Diagnostic Enzymes – Enzymes in health and diseases

Biochemical diagnosis of diseases by enzyme assays

SGOT and SGPT

Aldolase

The aldolase test measures the amount of aldolase in your blood. Increased levels of this enzyme may indicate a serious health problem.

Elevated aldolase is usually a sign of muscle or liver damage. For example, muscle damage from a heart attack releases aldolase in large quantities.

Liver damage, such as cirrhosis, raises aldolase levels as well.

In the past, the aldolase test was used to look for liver or muscle damage. However, today blood tests that are more specific can be used

Higher or abnormal levels may be due to health conditions, including:

•muscle damage•dermatomyositis•viral hepatitis•cancers of the liver, pancreas, or prostate•muscular dystrophy•heart attack (myocardial infarction)•polymyositis•leukemia•gangrene•hyperaldolasemia

Aldolase testing for conditions such as hyperaldolasemia is not straightforward. This condition causes muscle mass in the body to decrease. At first, muscle destruction causes higher aldolase levels. However, aldolase levels actually decline as the amount of muscle in the body decreases.

Amylase

CPK

Cholinesterase

An absence or mutation of the BCHE enzyme leads to a medical condition known as pseudocholinesterase deficiency. This is a silent condition that manifests itself only when people that have the deficiency receive the muscle relaxants succinylcholine or mivacurium during a surgery.

Pseudocholinesterase deficiency may also affect local anaesthetic selection in dental procedures. The enzyme plays an important role in the metabolism of ester-based local anaesthetics, a deficiency lowers the margin of safety and increases the risk of systemic effects with this type of anaesthetic. The selection of an amide-based solution is recommended in such patients.

Elevation of plasma BCHE levels was observed in 90.5% cases of acute myocardial infarction.[9]

The presence of ACHE in the amniotic fluid may be tested in early pregnancy. A sample of amniotic fluid is removed by amniocentesis, and presence of ACHE can confirm several common types of birth defect, including abdominal wall defects and neural tube defects.[10]

BCHE can be used as a prophylactic agent against nerve gas and other organophosphate poisoning.[8]

Inhibitors[edit]

LDH

FUNCTION TEST OF KIDNEY AND PANCREAS

Clinical significance

A puncture of the pancreas, which may lead to the secretion of digestive enzymes such as lipase and amylase into the abdominal cavity as well as subsequent pancreatic self-digestion and digestion and damage to organs within the abdomen, generally requires prompt and experienced medical intervention.It is possible for one to live without a pancreas, provided that the person takes insulin for proper regulation of blood glucose concentration and pancreatic enzyme supplements to aid digestion.[1

Inflammation

Inflammation of the pancreas is known as pancreatitis. Pancreatitis is most often associated with recurrent gallstones or chronic alcohol use, although a variety of other causes, including measles, mumps, some medications, the congenital condition alpha-1 antitrypsin deficiency and even some scorpion stings, may cause pancreatitis. Pancreatitis is likely to cause intense pain in the central abdomen, that often radiates to the back, and may be associated with jaundice. In addition, due to causing problems with fat digestion andbilirubin excretion, pancreatitis often presents with pale stools and dark urine.[14]

In pancreatitis, enzymes of the exocrine pancreas damage the structure and tissue of the pancreas. Detection of some of these enzymes, such as amylase and lipase in the blood, along with symptoms and findings on X-ray, are often used to indicate that a person has pancreatitis. A person with pancreatitis is also at risk of shock. Pancreatitis is often managed medically with analgesics, removal of gallstones or treatment of other causes, and monitoring to ensure a patient does not develop shock.[14]

Cancer

Pancreatic cancers, particularly the most common type, pancreatic adenocarcinoma, remain very difficult to treat, and are mostly diagnosed only at a stage that is too late for surgery, which is the only curative treatment. Pancreatic cancer is rare in those younger than 40, and the median age of diagnosis is 71.[15] Risk factors include: smoking, obesity,diabetes, and certain rare genetic conditions including: multiple endocrine neoplasia type 1 and hereditary nonpolyposis colon cancer among others.[16] About 25% of cases are attributable to tobacco smoking,[17]

 while 5-10% of cases are linked to inherited genes.[15]

There are several types of pancreatic cancer, involving both the endocrine and exocrine tissue. Pancreatic adenocarcinoma, which affects the exocrine part of the pancreas, is by far the most common form. The many types of pancreatic endocrine tumors are all uncommon or rare, and have varied outlooks. However the incidence of these cancers has been rising sharply; it is not clear to what extent this reflects increased detection, especially through medical imaging, of tumors that would be very slow to develop. Insulinomas(largely benign) and gastrinomas are the most common types.[18] In the United States pancreatic cancer is the fourth most common cause of deaths due to cancer.[19] The disease occurs more often in the developed world, which had 68% of new cases in 2012. [20] Pancreatic adenocarcinoma typically has poor outcomes with the average percentage alive for at least one and five years after diagnosis being 25% and 5% respectively.[20][21] In localized disease where the cancer is small (< 2 cm) the number alive at five years is approximately 20%.[22] For those with neuroendocrine cancers the number alive after five years is much better at 65%, varying considerably with type.[20]

A solid pseudopapillary tumour is a low-grade malignant tumour of the pancreas of papillary architecture that typically afflicts young women.[23]

Diabetes

Type 1 diabetesDiabetes mellitus type 1 is a chronic autoimmune disorder in which the immune system attacks the insulin-secreting cells of the pancreas. People with type 1 diabetes therefore lack the insulin needed to keep blood sugar levels within optimal ranges. If left untreated, this leads to high blood sugar and the array of associated symptoms. Type 1 diabetes develops in people of all ages but is most often diagnosed before adulthood. For type 1 diabetics, insulin injections are critical for survival. [24]

Type 2 diabetesDiabetes mellitus type 2 is the most common form of diabetes. The causes for high blood sugar in this form of diabetes usually are a combination of insulin resistance and impaired insulin secretion, with both genetic and environmental factors playing an important role in the development of the disease. The management of type 2 diabetes relies on a series of changes in diet and physical activity with the purpose of reducing blood sugar levels to normal ranges and increasing insulin sensitivity. [24] Biguanides such asmetformin are also used as part of the treatment along with insulin therapy.[25]

Functions Test of Kidney

INULINE AND CLEARANCE TEST

Regulation of electrolyte content of body fluids and maintenance of pH

Maintenance of pH