CooL aes Estimation of enzyme activities in biological fluids (particularly plasma/serum) is of great clinical” importance. Particularly non-plasma Specific enzymes are very important for the diagnosis and prognosis of several diseases The ‘normal serum level of an enzyme indicates the balance between its synthesis and release in the routine cell turnover. The raised enzyme levels could be due to cellular damage, increased rate of cell tumover, proliferation Sf ells, increased synthesis of enzymes etc. Serum enzymes are conveniently “used as markers to detect the cellular damage which ultimately helps in the diagnosis of diseases, ‘Note : Ther term biomarker refers to any Laboratory analyte (enzyme, protein, antigen, amibody, metabolite etc.) that is useful for the iagnosis is of any disease. Biomarker is dion Ue, form, and less frequently used by biochemists,) A summary of the important enzymes useful for the diagnosis of specific diseases is given in Table 6.9. Detailed information onthe dagnontic Snzymes including reference values is provided brief account of selecteg ine cones scone oi ivity of serum amylase i ana re pancreatitis cerence ioast increased in srvalie is observed within 8.43 uf). The ote onset of disease which returns tg he er seona® day. Elvated acinar seria aso found in urine of the pation amylase is al Serum amylase is alyy ve pancreatitis important forthe diagnosis” of chrane poner acute parotitis (mumps) and pancreatitis, obstruction of pancreatic duct. Alanine transaminase (ALT/SGPT) : SGPT ig elevated in acute hepatitis of viral or toxic ‘origin, jaundice and cirrhosis of liver (reference 10-45 1U/). Aspartate transaminase (AST/SGOT) : SGOT activity in serum is increased in. myocardial infarction and also in liver diseases (reference 10-50 UM), N may be noted that SGPT is more specific for the diagnosis of liver diseases while SGOT is {or heart diseases. This is mainly because of their cellular distribution SGPT jg cytosomalTable 6.10 Increase in plasma (serum) enzymes in the diagnosis of diseases Diseases) in which inte Reference value Digest eyes demise soso ut A rcs. are at paris, bee pee At see dee emacs se sosour ose cats, mdete datos chon open Tansaminsee i ‘ne vrsoriaze (AL or sry 45 01 Ace hep ee, cat ‘hana pyre tara (SGPT) ‘Asatte tasaace AST) osu cri ean, ais, ba te: cron te sere guna aes asurrase (S607) Phosphates ‘ain posers (ALP 50-100 ut ne dass id oi cls cy elt, Page Gna, pepe (oxi 910) ‘hod tana oe ie Sessrcticve nes (ess) ct hss, dos le i rsphase (CP) os-s0.ur Frutececrama carer os gan fra ato ACP sare 2 nae (oH ena 5) fr sags ado, Pope Sass nays of carbs metab 2 % rt vaut Mur dst, bs oases mca econ, mashana gt, ekamis Lact ryaogerase (104) 0-450 01 cata tn. see ete hepa, mcd eeapy, era,percen aan, Miscetneous enzymes Caine nase (ON) er ene Maes: 50-200 Ut Myocardium te, hospotnas (CPX) Fries 90-10 Upon, aban. Chinese (Cn) s0ut epee, meat inten Nuclease motte phosphatase TF) 2-10 Ut Haas, nee ade, nes "lay ranspopease (667 sou ‘Acctisn icine hpi, cenit nde 240 m9 Batt riers, cig dene, cre, reper Cansolsin orcas)Alkaline phosphatase (ALP) : I's elevated in cenain bone and liver diseases (reference 50-100 Uf). ALP is useful for the diagnosis of rickets, hyperparathyroidism, carcinoma of bone, and obstructive jaundice. Acid phosphatase (ACP) + I is increased in the cancer of prostate gland (reference 0.5-5.0 UM). The tartarate labile ACP (reference <1 KA Lunits) is useful for the diagnosis and prognosis Of prostate cancers i.e. ACP is a good tumor marker. Lactate dehydrogenase (LDH) : LDH is useful for the diagnosis of myocardial infarction, infective hepatitis, leukemia and muscular dystrophy (reference 200-450 U/l). LOH has five isoenzymes, the details of which are described later. Creatine kinase (CK) : It is elevated in ‘myocardial infarction (early detection) and ‘muscular dystrophy (reference males : 50-200 UA; females ; 30-150 Uf). CK has three isoenzymes (described later) Glutamyl transpeptidase (GGT) : It is a sensitive diagnostic marker for the detection of alcoholism. GGT is also increased in infective hepatitis and obstructive jaundice. Pe ee TU un al BIOCHEMIS Tr ek sana “They, however, dlifler in their physical and tact proper wich nla he ruc cl smunological properties, lecrophoretic and. i Mund Vion values, pH optimum, relative susceptibility. to inhibitors and degree denaturation. Explanation for the existence of isoenzymes ‘Many possible reasons are offered to explait the presence of isoenzymes in the living system 1. Isoenzymes synthesized from diffe genes e.g. malate dehydrogenase of cytosol different from that found in mitochondria, 2. Oligomeric enzymes consisting of mi than one type of subunits e.g. lactate dehydl genase and creatine phosphokinase. 3. An enzyme may be active as monomer oligomer e.g. glutamate dehydrogenase 4. In glycoprotein enzymes, differences carbohydrate content may be responsible isoenzymes e.g. alkaline phosphatase.