Alpha fetoprotein in the differentiation of neonatal hepatitis and biliary atresia: current status and implications for the pathogenesis of these disorders

Niemann-Pick disease associated with liver disorders

We report a case of Niemann-Pick disease (NPD) with accumulation of sphingomyelin in reticuloendothelial system (RES), hepatocellular giant cell transformation (GCT), cirrhosis, and multiple hepatocellular adenomata in a 19-month-old girl. GCT, but no NP-cells, were seen at age 3 months by biopsy. Cirrhosis and hepatocellular adenomata were demonstrated in the liver at 19 months of age. Cytoplasmic, probably locally synthesized, globules of alpha-1-antitrypsin (A-1-AT) were accumulated in the hepatocellular adenomata. A-1-AT and alpha-fetoprotein (AFP) were present in the serum.

Differences in the structure of alpha-fetoprotein and its clinical use in pediatric surgery

Techniques have been studied which distinguish two variants of human alpha-fetoprotein (AFP) on the basis of characteristics of the carbohydrate moiety of this glycoprotein. AFP in serum samples from six children with tumors of yolk sac origin showed little concanavalin-A (Con A) binding. In contrast, Con A binding of AFP was almost complete in serum samples from 14 other subjects with elevated AFP, including two with liver-cell tumors, eight with neonatal cholestasis, and four normal newborn infants. Differences were confirmed by immunoelectrophoretic studies. Thus, AFP from cells of yolk sac origin can be distinguished from AFP from liver cells or from tumors of hepatic cell origin.

Alphafetoprotein in congenital biliary atresia and neonatal hepatitis

Alphafetoprotein (AFP) production was investigated clinically and histologically in cases of congenital biliary atresia and neonatal hepatitis. While serum AFP levels were all higher than 16,000 ng/ml in seven patients with neonatal hepatitis, they were less than 10,000 ng/ml in 50 per cent of 12 patients with biliary atresia. Therefore, serum AFP levels below 10,000 ng/ml were suggestive of a diagnosis of biliary atresia. A number of AFP granules were identified in the liver cells and multinucleated giant cells in patients with neonatal hepatitis and biliary atresia, using an immunoperoxidase method. The serum AFP levels paralleled the number of cells with AFP granules. However, no characteristic differences in distribution of these granules occurred in the hepatic cells and giant cells. The AFP producing mechanism was qualitatively the same in neonatal hepatitis and biliary atresia. These phenomena suggest that congenital biliary atresia and neonatal hepatitis may have the same pathogenesis.