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ENZYMES &CLINICAL ENZYMOLOGY. Prepared by: Assistant professor Dr.Sumreena Mansoor. Vignette 5. Presenting complaint : A 50 year old man complains of severe retrosternal pain radiating to his left arm and jaw.

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enzymes clinical enzymology

ENZYMES &CLINICAL ENZYMOLOGY

Prepared by: Assistant professor Dr.Sumreena Mansoor

vignette 5
Vignette 5
  • Presenting complaint: A 50 year old man complains of severe retrosternal pain radiating to his left arm and jaw.
  • Medical History: Severe chest pain on exertion that is relieved by sitting down. He is hypertensive and is on ACE inhibitors for the last two years
  • Examination: Anguished, dyspneic male, with hand clutched to chest. He is nauseated and has vomited a few times.
  • Family History: His father died of a Myocardial Infarction and his younger brother is also taking ACE inhibitors.
  • Investigations: EKG, CK-MB, LDH, Troponin I & T
  • Emergency treatment: Injection streptokinase
  • Diagnosis: Myocardial Infarction (MI)
slide5

ISOENZYMES

  • Catalyze the same reaction.
  • Differ in AA sequence and physical
  • properties
  • Separable on the basis of charge.
  • Are tissue specific.
isoenzymes
Isoenzymes
  • Different Isoenzymes may arise from

different tissues and their specific

detection may give clues to the site of

pathology.

lactate dehydrogenase ldh
LACTATE DEHYDROGENASE (LDH)

Pyruvate Lactate (anaerobic glycolysis)

  • LDH is elevated in myocardial infarction, blood

disorders

  • It is a tetrameric protein and made of two types

of subunits namely H = Heart, M = skeletal

muscle

  • It exists as 5 different isoenzymes with various

combinations of H and M subunits

creatine kinase ck
CREATINE KINASE (CK)
  • Creatine kinase is a dimer made of 2 monomers

occurs in the tissues

  • Skeletal muscle contains M subunit, Brain contains

B subunits

  • Three different isoenzymes are formed
alanine transaminase alt and aspartate transaminase ast
ALANINE TRANSAMINASE (ALT) AND ASPARTATE TRANSAMINASE( AST)

- Oxoglutarate + L-alanine

- Oxoglutarate + L-aspartate

Aspartate aminotransferase (AST)

Alanine aminotransferase (ALT)

L- glutamate + oxaloacetate

L - glutamate + pyruvate

  • Alanine transaminase (ALT) and Aspartate transaminase (AST) enzymes are the most abundantly present in the liver and is elevated in blood as a result of leakage from damaged cells
  • Alanine transaminase (ALT) increase is specific for liver damage involving hepatocellular damage
  • Aspartate transaminase (AST) is moderately increased in Muscular dystrophy and acute myocardial infarction
levels of enzymes in diseases involving liver damage
LEVELS OF ENZYMES IN DISEASES INVOLVING LIVER DAMAGE

In viral hepatitis

Rapid rise in transaminases (AST & ALT) in serum occurs even before bilirubin rise is seen

levels of enzymes in myocardial infarction
LEVELS OF ENZYMES IN MYOCARDIAL INFARCTION

AST and CK rise in 6 hours following acute myocardial infarction

LDH are elevated much later and remains high for a longer period of days

LDH

AST

CK

CK-MB

summary
SUMMARY
  • Enzymes are biological catalysts present in every cell of the body.
  • An enzyme will act on a specific substrate yielding a product.
  • An isoenzyme is a genetic variant produced largely within a specific tissue.
  • Isoenzyme patterns can give information about organ-specific disease.
  • Important enzymes in the investigation of heart disease are CK, LDH and AST.
  • Important enzymes in the investigation of liver disease are AST, ALT.
  • Creatine kinase has three isoenzymes: CK-MM, CK-MB and CK-BB.
  • LDH has five isoenzymes.
  • Alkaline phosphatase can be used in the investigation of liver and bone disease.
  • Increased levels of acid phosphatase are found in prostate cancer.