Clinical enzymology

Clinical enzymology is a subfield of clinical chemistry that focuses on the

study and measurement of enzymes in the diagnosis and monitoring of
diseases. Enzymes are biological catalysts that speed up biochemical
reactions in living organisms.
Some diseases can affect the structure, function, or concentration of
enzymes in the body, leading to abnormal enzyme levels in the blood or
other body fluids. For example, liver diseases can cause elevated levels of
enzymes such as alanine aminotransferase (ALT) and aspartate
aminotransferase (AST), which are involved in amino acid metabolism.
Heart diseases can cause elevated levels of enzymes such as creatine
kinase (CK) and lactate dehydrogenase (LDH), which are involved in
energy production and muscle contraction. Pancreatic diseases can cause
elevated levels of enzymes such as amylase and lipase, which are
involved in carbohydrate and fat digestion.
Adipose tissue is the body’s main store of fat. It also has endocrine and
metabolic functions, such as producing hormones and regulating glucose
and lipid metabolism. Adipose tissue diseases can affect the amount,
distribution, or function of adipose tissue in the body, leading to
disorders such as obesity, lipodystrophy, and lipomatosis. Some of these
diseases can also affect the levels of enzymes in the blood or other body
fluids. For example, obesity can cause elevated levels of enzymes such as
alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT), which
are involved in bone and liver metabolism. Lipodystrophy can cause
reduced levels of enzymes such as lipoprotein lipase (LPL) and hormone-
sensitive lipase (HSL), which are involved in lipoprotein and triglyceride
metabolism.
Therefore, clinical chemistry of clinical enzymology of diseases used in
diagnosis of adipose tissues is the application of biochemical methods
and techniques to measure and analyze the levels and activities of
enzymes in the blood or other body fluids that are related to the
structure, function, or concentration of adipose tissue in the body. This
can help in the diagnosis and monitoring of adipose tissue diseases, as
well as in the assessment of their effects on other organs and systems.
Some of the enzymes that are used in diagnosis of adipose tissue
diseases are:

 Alkaline phosphatase (ALP): This enzyme is involved in bone and

liver metabolism. Elevated levels of ALP in the blood can indicate
obesity or liver disease1.
 Gamma-glutamyltransferase (GGT): This enzyme is involved in
glutathione metabolism and detoxification. Elevated levels of GGT
in the blood can indicate obesity, liver disease, or alcohol abuse 2.
 Lipoprotein lipase (LPL): This enzyme is involved in lipoprotein and
triglyceride metabolism. Reduced levels of LPL in the blood can
indicate lipodystrophy, a condition characterized by abnormal
distribution of adipose tissue3.
 Hormone-sensitive lipase (HSL): This enzyme is involved in lipolysis,
the breakdown of stored fat. Reduced levels of HSL in the blood
can indicate lipodystrophy or insulin resistance 4.

These are some examples of enzymes that can be measured in the blood
or other body fluids to diagnose or monitor adipose tissue diseases.
However, these enzymes are not specific to adipose tissue and can also
be affected by other factors, such as diet, medication, or inflammation.
Therefore, enzyme-based diagnostic tests should be interpreted in
conjunction with other clinical and laboratory findings.

Some of the enzymes that are used in diagnosis of skeletal muscle

diseases are:

 Creatine kinase (CK): This enzyme is involved in cellular energy

storage and transfer via the production of high-energy ATP from
creatine phosphate. CK is the most widely used enzyme to
diagnose and follow muscle disease, as it is the most sensitive
indicator of muscle injury. There are three types of CK enzymes: CK-
MM (found mostly in skeletal muscles), CK-MB (found mostly in
heart muscle), and CK-BB (found mostly in brain tissue). Elevated
levels of CK in the blood can indicate skeletal muscle damage or
degeneration due to various causes, such as muscular dystrophy,
myositis, rhabdomyolysis, trauma, or exercise12.
 Lactate dehydrogenase (LDH): This enzyme is involved in energy
production and muscle contraction via the conversion of lactate to
 pyruvate. LDH is present in many tissues, including skeletal muscle,
heart, liver, kidney, and red blood cells. Elevated levels of LDH in
the blood can indicate tissue damage or hemolysis, but it is not
very specific for skeletal muscle disease. However, measuring the
different types of LDH isoenzymes can help to identify the source
of tissue damage. LDH-5 is the predominant isoenzyme in skeletal
muscle, and its elevation can indicate skeletal muscle injury or
disease13.
 Alanine aminotransferase (ALT) and aspartate aminotransferase
(AST): These enzymes are involved in amino acid metabolism and
are mainly found in the liver. However, they are also present in
skeletal muscle and can be elevated in the blood due to skeletal
muscle damage or disease. ALT is more specific for liver injury than
AST, while AST is more sensitive for skeletal muscle injury than ALT.
Therefore, the ratio of AST to ALT can help to differentiate between
liver and skeletal muscle disease. A ratio of more than 1 indicates
skeletal muscle disease, while a ratio of less than 1 indicates liver
disease1 .
 Aldolase: This enzyme is involved in glycolysis, the breakdown of
glucose for energy production. Aldolase is present in many tissues,
including skeletal muscle, liver, and red blood cells. Elevated levels
of aldolase in the blood can indicate tissue damage or hemolysis,
but it is not very specific for skeletal muscle disease. However,
measuring the different types of aldolase isoenzymes can help to
identify the source of tissue damage. Aldolase A is the predominant
isoenzyme in skeletal muscle, and its elevation can indicate skeletal
muscle injury or disease1 .

These are some examples of enzymes that can be measured in the blood
or other body fluids to diagnose or monitor skeletal muscle diseases.
However, these enzymes are not specific to skeletal muscle and can also
be affected by other factors, such as diet, medication, or inflammation.
Therefore, enzyme-based diagnostic tests should be interpreted in
conjunction with other clinical and laboratory findings.

There are different types of enzymes that can be used in diagnosis

of respiratory system diseases or disorders. Some of these enzymes
are:
 Oxidases: These are enzymes that catalyze the transfer of electrons
from a substrate to oxygen, producing hydrogen peroxide or water
as a byproduct. Oxidases are involved in various metabolic
pathways in the respiratory system, such as the electron transport
chain, the pentose phosphate pathway, and the production of
reactive oxygen species. Oxidases can be measured in the blood,
urine, or exhaled breath to assess the oxidative stress,
inflammation, or infection in the respiratory system. For example,
cytochrome c oxidase is a key enzyme in the mitochondrial electron
transport chain, and its activity can reflect the cellular oxygen
consumption and energy production. Cytochrome c oxidase can be
measured in the blood or exhaled breath to diagnose or monitor
respiratory diseases such as chronic obstructive pulmonary disease
(COPD), asthma, or lung cancer12.
 Dehydrogenases: These are enzymes that catalyze the removal of
hydrogen atoms from a substrate, usually transferring them to a
coenzyme such as NAD+ or FAD. Dehydrogenases are involved in
various metabolic pathways in the respiratory system, such as
glycolysis, the Krebs cycle, and fatty acid oxidation.
Dehydrogenases can be measured in the blood, urine, or exhaled
breath to assess the metabolic status, tissue damage, or disease
progression in the respiratory system. For example, lactate
dehydrogenase (LDH) is an enzyme that converts lactate to
pyruvate, and its activity can indicate the anaerobic metabolism
and tissue hypoxia in the respiratory system. LDH can be measured
in the blood or exhaled breath to diagnose or monitor respiratory
diseases such as pneumonia, pulmonary embolism, or acute
respiratory distress syndrome (ARDS)34.
 Catalases: These are enzymes that catalyze the decomposition of
hydrogen peroxide into water and oxygen. Catalases are involved
in the protection of the respiratory system from oxidative damage
caused by reactive oxygen species. Catalases can be measured in
the blood, urine, or exhaled breath to assess the antioxidant
capacity, inflammation, or infection in the respiratory system. For
example, catalase is an enzyme that is present in the peroxisomes
of the lung cells, and its activity can reflect the peroxisomal
function and the oxidative stress in the respiratory system. Catalase
can be measured in the blood or exhaled breath to diagnose or
 monitor respiratory diseases such as COPD, asthma, or tuberculosis
.

These are some examples of enzymes that can be used in diagnosis of

respiratory system diseases or disorders. However, these enzymes are not
specific to the respiratory system and can also be affected by other
factors, such as diet, medication, or inflammation. Therefore, enzyme-
based diagnostic tests should be interpreted in conjunction with other
clinical and laboratory findings.

There are different types of enzymes that can be used in diagnosis

of brain nerve system diseases. Some of these enzymes are:

 Oxidases: These are enzymes that catalyze the transfer of electrons

from a substrate to oxygen, producing hydrogen peroxide or water
as a byproduct. Oxidases are involved in various metabolic
pathways in the brain nerve system, such as the electron transport
chain, the pentose phosphate pathway, and the production of
reactive oxygen species. Oxidases can be measured in the blood,
urine, or exhaled breath to assess the oxidative stress,
inflammation, or infection in the brain nerve system. For example,
cytochrome c oxidase is a key enzyme in the mitochondrial electron
transport chain, and its activity can reflect the cellular oxygen
consumption and energy production. Cytochrome c oxidase can be
measured in the blood or exhaled breath to diagnose or monitor
brain nerve system diseases such as Alzheimer’s disease,
Parkinson’s disease, or stroke12.
 Dehydrogenases: These are enzymes that catalyze the removal of
hydrogen atoms from a substrate, usually transferring them to a
coenzyme such as NAD+ or FAD. Dehydrogenases are involved in
various metabolic pathways in the brain nerve system, such as
glycolysis, the Krebs cycle, and fatty acid oxidation.
Dehydrogenases can be measured in the blood, urine, or exhaled
breath to assess the metabolic status, tissue damage, or disease
progression in the brain nerve system. For example, lactate
dehydrogenase (LDH) is an enzyme that converts lactate to
pyruvate, and its activity can indicate the anaerobic metabolism
and tissue hypoxia in the brain nerve system. LDH can be measured
in the blood or exhaled breath to diagnose or monitor brain nerve
 system diseases such as traumatic brain injury, meningitis, or
encephalitis34.
 Catalases: These are enzymes that catalyze the decomposition of
hydrogen peroxide into water and oxygen. Catalases are involved
in the protection of the brain nerve system from oxidative damage
caused by reactive oxygen species. Catalases can be measured in
the blood, urine, or exhaled breath to assess the antioxidant
capacity, inflammation, or infection in the brain nerve system. For
example, catalase is an enzyme that is present in the peroxisomes
of the brain cells, and its activity can reflect the peroxisomal
function and the oxidative stress in the brain nerve system. Catalase
can be measured in the blood or exhaled breath to diagnose or
monitor brain nerve system diseases such as multiple sclerosis,
epilepsy, or schizophrenia .

These are some examples of enzymes that can be used in diagnosis of

brain nerve system diseases. However, these enzymes are not specific to
the brain nerve system and can also be affected by other factors, such as
diet, medication, or inflammation. Therefore, enzyme-based diagnostic
tests should be interpreted in conjunction with other clinical and
laboratory findings.

Some of the enzymes that are used in diagnosis of bone diseases

are:

 Alkaline phosphatase (ALP): This enzyme is involved in bone and

liver metabolism. Elevated levels of ALP in the blood can indicate
bone diseases such as osteoporosis, Paget’s disease, or bone
tumors123.
 Acid phosphatase (ACP): This enzyme is involved in bone
resorption and prostate function. Elevated levels of ACP in the
blood can indicate bone diseases such as osteomalacia, rickets, or
metastatic bone cancer12.
 Tartrate-resistant acid phosphatase (TRAP): This enzyme is a
specific marker of osteoclast activity, the cells that break down
bone tissue. Elevated levels of TRAP in the blood can indicate bone
diseases such as osteoporosis, Paget’s disease, or bone
metastases1 .
  Osteocalcin: This enzyme is a protein that is produced by
osteoblasts, the cells that build bone tissue. Osteocalcin is a marker
of bone formation and turnover. Elevated levels of osteocalcin in
the blood can indicate bone diseases such as osteoporosis, Paget’s
disease, or hyperparathyroidism1 .

These are some examples of enzymes that can be used in diagnosis of

bone diseases. However, these enzymes are not specific to bone and can
also be affected by other factors, such as diet, medication, or
inflammation. Therefore, enzyme-based diagnostic tests should be
interpreted in conjunction with other clinical and laboratory findings.

Some of the enzymes that are used in diagnosis of liver diseases are:

 Aspartate aminotransferase (AST) and alanine aminotransferase

(ALT): These are enzymes that are involved in amino acid
metabolism and are mainly found in the liver. They are released
into the bloodstream when the liver cells are damaged or
inflamed. Elevated levels of AST and ALT can indicate liver diseases
such as hepatitis, cirrhosis, or fatty liver123.
 Alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT):
These are enzymes that are involved in bile production and
secretion. They are found in the bile ducts and the liver. They are
increased in the blood when there is an obstruction or infection of
the bile ducts or a problem in the liver function. Elevated levels of
ALP and GGT can indicate liver diseases such as cholestasis,
cholangitis, or liver cancer124.
 Bilirubin: This is a pigment that is produced from the breakdown of
red blood cells. It is normally processed by the liver and excreted in
the bile. When the liver function is impaired or the bile flow is
blocked, bilirubin accumulates in the blood and causes jaundice, a
yellowing of the skin and eyes. High levels of bilirubin can indicate
liver diseases such as hemolytic anemia, Gilbert’s syndrome, or
biliary atresia12.

These are some examples of enzymes that can be used in diagnosis of

liver diseases. However, these enzymes are not specific to the liver and
can also be affected by other factors, such as diet, medication, or
inflammation. Therefore, enzyme-based diagnostic tests should be
interpreted in conjunction with other clinical and laboratory findings.

There are several enzymes that can be used in diagnosis of

alcoholism or excessive alcohol consumption. Some of the most
common ones are:

 Gamma-glutamyltransferase (GGT): This enzyme is involved in

glutathione metabolism and detoxification. Elevated levels of GGT
in the blood can indicate alcohol abuse, liver disease, or bile duct
obstruction12.
 Aspartate aminotransferase (AST) and alanine aminotransferase
(ALT): These enzymes are involved in amino acid metabolism and
are mainly found in the liver. They are released into the
bloodstream when the liver cells are damaged or inflamed. Elevated
levels of AST and ALT can indicate alcohol-induced liver damage,
hepatitis, cirrhosis, or fatty liver312.
 Carbohydrate-deficient transferrin (CDT): This is a protein that
transports iron in the blood. Alcohol consumption interferes with
the glycosylation of transferrin, resulting in a lower proportion of
transferrin with carbohydrates attached. CDT is a specific and
sensitive marker of chronic heavy drinking, detecting about 70% of
drinkers who consume more than 60 g of alcohol per day 31.

These are some examples of enzymes that can be used in diagnosis of

alcoholism or excessive alcohol consumption. However, these enzymes
are not specific to alcohol and can also be affected by other factors, such
as diet, medication, or inflammation. Therefore, enzyme-based diagnostic
tests should be interpreted in conjunction with other clinical and
laboratory findings.

Enzymes used in diagnosis of GIT diseases are enzymes that are

involved in the digestion and absorption of nutrients in the
gastrointestinal tract, such as amylase, lipase, pepsin, and
trypsin. These enzymes are normally secreted by the salivary
glands, stomach, pancreas, and small intestine, and enter the
blood or other body fluids after performing their functions.
However, when there is a disorder or disease in the GIT, such as
inflammation, infection, obstruction, or cancer, the levels or
activities of these enzymes may change, indicating the presence
or severity of the condition. For example, elevated levels of
amylase and lipase in the blood can indicate acute or chronic
pancreatitis, a condition where the pancreas is inflamed and
damaged12. Reduced levels of pepsin in the gastric juice can
indicate atrophic gastritis, a condition where the stomach lining
is thinned and produces less acid and enzymes 3. Elevated levels
of trypsin in the urine can indicate cystic fibrosis, a genetic
disorder that affects the secretion and function of mucus and
digestive enzymes4.
These are some examples of enzymes that can be used in
diagnosis of GIT diseases. However, these enzymes are not
specific to the GIT and can also be affected by other factors,
such as diet, medication, or inflammation. Therefore, enzyme-
based diagnostic tests should be interpreted in conjunction with
other clinical and laboratory findings.