Synthesized by organs, secreted into plasma Substrate found in plasma Concentration is high in physiologic condition Eg: lipoprotein lipase,

enzyme involved in complement reaction and blood clotting Not significant to diagnose disease

Founds and function in cells Excreted from cells by damaged cells Essential properties of non functional enzyme in diagnosing disease:
Duration if increasing enzyme activity Specific location Intracellular location Enzyme synthesis increase with loosing enzyme

Changes in plasma enzyme activity are nearly always due to increase in the rate of release of enzymes into the circulation, most commonly caused by: i) necrosis or severe damage to cells, usually caused by ischaemia or toxins.

ii) increased rate of cell turnover during active growth, tissue repair or in cancer.
iii) increased concentration of enzymes within cells. iv) duct obstruction.

Creatinine is a product of creatinine phosphate metabolism in skeletal muscle. CK is widely distributed in tissue, with highest activities found in skeletal muscle, heart muscle and brain tissue.

CK levels are frequently elevated in disorders of cardiac and skeletal muscle. CK level is considered a sensitive indicator of acute myocardial infarction (AMI) and muscular dystrophy. CK isoenzymes: CK-MM (muscle type), CK-MB (hybrid type), CK-BB (brain type)

Present in most tissues, but especially in skeletal and cardiac muscle, liver and kidney Behavior in acute myocardial infarction: In AMI, serum activity rises sharply within first 12 hours, with a peak level at 24 hours or over and returns to normal within 3 to 5 days. Normal value: 10-35 IU/L

ALT activity most often measured as one of a group of liver function tests as a measure of hepatocellular damage, since it is more liver specific than AST. Normal value: 10-40 IU/L

Liver, bone, placenta and intestine are clinically important sources of plasma ALP activity. Normal value: 40-100 IU/L Pathological increase: > 5 x ULN : Pagets disease, osteomalacia, rickets, cholestasis, cirrhosis < 5 x ULN : bone tumors, hepatitis, inflamatory bowel disease.

Prostate epithelium, spleen kidney, liver and pancreas. Normal value: <6.5 IU/L

-Glutamyl transferase (GGT)

Kidney, liver, biliary tract and pancreas. Normal value: 10-55 IU/L Pathological increase: > 10 x ULN: cholestasis, alcoholic liver disease 5-10 x ULN: hepatitis, cirrhosis < 5 x ULN: excessive alcohol ingestion, enzyme inducing drugs

Increase in plasma due to acute damage to the liver, skeletal muscle and kidneys, megaloblastic and hemolytic anaemias.

Amylase

Salivary glands and exocrine pancrease Activity increase 5 x or even 10 x ULN, in acute pancreatitis.

Enzyme

Isomer

Origin

Clinical Significance

Creatine kinase (CK)

CK MM CK MB CK BB
LD1, LD2 LD3, LD4 LD5

Heart, skeletal muscle Myocardial Heart, muscle infarction Brain, thyroid, kidney, colon
All tissues Cardiac, hepatic, renal disease Cardiac, hepatic disease Bone and liver disease (cholestasis)

Lactate dehydrogenase (LDH) Aspartate aminotransferase (AST) Alkaline phosphatase (ALP)

All tissues

Bone, liver, kidney, mucosa GIT, placenta

Enzyme
Acid phosphatase

Isomer

Origin
Prostate gland, liver, erythrocyte, platelet, bone Liver

Clinical Significance
Prostate carcinoma Chronic liver disease Acute pancreatitis

Alanine aminotransferase (ALT) Trypsin, lipase, -amylase

Pancreas

A 59-year-old man attended his doctors surgery complaining of weight loss. Further questioning revealed a recent alteration in bowel habit. No positive physical signs were seen, but investigations revealed a positive faecal occult blood and the following test results: Test Result Reference range bilirubin 16mmol/L 2-17mmol/L alanine aminotransferase 30 IU/L 10-40 IU/L alkaline phosphatase 310 IU/L 40-100 IU/L - Glutamyl transferase 190 IU/L 10-55 IU/L albumin 38g/L 36-48g/L Comment on these results.

A 66-year-old man had experienced central chest pain on exertion for some months, but in the afternoon of the day prior to admission had had a particularly severe episode of pain lasting for about an hour. On admission the following morning, he was noted to be pale, but there were no other abnormalities on examination. The ECG was normal, but plasma enzymes taken at that time were as follows:

Test Result (IU/L) Reference range(IU/L) alanine aminotransferase 150 30-200 creatine kinase 45 10-35 lactate dehydrogenase 2500 230-460
Comment on these results. Is there evidence that this man has had a myocardial infarct?

A blood specimen was taken from a 65-year-old women to check her serum potassium concentration as she had been on thiazide diuretics for some time. The GP left the specimen in his car and dropped it off at the laboratory on the way to the surgery the next morning. Immediately after analyzing the sample, the biochemist was on the phone to the GP. Why?

Enzymes can be classified on the basis of the type of reaction it catalyzes (International Union of Biochemists [IUB] classes). They are: 1. Oxidoreductases: Involved in oxidation and reduction of substrates. 2. Transferase: Help in transfer of a particular group such as methyl or glycosyl groups from one substrate to another. 3. Hydrolases: Bring about hydrolytic cleavage of bonds like C-C, C-O, C-N, etc. 4. Lyases: Facilitate removal of small molecule from a large substrate leaving double bonds; also add groups to double bonds. 5. Isomerases: Isomerisation of substrate. 6. Ligases: Involved in joining together of two substrates, coupled to the hydrolysis of an ATP.