Alanine aminotransferase (ALAT, AlAT, ALT, GPT, SGPT)

Alanine aminotransferase (ALAT, AlAT, ALT, GPT, SGPT) 

Alanine aminotransferase (ALAT, AlAT, ALT, GPT, SGPT) is found mainly in liver cells, and less commonly in skeletal muscles, heart muscle and the kidneys. Under normal conditions, ALT is detected in blood plasma in trace amounts. It is an enzyme that remains inside cells, where it performs its biological role. The appearance of alanine aminotransferase in the blood indicates damage to the cells in which it was contained. ALT is found mainly in hepatocytes, or liver cells, and to a lesser extent in other tissues. It is therefore considered a fairly liver-specific enzyme. However, to identify diseases of this organ more precisely, the de Ritis ratio (the ratio of AST to ALT activity) is calculated; a value above or below one suggests certain liver diseases.

Testing alanine aminotransferase levels is indicated when liver disease or damage is suspected. Symptoms that may suggest this include:

• jaundice and itchy skin – resulting from impaired metabolism of bilirubin, a bile pigment,
• general symptoms such as weakness, fatigue, loss of appetite, weight loss and painful muscle cramps – caused by poor nutritional status,
• digestive symptoms – bloating, nausea, vomiting and pain under the ribs on the right side,
• in men, loss of underarm and pubic hair, loss of libido, impotence and gynaecomastia (enlargement of breast tissue) – resulting from impaired metabolism of female sex hormones, known as oestrogens,
• in women, menstrual irregularities, absence of periods and infertility,
• petechiae (tiny spots of bleeding under the skin), frequent nosebleeds and bleeding gums – these occur because of clotting disorders caused by insufficient production of clotting factors by the failing liver.

The reference range for alanine aminotransferase (ALAT) in a blood biochemistry test is 5-40 U/I (85-680 nmol/l).

ALT values from 200 to 400 U/l may indicate:

• hepatic cholestasis, meaning blocked secretion or flow of bile. Bile produced by liver cells flows first into the gallbladder and then into the intestine. Blockage of its flow (or secretion by cells) can have various causes: bile duct stones, biliary cirrhosis, the use of certain medicines, tumours, cysts and infections (including hepatitis virus infections and sepsis). It can occur during pregnancy.
• liver cirrhosis – with simultaneously raised AST values
• a heart attack – with considerably higher AST values
• primary carnitine deficiency,
• infectious mononucleosis (ALT levels peak in the second week after infection and return to normal in the fifth week),
• raised levels are also observed with the use of many medicines – during treatment with high doses of salicylates and with long-term administration of fibrates and first-generation sulfonylureas,
• pancreatitis,
• liver diseases,
• haemolysis (the release of haemoglobin into plasma as a result of the destruction and breakdown of erythrocytes),
• ALT can also rise as a result of skeletal muscle damage (such as crush injuries to the limbs, other injuries, muscle inflammation and, less commonly, muscular dystrophy (muscle wasting)), intense, strenuous physical activity and strength training.
• raised levels can occur with poisoning and the use of certain medicines, especially statins, which lower cholesterol levels, and certain psychotropic medicines, such as agomelatine and amisulpride.

An increase in ALT activity to between 400 and 4000 U/l may indicate a number of conditions, including:

• viral hepatitis
• toxic liver damage
• circulatory failure
• hypoxia (a lack of oxygen in the tissues)

Testing ALT levels is very simple and involves taking a blood sample, usually from the inner elbow. The liver has a very high capacity to regenerate, and damage to it does not always cause painful symptoms. Hepatitis B (WZWB) causes symptoms similar to ordinary flu, while hepatitis C (WZWC) can remain symptom-free for many years while already damaging liver cells. It is worth checking the condition of your liver by having an alanine aminotransferase test. If your result is raised, contact your GP, who will probably arrange additional tests for anti-HCV and anti-HBs antibodies, or an abdominal ultrasound scan. The result report is issued in Polish.

* If your results fall outside the reference range, we recommend consulting a doctor.

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