ISOENZYMES

Physically distinct forms or protomers of an

oligomeric enzyme which can occur in

different tissues of the same organ,in different
cell types,or in subcellular compartmenmts
catalyzing same reaction.
These can be separated by electrophoresis.
Lactate dehydrogenase has 5 isoenzymes
giving 5 distint bands on electrophoresis and
is made up of 4 protomers.

LACTATE
LDH1
HHHH
Occurs in
DEHYDROGENASE
myocardium
LDH2

HHHM

LDH3

HHMM

LDH4

HMMM

LDH5

MMMM

in acute MI
In acute
leukemia
In acute
leukemia
Occurs in muscles
and liver
Occurs in muscles

CREATININE KINASE(CK)

CK1

BB

Occurs in
brain,smoth
muscles of GIT
and urinary
tract

CK2

MB

CK3

MM

Myocardium,SK
muscles.
in acute MI
In SK muscles,
in muscle

CLINICAL ENZYMOLOGY
Study of plasma levels in the diagnosis of
various diseases.
Plasma enzyme level depends on
-Rate of release from the damaged cell
-Extent of cell damage
In the absence of cell damage ,it depends on
-Rate of cell proliferation
-Degree of induction of enzyme synthesis
-Rate of enzyme clearance from the
circulation.

CLINICAL ENZYMOLOGY
PHYSIOLOGICAL FACTORS/VARIATIONS
-Plasma AST is increased in neonates.
-Alkaline phosphatase is increased in
children and in last trimester of
pregnancy.
-Transaminases and creatine kinase
increased after labour.

CLASSIFICATION OF ENZYMES IN BLOOD.

Plasma specific enzymes
-Procoagulants,Fibrinolytic enzymes
Secreted enzymes
-Lipase,Amylase,Acid phosphatase
True cellular enzymes
-LDH,ALT,AST,ALP

CRATINE PHOSPHOKINASE(CK)
Present iin heart and skeletal muscles
Normal levels 10-50U/L
Moderate increase
-muscle injury
-after exertion
-after surgery

Significant increase

-MYOCARDIAL INFARCTION
4-8 hours after the attack
Peak 24-48 hours
Normalizes within 3-5 days
-CIRCULATORY FAILURE
MUSCLE DYSTROPHIES

LACTATE DEHYDROGENASE(LDH)
- Present in heart, skeletal muscles,liver and

kidneys
- MODERATE INCREASE
Viral hepatitis
Skeletal muscle diasease
-SIGNIFICANT INCREASE
Myocardial infarction
24-48 hrs after the attack
Peak=2-3 days
Normalizes=7-12 days

Aspartate transaminase(AST)
Present in heart,liver,muscles,kidneys,RBCs,mitochondrial
and cytosolic enzyme
Moderate increae
Cirrhosis of liveer
Skeletal muscle disease
Significant ioncrease
MI
8-12 hrs after the attack
Peak=24hrs
Normalizes 5-6 days

Alanine transaminase(ALT)

Present in
liver.SK,kidneys,Heart,cytosolic enzyme.
-Moderate increase
Cirrhosis of liver
Jaundice
-Significant increase
Acute viral hepatitis

ALKALINE PHOSPHATASE

-Present in bone,hepatobiliary,intestinal
tract,renal tubules and placenta.
-Normal serum levels 25-85U/L
-Significant increase
Bone diseases,liver diseases(jaundice,drug
intoxication),tumor
-Levels decreases in
Hypothyroidism
Growth retardation in children

DIAGNOSTICALLY IMPORTANT
ENZYMES
ENZYME

PRINCIPLE
SOURCE
Acid
PROSTRATE
phosphata ,RBCs
se
Aldolase
SK,Heart
Amylase

Salivary
glands,pan

Principle clinal
use
Carcinoma of
prostrate
Muscular
dystrophies
Pancreatic disease

Glutamate
Liver
dehydrogenas
e

Hepatic
paranchymal
disease

Isocitrate
Liver
dehydrogenas
e

-DO-

Glucose-6Liver
phosphate
dehydrogenas
e

Hemolytic
disorders

Lipase

Pancrease

5-

Liver

Acute
pancreatitis
Hepatobiliary