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turnover),
enzyme
activity
in
plasma/serum
Extracellular
(E.C.)
space
and
its
rate
of
mitochondrial
cytosolic form).
form,
distinct
from
in
females
and
in
males
after
prostatectomy).
Clinical Applications:
The main use of ACP lies in the diagnosis of prostatic
cancer (only when the disease has spread to adjacent bone
e.g. pelvis). The enzyme in serum is markedly increased.
Spread to soft tissue: high ACP level may be seen.
If tumor remains as nodule / not extended beyond
prostate capsule: only of patients may show elevated
serum activity of ACP.
of
enzyme
location
predominantly
in
Isoenzymes:
Placental and small intestinal mucosa: ALP forms under
separate genetic control.
Bone, liver and kidney: ALP is a product of the same
gene locus but subject to post-translational modification
within each tissue.
Liver
Bone
Placenta
Intestine
Effect of Heat:
Placental ALP is unaffected at 65 C, whereas all other
ALP isozymes lose their activity totally. Heating at 56 C
for 10 minutes: Intestinal ALP loses 20% of its activity,
liver ALP 60% and bone ALP 80%. Urea denaturation
(2M): Placental ALP most stable, bone ALP the least.
Physiological causes for raised serum ALP:
1. In infancy due to predominance of bone ALP until
about the age of puberty (2-2 x adult normal). In
adult most ALP activity is due to liver isoenzyme.
2. Intestinal ALP appears only in serum if a person is of
blood groups O or A, secretors of ABH red cell
antigens and are positive for Lewis antigen.
3. At puberty: up to 5-6 x adult age.
4. Pregnancy: placental ALP appears in serum of
pregnant women only during second and third
trimester. Sharp reduction in P.ALP often indicates
placental insufficiency and death of fetus.
Clinical Applications:
1. Hepatobiliary Disease
A. Very high levels of ALP are seen in biliary
obstruction
Moderate levels of ALP are seen in parenchymal
liver disease
This is important in differential diagnosis of
hepatic and obstructive jaundice.
B. In extrahepatic obstruction: serum bilirubin and
ALP rise and fall in parallel.
C. In acute hepatic necrosis there is little change in
ALP even when bilirubin concentration is rising
dramatically. If icterus fails to clear and patients go
into cholestatic phase, ALP rises substantially.
D. In biliary cirrhosis: high level of ALP even when
bilirubin is normal. However, in portal cirrhosis
ALP level remains normal.
E. In alcoholic fatty liver: ALP is raised.
F. In carcinoma or lymphatous infilteraton of liver, the
Regan isoenzyme (resembles placental ALP) has
been detected in 1% - 3% of such patients
There are
hyperparathyroidism
with
bone
hyperparathyoidism,
as
in
renal
Creatine P + ADP
Clinical Applications:
1. Myocardial Infarction (M.I.): The most useful test in
establishing / refuting M.I. Increase in serum CK after 6
Re-infarction,
thromboembolism,
and
Other
Dehydrogenase
(LDH)
(NAD-
LD5
Clinical Applications:
1. Myocardial Infarction (M.I.): (>5 x normal).
2. Hepatobiliary Disease:
disease
including
obstructive
4. Cancer:
ALT
Asp + KG
AST
Pyruvate + Glu
oxloacetate + Asp
Tissue Distribution:
ALT: Almost exclusively found in the cytosol and in
high concentration in hepatocyte.
AST: found in cytosol and mitochondria. Abundant in:
liver, heart, and skeletal muscle.
Clinical Applications:
1. Myocardial Infarction:
In a proportion of