Clinical Significance of AST/ALT Ratio

VornalIST 4LT ratio is 0.8 1

ratio >2is seen in:
o Alcoholic hepatitis
o Hepatitis with cirrhosis
o Nonalcoholic steatohepatitis (NASH)
o Liver metastases
o
Myocardial infarction
o Erythromycin treatment

HLT higher than 4ST is seen in:

Acute hepatocellular injury
O Toxic exposure
 INTERPRETATION
Normal level of ALT: 10-40 IU/L

Incre ase ALT

Liver dise ase -(viral- acute and
chronic hepatitis)
Toxic hepatis- drugs like ccl4, NSAID, ATT
like ISONIAZID, Antibiotics like
AMOXYCILLIN AND ERYTHROMYCIN
Cirhosis of liver
 RESULT

The supplied serum sample contains

IU/L ALT.
 PROCEDURE
Allow the working reagent to attain 37°C
before performing the test
Test

Working reagent 1000 ul

Serum 100 pl

1000plworking reagent & 100ul serum sample were taken

in a test tube. It was mixed well& aspirated immediately.
 PRINCIPLE

a-ketoglutarate reacts with L-alanine in

presence of ALT to form pyruvate & L
glutamate. The increase in pyruvate is
determined in an indicator reaction catalyzed
by lactate dehydrogenase. The conversion of
NADHto NAD* at 340nm is proportional to the
activity of ALT in serum/plasma and is
determined kinelically as rate of decre ase in
absorbance.
 PRINCIPLE

ALT
L-alanine +a-ketoglutarate <......>.
-> pyruvate
+ L-glutamate
LDH

Pyruvate + NADH+ H<<------..> L-lactate

H* +

NAD
Composilion of reagent
Tris
buffer
L-Alanine
Alpha- keloglutarate
NADH
LDH
Aim of the experinent -
Toestimate the amount of ALTpresent in the
supplied serum sample by UV kinetic
method.
Apparatus required
Test tubes
Micropipete
semiautomated analyser
Chemicals required
Reagents
Supplied serum sample
 INTERPRETATON
:
Nomal level of AST 8-40 1U/L
INCREASE AST LEVEL
Myocardial infarction
Acute and chronic hepatitis
Liver cirrhosis
Hepatoma
NASH(Non Alcoholic Steato Hepalitis)
Nonalcoholic fatly liver
Muscular dystrophy
DECREASE AST LEVEL- Vit B6 deficiency
 RESULT

The supplied serum sample contains

1U/L AST.
 PROCEDURE
Allow the working reagent to attain 37°C
before performing the test
Test

Working reagent 1000 ul

Serum 100 ul

000ul working reagent & 100ul serum sample were take

in a test tube. It was mixed well & aspirated immediately.
 PRINCIPLE

a-ketoglutarate reactswith L-aspartate in

presence of aspartate transaminase to form
Oxaloacetate and L-glutamate. The increase in
Oxaloacetate is determined in an indicator reaction
catalyzed by malate dehydrogenase. The conversion
of NADHto NAD* at 340nm is proportional to the
activity of AST inserum/plasma and is determined
kinetically as rate of decrease in absorbance.
 PRINCIPLE

AST
L-aspartate a -ketogl utarate
+ <--........>.
Oxaloacetate + L-glutam ate
MDH
Oxaloacetate +NADH +H°<----...>-malate
+ NAD
Composition of reagent
Tris buffer
L-Aspartate
a-ketoglutarate
NADH
Malate dehydrogenase
Aim of the experiment -
Toestimate the amount of AST present in the
Supplied serum sample by UV kinetic
method.
Apparatus required
Test tubes
Micropipelte
semiautomated analyser
Chemicals require d
Reagenis
Supplied serum sample
Aim of the expeiment -

To estimate the amount of AST present in the

Supplied serum sample by UV kinetic
method.
 Clinical Signficance of transaminases

ALANINE AMINOTRANSEERASE (ALT) EC 2.6.1.2

'a/k/a Serum Glutamate Pyruvate Transaminase (5GPT).

*Only cytoplasmic

RR-10-40 W/L

*Itis signilficantly raised in

d. acute bepatits (tovic/irnal); 00-100W/L

b. In liver diseases both AlTand ASTare nised but AIAT
C Moderate rse in -50-100 U/L n chronic Iiver discases such as
cirhosis, hepatios Cand NASH
 Clinical Significance of transaminases
ASPARTATE AMINOTRANSFERASE (AST) EC 2.61.1

a/ka Serum Glutamate Oxaloacetate Iransaminase (SGOTO.

•Both cytoplasmic (cASDand Mitochondrial (mAST)
*Distributed in liver, muscde, bran, pancreas, kadncy so any damage to thesc
organs incTeases the AST level in blood.
• RR:840 U/L
• Itis sgnaficantly raiscd in
A. Myocardial inlarction-SGOTI/AST(Ctoplasmic AST)
b. clevated in liver discase-SGOT:/AST(aitoc hondrial AST)
Primary hepatomas
d. Alcoholic hepaitis:AST> ALTdue to mitos hondrial damage
 Functions ofTransaminases

Iransaminases are enzAmes that catalze a reaction

between an amino acid and an C-keto acid.

General Steps of transamination reactions

pyridoxamine

"amino
acidkto acid.

*Enzyme-bound puridoxamine in turn reacts with

*Pruvate Anine

•Ouloxetate Ayartic acid

*a ketoglutarte Glutamic acid

 LET Enzvme Panel
1 Alanine ominotranslerase (ALUI)
Marked increase in parenchymal liver diseases

2 Aspartate aminotranslerose (AST)

Increase in muscle disease, not specihc
3. Alkaline phosphatase lALP)

Marked increase in obstructive Iiver disease

4 Gammo-glutamyltransferase (GGT)

Increased in obstructive and alcoholiclver

5. /
AST ALT ratio
-ALT> AST- hepatitis
-43T> ALT- alcohol (or in cirrhoss)
 Serum Transaminases
AST and ALT are two most frequently measured transaminases bv
the clinical brochemistr laborator.

*Serum AST, ALT leves, and AST/ALT ratio are biomarkers for
Iver hcalth.
The cnzNmes are uscd n the dillerential dagnosis of various liver
discascs and the ratio of the two cnzvmes provides additional
dlnical msght
•Thesc tests are part of LFT pancl.
 ASTand ALT belong to the group called
Transaminase / Aminotransferase
AST- Aspartate Transaminase
SGOT- Serum Glutam ate Oxaloacetate
Transaminase
ALT- Alanine Transaminase
SGPT- Serum Glutamate Pyruvate
Transaninase
Estimatton of serUm AST and
ALT by UV
kineie nmethod