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LACTATE DEHYDROGENASE

-found in the myocardium,kidney,liver,muscles and RBC
-isoenzymes are tetramers built from 2 subunits (H and M)
-H has a higher affinity to PYRUVATE
-M has a higher affinity to LACTATE

5 ISOENZYMES:

1. LD1 (HHHH)
-seen in the heart, RBC and renal cortex - Myocardial enzyme
-GREATEST ANODIC MOBILITY -Rises 10-24 hours after MI
-Heat STABLE (resist denaturation at 65o for30mins) -With a peak activity of 48-96 hours
-Has an HBD activity -Returns to normal after 7-10 days
-Decreased LD/HBD ratio during MI

2. LD2 (HHHM)
-seen in the heart, RBC and renal cortex
-GREATEST ANODIC MOBILITY
-Heat STABLE

3. LD3( HHMM)
-seen in the lungs, lymphocytes,spleen, pancreas and brain

4. LD4 (HMMM) and LD5 (MMMM)
-seen in the liver and skeletal muscles
-LEAST ANODIC MOBILITY

Normal SERUM LD2>LD1>LD3>LD4>LD5 Normal CSF LD1>LD2>LD3>LD4>LD5

Acute MI Bacterial Meningitis LD5>LD4>LD3>LD2>LD1
Hemolysis LD>1>LD2
Acute renal infarct Hydrocephalus and seizures LD2>LD1

CLINICAL SIGNIFICANCE

LD1 and LD2- Increased in MEGALOBLASTIC ANEMIA and MYOCARDIAL INFARCTION

LD2 and LD3- Increased in METASTATIC LIVER CANCER

LD4 and LD5- Increased in ACUTE HEPATITIS and PULMONARY INFARCT

ALdoLase and PHospHoHexose Isomerase - Increased in METASTATIC LIVER CANCER and MYOCARDIAL
INFARCT
(heart and liver)

Additional info -SERUM is preferred(oxalate inhibits the enzyme) . PHYSICAL -Electrophoresis -DEAE cellulose which absorbs the fast ones (LD 1 and LD2) -Solvent precipitation which precipitates the slow ones (LD4 and LD5) -Heat denaturation at 65o 2.FREEZING must be avoided Assays: 1.CHEMICAL -Substrate product relationship which involves alpha HBD activity . pyruvate and lactate inhibition -Coenzyme affinity -Differential inhibition by urea. sulfate and chloroform 3.IMMUNOLOGIC -specific antibodies against LD1 and LD5 .

8 U/L ACP ISOENZYMES -Prostatic. Spleen. Placenta and Regan Bone Acid Phosphatase -PLASMA is the sample of choice (citrated) -1/2-1/3 is prostatic in origin -Newborns have ACP levels 2-3 times in adults -NORMAL VALUE: 0-0.PHOSPHATASES Alkaline Phosphatases ALP ISOENZYMES FASTEST: Liver SLOWEST: Intestine Carcinoplacental ALP : Regan and Nagao (similar to placental ALP) : seen in metastatic cancer of the pleural surface and adenocarcinoma of the pancreas and bile duct Kasahara isoenzyme: “Regan variant” : seen in HEPATOMA AND TUMORS OF GI TRACT L-phenylalanine RESISTANT: Heat Stable: Liver and Bone Placenta and Regan L-phenylalanine LABILE: Heat Labile: Intestine. Red cell. Platelet. Liver and Bone Marrow TARTRATE and CuSO4 RESISTANT: TARTRATE and CuSO4 LABILE: Prostate Red Cell FORMOL RESISTANT: FORMOL LABILE: Red Cell Prostate .