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Plasma cyanate concentrations in chronic renal failure.

be of clinical utility. Although it seems odd for the authors to claim a correlation as evidence of clinical utility after arguing against this use in their third paragraph, the issue, as we understand it, is not just utility, but relative utility. A literature search will reveal several previous clinical studies of skeletal ALP activity in serum as determined by WGA precipitation, heat inactivation, and (more recently) by the IRMA; and, in fact, the study in question [1] was an assessment of skeletal ALP in serum of subjects with osteoporosis. We attempted to present the information we had gleaned regarding the apparent limitations of each assay: the heat inactivation assay had the greatest variation; the IRIVIA was cross-reactive with hepatic ALP; and the WGA assay did not recognize our putative skeletal ALP standards as entirely skeletal. We certainly would not dispute the contention that the WGA assay for skeletal ALP is more selective for skeletal ALP than is a total ALP assay-but how selective is it, and is it as (or more) specific than the heat inactivation or the IRMA methods? We agree with Klein and Bodenmuller that resolution of this issue will require further studies using isoenzyme standards prepared from both human tissues and sera. In addition, we submit that, with regard to the WGA assay, resolution of this issue will also require an independent assessment of variation in glycosylation as a potentially uncontrolled source of variation in the assay.