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Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram
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Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Dec 31, 2015

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Page 1: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Enzymes

Biochemistry for NursingSummer semester, 2015

Dr. Mamoun Ahram

Page 2: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

What are enzymes?

• Enzymes are specialized proteins that are able to conduct chemical reactions under biological conditions.

• Most enzymes have very specific functions, and convert specific substrates to the corresponding products.

Page 3: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Enzymes are catalysts

• Enzymes are catalysts.– They increase the rate of a reaction.– Enzymes accelerate reactions by factors of as much as

a million or more.• They are used in small amounts relative to the

reactants.• They are not consumed in the reaction.• Enzymes do not change an energetically unfavorable

into a favorable one.

Page 4: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

How to express an enzymatic reaction?

• Reactants are known as substrates.• We can express an enzymatic reaction like this:

E + S ES EP E + Pwhere E is the free enzyme; S is the free substrate, ES is the enzyme-substrate complex; P is the product of the reaction; and EP is the enzyme-product complex before the product is released

• To simplify the reaction, the reaction is expressed asE + S ES E + P

Page 5: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Turnover number

• A simple reaction of the hydration of carbon dioxide is catalyzed by an enzyme called carbonic anhydrase.

• Each enzyme molecule can hydrate 106 molecules of CO2 per second.

• The catalyzed reaction is 107 times as fast as the uncatalyzed one.• The catalytic activity of an enzyme is measured by its turnover

number, the maximum number of substrate molecules converted by one molecule of enzyme per unit time.

Page 6: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

General properties of enzymes

• The function of nearly all proteins depends on their ability to bind other molecules (ligands).

• Two properties of a protein in regards to its interaction with ligands:– affinity: the strength of binding between a protein and

other molecules– specificity: the ability of a protein to bind one

molecule in preference to other molecules

Page 7: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Examples of very specific enzymes

Proteases

Page 8: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Some enzymes are less specific

Carbxypeptidase

Page 9: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Active sites of enzymes

• Each enzyme has a specific three-dimensional shape that includes a region where the biochemical reaction takes place, called the active site

• The active site contains a specialized amino acid sequence that facilitates the reaction.

Page 10: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Features of active site 1

• Binding is specific due to the precise interaction of the substrate with the enzyme.

• Binding occurs at least at three points.

• This illustrates the importance of chirality.• If a substrate is chiral, an

enzyme usually catalyzes the reaction of only one of the pair of enantiomers because only one fits the active site in such a way that the reaction can occur.

Page 11: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Features of active site 2

• The active site is small.• The “extra” amino acids: – create the three-

dimensional structure of active site,

– form regulatory sites that interact with other proteins or small molecules and control the activity of the enzyme.

Page 12: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Features of active site 3

• Active sites are structures that look like canals that bind substrate molecules.

Page 13: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Features of active site 4• Substrates are bound to

enzymes by multiple weak attractions including :– electrostatic interactions, – hydrogen bonds, – van der Waals forces, and – hydrophobic interactions.

Page 14: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Naming of enzymes

• In general, enzymes end with the suffix (-ase)• Most other enzymes are named for their substrates and

for the type of reactions they catalyze, with the suffix “ase” added– An ATPase is an enzyme that breaks down ATP– ATP synthase is an enzyme that synthesizes ATP

• Some enzymes have common names that provide little information about the reactions that they catalyze

• Examples include the proteolytic enzyme trypsin

Page 15: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Classification of enzymes

• Enzymes were classified into six major groups– Oxidoreductases– Transferases– Hydrolases– Lyases– Isomerases– Ligases

Page 16: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Oxidoreductases

• These enzymes catalyze oxidation and reduction reactions involving the transfer of hydrogen atoms or electrons

• This group can be further divided into 4 main classes:– Dehydrogenases– Oxidases– Peroxidases– Oxygenases

Page 17: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Dehydrogenases

• Dehydrogenases catalyze Removal of 2 hydrogens to form a double bond .

• Usually, hydrogen is transferred from the substrate to a molecule known as nicotinamide adenine dinucleotide (NAD+)

• Lactate dehydrogenase catalyzes this reaction

Page 18: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Alcohol dehydrogenase

• Another example is alcohol dehydrogenase

Page 19: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Oxidases

• Oxidases catalyze hydrogen transfer from the substrate to molecular oxygen producing hydrogen peroxide (H2O2) as a one product (or addition of O2 to a substrate)

• Glucose oxidase catalyzes this reaction: -D-glucose + O2 gluconolactone + H2O2

Page 20: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Peroxidases

• Peroxidases catalyze oxidation of a substrate by hydrogen peroxide.

• Example: the oxidation of two molecules of glutathione (GSH) in the presence of hydrogen peroxide:

Page 21: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Oxygenases

• Oxygenases catalyze substrate oxidation by oxygen• The reduced product of the reaction in this case is

water and not hydrogen peroxide• An example of this is the oxidation of lactate to acetate

catalyzed by lactate-2-monooxygenaseCH3-CH(OH)-COOH + O2 CH3COOH + CO2 + H2O

Page 22: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Transferases

• These enzymes transfer a functional group (C, N, P or S) from one substrate to an acceptor molecule

• Types: transaminases and kinases

Page 23: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Transaminases

• A transaminase transfers an amino functional group from one amino acid to a keto acid, converting the amino acid to a keto acid and the keto acid to an amino acid

• This allows for the interconversion of certain amino acids

Page 24: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Kinases transfer of a phosphoryl group between substrates

Page 25: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Hydrolases

• These enzymes catalyze cleavage reactions while using water

• Peptidases, esterases, lipases, glycosidases, phosphatases are all examples of hydrolases named depending on the type of bond cleaved

Page 26: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Proteases

• A class of hydrolytic enzymes is proteases• These enzymes catalyze proteolysis, the hydrolysis of

a peptide bond within proteins

• Proteolytic enzymes differ in their degree of substrate specificity

Page 27: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Exmaples

• Trypsin, a digestive enzyme, is quite specific and catalyzes the splitting of peptide bonds only on the carboxyl side of lysine and arginine residues

• Thrombin, an enzyme that participates in blood clotting, catalyzes the hydrolysis of Arg-Gly bonds in particular peptide sequences only

Page 28: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Lyases

• These enzymes remove groups from their substrates resulting in the formation or removal of double bonds between C-C, C-O and C-N by a means other than hydrolysis

Page 29: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Types of lyases

• Dehydrases: Removal of H2O from substrate to give double bond (example: enolase)

• Decarboxylases: Replacement of a carboxyl group by a hydrogen

• (example: pyruvate decarboxylase)

• Synthases: Addition of a small molecule to a double bond (example: citrate synthase)

Page 30: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Isomerases

• These enzymes catalyze intramolecular rearrangements

Page 31: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Ligases

• Ligases join C-C, C-O, C-N, C-S and C-halogen bonds• The reaction is usually accompanied by the

consumption of a high energy compound such as ATP and other nucleoside triphosphates

• Example: pyruvate carboxylase, which catalyzes:Pyruvate + HCO3

- + ATP Oxaloacetate + ADP + Pi

Page 32: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

HOW DO SUBSTRATES FIT INTO THE ACTIVE SITE OF ENZYMES?

Page 33: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Lock-and-key model

• The first is known as lock-and-key model where the substrate fits directly into the active site.

Lock-and-key model Induced fit model

Page 34: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Induced fit model

• The other model known as induced fit model states that enzymes are flexible and that the shapes of the active sites can be changed by the binding of substrate.

Lock-and-key model Induced fit model

Page 35: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Activation energy

• Conversion of a substrate to a product requires an energy called activation energy.

• Enzymes accelerate reactions by lowering this energy.

Binding of substrate to an enzyme makes it less stable

Page 36: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

ENZYME REGULATION

Page 37: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Mechanisms of regulation

• Non-specific inhibition (pH and temperature)• Regulation of substrate and enzyme amount• Location (Compartmentalization and complexing of

enzymes)• Expression of enzyme type (isoenzymes)• Regulation of enzymatic activity• Inhibitors• Allostery• Reversible covalent modification• Irreversible covalent modification

Page 38: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Effect of substrate Concentration

• The rate increases with more substrate added to the reaction because more enzyme molecules are bound by the substrate.– If the substrate

concentration doubles, the rate of the reactions doubles.

• But: the increase in the rate begins to level off because the active sites are occupied (they become saturated).

The rate of the reaction is determined by the efficiency of the enzyme, the pH, and the temperature

Page 39: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Saturation

Page 40: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Effect of Enzyme Concentration

• If the enzyme concentration doubles, the rate doubles; if the enzyme concentration

• triples, the rate triples; and so on.

Page 41: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Regulation of enzyme amount

• There are basically two mechanisms:– controlling rate of enzyme synthesis at the gene level– controlling rate of enzyme degradation by proteases

Page 42: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Temperature

• Usually, the reaction rate increases

• But, at high temperatures, the activity decreases because the protein part of the enzyme begins to denature

• Enzymes have an optimal temperature– For humans, it is 37°C– For thermophilic bacteria, it

can be 65°C

Page 43: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Hypothermia

• A severe drop in body temperature creates the potentially fatal condition of hypothermia, which is accompanied by a slowdown in metabolic reactions.

• This effect is used to advantage by cooling the body during cardiac surgery.

• Upon gentle warming, enzymatic reaction rates return to normal because cooling does not denature proteins.

Page 44: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

pH

• pH can alter binding of substrate to enzyme by altering the protonation state of the substrate and/or altering the conformation of the enzyme

• The effect of pH is enzyme-dependent

Page 45: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Enzymes can be placed in small cellular compartments• For example, lysosomes contain many of the

proteolytic enzymes responsible for protein degradation

• Another example, synthesis of fatty acids are located in cytosol, whereas enzymes responsible for oxidation (break-sown) of fatty acids are located in the mitochondria

Page 46: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Enzymes can be made of multiple enzymes• The enzymes involved in a reaction sequence form a

multienzyme complex– This allows the product of enzyme A to be passed

directly to enzyme B• Example: Pyruvate dehydrogenase

Pyruvate + CoA + NAD+ Acetyl CoA + CO2 + NADH

Page 47: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Allostery

• Allosteric regulation: binding of one molecule to one site changes binding of another molecule on a different site

• Allosteric enzymes tend to be a multi-subunit • Allosteric enzymes contain an active site and a

regulatory site• The binding of regulatory molecules causes

conformational changes in the active site

Page 48: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Allosteric control

Negative allosteric regulation

Positive allosteric regulation

Page 49: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Enzyme inhibitors

• The activity of many enzymes can be inhibited by the binding of specific small molecules.

• Enzyme inhibition can be either reversible or irreversible.

• Physiological inhibitors are reversible.

Page 50: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Irreversible inhibitors

• An irreversible inhibitor tightly binds to the enzyme preventing the substrate from binding.

• The inhibitor forms a bond that is not easily broken with a group in an active site.

• Examples:– Heavy metals like mercury bind to –SH groups of

cysteine– Sarin (nerve gas) binds to serine in the active site of

acetylcholinesterase inhibiting it (no ore nerve impulses, paralysis)

Page 51: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Reversible inhibitors

• Reversible inhibition is characterized by a rapid dissociation of the enzyme-inhibitor complex

• Usually these inhibitors bind to enzymes by non-covalent forces

Page 52: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Types of reversible inhibitors

Competitive• The inhibitor competes with

the substrate for the active site

Noncompetitive• the inhibitor binds at a site

other than the catalytic site

Page 53: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Reversible covalent modification

• A small group is added to the enzyme affecting its function.

• Advantage: fast and transient regulation of enzyme activity

The addition (phosphorylation) or removal (dephosphorylation) of a phosphate group by enzymes may activate or inactivate proteins like other enzymes

Page 54: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Irreversible covalent modification (proteolytic activation)• Many enzymes are synthesized as inactive precursors called

zymogens or proenzymes• When a substrate is present, part of the enzyme is removed

to make it an active enzyme• However, it is an irreversible process, so once the pro region is

removed, it cannot go back

Page 55: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Examples of zymogens (digestive enzymes)

Page 56: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

How does it work?

• Three of the enzymes that digest proteins in the small intestine are produced in the pancreas as the zymogens trypsinogen, chymotrypsinogen, and proelastase.

• These enzymes are inactive when they are synthesized so that they do not digest the pancreas.

• Each zymogen has a polypeptide segment at one end that is not present in the active enzymes.

• The extra segments are snipped off to produce trypsin, chymotrypsin, and elastase, the active enzymes, when the zymogens reach the small intestine, where protein digestion occurs.

Page 57: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Acute pancreatitis

• One danger of traumatic injury to the pancreas or the duct that leads to the small intestine is premature activation of these zymogens, resulting in acute pancreatitis, a painful and potentially fatal condition in which the activated enzymes attack the pancreas.

Page 58: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Isoenzymes (isozymes)

• These are enzymes that – Are produced by different genes – Can act on the same substrate(s) producing the same

product(s)– Have different tissue distribution– Have different mechanisms of regulation– May have different catalytic activity

Page 59: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

LDH

• Lactate dehydrogenase (LDH) is a tetrameric enzyme composed of two protein subunits; the subunits are known as H (for heart) and M (for skeletal muscle)

• These subunits combine in various combinations leading to 5 distinct isozymes

• These subunits combine in various combinations leading to 5 distinct isozymes (LDH1-5) with different combinations of the M and H subunits

• The all H isozyme is characteristic of that from heart tissue, and the all M isozyme is typically found in skeletal muscle and liver

Page 60: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

MODES OF REGULATION

Page 61: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Feedback inhibition

• A common type of control occurs when an enzyme present early in a biochemical pathway is inhibited by a late product of pathway

• This is known as feedback inhibition or negative feedback regulation

Page 62: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Positive feedback regulation

• Enzymes can also be subject to positive feedback regulation where a product stimulates the activity of an enzyme

Page 63: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Feed-forward regulation

• A third mechanism is feed-forward regulation where a substrate produced early in a pathway activates an enzyme downstream of the same pathway

Page 64: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

A committed step

• A committed step is an irreversible reaction that, once occurs, leads to the formation of a final substrate with no point of return

• For example, the committed step for making product E is (B → C), not (A → B)

A B

C

X Y

D E

Z

A B

C

X Y

D E

Z

Page 65: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Rate-limiting reactions

• Some reactions are called rate-limiting since they limit rate (speed) of reactions.

• Why do they limit reactions?– They need lots of energy.– They are highly regulated.

Page 66: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

ENZYMES IN DISEASE DIAGNOSIS

Page 67: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Concept

• The measurement of the serum levels of numerous enzymes has been shown to be of diagnostic significance

• This is because the presence of these enzymes in the serum indicates that tissue or cellular damage has occurred resulting in the release of intracellular components into the blood

Page 68: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Information from enzymes measurements in serum• Presence of disease• Organs involved• Etiology /nature of disease: differential diagnosis• Extent of disease-more damaged cells-more leaked

enzymes in blood• Time course of disease

Page 69: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Measurement of enzyme activity

• Enzyme activity is expressed in International unit (IU)• It corresponds to the amount of enzymes that

catalyzes the conversion of one micromole (mol) of substrate to product per minute

Page 70: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Enzymes used in the clinic

ENZYME PRESENT INAspartate Amino transferase (AST)Serum glutamate-oxaloacetate transaminase (SGOT)

Heart and Liver

Alanine Amino transferase (ALT)Serum glutamate-pyruvate transaminase (SGPT)

Heart and Liver

Alkaline Phosphatase (ALP) Bone, intestine and other tissuesAcid Phosphatase (ACP) Prostate glutamyl Transferase ( GT) LiverCreatine kinase (CK) Muscle Including cardiac muscleLactate Dehydrogenase (LDH) Heart, liver, muscle, RBC Amylase Pancreas

Page 71: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

AST and ALT

• The typical liver enzymes measured are AST and ALT• ALT is particularly diagnostic of liver involvement as

this enzyme is found predominantly in hepatocytes.• When assaying for both ALT and AST the ratio of the

level of these two enzymes can also be diagnostic.• Normally in liver disease or damage that is not of

viral origin the ratio of ALT/AST is less than 1.• However, with viral hepatitis the ALT/AST ratio will be

greater than 1.

Page 72: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

ALKALINE PHOSPHATASE (ALP)

• Is a group of enzymes that have maximal activity at a high pH 9.0-10.5

• High levels are seen is liver and bone, and useful to assess hepatobiliary and bone diseases

• In liver, high levels of ALP is indicative of extrahepatic obstruction

• In bones, the enzyme is increased in bone diseases like rickets, osteomalacia, neoplastic diseases with bone metastates and healing fractures

Page 73: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

ACID PHOSPHATASE (ACP)

• Is a group of enzymes that have maximal activity at pH 5.0-6.0

• It is present in prostate gland.• The main source of ACP is prostate gland and so can

be used as a marker for prostate disease.

Page 74: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

AMYLASE

• Is the digestive enzymes from the pancreas and salivary glands to digest complex carbohydrates.

• Elevated in acute pancreatitis.• It is used as a marker to detect acute pancreatitis and

appendicitis.

Page 75: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

-Glutamyltransferase (-GT)

• Amino acid + Glutathione -glutamyl amino acid + Cysteinylglycine

• Found mainly in biliary ducts of the liver, kidney and pancreas.• Enzyme activity is induced by a number of drugs and in

particular alcohol.• -GT increased in liver diseases especially in obstructive

jaundice.• -GT levels are used as a marker of alcohol induced liver

disease and in liver cirrhosis.

Page 76: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

Myocardial infarction

Page 77: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

CPK

• CPK is found primarily in heart and skeletal muscle as well as the brain. Therefore, measurement of serum CPK levels is a good diagnostic for injury to these tissues

• Like LDH, there are tissue-specific isozymes of CPK:– CPK3 (CPK-MM) is the predominant isozyme in muscle– CPK2 (CPK-MB) accounts for about 35% of the CPK

activity in cardiac muscle, but less than 5% in skeletal muscle.

– CPK1 (CPK-BB) is the characteristic isozyme in brain and is in significant amounts in smooth muscle

Page 78: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

CPK and myocardial infarction

• Since most of the released CPK after a myocardial infarction is CPK-MB, an increased ratio of CPK-MB to total CPK may help in diagnosis of an acute infarction, but an increase of total CPK in itself may not

Page 79: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

LDH

• Lactate dehydrogenase exists in 5 types differentially and specifically distributed in tissues

• The 5 isoforms of LDH: LDH1, 2, 3, 4, and 5• LDH is especially diagnostic for myocardial infarction

(heart attacks) among other diseases like acute hepatitis (LDH5 > LDH4).

Page 80: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

LACTATE DEHYDROGENASE IN MI

Page 81: Enzymes Biochemistry for Nursing Summer semester, 2015 Dr. Mamoun Ahram.

LDH1 vs. LDH2

• A characteristic change following a heart attack is an elevated level of LDH1 above LDH2.

• A comparison of serum levels of LDH-1/LDH-2 ratio is diagnostic

• Normally, this ratio is less than 1

• Following an acute myocardial infarct, the LDH ratio will be more than 1.