Medical use of enzymes
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Application of enzymes for diagnosis and prognosis of disease, analytic reagents and as therapeutic agents
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Medical use of enzymes
- 1. Medical use of Enzymes Prepared by: Mohammad Reza Abdullahi Master student in IIUM, Malaysia
- 2. Content • Localization of enzymes • Diagnosis and prognosis of disease • Liver enzyme • Pancreas enzyme • Muscle enzyme • Enzymes as analytic reagents • Enzymes as therapeutic agents
- 3. Clinical use of enzymes Diagnosis and prognosis of disease Analytic reagents Therapeutic agents
- 4. Localization of enzymes • intracellular • Lysosome • Nucleous • Cytosol • Mithochondria • Extracellular • Are secreted and function out from the cell • Mainly digestive enzymes (alfa amylase)
- 5. Enzymes for diagnosis and prognosis of disease
- 6. Liver enzymes • Aspartate aminotransferase • Alanine aminotransferase • Gamma glutamyl transferase • Alkaline phosphatase • 5’- nucleotidase
- 7. Aspartate aminotransferase • AST/ SGOT/ GOT • Requires pyridoxal 5’ phosphate • Tissue sources • Widely distributed • Cardiac muscle, liver and skeletal muscle (higher concentration) • Kidney, pancreas and erythrocyte (lower concentration)
- 8. Clinical significance Hepatocellular disorder Viral hepatitis Cirrhosis Skeletal muscle disorder Muscular dystrophy Cardiac disease AMI Congestive heart failure
- 9. Alanine aminotransferase • ALT/ GPT/ SGPT • Tissue sources • All tissue • Higher concentration in Liver
- 10. Clinical significance Evaluation of hepatic disorder ALT is higher than AST in acute inflammation condition Longer half life than AST
- 11. γ-Glutamyltransferase • GGT • catalyze the transfer of amino acids from one peptide to another amino acid or peptide
- 12. Tissue sources • Kidney, brain, prostate, pancreas and liver Clinical significance • Biliary tract obstruction • Medications (warfarin, phenobarbital and phenytoin) • Alcohol consumption • GGT activity is normal during pregnancy and in patients with bone disorders, conditions that exhibit elevated ALP activity
- 13. Alkaline phosphatase • ALP • catalyze the hydrolysis of various phosphomonoesters at an alkaline PH • Require Mg++ • Tissue sources • Bone, liver, intenstin, spleen, • Placenta, kidney
- 14. Clinical significance • Biliary tract obstruction • Bone disease • Physiologically increases in pregnancy, infant and children
- 15. 5’-nucleotidase • A phosphatase that acts only on nucleoside 5’-phasphates, such as AMP and adenylic acid, releasing inorganic phosphate. • Mainly increase in hepatobiliary disease
- 17. Amylase • AMS • Catalyze hydrolysis of α, 1-4 glycosidic bonds in starch and glycogen to produce glucose, maltose and intermediate chains called dextrins which contain α, 1-6 branching linkages. • Require Calcium • Normally seen in urine • Tissue sources • Pancreas • Salivary gland • Clinical significance • Acute pancreatitis • Mumps
- 18. Lipase • catalyzes the hydrolysis of triglycerides to produce glycerol and fatty acids • Tissue source • Pancreas • Clinical significance • Acute pancreatitis • lipase activity increases 5 to 8 hours after the onset of symptoms, peak at 24 hours and a return to normal after 8 to 14 days.
- 19. Muscle enzymes • Creatine kinase • Lactate dehydrogenase • Glycogen phosphorylase
- 20. Creatine Kinase • CK/ CPK • catalyze the reversible phosphorylation of creatine to creatine phosphate by ATP • It is an enzyme found primarily in the heart and skeletal muscles • Dimer with subunits B and M
- 21. Isoenzy me name Compo sition Present in Elevated in CK-1 Fast moving BB Brain,prostate,GI tract,lung,bladder,uteru s,placenta CNS diseases CK-2 2% of total MB Myocardium/ Heart Acute myocardial infarction CK-3 Slow moving MM Skeletal muscle, Myocardium
- 22. Clinical significance • AMI • Muscular dystrophy • Following MI, the CK-MB levels begin to rise within 4 to 8 hours, peak at 12 to 24 hours and return to normal levels within 48 to 72 hours
- 23. Lactate Dehydrogenase • LD/ LDH • catalyzes the interconversion of lactic to pyruvic acids. It is a hydrogen-transfer enzyme that uses the coenzyme NAD+ • Tetramer (H and M)
- 24. Isoenzyme name Composition Electrophore tic migration Present in Elevated in LDH 1 Heat resistant ( H4) Fastest moving Myocardium, RBC,kidney myocardial infarction LDH2 Heat resistant (H3M1) Myocardium, RBC,kidney Kidney disease,megalo blastic anemia LDH3 (H2M2) brain Leukemia,malig nancy LDH4 Heat labile (H1M3) Lung,spleen Pulmonary infarction LDH5 Heat labile Inhibited by urea (M4) Slowest moving Skeletal muscle, Liver Skeletal muscle and liver diseases
- 25. Clinical significance The highest levels of total LDH are seen in pernicious anemia and hemolytic disorders Liver disorders, such as viral hepatitis and cirrhosis show slight elevations of two to three times ULN In AMI, LDH levels begin to rise within 12 to 24 hours, reach peak levels within 48 to 72 hours, and may remain elevated for 10 days Skeletal muscle disorders and some leukemias contribute to increased LDH levels
- 27. Glycogen phosphorylase • Glycogen phosphorylase uses inorganic HPO4 2+ to split glucose from the polysaccharide chains of glycogen • The glucose 1-phosphate so formed can be used for ATP synthesis in muscle or converted to free glucose in the liver • Requires pyridoxal phosphate as coenzyme • Lack of glycogen phosphorylase result in Mc Ardle disease (glycogen storage disease type 5) which causes muscle cramp and muscle damage due to inadequate energy supply.
- 28. Enzymes as Analytic Reagents • Measurement of substrates, drugs and enzyme activity • Specific for substrate (advantage than chemical method) • Direct measurement of the substrate in the complex mixture • Methods for substrate measurements • End point (the substrate is completely converted to product before it is measured) • Two-point Kinetic method (a change in substrate concentration produced during a fixed-time interval is measured)
- 30. Enzymes as therapeutic agents • Transfusion of fresh blood or its active components in bleeding disorders • Oral administration of digestive enzymes in digestive diseases • Administration of fibrinolytic enzymes (e.g. streptokinase) • Cancer treatment
- 32. Reference • Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics 2015 • Clinical Chemistry Techniques Principles Correlations, Michael L.Bishop and others, 2010 • Clinical chemistry, fundementals and laboratory techniques, Donna L.Larson 2017
- 33. Thank you
Editor's Notes
- With concentrations up to 5000 times higher than in other tissues