.05) observed between male and female patients with diarrhoea produced by E. histolytica and pathogenic bacteria, compared to those with diarrhoea caused only by E. histolytica. There were no significant changes (P ≥ 0.05) in any blood parameters (mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration) between male and female patients with diarrhoea and the control group. The findings of the study revealed that there was no statistically significant increase (p < 0.05) in the levels of Aspartate aminotransferase, Alanine aminotransferase, and Alkaline phosphatase in patients infected with E. histolytica. However, in patients infected solely with E. histolytica, there was a significant increase in enzyme levels compared to both the pathogenic and control groups. The present study demonstrated a notable elevation in the levels of urea and creatinine among male and female patients diagnosed with diarrhoea in comparison to the control group. However, no statistically significant difference was observed between male and female patients with diarrhoea caused by E. histolytica and pathogenic bacteria, as compared to those with diarrhoea solely caused by E. histolytica.

Evaluation of Immunoglobulin’s, Biochemical and Hematological Parameters in Children with Celiac Disease

Celiac disease (CD) is an autoimmune illness which has affected about 1% of the population and it has appeared due to gluten intolerance in genetically susceptible people. The current study was designed to determine the level of immunoglobulin IgA and IgG in children with celiac disease and to estimate their impact on biochemical and hematological parameters. The current study was conducted on 120 subjects, including 60 blood samples were collected from diagnosed celiac disease children aged less than 12 years along with 60 healthy control subjects of same age range. The results of the present study have shown a statistically significant difference between celiac disease patients and control group. Value of immunoglobulin IgA in CD patients was 205.98 ± 181.48 U/ml as compared to the control group i.e. 4.18 ± 1.77 U/ml which showed a statistically significant difference. The mean value of immunoglobulin IgG in patients was 77.21 ± 71.35 U/ml as compared to the control group i.e. 6.13 ± 1.33 U/ml which showed a statistically significant difference. The mean value of Serum alkaline Phosphatase in patients was 382.58 ± 114.99 U/L as associated to the control group i.e. 265.75 ± 65.2 U/L which showed a statistically significant change. The mean value of serum phosphorus in CD patients was 4.64 ± 1.01 mg/dL as compared to the control group i.e. 3.85 ± 0.55 mg/dL which showed a statistically significant difference. It has been concluded from the above results that in most of the cases of CD the values of serum IgA, serum IgG, serum alkaline phosphate, serum calcium, serum phosphorus and hemoglobin values can prove important clinical diagnostic markers for celiac disease which would ultimately be helpful in the management of this life-threatening disease.

Associations Between Atherosclerosis and Elevated Serum Alkaline Phosphatase in Patients With Coronary Artery Disease in an Inflammatory State.

Serum alkaline phosphatase (ALP) has been shown to be associated with cardiovascular disease (CVD) risk. Inflammation is the initiator of atherosclerosis, throughout the life of atherosclerosis. This study investigated the relationship between serum ALP and atherosclerosis in patients with coronary artery disease (CAD) in an inflammatory state. This was a multicentre retrospective study including 22,989 patients with CAD. Serum alkaline phosphatase was converted into the quartiles. C-reactive protein (CRP) was assayed as a marker of systemic inflammation. The atherosclerosis index (AI) was used to assess the degree of atherosclerosis. Binary logistic regression was used to analyse the relationship between ALP and AI. Stratified analysis was performed according to sex and age. Elevated serum ALP was associated with the risk of atherosclerosis in patients with CAD, and after quartiling ALP, the OR for Q4 was 1.17 (95% CI 1.08-1.26; p<0.001) when using Q1 as reference. The odds ratio (OR) for ALP and risk of atherosclerosis was higher in patients aged ≤60 years (OR 1.33, 95% CI 1.15-1.53; p<0.001) than in patients aged >60 years (OR 1.11, 95% CI 1.01-1.23; p<0.05), and higher in males (OR 1.21, 95% CI 1.09-1.35; p<0.001) than in females (OR 1.16, 95% CI 1.03-1.31; p<0.05). Q4 (ALP >83.00 U/L) was significantly associated with increased risk of atherosclerosis in the inflammatory state (OR 1.48, 95% CI 1.18-1.86; p<0.001), and it remained after stratified analysis according to sex and age. The risk of atherosclerosis tended to increase with increasing ALP levels and the correlation between ALP and the degree of atherosclerosis was significantly stronger when ALP was >83.00 U/L. This relationship was more pronounced in inflammatory states, and there were sex and age differences. URL: https://www. gov; Unique identifier: NCT04026724.

Assessment of salivary Alkaline Phosphatase in patients with healthy gingiva on reduced periodontium versus periodontitis

Assessment of salivary Alkaline Phosphatase in patients with healthy gingiva on reduced periodontium versus periodontitis

Evaluation of Omega-3 Effect as Adjuvant Therapy to Methotrexate on Alkaline Phosphatase Level in Iraqi Patients with Active Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a common inflammatory disease associated with many extraarticularfeatures. The aim: of the current study is to assess the influence of omega-3 fatty acids(EPA, DHA) on serum alkaline phosphatase in patients with active RA. A single blinded placebocontrolled clinical trial with 12 weeks follow up period at which 50 patients with active RAusing methotrexate were randomized into 2 groups to receive either omega-3 (1000 mg) capsulethree times daily or capsules prefilled with glucose as placebo and were evaluated at zero time(baseline) and after 12 weeks for alkaline phosphatase level in serum. In addition to twenty fivehealthy subjects as control group. The age of RA patients in omega-3 group ranged from 25-80years (50.36±2.46), whereas the age of RA patients in placebo group ranged from 35-68 years(50.08±1.84 ), while the age of apparently healthy subjects in control group where ranged from40-60 years (94.20±1.12). The RA disease activity was measured using disease activity score of28 joints(DAS28-ESR) and clinical disease activity index (CDAI). After 12 weeks of startingadjuvant treatment with either omega-3 or placebo, the results showed that there were nosignificant difference between the effect of omega- 3 and placebo on alkaline phosphatase level.In Conclusion, omega-3 significantly decreased alkaline phosphatase level in patient with activerheumatoid arthritis

Effect of statins on alkaline phosphatase in patients with dyslipidemia: A 6-year retrospective study

Background and Aims : Alkaline phosphatase (ALP) has been associated with atherosclerotic cardiovascular disease. The effect of statins on ALP is unknown. We aimed to investigate the effect of statin therapy on ALP in patients with dyslipidemia.

Evaluation of the Diagnostic Potential of Liver Aminotransferases and Alkaline Phosphatase in Patients with Cardiovascular Diseases

Background Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, particularly in developing countries. Early diagnosis with the best diagnostic marker is highly desired for the prevention and timely treatment of CVDs. However, there is still a dearth of an ideal marker for the detection of CVDs.&#x0D; Objective To explore the diagnostic potential of liver aminotransferases (AST and ALT), and alkaline phosphatase for the diagnosis of CVDs without liver involvement.&#x0D; Method This was a cross-sectional study conducted among 200 adult patients with CVDs, who visited the cardiology and emergency units of Manipal Teaching Hospital, Pokhara, Nepal. The study was conducted from January 2018 to December 2020. The baseline data on family history, anthropometry, baseline biochemical parameters, liver enzymes, and cardiac biomarkers were collected using standard and validated methods. The data were analyzed using SPSS version 21 and MedCalc software 2021.&#x0D; Result The diagnostic sensitivity of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were 53.7%, 52.6%, and 33.7% and specificity were 99%, 90%, and 90% respectively. The area under the curve (AUC) of AST, ALT, and ALP were 0.78, 0.73, and 0.52 respectively. ROC curve indicated that serum AST and ALT activity was a better reliable marker than the serum ALP activities.&#x0D; Conclusion Our study suggests that serum aspartate aminotransferase and alanine aminotransferase but not alkaline phosphatase could have some diagnostic potential to diagnose the risk of CVDs. However, they could not replace the currently adopted cardiac biomarkers such as cTnI and CK-MB.

SIGNIFICANCE OF DETECTION OF FREE/TOTAL PSA RATIO AND OTHER BIOCHEMICAL PARAMETERS IN PATIENTS WITH BPH, CARCINOMA PROSTATE AND ITS CLINICOPATHOLOGIC CORRELATION

Background. Benign prostatic hyperplasia (BPH) can raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level does not indicate Prostate Cancer (PCa), but the higher the PSA level, the higher the chance of having PCa. Detection and treatment have been profoundly affected by the advent of Free/Total PSA ratio testing. Objectives. The aim of the study was to estimate free, total PSA levels and its ratio for serum levels of calcium, acid phosphatase and alkaline phosphatase in patients with BPH and PCa; to correlate clinical, biochemical and histopathological findings in the above patients. Methods. PSA levels were detected by Chemiluminescent assay; serum calcium – by Modified Arsenazo method; serum acid phosphatase – by Doumas et al method; and Alkaline phosphatase – by Lowry et al method. Results. Present study found high levels of total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa rate. Free/Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were considerably higher in PCa as compared to BPH. Serum calcium levels did not show significant difference in control and study groups. Conclusions. It was established that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in those without PCa. Therefore, in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary. Objectives: The study was carried out with the following objectives: to estimate free, total PSA levels and calculate Free/Total PSA ratio in patients with BPH and Carcinoma Prostate, to study the serum levels of calcium, acid phosphates, and alkaline phosphatase in patients with BPH and PCa. and to correlate clinical, biochemical and histopathological findings in the above patients. Methods. Free and total PSA levels were detected by Chemiluminescent assay; Serum Calcium was detected by Modified Arsenazo method. Serum acid phosphatase was detected by Doumas et al method and Alkaline phosphatase were detected by Lowry et al method Results: Present study found high levels of Total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa ate. Free /Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were slightly raised in PCa as compared to BPH. Serum calcium levels did not show a significant difference in control and study groups. Conclusion: We concluded that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in men without PCa. There was a negative correlation found between the free/total PSA ratio and the histopathologic findings. The lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary

The relationship Between Osteocalcin and Bone Alkaline Phosphatase in Patients with Diabetic Neuropathy.

The current study aimed to determine bone formation markers ( osteocalcin and bone alkaline phosphatase) as biomarkers for diagnosis the patients with diabetic neuropathy (DN) and to find the relationship between these markers and dyslipidemia in Iraqi patients with diabetic neuropathy, and if these patients are more prone to the risk of atherosclerosis disease.Subjects & Methods: in this study, serum samples were obtained from 25 healthy individuals as a control group (G1), 25 diabetic patients with dyslipidemia as a group (G2), and 25 diabetic patients without dyslipidemia as a group (G3). Age range (45-65) years for all subjects.Patients were attended in the National Diabetes Center / AL-Mustansiriya University/Baghdad. Serum was frozen until used for the analysis of FBG, Ocn , BALP, TG, Ch, HDL-ch, LDL-ch, and VLDL-ch. HbA1C is determined in whole blood.Results: the results showed a highly a significant increase in FBG,HbA1C, Ocn and BALP in G2 and G3 when compare with G1, and a significant difference in lipids levels between two patients groups and control. There is a significant negative correlation between serum Ocn and BALP. Serum Ocn and ALP level concentrations were independently and highly positively correlated with TG,VLDL-ch, and AIP ratio. Conclusions: Ocn and BALP were further increased in DN with complications and poor glycemic control. The AIP ratio was highly significant elevated in DN patients with and without dyslipidemia comparing with control ,therefore, these patients are more prone to the risk of atherosclerosis disease. Much remains to be further investigated to confirm such a relationship between Ocn and BALP, in addition, to clarify their role in DN. Changes in bone biomarkers can reflect these underlying changes ahead of time, enabling clinicians to respond fast and effectively, which allows bone biomarkers to be used as markers for DN diagnosis.

MO576ASSOCIATION OF BONE MATERIAL STRENGTH WITH BONE DENSITY IN PATIENTS WITH END-STAGE RENAL DISEASE

Abstract Background and Aims Patients with end-stage renal disease (ESRD) have an increased risk of skeletal complications, including an increased fracture risk, which is only partially identified by determination of bone mineral density (BMD). Experimentally, the complex bone-and mineral disorders in ESRD cause disturbances of bone material properties, but these have not been studied in vivo. Determination of bone material strength index (BMSi) by reference point indentation (RPI) is a novel method to determine bone material quality in vivo and can identify patients at increased fracture risk, even in the presence of normal BMD. We determined BMSi in ESRD patients and investigated its association with BMD and serum markers of mineral metabolism. Method 15 Adult patients with ESRD, scheduled for a living-donor kidney transplantation, were included in this cross-sectional study. Laboratory analyses included calcium, phosphate, PTH 1-84 and alkaline phosphatase. BMSi was determined by RPI with the OsteoProbe RUO in the tibia. Bone mineral density was measured by dual X-ray absorptiometry. Results Patients with bone mineral strenght index above median had higher bone mineral density of the right hip and total body than patients below median (p = 0.04). Alkaline phosphatase was lower in patients with BMSi below the median (47 (35-71) U/L vs. 103 (53-318) U/L, p = 0.009). There was a trend towards a significant relationship between length and BMSi (p = 0.09). Conclusion We identified for the first time an association of BMSi with BMD and alkaline phosphatase in patients with ESRD. Our findings of an association of BMSi with BMD are in accordance with findings in other populations with increased fracture risk.

Serum Calcium and Serum Alkaline Phosphatase Levels and their Correlations with Disease Activity in Patients with Rheumatoid Arthritis

Rheumatoid Arthritis is a systemic autoimmune disease, characterized by chronic synovial inflammationleading to joint destruction and bone erosion. Metabolic changes have been studied in rheumatoid arthritis,with several studies reported decrease in serum calcium, and increase in serum alkaline phosphatase inrheumatoid arthritis patients in comparison to healthy individuals. This study has been undertaken toevaluate serum calcium and serum alkaline phosphatase levels in patients with rheumatoid arthritis, andtheir correlation with disease activity. A total of 100 patients with rheumatoid arthritis were enrolled in thestudy and compared with 50 healthy controls (46 female: 4 male) matched for age and sex. No significantdifferences have been noticed in mean values of serum calcium, corrected calcium, and serum alkalinephosphatase in patients with rheumatoid arthritis and healthy controls. The mean values of serum calcium,corrected calcium and serum alkaline phosphatase levels were slightly higher with moderate and high diseaseactivity in comparison to low disease activity in patients with rheumatoid arthritis, but the differences didnot reach the statistical significance.

Correlation between Plasma Osteopontin and Alkaline Phosphatase in Type 2 Diabetes Mellitus Patients

Diabetes Mellitus (DM) is a chronic disease caused by pancreas the inability to produce insulin or ineffectively insulin use.Fracture risk in type 2 DM patients increases even though the bone density is normal. This study aimed to examine thecorrelation of osteopontin (OPN) and alkaline phosphatase (ALP) in type 2 DM patients. An observational analytical studywas conducted in 73 type 2 DM patients in Dr. Moewardi Hospital, Surakarta from October to November 2018. The subjectswere examined for blood pressure, fasting blood glucose, two hours postprandial blood glucose, HbA1c, OPN, and ALPlevels. P-value &lt;0.05 was statistically significant with a 95% confidence interval. Poorly controlled type 2 DM had higher OPNlevels than well-controlled (20.5±2.8 vs. 14.8±3.1 ng/mL, p &lt;0.001). The ALP concentration was also higher in poorlycontrolled type 2 DM patients (79.9±31.7 vs. 61.1±25 U/L, p=0.003). The levels of OPN and ALP were significantly correlatedin type 2 diabetes (r=0.273; p=0.020) and in well-controlled patients (r=0.353; p=0.047) but no correlation was found inpoorly controlled type 2 DM patients (r= -0.073; p= 0.652). In this study, a significant correlation was found between OPNand ALP in patients with type 2 DM and well-controlled. Further study involving healthy controls and bone ALPmeasurement is needed.

A randomized, placebo-controlled, phase II study of obeticholic acid for primary sclerosing cholangitis

Background & Aims:Primary sclerosing cholangitis (PSC) is a rare, cholestatic liver disease with no currently approved therapies. Obeticholic acid (OCA) is a potent farnesoid X receptor (FXR) agonist approved for the treatment of primary biliary cholangitis. We investigated the efficacy and safety of OCA in patients with PSC.Methods:AESOP was a phase II, randomized, double-blind, placebo-controlled, dose-finding study. Eligible patients were 18 to 75 years of age with a diagnosis of PSC and serum alkaline phosphatase (ALP) ≥2× the upper limit of normal (ULN) and total bilirubin <2.5× ULN. Patients were randomized 1:1:1 to receive placebo, OCA 1.5–3.0 mg, or OCA 5–10 mg once daily for a 24-week, double-blind phase followed by a 2-year, long-term safety extension (LTSE). Primary endpoints were change in ALP from baseline to week 24, and safety.Results:The intent-to-treat population comprised 76 patients randomized to placebo (n = 25), OCA 1.5–3.0 mg (n = 25), and OCA 5–10 mg (n = 26). At week 24, serum ALP was significantly reduced with OCA 5–10 mg vs. placebo (least-square [LS] mean difference = −83.4 [SE = 40.3] U/L; 95% CI −164.28 to −2.57; p = 0.043). Serum ALP was not significantly reduced with OCA 1.5–3.0 mg vs. placebo at week 24 (LS mean [SE] difference = −78.29 [41.81] U/L; 95% CI −162.08 to 5.50; p = 0.067). Total bilirubin remained comparable to baseline in all groups. The most common treatment-emergent adverse event was dose-related pruritus (placebo 46%; OCA 1.5–3.0 mg 60%; OCA 5–10 mg 67%). Reductions in ALP were maintained during the LTSE, and no new safety signals emerged.Conclusions:Treatment with OCA 5–10 mg reduced serum ALP in patients with PSC. Mild to moderate dose-related pruritus was the most common adverse event.Registration:ClinicalTrials.gov: NCT02177136; EudraCT: 2014-002205-38.

Correlation between anti-mitochondrial antibodies and clinical serological and cirrhotic markers of primary biliary cholangitis

Objective To explore the correlation between the level of anti-mitochondrial antibody (AMA) and clinical indicators of first visited primary biliary cholangitis (PBC) patients with positive AMA. Methods From January 2013 to December 2016, the clinical data of 1 323 patients with positive AMA and/or AMA-M2 detected for the first time were collected through the Information System of Peking University People′s Hospital. Among them, 183 were detected by indirect immunofluorescence assay, 431 were measured by immunoblotting, and 709 were determined by enzyme-linked immunosorbent assay (ELISA). Patients were divided into undiagnosed PBC group (non-PBC group, 973 cases) and newly diagnosed PBC group (new-PBC group, 350 cases including 268 cases of non-liver cirrhosis and 82 cases of liver cirrhosis); among 709 cases detected by ELISA, there were 567 cases in the non-PBC group and 142 cases in the new-PBC group (115 cases of non-liver cirrhosis PBC group and 27 cases of liver cirrhosis PBC group). Among 183 cases determined by indirect immunofluorescence assay, there were 118 cases in the non-PBC group and 65 cases in the new-PBC group. Among them 69 cases with low AMA titer (1∶40—1∶80) (53 cases of non-PBC group and 16 cases of new-PBC group), 95 cases with medium titer (1∶160—1∶320) (59 cases of non-PBC group and 36 cases of new-PBC group) and 19 cases with high titer (≥1∶640) (six cases of non-PBC group and 13 cases of new-PBC group). AMA levels among groups were compared, and its correlation with clinical serology and cirrhosis indicators of PBC including immunoglobulin (Ig)G, IgM, platelet, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltranspeptadase (GGT), alkaline phosphatase (ALP), serum total protein, serum albumin, total bilirubin (TBil), total cholesterol (TC), and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis (Fib-4) was analysed. Mann-Whitney U test, Kruskal-Wallis test, and linear regression analysis were performed for statistical analysis. Results By ELISA method, the median titer of AMA-M2 of 709 patients was 53 RU/mL, the serum AMA and AMA-M2 levels of new-PBC group were both higher than those of non-PBC group (1∶320 vs. 1∶80, 180 RU/mL vs. 47 RU/mL), and the differences were statistically significant (χ2 = 14.111, Z = -7.531, both P 0.05). AMA-M2 value of patients in PBC with liver cirrhosis group was positively correlated with IgM level (r = 0.38, P = 0.039), but was not correlated with APRI and Fib-4 (all P > 0.05). The median of AMA value of 183 patients who underwent indirect immunofluorescence test was 1∶160. In non-PBC group, the IgM levels of patients with low, medium and high AMA titers gradually increased (the median levels were 1.2, 1.7 and 1.8 g/L, respectively); in new-PBC group, the levels of IgM, GGT and ALP of patients with low, medium and high AMA titers gradually increased (median IgM levels were 1.5, 3.7 and 4.1 g/L, respectively; GGT levels were 144, 182 and 317 U/L, respectively; and ALP levels were 137, 168 and 221 U/L, respectively), and the differences were statistically significant (χ2 =6.260, 7.081, 8.030, 15.226, all P<0.05). In non-PBC group, the median level of serum AMA-M2 of men was lower than that of women (41 RU/L vs. 50 RU/L), and the difference was statistically significant (Z = -2.945, P = 0.003). In new-PBC group, the median level of serum AMA-M2 of men tended to be lower than that of women (113 RU/mL vs. 206 RU/mL), but the difference was not statistically significant (P=0.257). Conclusion Serum AMA level is correlated with many clinical parameters and may be related with the disease severity in patients with PBC. Key words: Anti-mitochondrial antibody; Primary biliary cholangitis; Liver cirrhosis; Clinical significance

Association between serum alkaline phosphatase and renal outcome in patients with type 2 diabetes mellitus

This retrospective study included 299 patients with type 2 diabetes mellitus and biopsy-confirmed diabetic nephropathy (DN) to investigate the prognostic value of alkaline phosphatase (ALP) for renal outcome. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for the serum ALP level on renal outcome, which was defined as end-stage renal disease (ESRD) or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline. The median baseline ALP was 80 IU/L with an interquartile range of 64–97 IU/L. Serum ALP was negatively associated with eGFR but positively associated with proteinuria and renal interstitial fibrosis. During a median follow-up period of 23 months, ESRD or a 50% declined in the eGFR occurred in 156 (52.2%) patients. The highest quartile of ALP was significantly associated with poor renal outcome, as defined above (HR 2.38, 95% confidence interval [CI] 1.09–5.17), when adjusted for sociodemographics, baseline eGFR, proteinuria, liver function parameters, parathyroid hormone levels, and renal pathological findings. Each standard deviation higher in the natural log-transformed ALP was associated with a 25% increased risk for poor renal outcome. Additionally, there was a graded increase in the risk for poor renal outcome with higher ALP in patients with nephrotic-range proteinuria. However, no significant associations were observed between serum ALP levels and renal outcome in patients with non-nephrotic-range proteinuria. In conclusion, an elevated ALP level was independently associated with poor renal outcome in patients with type 2 diabetes mellitus and nephrotic-range proteinuria after multivariate adjustment.

Plasma inorganic pyrophosphate and alkaline phosphatase in patients with pseudoxanthoma elasticum.

Inorganic pyrophosphate (PPi) plays a major role inhibiting dystrophic calcification. The aim was to analyze levels of PPi in patients having pseudoxanthoma elasticum (PXE), and controls as well as the enzymes who regulate the PPi plasma concentration. We collected fasting blood samples from PXE patients and age- and sex-matched controls in ethylenediamine tetraacetic acid (EDTA) and citrate-theophylline-adenosine-dipyridamole (CTAD) containing tubes. We measured PPi, ENPP1 mass and activity, alkaline phosphatase (AP) and tissue non-specific alkaline phosphatase (TNAP), CD73 and Human Platelet Factor-4 (CXCL4). PPi in EDTA and CTAD samples were lower in PXE subjects than in controls (1.11±0.26 vs. 1.43±0.41 µM/L and 0.35±0.15 vs. 0.61±0.18 µM/L respectively, P<0.05). TNAP and liver TNAP activities were also higher in PXE than in controls (80.3±27.0 vs. 63.3±16.4 UI/L and 25.6±14.9 vs. 12.9±9.2 UI/L respectively, P<0.05). ENPP1 mass and activity as well as CD73 were almost identical. There was a weak but significant inverse correlation between TNAP activity and PPi levels (Pearson correlation -0.379, P<0.05) in both groups. High TNAP activity seems to contribute to low plasma levels of PPi in subjects with PXE, reinforcing the idea that pharmacological reduction of TNAP activity may help to reduce dystrophic calcification in PXE patients.

Hepatic glypican-3 and alpha-smooth muscle actin overexpressions reflect severity of liver fibrosis and predict outcome after successful portoenterostomy in biliary atresia

BackgroundGlypican-3 plays a vital role in regulating embryonic morphogenesis of the liver. This study aimed to investigate associations of hepatic expressions of glypican-3 and alpha-smooth muscle actin with clinical parameters in biliary atresia. MethodsLiver specimens were obtained from 20 biliary atresia infants and 7 non-biliary atresia controls. Relative mRNA expressions of glypican-3, alpha-smooth muscle actin, and signaling molecules of Wnt/β-catenin were measured using real-time polymerase chain reaction. Protein expressions of glypican-3 and alpha-smooth muscle actin were examined using immunohistochemistry. Masson’s trichrome staining was conducted to evaluate the stage of liver fibrosis. ResultsUp-regulation of glypican-3 mRNA expression was observed in biliary atresia livers, and its expression was positively associated with alpha-smooth muscle actin, β-catenin, c-Myc, and cyclin D-1. Immunostaining scores of glypican-3 and alpha-smooth muscle actin were significantly increased in biliary atresia livers. Biliary atresia patients with poor outcomes had significantly greater glypican-3 expression than those with good outcomes, consistent with hepatic alpha-smooth muscle actin expression analysis. Hepatic glypican-3 expression was associated with age, albumin, aspartate transaminase, and alkaline phosphatase in biliary atresia patients, while hepatic alpha-smooth muscle actin expression was correlated with alkaline phosphatase in the patients. Moreover, glypican-3 and alpha-smooth muscle actin expressions were positively associated with fibrosis stage in biliary atresia livers. There was a positive relationship between glypican-3 and alpha-smooth muscle actin expression in biliary atresia livers. Combined high expressions of glypican-3 and alpha-smooth muscle actin were associated with poor survival. ConclusionHepatic overexpressions of glypican-3 and alpha-smooth muscle actin were associated with hepatic dysfunction and the degree of liver fibrosis in biliary atresia.

1067 Use of Obeticholic Acid in Patients With Primary Biliary Cholangitis: A Systematic Review and Meta-Analysis

INTRODUCTION: Obeticholic acid (OCA), a farnesoid-X receptor agonist, has been approved for the management of PBC since 2016. It has been shown to significantly decrease serum alkaline phosphatase (ALP) and total bilirubin levels in patients with primary biliary cholangitis (PBC), either alone or in combination with ursodiol. Data on the efficacy of OCA in PBC is limited. We conducted a systematic review and meta-analysis to evaluate the efficacy of OCA in patients with PBC. METHODS: We searched PubMed, Cochrane and Embase databases for randomized control trials (RCTs) comparing OCA to placebo in the management of PBC through 2019. The Cochrane Risk of Bias tool was used to assess the quality of the RCTs. We estimated odds ratio (OR) with 95% confidence interval (CI) for each outcome using a random effects model. The quality of the evidence was assessed using the GRADE approach. RESULTS: A total of 3 randomized controlled trials including 440 patients were identified. The mean age of patients was 54 and follow up ranged from 3-12 months. The studies varied with respect to whether OCA was used as monotherapy or added to standard of care (ursodiol). Compared to placebo, OCA resulted in reduction of ALP to &lt; 1.67X the ULN with an OR of 5.92 (CI 2.98 – 11.94, P &lt; 0.00001); and 1.76X the ULN with an OR of 5.95 (CI 3.25 – 10.93; P &lt; 0.00001). Across the three studies, patients on OCA experienced higher rates of pruritus as compared with placebo. The overall certainty of evidence was moderate. Data on clinical endpoints such as quality of life, progression to cirrhosis or liver transplantation, and mortality were lacking. CONCLUSION: Obeticholic acid is superior to placebo in reducing ALP in patients with PBC. An important limitation in these studies is the lack of data on clinical endpoints however, ALP levels have been shown to correlate with risk of liver transplantation and death. More RCT data with longer follow up is needed to fully assess the net benefits and harms of OCA in patients with PBC.

Use of Removable Orthodontic Appliance: Does it influence The Salivary Components?

Introduction: Saliva plays a key role in the oral cavity health. It contains many defense elements and is considered a cornerstone in the oral metabolism. Objective: The aim of this study was to investigate the changes in the salivary concentrations of calcium, glucose, total protein, lactate dehydrogenase and alkaline phosphatase in patients undergoing removable orthodontic appliances treatment. Methods: Ninety saliva samples were collected from thirty subjects ranging in age from 8 to 11 years. An initial sample was attained before starting treatment with removable orthodontic appliances; a second sample 1 month after treatment and a third sample was obtained three months following treatment. The saliva was collected from each patient in pre-labeled sterile containers using the passive drool method. Results: Salivary lactate dehydrogenase and alkaline phosphatase concentrations were significantly increased in patients undergoing removable orthodontic treatment after as compared to before treatment. There was also an increase in the calcium, glucose and total protein concentrations but the differences were insignificant. Conclusion: Removable orthodontic treatment changes the oral fluid contents, promotes an increase in the levels of salivary lactate dehydrogenase and alkaline phosphatase enzymes after one month of treatment with increased values after three months. These oral changes emphasize the importance of maintaining proper oral hygiene measures during treatment.