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<p><strong>Alpha fetoprotein</strong> (<strong>AFP</strong>) is a molecule produced in the developing embryo and fetus. In humans, AFP levels decrease gradually after birth, reaching adult levels by 8 to 12 months. Normal adult AFP levels are low, but detectable; however, AFP has no known function in normal adults. In normal fetuses, AFP binds the hormone estradiol. AFP is measured in pregnant women, using maternal blood or amniotic fluid, as a screening test for a subset developmental abnormalities, principally open neural tube defects. It is also measured in pregnant women, other adults, and children, serving as a biomarker to detect a subset of tumors, principally <font color="#800080">hepatocellular carcinoma</font> and endodermal sinus tumors.</p>
<p>&nbsp;</p>
<p><span class="mw-headline"><font size="5">Structure and levels</font></span></p>
<p>AFP is a glycoprotein of 590 amino acids and a carbohydrate moiety.&nbsp;<br />
Many functions have been proposed for AFP; an anti-cancer active site peptide has been identified and is referred to as AFPep. AFP is normally produced by the fetal yolk sac, the fetal gastrointestinal tract, and eventually by the fetal liver. Levels of AFP in fetal serum rise until the end of the first trimester of gestation and then fall. Because the fetus excretes AFP into its urine, amniotic fluid levels of AFP tend to mirror fetal serum levels. In contrast, maternal serum levels of fetal AFP are much lower but continue to rise until about week 32.</p>
<p>&nbsp;</p>
<p><span class="mw-headline"><font size="5">History</font></span></p>
<p>LabCorp, a large US clinical laboratory testing company, began offering AFP screening tests in the early 1980s.<sup class="reference" id="cite_ref-0"><font color="#800080">[1]</font></sup></p>
<p><font color="#800080"></font></p>
<h2><span class="mw-headline">AFP in normal infants</span></h2>
<p>The normal range of AFP for adults is variously reported as under 50, under 10, and under 5. At birth, normal infants have AFP levels 4 or more magnitudes above<sup class="reference" id="cite_ref-pmid9592840_1-0"><font color="#800080">[2]</font></sup><sup class="reference" id="cite_ref-pmid9402482_2-0"><font color="#800080">[3]</font></sup><sup class="reference" id="cite_ref-pmid2483492_3-0"><font color="#800080">[4]</font></sup><sup class="reference" id="cite_ref-pmid2439023_4-0"><font color="#800080">[5]</font></sup><sup class="reference" id="cite_ref-pmid15469851_5-0"><font color="#800080">[6]</font></sup><sup class="reference" id="cite_ref-Wu.2B1985_6-0"><font color="#800080">[7]</font></sup> the normal range for adults,<sup class="reference" id="cite_ref-pmid1375809_7-0"><font color="#800080">[8]</font></sup><sup class="reference" id="cite_ref-pmid65304_8-0"><font color="#800080">[9]</font></sup> decreasing to adult levels over the first year of life. Correct evaluation of <em>abnormal</em> AFP levels in infants must take into account this normal pattern.</p>
<p>Very high AFP levels may be subject to <strong>hooking</strong>, resulting in a false low level.<sup class="reference" id="cite_ref-Jassam.2B2006_9-0"><font color="#800080">[10]</font></sup></p>
<table style="FONT-SIZE: 95%; TEXT-ALIGN: left" cellspacing="0" width="200" class="infobox">
    <tbody>
        <tr>
            <td style="FONT-SIZE: 95%; BACKGROUND: lightgrey; TEXT-ALIGN: center" colspan="2"><strong>Elevated alphafetoprotein</strong><br />
            <em>Classification and external resources</em></td>
        </tr>
        <tr>
            <th>ICD-10</th>
            <td>R77.2, Z36.1</td>
        </tr>
        <tr>
            <th>ICD-9</th>
            <td>V28.1</td>
        </tr>
    </tbody>
</table>
<p>&nbsp;</p>
<h2><span class="mw-headline">AFP tests</span></h2>
<p>There are two categories of AFP tests: tests performed on serum (blood plasma), and tests performed on amniotic fluid. Tests performed on serum are further categorized by the reason for performing the test: maternal serum, adult tumor marker, and pediatric tumor marker.</p>
<p>&nbsp;</p>
<h3><span class="mw-headline">Tests performed on serum</span></h3>
<p>The standard is a quantitative test, reporting a measured concentration of AFP in the sample, but there is also a less expensive qualitative test, reporting only that the concentration is normal or high. The qualitative test is appropriate only in some circumstances.</p>
<p>The resulting test report should specify the assay method and equipment used, and the report of a quantitative test should also provide a reference range for the test result. Many laboratories report reference ranges that are based on all other samples tested in that laboratory, necessarily including samples with abnormal AFP concentrations due to disease. Superior reference ranges are produced by research on healthy subjects.</p>
<p>&nbsp;</p>
<h4><span class="mw-headline">Maternal serum</span></h4>
<p>Maternal serum AFP tests need to be interpreted according to the gestational age, as levels rise until about 32 weeks gestation. Typically, such measurements are done in the middle of the second trimester (14-16 weeks). Elevated levels are seen in multiple gestation as well as in a number of fetal abnormalities, such as neural tube defects including spina bifida and anencephaly, and abdominal wall defects. Other possibilities are errors in the date of the gestation or fetal demise. In contrast, low levels of maternal serum AFP are associated with Down syndrome and Trisomy 18. Diabetic patients also have lower levels. Patients with abnormal levels need to undergo detailed obstetric ultrasonography. The information is then used to decide whether to proceed with amniocentesis.</p>
<p>Maternal serum AFP may be measured as part of a routine prenatal screening test:</p>
<ul>
    <li>Triple test: AFP, hCG and estriol </li>
    <li><strong>Quad test</strong>: AFP, hCG, estriol, and Inhibin </li>
    <li>Genetic counseling usually is offered when the screening test result is positive. </li>
</ul>
<p>&nbsp;</p>
<h4><span class="mw-headline">Tumor marker</span></h4>
<p>Like any elevated tumor marker, elevated AFP by itself is not diagnostic, only suggestive. Tumor markers are used primarily to monitor the result of a treatment (e.g. chemotherapy). If levels of AFP go down after treatment, the tumor is not growing. In the case of babies, after treatment AFP should go down <strong>faster</strong> than it would normally. A temporary increase in AFP immediately following chemotherapy may indicate not that the tumor is growing but rather that it is shrinking (and releasing AFP as the tumor cells die). AFP-L3, an isoform of AFP which binds <em>Lens culinaris</em> agglutinin, can be particularly useful in early identification of aggressive tumors associated with <font color="#800080">hepatocellular carcinoma</font> (HCC).</p>
<p>AFP is the main tumor marker (sometimes with HCG) used to monitor testicular cancer, ovarian cancer, and malignant teratoma in any location: values of AFP over time can have significant effect on the treatment plan.</p>
<p>AFP is normally elevated in infants, and because teratoma is the single most common kind of tumor in infants, several studies have provided reference ranges for AFP in normal infants.<sup class="reference" id="cite_ref-10"><font color="#800080">[11]</font></sup><sup class="reference" id="cite_ref-11"><font color="#800080">[12]</font></sup><sup class="reference" id="cite_ref-12"><font color="#800080">[13]</font></sup>. Perhaps the most useful is this equation: log Y = 7.397 - 2.622.log (X + 10), where X = age in days and Y = AFP level in nanograms per milliliter.<sup class="reference" id="cite_ref-13"><font color="#800080">[14]</font></sup></p>
<p><font color="#800080"><br />
</font></p>
<p><font color="#800080"></font></p>
<h3><span class="mw-headline">Tests performed on cerebrospinal fluid (CSF)</span></h3>
<p>In normal infants, AFP in CSF is<sup class="reference" id="cite_ref-14"><font color="#800080">[15]</font></sup>:</p>
<ul>
    <li>median 61 kIU/L (5th-95th centile: 2-889 kIU/L) in infants -69 to 31 days old </li>
    <li>median 1.2 kIU/L (5th-95th centile: 0.1-12.5 kIU/L) in infants 32 to 110 days old </li>
</ul>
<p>Levels of AFP in CSF decline with gestational age in proportion to levels of AFP in serum<sup class="reference" id="cite_ref-15"><font color="#800080">[16]</font></sup></p>
<p><font color="#800080"></font></p>
<h2><span class="mw-headline">Interpretation of AFP test results</span></h2>
<p>AFP test results often are reported as either ng/ml or MoM (multiple of the median, where the median is calculated for an appropriate reference population).</p>
<p>&nbsp;</p>
<h3><span class="mw-headline">Maternal serum</span></h3>
<p>Abnormally elevated AFP in the serum of a pregnant woman can have one or more of these sources:</p>
<ul>
    <li>a problem with the fetus </li>
    <li>a problem with the placenta </li>
    <li>a tumor or liver disease in the woman </li>
    <li>a normally elevated AFP in the fetus or woman (some people naturally have very high AFP) </li>
</ul>
<p>Usual follow-up steps include (1) a prenatal ultrasound exam to look for fetal abnormalities and/or (2) measurement of AFP in amniotic fluid obtained via amniocentesis.</p>
<p>&nbsp;</p>
<h3><span class="mw-headline">Amniotic fluid</span></h3>
<p>AFP in amniotic fluid has one or two sources. The fetus normally excretes AFP into its urine, hence into the amniotic fluid. A fetus with one of three broad categories of defects also releases AFP by other means. These categories are <strong>open</strong> neural tube defect, <strong>open</strong> abdominal wall defect, and skin disease or other failure of the interior or exterior body surface.</p>
<p>Abnormally elevated AFP in amniotic fluid can have one or more of many different causes:</p>
<ul>
    <li>normal elevation. 75% of AF AFP test results in the range 2.0 to 4.9 MoM are false positives: the baby is normal. </li>
    <li>open neural tube defect </li>
    <li>open abdominal wall defect </li>
    <li>congenital nephrosis </li>
    <li>others </li>
</ul>
<p>&nbsp;</p>
<h2><span class="mw-headline">Sources of AFP: Normal</span></h2>
<p>Serum alpha-fetoprotein is a fetal serum protein produced by the yolk sac and liver.</p>
<p>&nbsp;</p>
<h2><span class="mw-headline">Sources of AFP: Abnormal</span></h2>
<p>&nbsp;</p>
<h3><span class="mw-headline">Tumors</span></h3>
<p>Principal tumors that secrete AFP are endodermal sinus tumor (yolk sac carcinoma), neuroblastoma, hepatoblastoma, and <font color="#800080">hepatocellular carcinoma</font>.</p>
<p>With regard to hepatocellular carcinoma, AFP is not useful for screening<sup class="reference" id="cite_ref-pmid18087192_16-0"><font color="#800080">[17]</font></sup> but is somewhat useful for surveillance after treatment.<sup class="reference" id="cite_ref-pmid18087182_17-0"><font color="#800080">[18]</font></sup></p>
<p>Rare AFP-secreting tumor types include carcinoma in a malignant mixed M&uuml;llerian tumor.<sup class="reference" id="cite_ref-pmid10739713_18-0"><font color="#800080">[19]</font></sup></p>
<p>In Wilms tumor AFP is rarely elevated, but when it is elevated it may serve as a marker of disease progression or recurrence.<sup class="reference" id="cite_ref-pmid17987303_19-0"><font color="#800080">[20]</font></sup></p>
<p>There are case reports of elevated AFP associated with teratoma. However, some of these case reports involve infants but do not correct for the normal elevation of AFP in infants, while others ignore the likelihood that teratoma (and other germ cell tumors) may in fact be mixed tumors containing elements of endodermal sinus tumor.</p>
<p>In patients with AFP-secreting tumors, serum levels of AFP often correlate with tumor size. Resection is usually associated with a fall in serum levels. Serum levels are useful in assessing response to treatment.</p>
<p>&nbsp;</p>
<h3><span class="mw-headline">Other</span></h3>
<p>Increased serum levels in adults are also seen in acute hepatitis, colitis and ataxia telangiectasia.</p>
<p>&nbsp;</p>
<h2><span class="mw-headline">References</span></h2>
<div class="references-small" style="moz-column-count: 2; webkit-column-count: 2; column-count: 2">
<ol class="references">
    <li id="cite_note-0"><strong><font color="#800080">^</font></strong> LabCorp 2004 Annual Report </li>
    <li id="cite_note-pmid9592840-1"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Blohm ME, Vesterling-H&ouml;rner D, Calaminus G, G&ouml;bel U (1998). &quot;Alpha 1-fetoprotein (AFP) reference values in infants up to 2 years of age.&quot;. <em>Pediatric hematology and oncology</em> <strong>15</strong> (2): 135-42. PMID 9592840.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha+1-fetoprotein+%28AFP%29+reference+values+in+infants+up+to+2+years+of+age.&amp;rft.jtitle=Pediatric+hematology+and+oncology&amp;rft.date=1998&amp;rft.volume=15&amp;rft.issue=2&amp;rft.au=Blohm+ME%2C+Vesterling-H%C3%B6rner+D%2C+Calaminus+G%2C+G%C3%B6bel+U&amp;rft.pages=135-42&amp;rft_id=info:pmid/9592840"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid9402482-2"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Ohama K, Nagase H, Ogino K, <em>et al</em> (1997). &quot;Alpha-fetoprotein (AFP) levels in normal children.&quot;. <em>European journal of pediatric surgery&nbsp;: official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift f&uuml;r Kinderchirurgie</em> <strong>7</strong> (5): 267-9. PMID 9402482.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha-fetoprotein+%28AFP%29+levels+in+normal+children.&amp;rft.jtitle=European+journal+of+pediatric+surgery+%3A+official+journal+of+Austrian+Association+of+Pediatric+Surgery+...+%5Bet+al%5D+%3D+Zeitschrift+f%C3%BCr+Kinderchirurgie&amp;rft.date=1997&amp;rft.volume=7&amp;rft.issue=5&amp;rft.au=Ohama+K%2C+Nagase+H%2C+Ogino+K%2C+%27%27et+al%27%27&amp;rft.pages=267-9&amp;rft_id=info:pmid/9402482"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid2483492-3"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Lee PI, Chang MH, Chen DS, Lee CY (1988). &quot;Serum alpha-fetoprotein in normal Chinese infants.&quot;. <em>Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui</em> <strong>29</strong> (3): 152-8. PMID 2483492.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Serum+alpha-fetoprotein+in+normal+Chinese+infants.&amp;rft.jtitle=Zhonghua+Minguo+xiao+er+ke+yi+xue+hui+za+zhi+%5BJournal%5D.++Zhonghua+Minguo+xiao+er+ke+yi+xue+hui&amp;rft.date=1988&amp;rft.volume=29&amp;rft.issue=3&amp;rft.au=Lee+PI%2C+Chang+MH%2C+Chen+DS%2C+Lee+CY&amp;rft.pages=152-8&amp;rft_id=info:pmid/2483492"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid2439023-4"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Blair JI, Carachi R, Gupta R, Sim FG, McAllister EJ, Weston R (1987). &quot;Plasma alpha fetoprotein reference ranges in infancy: effect of prematurity.&quot;. <em>Arch. Dis. Child.</em> <strong>62</strong> (4): 362-9. PMID 2439023.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Plasma+alpha+fetoprotein+reference+ranges+in+infancy%3A+effect+of+prematurity.&amp;rft.jtitle=Arch.+Dis.+Child.&amp;rft.date=1987&amp;rft.volume=62&amp;rft.issue=4&amp;rft.au=Blair+JI%2C+Carachi+R%2C+Gupta+R%2C+Sim+FG%2C+McAllister+EJ%2C+Weston+R&amp;rft.pages=362-9&amp;rft_id=info:pmid/2439023"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid15469851-5"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Bader D, Riskin A, Vafsi O, <em>et al</em> (2004). &quot;Alpha-fetoprotein in the early neonatal period--a large study and review of the literature&quot;. <em>Clin. Chim. Acta</em> <strong>349</strong> (1-2): 15-23. doi:10.1016/j.cccn.2004.06.020. PMID 15469851.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha-fetoprotein+in+the+early+neonatal+period--a+large+study+and+review+of+the+literature&amp;rft.jtitle=Clin.+Chim.+Acta&amp;rft.date=2004&amp;rft.volume=349&amp;rft.issue=1-2&amp;rft.au=Bader+D%2C+Riskin+A%2C+Vafsi+O%2C+%27%27et+al%27%27&amp;rft.pages=15-23&amp;rft_id=info:pmid/15469851&amp;rft_id=info:doi/10.1016%2Fj.cccn.2004.06.020"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-Wu.2B1985-6"><strong><font color="#800080">^</font></strong> <cite class="book" style="FONT-STYLE: normal">Wu JT, Roan Y, Knight JA (1985). &quot;Serum levels of AFP in normal infants: their clinical and physiological significance&quot;, Mizejewski GJ, Porter I: <em>Alfa-Fetoprotein and Congenital Disorders</em>. Academic Press, 111-122.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&amp;rft.genre=book&amp;rft.btitle=Alfa-Fetoprotein+and+Congenital+Disorders&amp;rft.atitle=Serum+levels+of+AFP+in+normal+infants%3A++their+clinical+and+physiological+significance&amp;rft.au=Wu+JT%2C+Roan+Y%2C+Knight+JA&amp;rft.pub=Academic+Press&amp;rft.pages=111-122">&nbsp;</span> </li>
    <li id="cite_note-pmid1375809-7"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Ball D, Rose E, Alpert E (1992). &quot;Alpha-fetoprotein levels in normal adults&quot;. <em>Am. J. Med. Sci.</em> <strong>303</strong> (3): 157-9. doi:10.1097/00000441-199203000-00004. PMID 1375809.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha-fetoprotein+levels+in+normal+adults&amp;rft.jtitle=Am.+J.+Med.+Sci.&amp;rft.date=1992&amp;rft.volume=303&amp;rft.issue=3&amp;rft.au=Ball+D%2C+Rose+E%2C+Alpert+E&amp;rft.pages=157-9&amp;rft_id=info:pmid/1375809&amp;rft_id=info:doi/10.1097%2F00000441-199203000-00004"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid65304-8"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Sizaret P, Martel N, Tuyns A, Reynaud S (1977). &quot;Mean alpha-fetoprotein values of 1,333 males over 15 years by age groups&quot;. <em>Digestion</em> <strong>15</strong> (2): 97-103. PMID 65304.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Mean+alpha-fetoprotein+values+of+1%2C333+males+over+15+years+by+age+groups&amp;rft.jtitle=Digestion&amp;rft.date=1977&amp;rft.volume=15&amp;rft.issue=2&amp;rft.au=Sizaret+P%2C+Martel+N%2C+Tuyns+A%2C+Reynaud+S&amp;rft.pages=97-103&amp;rft_id=info:pmid/65304"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-Jassam.2B2006-9"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Jassam N, Jones CM, Briscoe T, Horner JH (2006). &quot;The hook effect: a need for constant vigilance.&quot;. <em>Ann. Clin. Biochem.</em> <strong>43</strong> (Pt 4): 314-7. doi:10.1258/000456306777695726. PMID 16824284.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=The+hook+effect%3A+a+need+for+constant+vigilance.&amp;rft.jtitle=Ann.+Clin.+Biochem.&amp;rft.date=2006&amp;rft.volume=43&amp;rft.issue=Pt+4&amp;rft.au=Jassam+N%2C+Jones+CM%2C+Briscoe+T%2C+Horner+JH&amp;rft.pages=314-7&amp;rft_id=info:pmid/16824284&amp;rft_id=info:doi/10.1258%2F000456306777695726"><span style="DISPLAY: none">&nbsp;</span></span> PubMed </li>
    <li id="cite_note-10"><strong><font color="#800080">^</font></strong> Serum alpha fetoprotein (AFP) levels in normal infants </li>
    <li id="cite_note-11"><strong><font color="#800080">^</font></strong> Alpha 1-fetoprotein (AFP) reference values in infants up to 2 years of age </li>
    <li id="cite_note-12"><strong><font color="#800080">^</font></strong> Alpha-fetoprotein in the early neonatal period--a large study and review of the literature </li>
    <li id="cite_note-13"><strong><font color="#800080">^</font></strong> Serum alpha-fetoprotein levels in normal infants: a reappraisal of regression analysis and sex difference </li>
    <li id="cite_note-14"><strong><font color="#800080">^</font></strong> Coakley J, Kellie SJ, Nath C, Munas A, Cooke-Yarborough C. Interpretation of alpha-fetoprotein concentrations in cerebrospinal fluid of infants. Ann Clin Biochem. 2005 Jan;42(Pt 1):24-9. PubMed abstract </li>
    <li id="cite_note-15"><strong><font color="#800080">^</font></strong> Alpha-fetoprotein in human fetal cerebrospinal fluid </li>
    <li id="cite_note-pmid18087192-16"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Paul SB, Gulati MS, Sreenivas V, Madan K, Gupta AK, Mukhopadhyay S, Acharya SK (2007). &quot;Evaluating patients with cirrhosis for hepatocellular carcinoma: value of clinical symptomatology, imaging and alpha-fetoprotein.&quot;. <em>Oncology</em> <strong>72 Suppl 1</strong>: 117&ndash;23. doi:10.1159/000111717. PMID 18087192.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Evaluating+patients+with+cirrhosis+for+hepatocellular+carcinoma%3A+value+of+clinical+symptomatology%2C+imaging+and+alpha-fetoprotein.&amp;rft.jtitle=Oncology&amp;rft.date=2007&amp;rft.volume=72+Suppl+1&amp;rft.au=Paul+SB%2C+Gulati+MS%2C+Sreenivas+V%2C+Madan+K%2C+Gupta+AK%2C+Mukhopadhyay+S%2C+Acharya+SK&amp;rft.pages=117%E2%80%9323&amp;rft_id=info:pmid/18087192&amp;rft_id=info:doi/10.1159%2F000111717"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid18087182-17"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Kim do Y, Paik YH, Ahn SH, Youn YJ, Choi JW, Kim JK, Lee KS, Chon CY, Han KH (2007). &quot;PIVKA-II is a useful tumor marker for recurrent hepatocellular carcinoma after surgical resection.&quot;. <em>Oncology</em> <strong>72 Suppl 1</strong>: 52&ndash;7. doi:10.1159/000111707. PMID 18087182.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=PIVKA-II+is+a+useful+tumor+marker+for+recurrent+hepatocellular+carcinoma+after+surgical+resection.&amp;rft.jtitle=Oncology&amp;rft.date=2007&amp;rft.volume=72+Suppl+1&amp;rft.au=Kim+do+Y%2C+Paik+YH%2C+Ahn+SH%2C+Youn+YJ%2C+Choi+JW%2C+Kim+JK%2C+Lee+KS%2C+Chon+CY%2C+Han+KH&amp;rft.pages=52%E2%80%937&amp;rft_id=info:pmid/18087182&amp;rft_id=info:doi/10.1159%2F000111707"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid10739713-18"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Rebischung C, Pautier P, Morice P, Lhomme C, Duvillard P (2000). &quot;Alpha-fetoprotein production by a malignant mixed M&uuml;llerian tumor of the ovary.&quot;. <em>Gynecol. Oncol.</em> <strong>77</strong> (1): 203&ndash;5. doi:10.1006/gyno.1999.5653. PMID 10739713.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha-fetoprotein+production+by+a+malignant+mixed+M%C3%BCllerian+tumor+of+the+ovary.&amp;rft.jtitle=Gynecol.+Oncol.&amp;rft.date=2000&amp;rft.volume=77&amp;rft.issue=1&amp;rft.au=Rebischung+C%2C+Pautier+P%2C+Morice+P%2C+Lhomme+C%2C+Duvillard+P&amp;rft.pages=203%E2%80%935&amp;rft_id=info:pmid/10739713&amp;rft_id=info:doi/10.1006%2Fgyno.1999.5653"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li id="cite_note-pmid17987303-19"><strong><font color="#800080">^</font></strong> <cite style="FONT-STYLE: normal">Crocoli A, Madafferi S, Jenkner A, Zaccara A, Inserra A (2007). &quot;Elevated serum alpha-fetoprotein in Wilms tumor may follow the same pattern of other fetal neoplasms after treatment: evidence from three cases.&quot;. <em>Pediatr Surg Int</em>: 499. doi:10.1007/s00383-007-2067-7. PMID 17987303.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Elevated+serum+alpha-fetoprotein+in+Wilms+tumor+may+follow+the+same+pattern+of+other+fetal+neoplasms+after+treatment%3A+evidence+from+three+cases.&amp;rft.jtitle=Pediatr+Surg+Int&amp;rft.date=2007&amp;rft.au=Crocoli+A%2C+Madafferi+S%2C+Jenkner+A%2C+Zaccara+A%2C+Inserra+A&amp;rft.pages=499&amp;rft_id=info:pmid/17987303&amp;rft_id=info:doi/10.1007%2Fs00383-007-2067-7"><span style="DISPLAY: none">&nbsp;</span></span> </li>
</ol>
</div>
<p>&nbsp;</p>
<h2><span class="mw-headline">Further reading</span></h2>
<div class="references-small" style="MARGIN-LEFT: 1.5em; moz-column-count: 2; webkit-column-count: 2; column-count: 2">
<ul>
    <li><cite style="FONT-STYLE: normal">Nahon JL (1987). &quot;The regulation of albumin and alpha-fetoprotein gene expression in mammals.&quot;. <em>Biochimie</em> <strong>69</strong> (5): 445-59. PMID 2445387.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=The+regulation+of+albumin+and+alpha-fetoprotein+gene+expression+in+mammals.&amp;rft.jtitle=Biochimie&amp;rft.date=1987&amp;rft.volume=69&amp;rft.issue=5&amp;rft.au=Nahon+JL&amp;rft.pages=445-59&amp;rft_id=info:pmid/2445387"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Tilghman SM (1989). &quot;The structure and regulation of the alpha-fetoprotein and albumin genes.&quot;. <em>Oxf. Surv. Eukaryot. Genes</em> <strong>2</strong>: 160-206. PMID 2474300.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=The+structure+and+regulation+of+the+alpha-fetoprotein+and+albumin+genes.&amp;rft.jtitle=Oxf.+Surv.+Eukaryot.+Genes&amp;rft.date=1989&amp;rft.volume=2&amp;rft.au=Tilghman+SM&amp;rft.pages=160-206&amp;rft_id=info:pmid/2474300"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Mizejewski GJ (2003). &quot;Biological role of alpha-fetoprotein in cancer: prospects for anticancer therapy.&quot;. <em>Expert Rev Anticancer Ther</em> <strong>2</strong> (6): 709-35. doi:10.1586/14737140.2.6.709. PMID 12503217.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Biological+role+of+alpha-fetoprotein+in+cancer%3A+prospects+for+anticancer+therapy.&amp;rft.jtitle=Expert+Rev+Anticancer+Ther&amp;rft.date=2003&amp;rft.volume=2&amp;rft.issue=6&amp;rft.au=Mizejewski+GJ&amp;rft.pages=709-35&amp;rft_id=info:pmid/12503217&amp;rft_id=info:doi/10.1586%2F14737140.2.6.709"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Yachnin S, Hsu R, Heinrikson RL, Miller JB (1977). &quot;Studies on human alpha-fetoprotein. Isolation and characterization of monomeric and polymeric forms and amino-terminal sequence analysis.&quot;. <em>Biochim. Biophys. Acta</em> <strong>493</strong> (2): 418-28. PMID 70228.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Studies+on+human+alpha-fetoprotein.+Isolation+and+characterization+of+monomeric+and+polymeric+forms+and+amino-terminal+sequence+analysis.&amp;rft.jtitle=Biochim.+Biophys.+Acta&amp;rft.date=1977&amp;rft.volume=493&amp;rft.issue=2&amp;rft.au=Yachnin+S%2C+Hsu+R%2C+Heinrikson+RL%2C+Miller+JB&amp;rft.pages=418-28&amp;rft_id=info:pmid/70228"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Aoyagi Y, Ikenaka T, Ichida F (1977). &quot;Comparative chemical structures of human alpha-fetoproteins from fetal serum and from ascites fluid of a patient with hepatoma.&quot;. <em>Cancer Res.</em> <strong>37</strong> (10): 3663-7. PMID 71198.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Comparative+chemical+structures+of+human+alpha-fetoproteins+from+fetal+serum+and+from+ascites+fluid+of+a+patient+with+hepatoma.&amp;rft.jtitle=Cancer+Res.&amp;rft.date=1977&amp;rft.volume=37&amp;rft.issue=10&amp;rft.au=Aoyagi+Y%2C+Ikenaka+T%2C+Ichida+F&amp;rft.pages=3663-7&amp;rft_id=info:pmid/71198"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Aoyagi Y, Ikenaka T, Ichida F (1978). &quot;Copper(II)-binding ability of human alpha-fetoprotein.&quot;. <em>Cancer Res.</em> <strong>38</strong> (10): 3483-6. PMID 80265.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Copper%28II%29-binding+ability+of+human+alpha-fetoprotein.&amp;rft.jtitle=Cancer+Res.&amp;rft.date=1978&amp;rft.volume=38&amp;rft.issue=10&amp;rft.au=Aoyagi+Y%2C+Ikenaka+T%2C+Ichida+F&amp;rft.pages=3483-6&amp;rft_id=info:pmid/80265"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Aoyagi Y, Ikenaka T, Ichida F (1979). &quot;alpha-Fetoprotein as a carrier protein in plasma and its bilirubin-binding ability.&quot;. <em>Cancer Res.</em> <strong>39</strong> (9): 3571-4. PMID 89900.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=alpha-Fetoprotein+as+a+carrier+protein+in+plasma+and+its+bilirubin-binding+ability.&amp;rft.jtitle=Cancer+Res.&amp;rft.date=1979&amp;rft.volume=39&amp;rft.issue=9&amp;rft.au=Aoyagi+Y%2C+Ikenaka+T%2C+Ichida+F&amp;rft.pages=3571-4&amp;rft_id=info:pmid/89900"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Torres JM, Anel A, Uriel J (1992). &quot;Alpha-fetoprotein-mediated uptake of fatty acids by human T lymphocytes.&quot;. <em>J. Cell. Physiol.</em> <strong>150</strong> (3): 456-62. doi:10.1002/jcp.1041500305. PMID 1371512.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha-fetoprotein-mediated+uptake+of+fatty+acids+by+human+T+lymphocytes.&amp;rft.jtitle=J.+Cell.+Physiol.&amp;rft.date=1992&amp;rft.volume=150&amp;rft.issue=3&amp;rft.au=Torres+JM%2C+Anel+A%2C+Uriel+J&amp;rft.pages=456-62&amp;rft_id=info:pmid/1371512&amp;rft_id=info:doi/10.1002%2Fjcp.1041500305"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Greenberg F, Faucett A, Rose E, <em>et al.</em> (1992). &quot;Congenital deficiency of alpha-fetoprotein.&quot;. <em>Am. J. Obstet. Gynecol.</em> <strong>167</strong> (2): 509-11. PMID 1379776.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Congenital+deficiency+of+alpha-fetoprotein.&amp;rft.jtitle=Am.+J.+Obstet.+Gynecol.&amp;rft.date=1992&amp;rft.volume=167&amp;rft.issue=2&amp;rft.au=Greenberg+F%2C+Faucett+A%2C+Rose+E%2C+%27%27et+al.%27%27&amp;rft.pages=509-11&amp;rft_id=info:pmid/1379776"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Bansal V, Kumari K, Dixit A, Sahib MK (1991). &quot;Interaction of human alpha fetoprotein with bilirubin.&quot;. <em>Indian J. Exp. Biol.</em> <strong>28</strong> (7): 697-8. PMID 1703124.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Interaction+of+human+alpha+fetoprotein+with+bilirubin.&amp;rft.jtitle=Indian+J.+Exp.+Biol.&amp;rft.date=1991&amp;rft.volume=28&amp;rft.issue=7&amp;rft.au=Bansal+V%2C+Kumari+K%2C+Dixit+A%2C+Sahib+MK&amp;rft.pages=697-8&amp;rft_id=info:pmid/1703124"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Pucci P, Siciliano R, Malorni A, <em>et al.</em> (1991). &quot;Human alpha-fetoprotein primary structure: a mass spectrometric study.&quot;. <em>Biochemistry</em> <strong>30</strong> (20): 5061-6. doi:10.1021/bi00234a032. PMID 1709810.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Human+alpha-fetoprotein+primary+structure%3A+a+mass+spectrometric+study.&amp;rft.jtitle=Biochemistry&amp;rft.date=1991&amp;rft.volume=30&amp;rft.issue=20&amp;rft.au=Pucci+P%2C+Siciliano+R%2C+Malorni+A%2C+%27%27et+al.%27%27&amp;rft.pages=5061-6&amp;rft_id=info:pmid/1709810&amp;rft_id=info:doi/10.1021%2Fbi00234a032"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Liu MC, Yu S, Sy J, <em>et al.</em> (1985). &quot;Tyrosine sulfation of proteins from the human hepatoma cell line HepG2.&quot;. <em>Proc. Natl. Acad. Sci. U.S.A.</em> <strong>82</strong> (21): 7160-4. doi:10.1073/pnas.82.21.7160. PMID 2414772.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Tyrosine+sulfation+of+proteins+from+the+human+hepatoma+cell+line+HepG2.&amp;rft.jtitle=Proc.+Natl.+Acad.+Sci.+U.S.A.&amp;rft.date=1985&amp;rft.volume=82&amp;rft.issue=21&amp;rft.au=Liu+MC%2C+Yu+S%2C+Sy+J%2C+%27%27et+al.%27%27&amp;rft.pages=7160-4&amp;rft_id=info:pmid/2414772&amp;rft_id=info:doi/10.1073%2Fpnas.82.21.7160"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Gibbs PE, Zielinski R, Boyd C, Dugaiczyk A (1987). &quot;Structure, polymorphism, and novel repeated DNA elements revealed by a complete sequence of the human alpha-fetoprotein gene.&quot;. <em>Biochemistry</em> <strong>26</strong> (5): 1332-43. doi:10.1021/bi00379a020. PMID 2436661.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Structure%2C+polymorphism%2C+and+novel+repeated+DNA+elements+revealed+by+a+complete+sequence+of+the+human+alpha-fetoprotein+gene.&amp;rft.jtitle=Biochemistry&amp;rft.date=1987&amp;rft.volume=26&amp;rft.issue=5&amp;rft.au=Gibbs+PE%2C+Zielinski+R%2C+Boyd+C%2C+Dugaiczyk+A&amp;rft.pages=1332-43&amp;rft_id=info:pmid/2436661&amp;rft_id=info:doi/10.1021%2Fbi00379a020"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Sakai M, Morinaga T, Urano Y, <em>et al.</em> (1985). &quot;The human alpha-fetoprotein gene. Sequence organization and the 5' flanking region.&quot;. <em>J. Biol. Chem.</em> <strong>260</strong> (8): 5055-60. PMID 2580830.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=The+human+alpha-fetoprotein+gene.+Sequence+organization+and+the+5%27+flanking+region.&amp;rft.jtitle=J.+Biol.+Chem.&amp;rft.date=1985&amp;rft.volume=260&amp;rft.issue=8&amp;rft.au=Sakai+M%2C+Morinaga+T%2C+Urano+Y%2C+%27%27et+al.%27%27&amp;rft.pages=5055-60&amp;rft_id=info:pmid/2580830"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Ruoslahti E, Pihko H, Vaheri A, <em>et al.</em> (1975). &quot;Alpha fetoprotein: structure and expression in man and inbred mouse strains under normal conditions and liver injury.&quot;. <em>Johns Hopkins Med. J. Suppl.</em> <strong>3</strong>: 249-55. PMID 4138095.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Alpha+fetoprotein%3A+structure+and+expression+in+man+and+inbred+mouse+strains+under+normal+conditions+and+liver+injury.&amp;rft.jtitle=Johns+Hopkins+Med.+J.+Suppl.&amp;rft.date=1975&amp;rft.volume=3&amp;rft.au=Ruoslahti+E%2C+Pihko+H%2C+Vaheri+A%2C+%27%27et+al.%27%27&amp;rft.pages=249-55&amp;rft_id=info:pmid/4138095"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Urano Y, Sakai M, Watanabe K, Tamaoki T (1985). &quot;Tandem arrangement of the albumin and alpha-fetoprotein genes in the human genome.&quot;. <em>Gene</em> <strong>32</strong> (3): 255-61. PMID 6085063.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Tandem+arrangement+of+the+albumin+and+alpha-fetoprotein+genes+in+the+human+genome.&amp;rft.jtitle=Gene&amp;rft.date=1985&amp;rft.volume=32&amp;rft.issue=3&amp;rft.au=Urano+Y%2C+Sakai+M%2C+Watanabe+K%2C+Tamaoki+T&amp;rft.pages=255-61&amp;rft_id=info:pmid/6085063"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Beattie WG, Dugaiczyk A (1983). &quot;Structure and evolution of human alpha-fetoprotein deduced from partial sequence of cloned cDNA.&quot;. <em>Gene</em> <strong>20</strong> (3): 415-22. PMID 6187626.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Structure+and+evolution+of+human+alpha-fetoprotein+deduced+from+partial+sequence+of+cloned+cDNA.&amp;rft.jtitle=Gene&amp;rft.date=1983&amp;rft.volume=20&amp;rft.issue=3&amp;rft.au=Beattie+WG%2C+Dugaiczyk+A&amp;rft.pages=415-22&amp;rft_id=info:pmid/6187626"><span style="DISPLAY: none">&nbsp;</span></span> </li>
    <li><cite style="FONT-STYLE: normal">Morinaga T, Sakai M, Wegmann TG, Tamaoki T (1983). &quot;Primary structures of human alpha-fetoprotein and its mRNA.&quot;. <em>Proc. Natl. Acad. Sci. U.S.A.</em> <strong>80</strong> (15): 4604-8. doi:10.1073/pnas.80.15.4604. PMID 6192439.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Primary+structures+of+human+alpha-fetoprotein+and+its+mRNA.&amp;rft.jtitle=Proc.+Natl.+Acad.+Sci.+U.S.A.&amp;rft.date=1983&amp;rft.volume=80&amp;rft.issue=15&amp;rft.au=Morinaga+T%2C+Sakai+M%2C+Wegmann+TG%2C+Tamaoki+T&amp;rft.pages=4604-8&amp;rft_id=info:pmid/6192439&amp;rft_id=info:doi/10.1073%2Fpnas.80.15.4604"><span style="DISPLAY: none">&nbsp;</span></span> </li>
</ul>
</div>
<p>&nbsp;</p>
<p><span class="mw-headline"><font size="5">See also</font></span></p>
<ul>
    <li>Tumor marker </li>
    <li>AFP-L3 </li>
</ul>
<p>&nbsp;</p>
<p><span class="mw-headline"><font size="5">External links</font></span></p>
<ul>
    <li><a title="Medical Subject Headings" href="http://en.wikipedia.org/wiki/Medical_Subject_Headings">MeSH</a> <em><a class="external text" title="http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&amp;term=alpha-Fetoproteins" rel="nofollow" href="http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&amp;term=alpha-Fetoproteins">alpha-Fetoproteins</a></em> </li>
    <li>&nbsp;</li>
</ul>
<br />