Podcast
Questions and Answers
Which type of plasma enzyme has a known function in the plasma and includes components like clotting factors?
Which type of plasma enzyme has a known function in the plasma and includes components like clotting factors?
What distinguishes isoenzymes from each other?
What distinguishes isoenzymes from each other?
Which of the following is an example of a non-functional plasma enzyme that is released during cell turnover?
Which of the following is an example of a non-functional plasma enzyme that is released during cell turnover?
Why are plasma enzymes important in clinical diagnosis?
Why are plasma enzymes important in clinical diagnosis?
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What is the primary aim of analyzing plasma enzymes in a clinical setting?
What is the primary aim of analyzing plasma enzymes in a clinical setting?
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What is the main function of lactate dehydrogenase (LDH)?
What is the main function of lactate dehydrogenase (LDH)?
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Which isoenzyme of LDH is specifically elevated in myocardial infarction?
Which isoenzyme of LDH is specifically elevated in myocardial infarction?
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What is the normal serum level ratio of LDH-1 to LDH-2?
What is the normal serum level ratio of LDH-1 to LDH-2?
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Which enzyme is primarily found in the liver and is indicative of liver function?
Which enzyme is primarily found in the liver and is indicative of liver function?
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What characterizes CK-MB in terms of its location and clinical significance?
What characterizes CK-MB in terms of its location and clinical significance?
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Which enzyme is known for having both mitochondrial and cytosolic forms?
Which enzyme is known for having both mitochondrial and cytosolic forms?
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Which isoenzyme of creatine kinase is associated with elevations in heart muscle injury?
Which isoenzyme of creatine kinase is associated with elevations in heart muscle injury?
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What condition is indicated by a significantly higher level of ALT compared to AST?
What condition is indicated by a significantly higher level of ALT compared to AST?
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In which scenario is alkaline phosphatase (ALP) levels expected to be elevated?
In which scenario is alkaline phosphatase (ALP) levels expected to be elevated?
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Which of the following enzymes is primarily associated with the bone form in elevated levels?
Which of the following enzymes is primarily associated with the bone form in elevated levels?
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What is the significance of elevated gamma-glutamyl transferase (GGT) levels?
What is the significance of elevated gamma-glutamyl transferase (GGT) levels?
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5'-nucleotidase is a marker that reflects liver status in cases of:
5'-nucleotidase is a marker that reflects liver status in cases of:
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Which of the following conditions is commonly associated with elevated acid phosphatase (ACP) levels?
Which of the following conditions is commonly associated with elevated acid phosphatase (ACP) levels?
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Elevations in alkaline phosphatase (ALP) and direct bilirubin collectively suggest what condition?
Elevations in alkaline phosphatase (ALP) and direct bilirubin collectively suggest what condition?
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When analyzing transaminase levels, which pattern would you expect to find in chronic hepatitis?
When analyzing transaminase levels, which pattern would you expect to find in chronic hepatitis?
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Physiologically increased levels of total alkaline phosphatase (ALP) can be seen in which population group?
Physiologically increased levels of total alkaline phosphatase (ALP) can be seen in which population group?
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What primarily causes permanent damage to the heart muscle during a myocardial infarction?
What primarily causes permanent damage to the heart muscle during a myocardial infarction?
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Which risk factor is NOT considered modifiable for myocardial infarction?
Which risk factor is NOT considered modifiable for myocardial infarction?
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What is the relationship between oxygen supply and demand during myocardial infarction?
What is the relationship between oxygen supply and demand during myocardial infarction?
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Which sequence accurately depicts the pathophysiological process of myocardial infarction?
Which sequence accurately depicts the pathophysiological process of myocardial infarction?
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What symptom is typically associated with myocardial infarction?
What symptom is typically associated with myocardial infarction?
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What is a common cause of sudden, irreversible obstruction in coronary arteries?
What is a common cause of sudden, irreversible obstruction in coronary arteries?
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Which of these factors has the least impact on the risk of myocardial infarction based on non-modifiable categories?
Which of these factors has the least impact on the risk of myocardial infarction based on non-modifiable categories?
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During a myocardial infarction, what does thrombolysis refer to?
During a myocardial infarction, what does thrombolysis refer to?
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Which statement best describes the term 'ischemia' in the context of myocardial infarction?
Which statement best describes the term 'ischemia' in the context of myocardial infarction?
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Study Notes
Course Information
- Course: Biochemistry
- Year: 1
- Module: Human Body Function (HBF 102)
- Semester: 1
- Academic Year: 2024-2025
- Faculty: Medicine, Helwan National University
- Instructor: Prof. Dr. Mohamed I. Kotb & Ass. Prof. Dr. Ahmed M. A. Akabawy
Lecture: Enzyme III
- Topic: Enzymes in Clinical Diagnosis
- Lecturer: Prof. Dr. Mohammed Kotb & Assoc. Prof. Dr. Ahmed M. A. Akabawy
Objectives
- Analyze types of plasma enzymes
- Recognize enzymes important in clinical diagnosis
- Identify diagnostic biomarkers important in Myocardial infarction
Introduction
- Topic: Plasma Enzymes
- Subtopics: Definition, Types, Biological Importance, Myocardial Infarction, Biomarkers of MI
Plasma Enzymes
- Functional: Have known function in the plasma (e.g., clotting factors)
- Non-Functional: Have no function in the plasma; released into plasma during cell turnover from some damaged organs (e.g., transaminases)
Objectives
- Analyze plasma enzyme types
- Recognize diagnostically important enzymes
- Identify myocardial infarction biomarkers
Non-functional Plasma Enzymes in Health & Disease
- Normal tissue in cells with normal enzyme activity
- Tissue damage in cells, causing enzyme release into the blood stream
- Cell death in cells, causing enzyme release into the blood stream
- Elevated enzyme activity in the blood stream
Isoenzymes
- Multiple forms of the same enzyme catalyzing the same reaction but differing in their molecular structure, chemical characteristics, and localization depending on the tissue.
- Important diagnostic tool for identifying the location and severity of a disease (examples: LDH, CK, ACP, ALP)
Analyzing Plasma Enzymes
- Performing an assay to determine the concentration of particular plasma enzymes in blood for diagnosing or monitoring a condition
Why Plasma Enzymes are Important in Clinical Diagnosis
- Small amounts of intracellular enzymes are normally present in the blood due to normal cell turnover.
- When tissue damage occurs, increased amounts of enzymes are released into the blood, which results in elevated enzyme concentrations.
LDH (Lactate Dehydrogenase)
- Tetrameric protein with two subunit types (H and M) in heart and skeletal muscle.
- Catalyzes lactate to pyruvate conversion.
- Re-oxidizes NADH back into NAD.
- Five isoenzymes: LDH-1, LDH-2, LDH-3, LDH-4, and LDH-5
- Their location differs: LDH-1: Heart and Red Blood Cells; LDH-2: Heart and Red Blood Cells; LDH-3: Lungs; LDH-4: Kidney, Pancreas; LDH-5: Liver and Skeletal muscles.
- Elevated in myocardial infarction (MI).
- LDH-1/LDH-2 ratio diagnostic indicator for MI
- Elevated LDH-1/LDH-2 ratio in heart attack
CK (Creatine Kinase)
- Dimeric protein with two subunit types (B and M) in Brain and Muscle.
- CK-1(BB): Brain
- CK-2(MB): Heart
- CK-3(MM): Skeletal Muscle
- Elevated in myocardial infarction (MI) and skeletal muscle diseases
Transaminases (ALT & AST)
- ALT primarily in liver cells (cytosolic)
- AST in liver cells (mitochondrial) and heart muscle (cytosolic)
- AST and ALT levels are frequently compared and interpreted for diagnostic purposes
- Elevated ALT > AST in acute hepatitis and liver necrosis
Phosphatases
- Enzymes removing a phosphate group from its substrate
- Alkaline Phosphatase (ALP) pH 9-10.5
- Acid Phosphatase (ACP) pH 5-6
- ALP: Increased in cholestasis and bone diseases (e.g., rickets, osteomalacia).
Gamma-glutamyl transferase (“GGT”)
- Helps diagnose liver bile duct issues
- Increased GGT in bile duct obstructions and alcoholic hepatitis
5'-nucleotidase (5'-NT)
- Protein produced by the liver
- Used to assess liver function and cholestasis
Myocardial Infarction
- Sudden decrease in blood supply to the myocardium.
- Causes ischemia (inadequate oxygen supply)
- Prolonged ischemia leads to infarction (irreversible damage).
- Pathophysiology includes atherosclerosis, arterial spasms, and thrombi
- Leads to hypoxia and necrosis.
Risk Factors for MI
- Non-modifiable: Sex (males more common), Age, Family History.
- Modifiable: Smoking, Dyslipidemia, Diabetes, Hypertension, Obesity, Sedentary Lifestyle, Peripheral Vascular Disease
Symptoms of MI
- Chest discomfort
- Arm or back discomfort
- Neck or jaw discomfort
- Pain described as aching, crushing, squeezing.
- Tightness, Heaviness, Pressure
Cardiac Biomarkers for AMI
- Enzyme: LDH1, CK-MB, AST1, Troponin I
- Myoglobin (non-specific)
- Onset, peak, and return to baseline times vary for each biomarker
Troponins
- Contractile proteins in heart muscle.
- Cardiac troponin I and T are sensitive and specific indicators for cardiac damage.
- Elevated levels above reference ranges indicate heart muscle damage.
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Description
Test your knowledge on the role of plasma enzymes in clinical diagnosis, including their types and functions. This quiz covers important biomarkers relevant to conditions like myocardial infarction. Enhance your understanding of how these enzymes aid in medical assessments.
