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Aim of this study was to determine and further characterize the serum aminopeptidase-M in children with liver diseases. Based on our new assay, we have shown two fractions of the enzyme. Activity of the first fraction is expressed in undiluted serum at pH adjusted from 8.5 (pH of storaged serum) to 7.4. Activity of the second fraction (cryptic activity) appears in the serum (pH 7.4) as a result of dilution and/or addition of aniline naphthalene sulfonic acid. In children with Alagille syndrome, extrahepatic biliary duct atresia, Byler's disease, and acute hepatitis due to hepatitis B virus infection, activities of both fractions are highly elevated as compared to healthy children or those with chronic viral hepatitis. Moreover, serum aminopeptidase-M seems to reflect other aspects of the pathological process than those reflected by the alanine aminotransferase and gamma-glutamyltranspeptidase. Due to increased activity and broad substrate specificity, the enzyme seems to be also a cofactor of cholestasis and hepatitis.

Analysis of data on 9 cases with active cytomegalovirus infection in patients with kidney grafts showed a positive association of serum leucine aminopeptidase activity concentration with the appearance of plasmacytoid lymphocytes in blood. Additional studies indicate that like the liver, the lymphocytes contain leucine aminopeptidase in relatively large quantities and that this enzyme is increased about 3-fold in plasmacytoid lymphocytes when compared with the activity in normal lymphocytes. In contrast, the 'hepatic' enzyme alanine aminotransferase is practically absent in both lymphocytes and plasmacytoid cells. Therefore, the difference in serum between the relative increases of leucine aminopeptidase and alanine aminotransferase may be attributed to proliferating plasmacytoid lymphocytes. Earlier observations on a large number of cases of acute viral hepatitis A or B lend credence to this assumption. However, in this disease, the serum enzyme changes reflect the much greater involvement of the liver and the relatively slight, but significant, proliferation of plasmacytoid lymphocytes. Our hypothesis is confirmed by the recent observation of 3 cases of acute EBV infection (infectious mononucleosis) in otherwise healthy individuals showing greatly elevated leucine aminopeptidase in contrast to normal or slightly raised alanine aminotransferase in serum.

We examined the clinical usefulness of serum tripeptide aminopeptidase (EC 3.4.11.4) activity in diagnosing liver diseases. We found that increased tripeptide aminopeptidase activity accompanied an elevation in alanine aminotransferase activity (ALT) in the sera of patients with non-cancerous liver diseases and that these enzyme activities were correlated (r = 0.826-0.972). In contrast, an increase in tripeptide aminopeptidase activity did not coincide with an elevation in ALT activity in the sera of patients with cancerous liver diseases. We also observed a correlation in acute hepatitis and in patients following transcatheter arterial embolization of hepatoma throughout their subsequent clinical courses. The difference in serum enzyme activities for cancerous and non-cancerous liver diseases seems to result from changes in enzyme activities in cancerous liver tissues. We found that the ratio of tripeptide aminopeptidase to ALT activity in hepatoma tissues (1.9) was 4 times higher than that in normal liver tissues (0.5).