ENZYMES OF CLINICAL IMPORTANCE

Dr. Sathish
1st yr PG Dept of Biochemistry
Madurai Medical College
CLINICAL ENZYMOLOGY
• Plasma contains many functional enzymes

Functional enzyme
ex: Enzymes of coagulation

Non functional enzymes

usually very low but Level increase in cell death
BIOMARKER
• Naturally occurring molecule , gene or by which particular
pathological process can be identified

• Biomarker is a substance that can be used as an indicator oof a

particular disease
CARDIAC BIOMARKERS
• CREATINE KINASE CK-MB

• (LDH) LACTATE DEHYDROGENASE

• MYOGLOBIN non specific

• TROPONIN T & TROPONIN I

• BRAIN NATRIURETIC PEPTIDE (BNP) IN CCF

CREATINE KINASE CK-MB

• sensitive and specific for MI

• Elevated in 3- 6 hrs
• Peaks at 24 hrs
• Last s for 3-4 days
• Early cardiac enzymes to be elevated
• Marker for reinfarction
TROPONIN T & TROPONIN I

• Troponin t & troponin I

• sensitive and specific for MI
• Elevated in 4-6 hrs
• Peaks 14-24 hrs
• Lasts for 7-10 days
ENZYMES IN LIVER DISEASE
• (ALT) ALANAINE AMINO TRASFERASE

• (AST) ASPARTATE AMINOTRANSFERASE

• (ALP) ALKALINE PHOSPHATASE

• NUCLEOTIDE PHOSPHATASE

• (GGT)GAMMA GLUTAMYL TRANSFERASE

 (ALT) ALANAINE AMINO TRASFERASE
• Serum glutamate pyruvate transaminase(SGPT)
• Pyridoxal phosphate Vit B6 as co enzyme
• Normal range
male :13-35 U/L
female: 10-30U/L
Elevated in acute hepatitis 300-1000 U/L
CLD (50-100 U/L)-cirrhosis , hepatitis c NASH
ALT>AST
ALT is the earlier enzyme to rise in liver diseases before any clinical
signs
(AST) ASPARTATE AMINOTRANSFERASE

• Serum glutamate oxaloacetate transaminase

• Vit B6 as coenzyme
• Normal range (8 -20 U/L)
• Elevated in liver injury
ALKALINE PHOSPHATASE
• Produced by osteoblasts of bone
• Alpha 1 ALP synthesized in biliary canaliculi
• Increased in obstructive jaundice.
• Alpha 2 heat liable ALP
• synthesized in hepatic cells
• Alpha 2 heat stable ALP
• Placental origin elevated in ca lung,liver & gut regan iso enzyme
• Pre-beta ALP bony origin increased in bone disease
GAMMA GLUTAMYL TRANSFERASE
(GGT)
• used in synthesis of glutathione
• It as 11 isoenzymes
• Present in liver, kidney, pancreas, intestinal cells and prostate
• Normal range 10-30 U/L
• Increased in alcoholic
• GGT level directly proportional to the amount of alcohol intake
PROSTATE
• PROSTATE SPECIFIC ANTIGEN (PSA )
• produced from secretory epithelium of prostate gland
• Normal range 1-5 U/L
• Elevated in ca prostate >10
• ACID PHOSPHATASE
• Normal range 2.5-12 U/L
• Elevated in ca prostate and bony metastasis of ca prostate
AMYLASE
• produced by pancreas and salivary glands
• Major enzyme digests starch
• Normal range 50-120 U/L
• Elevated in acute pancreatitis
• peak level reaches at 5-12 hrs
• Returns to normal within 2-4 days
LIPASE
• Lipolytic enzyme which hydrolyzes glycerol esters of long chain
fatty acids.
• Normal range : 50 -175
• Elevated in acute pancreatitis persists for 7-14 days
• Specific for pancreatitis
ENZYME THERAPEUTIC APPLICATION
Asparaginase Acute lymphoblastic leukemia

Streptokinase To lyse clot

Urokinase To lyse clot

Recombinant tissue prothrombin Lysis of clot in CVA

activator rtPA

Pancreatin (trypsin and lipase) Pancreatic insufficiency

Papain Anti-inflammatory

Alpha 1 antitrypsin AAT deficiency ,emphysema

 ENZYMES USED FOR DIAGNOSTIC PURPOSE
Enzyme Used for testimg
urease urea

uricase Uric acid

Glucose oxidase glucose

peroxidase Glucose, cholesterol

hexokinase glucose

Cholesterol oxidase cholesterol

lipase triglycerides

Horse radish peroxidase ELISA