RADIO IMMUNO ASSAY

CLINICAL SIGNIFICANCE OF ENZYMESSHELVY S. 2011-09-123KERALA AGRICULTURAL UNIVERSITY

GOALS

WHERE

Helpful in the diagnosis of

Myocardial InfarctionLiver DiseasesGI Tract DiseasesMuscle DiseasesBone DisesasesCancer

DIAGNOSTIC ENZYME

Tissue damage or necrosis resulting from injury or disease is generally accompanied by increases in the levels of several nonfunctional plasma enzymes.

1. Yalow and Berson refused to patent the assay, because they felt that it should be freely available to the field of medicine4

Enzymes routinely measuredNAME OF THE ENZYMEPRESENT INAspartate Amino transferase (AST)Serum glutamate-oxaloacetate transaminase (SGOT)Heart and LiverAlanine 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 AmylasePancreas

sGPT and sGOT

ALT or sGPT (Serum Glutamate Pyruvate Transaminase)

ALT

GPT (ALT) catalyses the transfer of amino-groups from alanine to 2-oxoglutarate and thus the formation of glutamate and pyruvate.Alanine Transaminase

ALT is an enzyme produced in hepatocytes and is highly concentrated in the liver.

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GPT (ALT) is widely distributed in cells throughout the body. GPT (ALT) is found predominantly in the cytoplasm and is widely considered to be specifically for the liver. In addition, it is also active in the heart, skeletal muscle, pancreas, and the kidney.

GPT (ALT) activity in the liver is about 3,000 times higher than its activity in the serum. Only if cells are damaged GPT (ALT) will be excreted into the blood. In the plasma, GPT (ALT) has no biological function because the necessary substrates and co-substrates are lacking there. Source & biological action

Elevated levels of ALT may indicate : Alcoholic liver disease Cancer of the liver Cholestasis or congestion of the bile ducts Cirrhosis or scarring of the liver with loss of function Death of liver tissue Hepatitis or inflammation of the liver Noncancerous tumor of the liver Use of medicines or drugs toxic to the liverTherefore, when the liver is injured, ALT is released into the bloodstream.

Normal level :- 0-41 IU/L.The Aminotransferases are normally present in the serum in low concentrations. These enzymes are released into the blood in greater amounts when there is damage to the liver cell membrane resulting in increased permeability.Levels of up to 300 U/L are nonspecific and may be found in any type of liver disorder. Striking elevations i.e., aminotransferases > 1000 IU/L occur almost exclusively in disorders associated with extensive hepatocellular injury such as viral hepatitis Ischemic liver injury (prolonged hypotension), In most acute hepatocellular disorders, the ALT is higher than or equal to the AST.

AST or sGOT (Serum Glutamate Oxaloacetate Transaminase)

ASTAspartate aminotransferase (AST)

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Both these enzyme are found in most tissues, but the relative amounts vary. heart muscles are richer in AST, whereas liver contains both but more of ALT.Aspartate aminotransferase (AST)

AST also reflects damage to the hepatic cells and is less specific for liver disease. It can also be released with heart, muscle and brain disorders.Therefore, this test may be ordered to help diagnose various heart, muscle or brain disorders, such as a myocardial infarct (heart attack).

Elevated levels of AST may indicate:Acute hemolytic anemia, Acute pancreatitis or inflammation of the pancreas.Acute renal failure or loss of kidney function.Cirrhosis of the liver.HepatitisHeart attackPrimary muscle diseaseRecent surgerySevere burnsMuscle injury

The level is significantly elevated in Acute MI.Normal Value:- 0-41 IU/L at 37CIn acute MI- Serum activity rises sharply within the first 12 hours, with a peak level at 24 hours or over and returns to normal within 3-5 days. The rise depends on the extent of infarction.

Levels> 350 IU/L are due to massive infarction (Fatal), > 150 IU/L are associated with high mortality and levels,< 50 IU/L are associated with low mortality.Other diseases- The rise in activity is also observed in muscle and hepatic diseases. These can be well differentiated from simultaneous estimations of other enzyme activities like SGPT etc, which do not show and rise in activity in Acute MI.

In infectious hepatitis and other inflammatory conditions affecting the liver, ALT is characteristically as high as or higher than AST, and the ALT/AST (De Ritis) ratio becomes greater than unity, >1.5. sALT/sAST (De Ritis) ratio, normally is less than 1, about 0.7~0.9. Ratios between ALT and AST are useful to physicians in assessing the etiology of liver enzyme abnormalities.

19Serum enzymes in liver diseases:-

In viral hepatitis:-Rapid rise in transaminases (AST & ALT) in serum occurs even before bilirubin rise is seen

LEVELS OF ENZYMES IN MYOCARDIAL INFARCTION

CK-MBCKASTLDHHBDHAST and CK rise in 6 hours following acute myocardial infarction HBDH and LDH are elevated much later and remains high for a longer period of days

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Relax at the Lake Video Template(Basic)To reproduce the effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank.On the Insert tab, in the Media group, click Video, and then click Video from file. In the left pane of the Insert Video dialog box, click the drive or library that contains the video. In the right pane of the dialog box, click the video that you want and then click Insert.Under Video Tools, on the Format tab, in the bottom right corner of the Video Styles group, click the arrow opening the Format Video dialog box. In the Format Video dialog box, click Size in the left pane, and under Scale in the right pane uncheck Lock Aspect Ratio.Then under Size and Rotate in the right pane set the Height to 7.5 and Width the 10.Select the video. On the Animations tab, in the Timing group, click the arrow to the right of Start and select With Previous.With the video selected, under Video Tools, on the Playback tab, in the Video Options group, select Loop until Stopped.

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