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enzymes as diagnostic tools
Enzymes as

Diagnostic tools
How?
 *The measurement of the serum levels of
 numerous enzymes has been shown to be
 of diagnostic significance.

 *This is because the presence of these
 enzymes in the serum indicates that tissue
 or cellular damage has occurred resulting
 in the release of intracellular components
 into the blood &this increases the level of
 certain enzymes in blood according to the
 damaged organ
What are the enzymes most used in
 the diagnosis of certain diseases?
Plasma enzymes

          Functional           Non functional

**For example:-
1-Lactate dehydrogenase(LDH)
2-Creatine kinase(CK)
                                     Izoenzymes
3-Alanine transminase(ALT)      4-Aspartate transminase(AST)

5-Alkaline phsphatase            6-Acid phosphatase

               7-Amylase & Lipase enzymes
enzymes as diagnostic tools
Lactate dehydrogenase(LDH)
 Lactic acid                                  Pyruvic acid

                    NAD        NADH+H



*LDH is a tetramer(consists of 4 protomers)

*the protomers are 2 types:-

 1-H(after heart)

 2-M(after muscle)

 so LDH have 5 isoenzymes:-
LDH 1 – Found in heart and red-blood cells and is 17% – 27% of the
normal serum total
*It is formed of HHHH.It increases in myocardial infarction

LDH 2 – Found in heart and red-blood cells and is 27% – 37% of the
 normal serum total
*It is formed of HHHM.It increases in myocardial infarction

LDH 3 – Found in a variety of organs and is 18% – 25% of the normal
 serum total
*It is formed of HHMM.It increases in leukaemia

LDH 4 – Found in a variety of organs and is 3% – 8% of the normal
 serum total
*It is formed of HMMM.It increases in viral hepatitis

LDH 5 – Found in liver and skeletal muscle and is 0% – 5% of the
normal serum total
*It is formed of MMMM.It increases in viral hepatitis
enzymes as diagnostic tools
Creatine kinase (CK)
Creatine                                    Ceatine phosphate

                    ATP         ADP



*CK is a dimmer (consists of 2 protomers)

*the protomers are 2 types:

1-B (after brain)

2-M (after muscle)

*so CK has 3 isoenzymes:-
.CPK1 (CPK-BB) is the characteristic isoenzyme in brain and is
in significant amounts in smooth muscle and is 0% of the normal
serum total.

**It increases in brain tumors.

.CPK2 (CPK-MB) accounts for about 35% of the CPK activity in
cardiac muscle , but less than 5% in skeletal muscle and is 0% of
the normal serum total.

**It increases in heart diseases.

.CPK3 (CPK-MM) is the predominant isoenzyme in muscle and
is 100% of the normal serum total.

**It increases in skeletal muscle diseases.
enzymes as diagnostic tools
Alanine transminase(ALT)

*It is also called serum glutamic pyruvic transminase(SGPT)

*It catalyzes transfer of amino group (NH2) from
amino acid (alanine) to a-keto acid producting a new
amino acid & a new keto acid

*ALT is particularly diagnostic of liver involvement as this
enzyme is found predominantly in hepatocytes.

*It increases in liver & heart diseases.
Aspartate transminase(AST)
     Glutamic oxalacetic
     transminase(SGOT)
*It is also called aspartate glutamic oxalacetic
transminase(SGOT)
*It increases in liver & heart diseases
 *When assaying for both ALT and AST the ratio of the level of these two
enzymes can also be diagnostic. Normally in liver disease or damage that is not
of viral origin the ratio of ALT/AST is less than1.with viral hepatitis the ALT/AST
ratio will be greater than1.

*The level of AST elevation in the serum is directly proportional to the number
of cells involved as well as on the time following injury that the AST assay was
performed. Following injury, levels of AST rise within 8 hours and peak 24–36
hours later. Within 3–7 days the level of AST should return to pre-injury levels
unless further injury occurs.

* Although measurement of AST is not, in and of itself, diagnostic for
myocardial infarction, taken together with LDH and CK measurements the level
of AST is useful for timing of the infarct
enzymes as diagnostic tools
Alkaline phosphatase                     Acid phosphatase
**It is an enzyme which transport **is found in the prostate, red
phosphate groups across cell          blood cells, small amounts
membranes of organs.                  are found in bone, liver,
**It is found in the                  spleen and pancreas.
osteoblasts,bile canali ,small
intestinal epithelium and             **The assay of serum acid
proximal tubule.                      phosphatase is mostly used
**Increases mainly in bone            to detect prostatic
diseases such as Osteogenic           carcinoma and to monitor
sarcoma ,liver & bilary tract         the treatment.
diseases and
hyperparathyroidism

**Amylase and lypase enzymes increases in diseases of the pancreas as
acute pancreatitis
enzymes as diagnostic tools
Thank   yo

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enzymes as diagnostic tools

  • 3. How? *The measurement of the serum levels of numerous enzymes has been shown to be of diagnostic significance. *This is because the presence of these enzymes in the serum indicates that tissue or cellular damage has occurred resulting in the release of intracellular components into the blood &this increases the level of certain enzymes in blood according to the damaged organ What are the enzymes most used in the diagnosis of certain diseases?
  • 4. Plasma enzymes Functional Non functional **For example:- 1-Lactate dehydrogenase(LDH) 2-Creatine kinase(CK) Izoenzymes 3-Alanine transminase(ALT) 4-Aspartate transminase(AST) 5-Alkaline phsphatase 6-Acid phosphatase 7-Amylase & Lipase enzymes
  • 6. Lactate dehydrogenase(LDH) Lactic acid Pyruvic acid NAD NADH+H *LDH is a tetramer(consists of 4 protomers) *the protomers are 2 types:- 1-H(after heart) 2-M(after muscle) so LDH have 5 isoenzymes:-
  • 7. LDH 1 – Found in heart and red-blood cells and is 17% – 27% of the normal serum total *It is formed of HHHH.It increases in myocardial infarction LDH 2 – Found in heart and red-blood cells and is 27% – 37% of the normal serum total *It is formed of HHHM.It increases in myocardial infarction LDH 3 – Found in a variety of organs and is 18% – 25% of the normal serum total *It is formed of HHMM.It increases in leukaemia LDH 4 – Found in a variety of organs and is 3% – 8% of the normal serum total *It is formed of HMMM.It increases in viral hepatitis LDH 5 – Found in liver and skeletal muscle and is 0% – 5% of the normal serum total *It is formed of MMMM.It increases in viral hepatitis
  • 9. Creatine kinase (CK) Creatine Ceatine phosphate ATP ADP *CK is a dimmer (consists of 2 protomers) *the protomers are 2 types: 1-B (after brain) 2-M (after muscle) *so CK has 3 isoenzymes:-
  • 10. .CPK1 (CPK-BB) is the characteristic isoenzyme in brain and is in significant amounts in smooth muscle and is 0% of the normal serum total. **It increases in brain tumors. .CPK2 (CPK-MB) accounts for about 35% of the CPK activity in cardiac muscle , but less than 5% in skeletal muscle and is 0% of the normal serum total. **It increases in heart diseases. .CPK3 (CPK-MM) is the predominant isoenzyme in muscle and is 100% of the normal serum total. **It increases in skeletal muscle diseases.
  • 12. Alanine transminase(ALT) *It is also called serum glutamic pyruvic transminase(SGPT) *It catalyzes transfer of amino group (NH2) from amino acid (alanine) to a-keto acid producting a new amino acid & a new keto acid *ALT is particularly diagnostic of liver involvement as this enzyme is found predominantly in hepatocytes. *It increases in liver & heart diseases.
  • 13. Aspartate transminase(AST) Glutamic oxalacetic transminase(SGOT) *It is also called aspartate glutamic oxalacetic transminase(SGOT) *It increases in liver & heart diseases *When assaying for both ALT and AST the ratio of the level of these two enzymes can also be diagnostic. Normally in liver disease or damage that is not of viral origin the ratio of ALT/AST is less than1.with viral hepatitis the ALT/AST ratio will be greater than1. *The level of AST elevation in the serum is directly proportional to the number of cells involved as well as on the time following injury that the AST assay was performed. Following injury, levels of AST rise within 8 hours and peak 24–36 hours later. Within 3–7 days the level of AST should return to pre-injury levels unless further injury occurs. * Although measurement of AST is not, in and of itself, diagnostic for myocardial infarction, taken together with LDH and CK measurements the level of AST is useful for timing of the infarct
  • 15. Alkaline phosphatase Acid phosphatase **It is an enzyme which transport **is found in the prostate, red phosphate groups across cell blood cells, small amounts membranes of organs. are found in bone, liver, **It is found in the spleen and pancreas. osteoblasts,bile canali ,small intestinal epithelium and **The assay of serum acid proximal tubule. phosphatase is mostly used **Increases mainly in bone to detect prostatic diseases such as Osteogenic carcinoma and to monitor sarcoma ,liver & bilary tract the treatment. diseases and hyperparathyroidism **Amylase and lypase enzymes increases in diseases of the pancreas as acute pancreatitis
  • 17. Thank yo