Although it is recognized that more biomarkers are needed to evaluate the progression of liver disease and response to medications, plasma alkaline phosphatase and conjugated bilirubin are a focus of clinical trials and utilized by physicians in practice. Conjugated bilirubin is a surrogate marker for the status of bile acid transport and the lowering of plasma levels in response to administration of ursodeoxycholic acid indicates that a choleretic effect has occurred. Plasma alkaline phosphatase levels are affected by hepatic bile acid composition and flow and the status of the cholangioles. Medications that reduce endogenous bile acid pool size can augment the effect of ursodeoxycholic acid by expanding its proportion in those undergoing enterohepatic circulation. In addition, they can lower the elevated steady state concentration of hepatocellular bile acids and retard progression to cirrhosis.
Plasma biomarkers, Conjugated bilirubin, Alkaline phosphatase, FXR agonists, Ursodeoxycholic acid, Obeticholic acid, Cholangioles, Canalicular conduit