Biliary alkaline phosphatase measured by mini-column chromatography on DEAE-cellulose: application to detection of hepatobiliary diseases.

Using chromatography on diethylaminoethyl (DEAE) cellulose, we measured biliary alkaline phosphatase (BALP; EC 3.1.3.1) activities in sera from 182 patients, most with hepatobiliary disorders but some with non-hepatobiliary diseases. Relative BALP activities were extremely low in otherwise healthy carriers of hepatitis B virus (mean: 5.4 U/L) and in patients with non-hepatobiliary diseases (mean: 5.3 U/L). Although BALP activities were detectable in some cases of liver cirrhosis and chronic hepatitis, these values were generally low (respective means: 12.6 and 12.0 U/L). High BALP activities were detected in patients with primary hepatocellular carcinoma, secondary metastatic liver tumors, and obstructive jaundice: mean values were 27.2, 37.2, and 73.6 U/L, respectively. There was no correlation between BALP activity and bilirubin concentration in patients with obstructive jaundice, nor between BALP activities in obstructive jaundice caused by stones and in those caused by extrahepatic tumor. Some patients with primary hepatocellular carcinoma had high BALP but low alpha-fetoprotein (AFP) values, some others the reverse. Based on AFP alone, the sensitivity for detecting hepatocellular carcinoma was 79%; adding BALP in parallel improved the sensitivity to 97%. We found minicolumn chromatography on DEAE-cellulose useful for determining BALP activity in hepatobiliary diseases.