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Carcinofetale Antigene

Carcinofetal antigens. I. Alpha-fetoprotein

I. Alpha-Fetoprotein

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Summary

Alpha-fetoprotein (AFP) is an alpha1-glycoprotein (M.W. about 65000) appearing in the fetal serum of most mammals including man during the early stages of pregnancy; 4 weeks after birth in disappears altogether or exists at very low concentrations as in the normal adult. AFP is formed in the yolk sac, the fetal liver and the gastro-intestinal tract. One of its physiological functions in fetal life is supposed to be the protection of the fetus from maternal oestrogens (oestrophilic property).

The clinical significance of AFP is based on the regular and increasing production in primary liver cell carcinoma, less frequently in teratogenetic tumors where it serves as a control of therapy and course of the disease. Less frequent, minor and temporary increases in the AFP serum level occur in several primary tumors with secondary liver involvement, and in inflammatory gastro-intestinal diseases, e.g. of the liver (hepatitis, cirrhosis). AFP has an increasing importance in gynecology (gestational age, fetal distress syndrom, malformations, hydatidiform mole/chorion carcinoma).

The physico-chemical properties of AFP are widely known. Both fetal and tumor AFP appear to be immunologically and biochemically identical, as are that of tissue and biological fluids. The differences observed (variants, microheterogeneity) depend mainly on the different content of sialic acid. An antigenetic relationship exists. between the AFP of most species. The immunodiffusion (Ouchterlony) is the most frequently used but relatively insensitive test (1–5 µg/ml) in finding AFP, whereas the radioimmunoassay is the most sensitive one (up to 0,25 ng/ml) and permits the determination of normal serum levels in adults (below 20 ng/ml). The serum concentration in healthy pregnant women lies up to 500 ng/ml, in patients with hepatitis, liver cirrhosis and other liver diseases mostly under 3 µg/ml, whereas in those with primary liver cell carcinoma levels up to and above 600 mg-% have been found.

Zusammenfassung

Alpha-Fetoprotein (AFP) ist ein Alpha1-Glykoproteid (MG um 65000), das bei den meisten Säugetieren wie auch beim Menschen schon früh während der Gestation im Feten auftritt und etwa 4 Wochen nach Geburt im Neugeborenen wie später beim gesunden Erwachsenen nicht mehr oder nur in sehr geringer Konzentration nachweisbar ist. Es wird im Dottersack, der fetalen Leber und dem fetalen Gastrointestinaltrakt gebildet. Seine physiologische Bedeutung im Fetalleben besteht möglicherweise u.a. im Schutz des Feten vor den mütterlichen Östrogenen (östrophile Eigenschaft).

Die klinische Bedeutung von AFP beruht auf seiner regelmäßigen vermehrten und zunehmenden Bildung beim primären Leberzellcarcinom, seltener bei teratogeneitschen Geschwülsten. Dort dient es vornehmlich zur Therapie- und Verlaufskontrolle. Seltene, geringere und mehr vorübergehende Erhöhungen des AFP-Serum-spiegelsfanden sich bei einigen anderen Primärtumoren mit sekundärer Leberbeteiligung und bei entzündlichen gastrointestinalen Erkrankungen vor allem der Leber (Hepatitis, Cirrhose). Neuere Untersuchungen weisen auch auf eine wachsende Bedeutung von AFP für die Gynäkologie hin (Gestationsalter, fetal distress-Syndrom, Mißbildungen, Blasenmole/Chorioncarcinom).

Die physikalisch-chemischen Eigenschaften von AFP sind weitgehend bekannt. Fetal- wie Tumor-AFP scheinen immunologisch und biochemisch identisch, ebenso Gewebs-AFP mit dem aus biologischen Flüssigkeiten. Beobachtete Unterschiede (Varianten, Mikroheterogenität) sind hauptsächlich durch unterschiedlichen Sialinsäuregehalt bedingt. Zwischen Alpha-Fetoproteinen verschiedener Spezies besteht größtenteils antigenetische Verwandtschaft. Von den Nachweisverfahren für AFP in biologischen Flüssigkeiten ist die Immunodiffusion der verbreiteste aber auch unempfindlichste Test (1–5 µg/ml), während der Radioimmunoassay die größte Empfindlichkeit (bis 0,25 ng/ml) aufweist und auch Erwachsenen-Serumnormalspiegel (unter 20 ng/ml) zu bestimmen erlaubt. Serumkonzentrationen liegen bei gesunden Schwangeren bis 550 ng/ml (III. Trimenon), bei Hepatitiden, Lebercirrhosen und anderen Lebererkrankungen meist unter 3 µg/ml, während beim primären Leberzellcarcinom Erhöhungen bis über 600 mg-% gefunden wurden.

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Lamerz, R., Fateh-Moghadam, A. Carcinofetale Antigene. Klin Wochenschr 53, 147–169 (1975). https://doi.org/10.1007/BF01466760

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