levels of alkaline phosphatase, for example, hepatitis C. A high level of this enzyme does not reflect any damage in the liver, even though high alkaline phosphatase levels may result from a blockage of flow in the biliary tract or an increase in the pressure of the liver. Elevated levels If it is unclear why the level of alkaline phosphatase is elevated, isoenzyme studies using electrophoresis can confirm the source of the increase. Skelphosphatase (which is localized in osteoblasts and extracellular layers of newly synthesized matrix) is released into circulation by a yet unclear mechanism. Placental alkaline phosphatase is elevated in seminomas and active forms of rickets, as well as in the following diseases and conditions: Biliary obstruction Bone conditions Osteoblastic bone tumors Osteomalacia Osteoporosis Hepatitis Cirrhosis Acute cholecystitis Myelofibrosis Leukemoid reaction Lymphoma Paget's disease Sarcoidosis Hyperthyroidism Hyperparathyroidism Myocardial infarction Pregnancy Very high doses of estrogens Lowered levels The following conditions or diseases may lead to reduced levels of alkaline phosphatase: Hypophosphatasia, a genetic disorder Women receiving estrogen therapy for menopausal symptoms Estrogen-containing oral contraceptives Men with recent heart surgery, malnutrition, magnesium deficiency, or severe anemia Children with achondroplasia and congenital iodine deficiency Children after a severe episode of enteritis Pernicious anemia Aplastic anemia Wilson's disease Hypothyroidism Zinc deficiency Malnutrition Steroid treatment Colitis Prognostic uses Measuring alkaline phosphatase (along with prostate specific antigen) during, and after six months of hormone treated metastatic prostate cancer was shown to predict the survival of patients. Leukocyte alkaline phosphatase Leukocyte alkaline phosphatase is found within mature white blood cells. White blood cell levels of LAP can help in the diagnosis of certain conditions. Higher than typical levels are seen in the physiological response, the leukemoid reaction, and in pathologies that include mature white blood cells, such as polycythemia vera, essential thrombocytosis, and in primary myelofibrosis. Lower than typical levels are found in pathologies that involve undeveloped leukocytes, such as chronic myelogenous leukemia (CML), paroxysmal nocturnal hemoglobinuria and acute myelogenous leukaemia. Structure and properties Alkaline phosphatase is homodimeric enzyme, meaning it is formed with two molecules. Three metal ions, two Zn and one Mg, are contained in the catalytic sites, and both types are crucial for enzymatic activity to occur. The enzymes catalyze the hydrolysis of monoesters in phosphoric acid which can additionally catalyze a transphosphorylation reaction with large concentrations of phosphate acceptors. While the main features of the catalytic mechanism and activity are conserved