Al khoms Medical College Ibrahim Sobhi Zorob

Plasma Enzymes Page 1

Plasma Enzymes

Introduction:
There are two types of enzymes
present at all time in the blood, they are:
1. Functional plasma enzymes: they
perform physiological function in the blood
like lipoprotein lipase, most of these
enzymes are synthesized and secreted by
liver.
2. Non-functional plasma enzymes: they
perform no physiological function in the
plasma and mostly arise from destruction
of RBCs, Tissue damage caused by injury or
disease can cause marked increase in their
level, so measurement of these enzymes
level can help in diagnosis and prognosis of
diseases, the most important non-
functional plasma enzymes are:

1. Transaminases:
Two enzymes of this group are
considered as non-functional plasma
enzymes, Alanine transaminase (ALT or
SGPT) and Aspartate transaminase (AST or
SGOT).
Organ: Mainly the liver, but also found
in other tissue.
Function: both enzymes catalyze the
transfer of amino group from an amino
acid to another.
ALT is having a role in alanine cycle
catalyzing the reaction:

AST is catalyzing the reaction:
Aspartate + -ketoglutarate
oxaloacetate + glutamate
Normal value:
Male Female
ALT 45 IU/L 34 IU/L
AST 8 40 IU/L 6 34 IU/L
* IU for International unit
AST/ALT ratio: In healthy people ALT > AST
Diagnosis: In liver disease, this enzymes
"leak out" of hepatocytes reaching the
circulation, leading to marked increase in
their concentration in blood.
So, increase in these enzymes value in
blood indicates liver disease as hepatitis
and liver cirrhosis.
Change in AST/ALT ratio varies as follow:
- AST/ALT is normally < 1.0 and is also < 1.0
in viral hepatitis (albeit with extremely
high levels of both AST and ALT).
- When AST/ALT > 1.0 but < 2.0, it is
likely to be associated with cirrhosis
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Plasma Enzymes Page 2

- When AST/ALT > 2.0, it is more
likely to be associated with alcoholic
hepatitis or hepatocellular carcinoma.
2. Alkaline Phosphatase:
Organ: throughout the entire body but
mainly in liver, kidney, bone and placenta.
Function: is a hydrolase enzyme
responsible for removing phosphate group
from many types of molecules.
One of its isoenzymes, ALPL (tissue-
nonspecific isozyme) is found in bone (and
other tissue) and is thought to have a
function in matrix mineralization.
Normal value: in normal adult, normal
alkaline phosphatase level in plasma ranges
between 20 to 140 IU/L.
Diagnosis: elevated plasma level of
alkaline phosphatase indicate variety of
diseases, mainly associated with bone such
as Osteomalacia, rickets, vitamin D
deficiency , Fractured bone, Pagets disease
, osteosarcoma, and bone metastases of
cancer specially prostatic cancer .
Elevated level of this enzyme may also
indicate liver diseases (Cholestasis,
cirrhosis tumors (Breast carcinoma,
Colon cancer, Lung cancer and Hodgkin
lymphoma)
Also, some diseases may cause plasma
levels of alkaline phosphatase to drop below
normal value, such as Hypophosphatasia
(an autosomal recessive disease).
3. Acid Phosphatase:
Organ: many organs, but the most
important in diagnosis is prostatic acid
phosphatase present in prostate.
Function: like alkaline phosphatase, it
removes phosphate group, but this enzyme
works in acidic pH.
In prostate, its associated with the
liquefaction process of semen.
Normal value: in normal adult, its
normal level is 0.2 - 1.8 IU/L (some sources
say its between 0 and 0.8 U/L).
Diagnosis: high levels of prostatic acid
phosphatase indicate prostate cancer.
Highest level of this enzyme occurs in
metastasized prostate cancer.
Also, some other diseases (as Pagets
disease, hyperparathyroidism, sickle-cell
disease, multiple myeloma and lysosomal
storage diseases as Gauchers disease) are
associated with moderate increase in acid
phosphatase plasma level.

4. Lactate Dehydrogenase:
Organ: Lactate dehydrogenase (LDH) is
having 5 isoenzymes:
LDH-1 (4H) is found in heart and RBCs and
is the most important in diagnosis.
LDH-2 (3H1M) - in the reticuloendothelial system
LDH-3 (2H2M) - in the lungs
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Plasma Enzymes Page 3

LDH-4 (1H3M) - in the kidneys, placenta, and
pancreas
LDH-5 (4M) - in the liver and striated muscle
Function: the enzyme catalyzes the
conversion of pyruvate to lactate, using
NADH+H as a cofactor (converting it to
NAD), this reaction is important to provide
continuous supply of NAD during
anaerobic glycolysis.
Normal value: in normal adult, its level
in plasma ranges between 105 - 333 IU/L.
Diagnosis: higher level of LDH-1 in
plasma indicates myocardial infraction.
Also, cancer cells increase the level of
lactate dehydrogenase because cancer cells
use anaerobic glycolysis even in the
presence of oxygen.
Hemolysis of erythrocytes (RBCs) is also
associated with the increase in LDH level
because RBCs depend on anaerobic
glycolysis only and have large amount of
LDH.

5. Amylase:
Organ: in saliva secreted by salivary
glands and in pancreatic juice secreted by
pancreas.
Function: the enzyme catalysis the
hydrolysis of starch to starch dextrins in
the mouth first, then to maltose and
isomaltose by pancreatic amylase in the
small intestine.
Normal value: Normally, its plasma
level ranges between 23 to 85 U/L (some say
its between 40 to 140 U/L)
Diagnosis: increased concentration of
amylase in plasma is often associated with
acute pancreatitis.



6. Lipase:
Organ: mainly by pancreas.
Function: the enzyme is responsible for
digestion of triacylglycerol in small
intestine.
Normal value: in normal adult results are
between 0 to 160 units per liter.
This test requires the subject to be fasting
(do not eat or drink for 8 hours)
Diagnosis: the elevated amount of the
enzyme in the plasma indicate variety of
diseases including pancreatitis and cancer
of the pancreas, also duodenal ulcer and
Celiac disease is associated with increase
concentration of this enzyme.

7. Creatine kinase:
Organ: in many tissues that consumes
ATP rapidly (brain, retina especially
in muscles.
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Plasma Enzymes Page 4

Function: the enzyme is used as an
energy reservoir for the rapid buffering
and regeneration of ATP in situ, as well as
for intracellular energy transport.
Normal value: normally between 10 - 120
micrograms per liter (mcg/L).
Diagnosis: because the enzyme is
present mainly in muscles, increased
amount of CK enzyme in plasma is
associated with muscle diseases, this
includes rhabdomyolysis (severe muscle
breakdown), muscular dystrophy and
myocardial infraction.

8. Gamma-glutamyl transpeptidase:
Organ: in many tissues, but mainly the
liver.
Function: the enzyme is present in the
cell membrane and is involved in the
transfer of amino acids across the cellular
membrane, its also used in leukotriene
metabolism and glutathione metabolism.
Normal value: between 15-85 IU/L in
males and 5-55 IU/L in females.
Diagnosis: increased concentrations of
this enzyme in the plasma is associated
with liver diseases including hepatitis, its
also increased in alcohol abuse, diabetes
and block of bile flow from the liver.


Summary of non-functioning
plasma enzymes
Enzyme Organ Value
IU/L
Disease
Transaminases Liver 5-45 Liver
disease
Alkaline
phosphatase
Bone 20-
140
Bone
disease
Acid
phosphatase
Prostate
0.2-
1.8
Prostate
cancer
Lactate
dehydrogenase
Heart 105-
333
Heart
disease
Amylase
Pancreas
23-85 Pancre-
atitis
Lipase
Pancreas
0 -
160
Pancre-
atitis
Creatine
kinase
Muscle - Muscle
disease
Gamma-
glutamyl
transpeptidase
Liver 15-85 Liver
disease

Research by:
Ibrahim Sobhi Zorob
2011110

Sources:
1. Harper-s-Biochemistry-26th-Edition
2. English Wikipedia
3.http://www.nlm.nih.gov/medlineplus/medlineplus
.html