Name BCH and Physio
Acid Phosphatase • Class 3 (Hydrolase) Enzyme
(EC 3.1.3.2) or ACP • Optimal at pH 7 and below
• Tissues: prostate, liver, spleen,
erythrocytes, and bone
• Types: lysosomal, prostatic,
erythrocyte, macrophage, and
osteoclastic
• Erythrocyte ACP is inhibited by 2%
formaldehyde soln and 1-mM cupric
sulfate soln
• Tartrate-resistant ACP (TRAP) – hairy
cell leukemia (HCL)
Alkaline • Class 3 (hydrolase)
Phosphatase (EC • Chromosome 1 – kidney, liver, bone
3.1.3.1) or ALP • Chr 2 – placenta and intestine
• Bound to cell membranes, cleaves
phosphate containing compounds,
movement across membranes
• Bone ALP – by osteoblasts, cleaves
pyrophosphate, (-) bone mineralization
• Intestinal ALP – epithelial cells,
released after eating fatty foods
• Increased production after liver injury
• Half-life: intestine (minutes), bone
(1d), liver (3d), placenta (7d)
Angiotensin- • Kinase II and peptidyl-dipeptidase A
Converting Enzyme • Hydrolysis of peptide bonds, releasing
(3.4.15.1) the dipeptide His-Leu
• Can be an endopeptidase or
aminopeptidase
• Main function – cleave angiotensin I
Acetylcholinesterase • Isoenzymes that both cleave
(EC 3.1.1.7) and acetylcholine
Butyrylcholinesterase • Acetylcholinesterase – true
(EC 3.1.1.8) cholinesterase / choline esterase I (in
CNS, RBCs, Lung, Spleen, not
normally found in amniotic fluid)
• Pseudocholinesterase – choline
esterase II (liver, myocardium,
pancreas), cleaves acetylcholine
antagonists (succinylcholine and
mivacurium)
Range and Variation
• Higher in children and peaks at
3-4x adult levels in
adolescence
• Same for M/F till 55 y/o
• Unstable at normal pH,
acidified to prevent loss of
activity
• Half-life: 1-3 hours
• Depends on age + gender
• Gradually rise through 1st
decade, decrease by 20s
• Active bone formation in
children =  Bone ALP
• ALP in kids: boys > girls, equal
until 50s
• Pregnancy = 2-3x increase due
to placental ALP
• High BMI 10%
• OCP  20%
• Smoking  10%
• Fibric acid derivative  25%
•  with antiepileptic agents
•  blood transfusion and
cardiopulmonary bypass
•  children than in adults
• Adult levels by 18y/o
• Smoking (30%)
• Estrogen replacement (20%)
• Thyroid hormone ( ACE
synthesis, higher)
• Low in infants
• Rise to adult levels by 4months
of age
• In women, fall by 10% at
menarche and increase by
15% after menopause
• Half-life: 2-10 days
Measurement
• Measured by its ability to
cleave phosphate groups at
acidic pH
• Prostatic serum ACP for
diagnosis or monitoring of
prostatic adenocarcinoma
• Measured at alkaline pH
• Chelators in collecting tubes 
ALP activity
• Activity increases slowly in
storage due to loss of
inhibitors, fresh samples
needed
• Measured by its ability to
cleave synthetic peptides,
releasing hippuric acid (Hip)
• Measured
spectrophotometrically
• Pseudocholinesterase activity
is measured in serum
• AChE activity is measured in
a hemolysate of washed RBCs
• PChE is decreased in acute
hepatitis, cirrhosis, carcinoma
metastatic to liver, and
malnutrition. It is normal or
increased in nephrotic
syndrome
Significance
• Monitoring after
prostatectomy
• Investigation of rape
cases
• Vaginal swab tests
positive for ACP if (+)
semen
• Peaks for 12hrs and lasts
for 4d
• Used in Medication
• Competitive inhibitors
• Higher concentrations of
Hip-His-Leu substrate in
the ACE assay to
overcome inhibition or
sample can be diluted for
more accuracy
• Used to monitor exposure
to cholinesterase inhibitors
(Donezipil – Alzheimers)
• Used for liver function test
and diagnosis for genetic
variants
• PChE reflects synthetic
function of liver, not liver
injury
Causes of Abnormal Results
• Prostate diseases – benign prostatic hyperplasia, prostatic
infarct, prostatic carcinoma
• Urinary obstruction and acute retention
• Prostatic massage, prostatitis infarct, ischemia, needle
biopsy, cystoscopy
• Increase in ACP and PSA (prostate specific antigen) –
suggests prostatic cancer, for staging patients
• Liver and bone disease
• Intestinal infarct, inflammation, ulceration
• Ectopic production by neoplasm, hypophosphatasia, zinc
deficiency
• Elevated: sarcoidosis (if progressing to fibrosis ACE
declines), MS, Addison’s, Hyperthyroidism, DM, Alcoholic
hepatitis, Peptic Ulcer, Nephrotic Syndrome,
Pneumocystis pneumonitis
• Significantly Increased: pulmonary disorders, CKD
• Decreased: malignancies, chronic liver disease, anorexia
nervosa, hypothyroidism
• Organophosphate insecticides are irreversible inhibitors
of ACE and PChE, PChE plasma activity falls first
• AChE is present in amniotic fluid from pregnancies w/
neural tube defects
 Name BCH and Physio
Lactate • Class 1 enzyme (Oxidoreductase)
Dehydrogenase (EC • Zinc-containing, part of the glycolytic
1.1.1.27) pathway
• Found in the cytoplasm of all cells
and tissues
• 2 subunits (H/M) 5 isoenzymes (LD1-
LD5)
• Composition of elevated isoenzyme
levels will reflect tissue origin, plasma
sample is more reliable than serum
• Significant elevation of plasma levels
occur w/ small amount of tissue
damage
• LD1 and LD2 –  myocardium and
RBC;  skeletal muscle and liver
• LD3 and LD4 –  lungs and skeletal
muscle
• LD4 and LD5 –  skeletal muscle
and liver
• LD6 – poor prognosis
5’-Nucleotidase (EC • Class 3 enzyme (hydrolase)
3.1.3.5) • Cytoplasmic membrane-bound
enzyme
• Acts only on nucleotides
(extracellular production, nutrient
absorption, cell proliferation)
• Plasma 5’-NT is derived
predominantly from liver
Creatinine • 2 isoenzymes M and B
Phosphokinase (CK) • 3 dimers: MM (skeletal), MB
(cardiac), BB (brain and intestines)
• Intramitochondrial forms: MtCK
(non-muscle or ubiquitous MtCK) and
Sarcomeric Muscle CK
Range and Variation
• Highest in newborns and
infants
• Does not change with age in
adults, slightly higher values at
above 65
• Slightly increases with exercise
• Hemolysis invalidates LD and
LD isoenzymes analysis
(samples should never pass
through pneumatic tube)
• Contact with clot and physical
agitation in pneumatic tubes
can increase LD
• Normally low in children,
increases in adolescence,
plateaus until 40, then
increases again
• Increased during 2nd and 3rd
trimesters, and with anti-
epileptic drugs
• Inhibited by EDTA
Measurement Significance Causes of Abnormal Results
• Electrophoretic separation of • Abnormal value does not mean damage
LD isoenzyme is used when • LD increase
quantitation of different - damage to multiple organs, shock
isoenzymes is required - Metastatic carcinoma
• Forward (lactate to pyruvate) • Moderate elevations
and backward reactions are - Pneumocystis carinii pneumonia
used for quantitation - Most forms of pneumonia
• Forward is used more often - Not sufficient to diagnose HIV
because lactate is a more • Marked elevation (>5 to 10 times normal)
specific substrate for LD - Megaloblastic anemia
• Serum LD, 30 IU/L higher than - haemolytic anemias
plasma LD, release from - advanced leukemia/lymphoma
platelets - sepsis
• LD not stable at 4⁰ C because - cardiopulmonary arrest
of cold lability of LD5 • Can be elevated
• Samples can be stored for 24h - Hepatitis
at room temp • LD1 inc – germ cell tumors
• Serum should not be frozen • LD5 – prostate carcinoma
• High LD, normal AST, ALT, and CK – damage to cells
• Inc LD, CK, AST> ALT = cardiac/skeletal muscle injury
• Inc LD/AST – pancreatic necrosis (biliary pancreatitis)
• Inc LD and ALT – fulminant hepatic failure, ALT-LD index
is predictor of survival
• LD1/LD2 ≥ 1 (normal is ≤ 1) = MI, hemolytic and
megaloblastic anemia, renal infarct and cell carcinoma
• Isomorphic pattern – LD is increased but isoenzymes are
normal
Tombstone pattern – amount of each isoenzyme is the
same; indicates tissue damage w/ shock and hypoxemia
• Usually elevated in cholestatic disorders, acute hepatitis,
ovarian carcinoma, rheumatoid arthritis
• CK-MB – in myocardial • Skeletal muscle injury – Rapid increase (5-6x) then falls
tissue, serdiagnostic test quickly, returning to baseline with a half-life of approx. 24h
for MI • Chronic Muscle Damage – persistent elevation of CK
• Test for Neuroleptic - Medications (glucocorticoids)
Malignant Syndrome - Congenital myopathies (Duchenne Muscular Dystrophy)
(assoc. with acute muscle - Inflammatory disorders (polymyositis)
injury) – rigidity, fever, - Hypothyroidism
high WBC - Alcohol abuse
• Rhabdomyolysis – severe acute muscle injury
- Inc CK-MB / CK total (in the absence of AMI)