LACTATE DEHYDROGENASE

-found in the myocardium,kidney,liver,muscles and RBC

-isoenzymes are tetramers built from 2 subunits (H and M)
-H has a higher affinity to PYRUVATE
-M has a higher affinity to LACTATE

5 ISOENZYMES:

1. LD1 (HHHH)
-seen in the heart, RBC and renal cortex - Myocardial enzyme
-GREATEST ANODIC MOBILITY -Rises 10-24 hours after MI
-Heat STABLE (resist denaturation at 65o for30mins) -With a peak activity of 48-96 hours
-Has an HBD activity -Returns to normal after 7-10 days
-Decreased LD/HBD ratio during MI

2. LD2 (HHHM)
-seen in the heart, RBC and renal cortex
-GREATEST ANODIC MOBILITY
-Heat STABLE

3. LD3( HHMM)
-seen in the lungs, lymphocytes,spleen, pancreas and brain

4. LD4 (HMMM) and LD5 (MMMM)

-seen in the liver and skeletal muscles
-LEAST ANODIC MOBILITY

Normal SERUM LD2>LD1>LD3>LD4>LD5 Normal CSF LD1>LD2>LD3>LD4>LD5

Acute MI Bacterial Meningitis LD5>LD4>LD3>LD2>LD1

Hemolysis LD>1>LD2
Acute renal infarct Hydrocephalus and seizures LD2>LD1

CLINICAL SIGNIFICANCE

LD1 and LD2- Increased in MEGALOBLASTIC ANEMIA and MYOCARDIAL INFARCTION

LD2 and LD3- Increased in METASTATIC LIVER CANCER

LD4 and LD5- Increased in ACUTE HEPATITIS and PULMONARY INFARCT

ALdoLase and PHospHoHexose Isomerase - Increased in METASTATIC LIVER CANCER and MYOCARDIAL
INFARCT
(heart and liver)
Additional info
-SERUM is preferred(oxalate inhibits the enzyme)
- FREEZING must be avoided

Assays:
1. PHYSICAL
-Electrophoresis
-DEAE cellulose which absorbs the fast ones (LD 1 and LD2)
-Solvent precipitation which precipitates the slow ones (LD4 and LD5)
-Heat denaturation at 65o

2.CHEMICAL
-Substrate product relationship which involves alpha HBD activity , pyruvate and lactate inhibition
-Coenzyme affinity
-Differential inhibition by urea, sulfate and chloroform

3.IMMUNOLOGIC
-specific antibodies against LD1 and LD5
PHOSPHATASES
Alkaline Phosphatases

ALP ISOENZYMES

FASTEST: Liver
SLOWEST: Intestine
Carcinoplacental ALP : Regan and Nagao (similar to placental ALP)
: seen in metastatic cancer of the pleural surface and adenocarcinoma of the
pancreas and bile duct

Kasahara isoenzyme: “Regan variant”

: seen in HEPATOMA AND TUMORS OF GI TRACT

L-phenylalanine RESISTANT: Heat Stable:

Liver and Bone Placenta and Regan

L-phenylalanine LABILE: Heat Labile:

Intestine, Placenta and Regan Bone

Acid Phosphatase
-PLASMA is the sample of choice (citrated)
-1/2-1/3 is prostatic in origin
-Newborns have ACP levels 2-3 times in adults
-NORMAL VALUE: 0-0.8 U/L

ACP ISOENZYMES
-Prostatic, Red cell, Platelet, Spleen, Liver and Bone Marrow

TARTRATE and CuSO4 RESISTANT: TARTRATE and CuSO4 LABILE:

Prostate Red Cell

FORMOL RESISTANT: FORMOL LABILE:

Red Cell Prostate