Ch. 7: Clinical Enzymology & Biomarkers of Tissue Injury

Question 1

3 main ways enzymes are used clinically?

Answer 1

1) Diagnosis & prognosis of diseases
2) Analytical reagents: Measure activity of other enzymes/nonenzyme substances in body fluids
3) Therapeutic agents

Question 2

Difference between serum vs plasma?

Answer 2

Plasma: liquid in which blood cells suspended

Serum = plasma - clotting factors

Question 3

What processes are plasma specific enzymes involved in?

Answer 3

Blood clotting
fibrinolysis
complement activation
cholinesterase
ceruloplasmin

Question 4

What are non-plasma specific enzymes?

When are they seen? What causes this?

Answer 4

Intracellular enzymes

High turnover, cellular damage, impairment of cells

⬇️O2 supply, infection, toxic chemicals

Question 5

Acid phosphatase: main tissue source?

Answer 5

Prostate

Question 6

Alanine aminotransferase: main tissue source?

Answer 6

Liver

Question 7

Alcohol dehydrogenase: main tissue source?

Answer 7

Liver

Question 8

Alkaline phosphatase: main tissue sources?

Answer 8

Bone
intestinal mucosa
hepatobiliary system
placenta
kidney

Question 9

Amylase: main tissue sources?

Answer 9

Pancreas

Salivary glands

Question 10

Arginase: main tissue source?

Answer 10

Liver

Question 11

Aspartate aminotransferase: main tissue sources?

Answer 11

Heart & skeletal muscle
Liver
Kidney
Brain

Question 12

Ceruloplasmin: main tissue source?

Answer 12

Liver

Question 13

Cholinesterase: main tissue source?

Answer 13

Liver

Question 14

Chymotrypsinogen: main tissue source?

Answer 14

Pancreas

Question 15

Creatine kinase: main tissue sources?

Answer 15

Skeletal & heart muscle

Brain

Question 16

Fructose-bisphosphate aldolase: main tissue sources?

Answer 16

Skeletal & heart muscle

Question 17

Gamma-glutamyl transferase: main tissue sources?

Answer 17

Kidney
Hepatobiliary system
Prostate
Pancreas

Question 18

Glutamate dehydrogenase: main tissue source?

Answer 18

Liver

Question 19

Isocitrate dehydrogenase: main tissue source?

Answer 19

Liver

Question 20

Lactate dehydrogenase: main tissue sources?

Answer 20

Skeletal & heart muscle
Liver
Kidney
RBCs
Pancreas
Lungs

Question 21

Leucine aminopeptidase: main tissue sources?

Answer 21

Hepatobiliary system
Intestine
Pancreas
Kidney

Question 22

Ornithine carbamoyl-transferase: main tissue source?

Answer 22

Liver

Question 23

Pepsinogen: main tissue source?

Answer 23

Gastric mucosa

Question 24

Prostatic specific antigen (serine protease): main tissue source?

Answer 24

Prostate

Question 25

Sorbitol dehydrogenase: main tissue source?

Answer 25

Liver

Question 26

Triacylglycerol lipase: main tissue source?

Answer 26

Pancreas

Question 27

Trypsinogen: main tissue source?

Answer 27

Pancreas

Question 28

What enzymes indicate heart disease? (Old and new)

Answer 28

Old: creatine kinase (CK): CK-MB (CK2) New: cardiac troponin I

Question 29

What isoenzyme pattern is found in skeletal muscle?

Answer 29

Creatine kinase (CK): CK-MM (CK3)

Question 30

How is the rate of an enzyme-catalyze reaction measured?

Answer 30

Measure product formation (via photometric procedures, e.g. spectrophotometer ➡️ NAD+, product of indicator reaction, absorbs light)

Question 31

Serum markers of acute pancreatitis?

Answer 31

Amylase Lipase Trypsinogen

Question 32

Serum markers of hepatocellular necrosis?

Answer 32

AST | ALT

Question 33

Serum markers of cholestasis?

Answer 33

Alkaline phosphatase 5'-nucleotidase Gamma-glutamyl transferase

Question 34

Where can gallstones occur?

Answer 34

Ampulla of Vater

Question 35

What is the advantage of using enzymes as analytical reagents?

Answer 35

Specificity & direct measurement of substrate in complex mixture

Question 36

What monitoring assay procedures are used when enzymes are used as analytical reagents?

Answer 36

ELISA

Question 37

Describe steps of using enzymes as analytical reagents via specific antibodies absorbed to beads?

Answer 37

1) antibody + bead bind to antigen in test specimen 2) antibody + bead + antigen bind to antibody + enzyme 3) incubate w/substrate & quantitate products ([products directly proportional to [antigen])

Question 38

Enzyme as reagent: what is the negative reaction for incubating enzyme + hapten w/specimen (w/out hapten)?

Answer 38

Antibody for hapten added ➡️ competes to bind to enzyme + hapten ➡️ inactive enzyme (when substrate added ➡️ no products)

Question 39

Enzyme as reagent: what is the positive reaction for incubating enzyme + hapten w/specimen (w/hapten)?

Answer 39

Antibody for hapten added ➡️ competes to bind to free hapten ➡️ active enzyme (when substrate added ➡️ products correlated to [free hapten])

Question 40

Enzyme as reagent: Antibody bind to solid phase + antigen in sample + antigen w/chemiluminescent compound (cc) If less antigen in sample ➡️ ? If more antigen in sample ➡️ ?

Answer 40

Less antigen ➡️ more antigen-cc binds to antibody ➡️ more light More antigen ➡️ less antigen-cc binds antibody ➡️ less light

Question 41

Enzymes as therapeutic agents: how it is used with bleeding disorders?

Answer 41

Transfusion of fresh blood or its active components

Question 42

Enzymes as therapeutic agents: oral admin of digestive enzymes in digestive diseases ➡️ example?

Answer 42

Cystic fibrosis

Question 43

Enzymes as therapeutic agents: admin of fibrinolytic enzyme to recanalize blood vessels occluded by thrombi What enzyme? Examples of diseases?

Answer 43

Streptokinase Pulmonary embolism AMI (acute MI)

Question 44

Enzymes as therapeutic agents: treating disorders of inborn metabolism & cancer therapy ➡️ examples of each?

Answer 44

Gaucher's disease: can't properly bind sugars to phospholipids L-asparaginase in acute lymphocytic leukemia