NAME: Montalban, Kimberly N. YR.
& SECTION: 3RD YR- MED21B DATE: DECEMBER 14,
2023
SPECIFIC CLINICAL ENZYMES
1. ALKALINE PHOSPHATASE (ALP)
Methods/Assay
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the enzyme is Diseases present if the
REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay ELEVATED enzyme is DECREASE
and its End
ALP 1 Liver Bowers & Mc Comb Osteoblastic bone tumors After blood transfusion
ALP 2 Bone - continuous-monitoring Hepatitis Malnutrition
ALP 3 Placenta technique Cirrhosis Hypophosphatemia
ALP 4 Intestine - Specific method Rickets Zinc deficiency
Reax’n; Osteomalcia 30-90 /L
Obstructive Jaundice
Diabetes
Renal failute
*requires
2. ACID PHOSPHATASE (ACP)
Methods/Assay
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the enzyme is
Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay ELEVATED
and its End
Band 1 Prostate (Major source) (band 1) Gutman and Gutman: Moderate elevations: Tartrate-Inhibited ACP
Band 2 RBC (band 3; band 2&4- - Phenyl PO4 —> Inorganic Female Breast CA (Prostatic isoenzyme)
Band 3 granulocytes) PO4 Paget’s Disease - For prostatic
Band 4 Platelets (Band 3) Shinowara Hyperthyroidism CA
Band 5 Osteoclasts (band 5) - PNPP—> P-nitrophenol Non-prostatic ACP elevations: - Medico-legal Total ACP MALE:
Babson, Read and Phillips Niemann-Pick Disease cases 2.5-11.7 U/L
- Alpha-naphthyl PO4 —> Gaucher’s Disease (POSITIVE Prostatic ACP
Alpha-naphthol Myelocytic Leukemia ACP is evident 0-3.5 ng/mL
Roy and Hillman in vaginal swab
- Thymolphthalein if semen is
monoPO4 —> Free present for the
Thymolphthalein first 12hrs up
1
to 4 days from
incident).
Tartrate-resistant ACP
(Bone isoenzyme)
- Active
osteoclast-
mediated bone
resorption
- Gaucher’s cells
- Hairy cell
leukemia
Diagnostic significance:
- Detection of
prostatic CA.
3. ALANINE AMINOTRANSFERASE (ALT)/ (SGPT)
Methods/Assay
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the enzyme is
Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay ELEVATED
and its End
Liver (highest concentration) Coupled Enzymatic reaction Acute or chronic VIRAL hepatitis Monitors the course of
Kidney - pH 7.5; 340nm Hepatic injury hepatitis treatment and
Pancreas Reitmann-Frankel Method Muscle injury effect of drug therapy
RBC - uses lactate dehydrogenase Kidney infarcts
Heart Reax’n: Renal Failure 6-37 U/L
Skeletal muscles Alanine + a-ketoglutarate <—ALT—>
Lungs pyruvate + glutamate
Pyruvate + NAD +H <—LD—> lactate
+ NAD
4. ASPARTATE AMINOTRANSFERASE (AST)/ (SGOT)
Methods/Assay
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the
ELEVATED REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay enzyme is DECREASED
and its End
Cardiac tissue Karmen Method Myocardial infarction Pregnancy
Liver - Uses malate dehydrogenase Hepatocellular disease
Skeletal muscles Reax’n: Skeletal muscle involvement
c-AST (cytoplasm)
Kidney Aspartate + a-ketoglutarate Diagnosis of Alcohol abuse & drug abuse
m-AST 5-37 U/L
Pancreas <—(AST)—> oxaloacetate + Pulmunary infection
(mitochondrial)
RBC glutamate Pericarditis
Oxaloacetate + NAD+H <—MD—> Acute Hepatitis
Malate + NAD
5. CREATINE KINASE (CK)
2
Methods/Assay
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per +
ELEVATED Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay
and its End
CK-1 (CK-BB) – Brain Tanzer-Gilvarg Assay Acute myocardial infarction (AMI) Electrophoresis – method Male:
most rapid moving Smooth and skeletal muscles - Forward/ direct method Duchenne’s Muscular Dystrophy of choice and seldom 15-160 U/L
CK2 (CK-MB) - Reax’n: - highest elevation of total CK used. Female:
hybrid Creatine + ATP <—CPK—> Creatine Poliomyelitis Mass immunoassay- most 15-130 U/L
CK3 (CK-MM) – PO4 +ADP Acute Myopathy commonly used for CK-MB:
slowest and most ADP+ Phosphoenopyruvate <—PK— Delirium tremens measuring CK-MB. <6% of total CK
common >Pyruvate + ATP Hypothyroidism “conan” monoclonal Ab-
Macro-CK Pyruvate + NADH <—LD—> Lactate Malignant hyperthermia specific for CK-MB
+ NAD Trichinosis and dermatomyositis CK is light sensitive
Acute cerebrovascular diseas
Oliver-Rosalki Method:
- Reverse/indirect method CK-BB increased:
- Most commonly used and Smooth muscle injury
FASTER reaction Prostate CA
Reax’n: Small cell Carcinoma of the lung
Creatine PO4 + ADP <—CPK—> Intestinal malignancies
Creatine + ATP
ATP + Glucose <—HK—> ADP + Macro-CK2 present :
G6PO4 Myocardial Infarction
G6PO4 + NADP <—G6PD—> 6-
phosphogluconate + NADPH
6. LACTATE DEHYDROGENASE (LD)
Methods/Assay
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per +
ELEVATED Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay
and its End
Heart, Rbc, Kidney (LD1) Wacker method Viral hepatitis and Cirrhosis (2-3x LD1 & LD2
Lungs ,Pancreas, Spleen (LD3) - Forward / direct reaction increased) - FLIPPED Forward reaction:
Skeletal muscles, Liver, Intestine Lactate + NAD <—LD—> Pyruvate + Acute Viral Hepatitis (LD5 moderate) PATTERN in 100-225 U/L
(LD4 & LD5) NADH at 340nm Hepatic carcinoma and toxic hepatitis Myocardial Reverse Reaction
- (LD5 markedly increased/ 10 infarction and 80-280 U/L
Wroblewski La Due fold increase) Hemolytic
LD1 (H4)
- Reverse/ indirect reaction anemia
LD2 (H3M)
Pyruvate + NADH <—LD—> Lactate HIGHEST LEVEL IN: LD2 always higher than
LD3 (H2M2)
+ NAD Pernicious anemia LD1
LD4 (HM3)
Hemolytic disorders
LD5 (M4)
3
7. AMYLASE / DIASTASE
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per
Methods/Assay ELEVATED Additional REFERENCE VALUES
FORMS isoenzyme, if present)
Pancreas Saccharogenic Acute pancreatitis -earliest pancreatic
- measures the amount of marker
reducing sugars produced - Smallest enzyme
by the hydrolysis of starch
Amyloclastic
- amylase activity is
evaluated by following the
decrease in substrate
concentration
S-type (ptyalin) 60-180 SU/dL (Somogyi Units)
Chromogenic
P-type (amylopsin) 95-290 U/L
- measures the increasing
color from production of
product coupled with a
chromogenic dye
Continuous Monitoring
- coupling of several enzyme
systems to monitor
amylase activity
8. GAMMA-GLUTAMYL TRANSFERASE (GGT)
Methods/Assay
Diseases present if the enzyme is
ORGAN/ TISSUE SOURCE (per + Diseases present if the
ELEVATED REFERENCE VALUES
isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay enzyme is DECREASED
and its End
-Evaluation of liver Liver Szasz Assay Liver – Major source of GGT release. Pregnancy (first Male:
injury Canaliculi cells - GGT is measured by Smoking (moderate-10% increase; heavy- trimester-25% decrease) 6-45 U/L
- test for alcoholic Proximal renal tubule cleavage of Chromogen o- 20% increase) Oral Contraceptives (20% 5-30 U/L
abuse Intestinal Epithelium carboxyl p-` from a Medications (e.g ethanol, phenytoin, decrease)
Prostate gland glutamate modified form of barbiturates, carbazepine, valproic acid)
the compound
9. LIPASE
Methods/Assay
Diseases present if the enzyme is
ORGAN/ TISSUE SOURCE (per +
ELEVATED Additional REFERENCE VALUES
isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay
and its End
4
Exclusively secreted in the pancreas Cherry Crandall Method Most specific pancreatic
- Reference Method marker
- Hydrolysis of Olive oil Lipemic spx
after incubation for 24 hrs - Reduction of
Acute pancreatitis
at 37 degree C and titration lipase activity
Pancreatic duct obstruction
of fatty acids using NaOH. Opiates and morphine
Tumors of Pancreas
Substrate: - Increase LPS
0-1.0 U / mL
- 50% olive oil (TRIOLEIN) activity due to
Chronic Acute pancreatitis- acinar cell
End Product: its spastic effect
degradation occurs which results to loss
- Fatty acid on the
of amylase and lipase production.
duodenal
musculature
and sphincter
of Oddi
