Macroaspartasemia as a Cause of Isolated Elevation of Aspartate Aminotransferase

OBJECTIVES The increase of serum aspartate aminotransferase (AST) is generally found in hepatic, cardiac, muscular disease and hemolytic disorders of the red blood cell (RBC). The elevation of its activity is suspected in pathological conditions of these organs. However, instances without any of those conditions rarely exist. METHODS The experimental samples were obtained from a normal person's hemolysed RBC, a hepatitis patient and a macroaspartatemic female's serum. They were studied with exclusion chromatography, electrophoresis of AST and changes of AST activity due to Polyethylene Glycol (PEG) and various conditions on storage. RESULTS 1) The patterns of AST activity by exclusion chromatography are similar to the hemolysed RBC and the hepatitis's serum but differs by the isolated AST elevation. 2) The AST activity with addition of PEG and different anti-immunoglobulin subtypes to different serums are slightly decreased in hepatitis but markedly decreased with PEG and anti-IgG in macroaspartatemia. 3) The patterns of AST activity in electrophoresis are single band-cytosomal AST (cAST)-from hemolysed RBC and two bands-mitochondrial AST (mAST) and cAST-from hepatitis, the major being cAST and the minor mAST. Even though there are two bands, the major one is atypical and the minor corresponds to mAST in macroaspartatemia. 4) The changes of AST activity on storage according to time and temperature show to be stable over 4 weeks at room temperature and cooled condition, and 9 weeks under frozen state in macroaspartatase. CONCLUSION Concluding from the above findings, macroaspartatemia is an enzyme-immunoglobulin complex composed of cAST with IgG. MacroAST might be stabler than usual AST at physical conditions.