Enzymes VI-enzymes of clinical imp-I

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Enzymes VI – enzymes of clinical importance- I:

Dr. Hariharan MD, Assistant Professor,Dept of Biochem , Karpagam Faculty of medical Sciences and Research, Coimbatore. Dr. Hariharan. V, free download available in Internet Enzymes VI – enzymes of clinical importance- I

Enzymes elevated in liver disease:

Enzymes elevated in liver disease Dr. Hariharan. V, free download available in Internet Alanine aminotransferase Aspartate amino transferase Nucleotide phosphatase Gamma glutamyl transferase

Aspartate amino transferase:

Aspartate amino transferase Dr. Hariharan. V, free download available in Internet Old name- SGOT(serum glutamate oxaloacetate transaminase) Glutamate + oxaloacetate  Aspartate + alpha keto glutarate It needs pyridoxal phosphate for its action Normal level is 8-20 U/L It is elevated in myocardial infarction and liver diseases. Markedly elevated in hepatoma(hepatocellular carcinoma)

Alanine amino transferase:

Alanine amino transferase Dr. Hariharan. V, free download available in Internet Old name – SGPT(serum glutamate pyruvate transaminase ) Glutamate + Pyruvate  Alpha ketoglutarate + Alanine PLP is required as a co factor. Normal serum level is 13-35 U/L Very high levels are seen in acute hepatitis Both ALT and AST are increased in liver diseases. But ALT>AST AST>ALT seen in alcoholic hepatitis, cirrhosis and hepatoma Moderate elevations of ALT are seen in cirrhosis, hepatitis C, Non alcoholic steatohepatitis

Nucleotide phosphatase:

Nucleotide phosphatase Dr. Hariharan. V, free download available in Internet Also known as 5’ Nucleotidase Hydrolyses 5’ end of nucleosides Its an ecto enzyme(present in plasma membrane) Normal level is 2-10 U/L Increased in biliary obstruction, mildly elevated in hepatitis.

Gamma glutamyl transferase:

Gamma glutamyl transferase Dr. Hariharan. V, free download available in Internet Old name- gamma glutamyl transpeptidase Normal level- 10-30 U/L GGT is elevated even in mild biliary obstruction. In alchoholics, there is inflammation in biliary canaliculi and the cells swell leading to mild obstruction. So GGT is used to diagnose alcohol abuse. It will be elevated even when other LFT are normal

Enzymes elevated in heart disease:

Enzymes elevated in heart disease Dr. Hariharan. V, free download available in Internet CK-MB LDH AST Cardiac troponins

Cardiac troponins:

Cardiac troponins Dr. Hariharan. V, free download available in Internet They are not enzymes. They aid in diagnosing Myocardial infarction Troponin complex- 3 components- troponin C(Ca binding), Troponin T(Tropomyosin binding), Troponin I( inhibitory) Trp I has cardiac sprcific isoform. Cardiac Trp I is released within 4 hours of MI. it peaks at 14-24 hrs and remains elevated for 3-5 days Trp T elevates within 6 hrs and peaks at 72 hrs

PowerPoint Presentation:

Dr. Hariharan. V, free download available in Internet

Prostrate diseases:

Prostrate diseases Dr. Hariharan. V, free download available in Internet Acid phosphatase Prostrate specific antigen

Acid phosphatase:

Acid phosphatase Dr. Hariharan. V, free download available in Internet Normal levels- 2.5 to 12 U/L It is produced by prostrate cells, RBC, Platelets and WBC Tartarate resistant acid phosphatase is prostrate isoform It is elevated in prostrate cancer It is measured during the treatment of prostrate cancer.

Prostrate specific antigen:

Prostrate specific antigen Dr. Hariharan. V, free download available in Internet Produced by the epithelium of prostrate gland Its purpose is to liquefy the seminal fluid It is a serine protease Normal level- 1-5 mcg/L Elevated in prostrate cancer

Pancreatic diseases:

Pancreatic diseases Dr. Hariharan. V, free download available in Internet Amylase lipase

Amylase :

Amylase Dr. Hariharan. V, free download available in Internet Produced by pancreas and salivary glands Normal value- 50-120 IU/L It is elevated 1000 times in acute pancreatitis Peak values seen 5-12 hrs after the attack, remains elevated up to2-4 days after the acute phase subsided Moderate increases are seen in chr. Pancreatitis, mumps and pancreatic duct obstruction It is one of proteins seen in urine, when elevated.

Lipase:

Lipase Dr. Hariharan. V, free download available in Internet Its level is highly elevated in pancreatitis. Elevated up to 7-14 days Lipase is more sensitive for pancreatitis than amylase Moderate elevations seen in carcinoma pancreas, biliary diseases and perforated peptic ulcers

Other enzymes-cholinesterase:

Other enzymes-cholinesterase Dr. Hariharan. V, free download available in Internet Acetyl Cholinesterase or true ChE present in nerve endings and RBC. OPP(organophosphorous poisons) irreversibly inhibits AChE. Measurement of ChE level in RBC can be used as a marker for continuous exposure Pseudocholinesterase is produced by liver. Succinyl Choline is a muscle relaxant given during anasthesia during surgeries. This is hydrolysed by ChE within 2-4 min. but in some patients the ChE activity is absent. Leads to scoline apnea.

Glucose-6 Phosphate Dehydrogenase:

Glucose-6 Phosphate Dehydrogenase Dr. Hariharan. V, free download available in Internet It is an enzyme of HMP shunt and is needed for NADPH production NADPH is continuously needed by the RBCs to remove H2O2 produced In G6PD deficient individuals, H2O2 destroys cell membrane leading to reduced lifespan of RBC, leading to hemolytic anemia Drugs like aspirin and fava beans leads to increased oxidation and triggers hemolytic anemia in these patients Trait: gives protection from malaria

Enzymes as theraupeutic agents:

Enzymes as theraupeutic agents Dr. Hariharan. V, free download available in Internet Some of the enzymes are used as drugs in some clinical settings due to their unique properties. They are: Streptokinase- dissolves clot- used in MI Urokinase - dissolves clot- used in MI Pepsin- digestion- used for indigestion Trypsin-anti inflammatory-removes inflammatory proteins Chymotrypsin – --do--- Serratiopeptidase- anti edema- proteinase Asparginase – anti cancer

Diagnostic use of enzymes:

Diagnostic use of enzymes Dr. Hariharan. V, free download available in Internet Glucose oxidase(GOD) used to measure glucose Lipase- Triglycerides Restriction endonuclease- Restriction fragment length polymorphism Immobilised enzymes- ELISA

ELISA-Enzyme linked immunosorbant assay:

ELISA-Enzyme linked immunosorbant assay Dr. Hariharan. V, free download available in Internet

References :

References Dr. Hariharan. V, free download available in Internet Vasudevan Thank you

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