Enzymes are known as marker of cellular damage. The amount of enzymes present in the plasma is used for the investigation of the diseases of liver, heart, skeletal muscle, biliary tract etc.

Classification of diagnostically important enzymes:

• Liver, cardiac and skeletal enzymes
• Biliary tract enzymes
• Digestive enzymes of pancreatic origin

Liver, cardiac and skeletal enzymes:- Enzymes in this category include:

1. Aminotransferases or transaminase

• Increases plasma Aspartate aminotransferase(AST) level and increased plasma alanine aminotransferase (ALT) level indicates liver diseases.
• Increased AST level occurs after myocardial infraction as heart muscle contains relatively high concentration of AST.
• AST activity levels are increased in muscular dystrophy and dermatomyositis.
• Moderate increase of both AST and ALT have been observed after the intake of alcohol, or after taking various drugs such as salicylates ampicillin etc.

2. Alkaline phosphatase:- Plasma ALP level are particularly used in the investigation of bone diseases and hepatobiliary diseases.

Biliary tract enzymes:-  Enzymes included in this category are

1. 5’-Nucleotidase (nucleotide phosphate NTP)- Increased level of serum NTP occur in hepatobiliary diseases in which there is obstruction in the secretion of bile.
2. Gamma-glutamyl transferase GGT- Increased level of GGT occurs in all form of liver diseases. It is used for the investigation of obstructive jaundice, cholangitis (inflammation of bile duct) and cholecystitis (inflammation of gall bladder).

Digestive enzymes of pancreatic origin:- The digestive enzymes are investigated for the diagnosis of pancreatic diseases

1. Alpha-amylase:- Assays of amylase in the serum and urine are primarily used for the diagnosis of pancreatic diseases like pancreatitis, cholecystitis, tumors etc.
2. Trypsin:- Determination of serum trypsin can be used to screen for the cystic fibrosis during first 6 weeks of life. Also it is used in pancreatic ductules.
3. Chymotrypsin:- As with amylase and trypsin, elevation of serum chymotrypsin level if reaches 8 times the normal level than it indicates renal failure.

Enzymes as tumor marker

Elevated enzyme level may mark the presence of malignancy. The below table describes the same:

Analytical uses of enzymes

Enzymes can be used as reagents and labels.

Enzymes as reagents:- Enzymes are widely used in the laboratories as reagents for the estimation of serum constituents.

Enzymes as labels:- Many enzymes are used as the label in various immunoassays for the determination of serum level of drugs, hormones, and other compounds. Examples include:

• Glucose-6-phosphate dehydrogenase
• Alkaline phosphatase
• Beta-galactosidase
• Peroxidase

Therapeutic uses of enzymes

Some enzymes are used in the treatment of several diseases of human being, Like:

• Bacterial asparginase is used for the treatment of some type of leukemia.
• Chymotrypsin is used in ophthalmology for dissolving ligaments of the lens during the extraction.
• Collagenase is use to clean the wound by removing the dead tissue of dermal ulcers and severe burns.
• Hyaluronidase is used to promote the absorption of the drugs injected subcutaneously.
• Penicillinase: Used for the treatment of persons suffering from penicillin allergy.
• Streptokinase and urokinase: Used in myocardial infraction to dissolve the clot or purulent material.
• Pepsin, lipase, amylase elastase, trypsin peptidase are used in GIT disorders and chronic pancreatitis.

Some other enzymes and its therapeutic is described in below given image.

Multiple Choice Questions (MCQs)

1. In how many types, uses of enzymes are classified?
A. 2

B. 3

C. 4

D. 5

2. What indicates liver diseases?
A. Increased AST

B. Increased ALT

C. Decreased AST

D. Both A and B

3. Assay of which is used for the diagnosis of pancreatitis?
A. Bacterial asparginase

B. Amylase

C. Trypsin

D. Chymotrypsin

4. Elevated level of aldolase indicates which type of cancer?
A. Liver

B. Lung

C. Bone

D. Prostate

5. Which of the following is use for the treatment of leukemia?
A. Bacterial asparginase

B. Amylase

C. Trypsin

D. Chymotrypsin

6. Match the following enzyme indicating disease-
a. Chymotrypsin 1. Liver cancer
b. Trypsin 2. tumors
c. Amylase 3. Cystic fibrosis
d. 5-nucleotidase 4. Renal failure

7. Which of the following enzyme is used as a label for the determination of serum level of drugs?
A. Peroxidase

B. Alkaline phosphatase

C. Glucose-6- phosphate dehydrogenase

D. All of the above

8. Which of the following statement is NOT true?
A. AST was formerly known as glutamate oxaloacetate transaminase
B. Penicillinase is used for treatment of penicillin allergy
C. Pepsin is used for the treatment of jaundice
D. Urokinase is used in myocardial infraction

9. Elevated level of which enzyme indicates renal failure?
A. Bacterial asparginase

B. Amylase

C. Trypsin

D. Chymotrypsin

10. What occurs during hepatobiliary diseases?
A. Increased level of NTP

B. Increased level of GGT

C. Decreased level of NTP

D. Decreased level of GGT

11. Increased level of GGT indicates which disease?
A. Obstructive jaundice

B. Pancreatitis

C. Renal failure

D. All of the above

12. Moderate increase in level of AST and ALT occur after the intake of which liquid?
A. Tea

B. Alcohol

C. Orange juice

D. None of the above

13. What happens to the level of AST after myocardial infraction?
A. Increased

B. Decreased

C. Constant

D. None of the above

14. Bone cancer is indicated by the elevated level of which enzyme?
A. Aldolase

B. Alkaline phosphatase

C. Kinase

D. None of the above

15. Enzymes are known as marker of —— damage?
A. Tissue

B. Organ

C. Both

D. None of the above

ANSWERS:-

1. 3
2. Both A and b
3. Amylase
4. Liver
5. Bacterial asparginase
6. a – 4 b – 3 c – 2 d – 1
7. All of the above
8. Pepsin is used for the treatment of jaundice
9. Chymotrypsin
10. Increased level of NTP
11. Obstructive jaundice
12. Alcohol
13. Increased
14. Alkaline phosphatase
15. None of the above

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• Digestion of proteins:- digestion of proteins starts in the stomach where proteins undergo breakdown and forms peptides by the action of an enzyme called as pepsin. Digestion continues in small intestine where the enzymes of pancreatic juice like- trypsin, chymotrypsin, carboxypeptidase and elastase also converts the proteins into peptides but these enzymes differ in their function like trypsin, chymotrypsin and elastase breaks the peptide bond between amino acid and its neighbor amino acid while the carboxypeptidase splits the amino acid at the carboxyl end of peptide. Digestion of proteins is completed by two peptidases of brush border which are aminopeptidases and dipeptidases, where aminopeptidase splits the amino acid at the amino end of peptide and dipeptidase splits the dipeptide in each amino acid.

• Absorption of proteins:- most of the proteins are absorbed as amino acid through the active transport method that occurs in duodenum and jejunum. About 95-98% of amino acid in small intestine is digested and absorbed.

Different types of transporters carry different types of amino acid like some amino acids are transported by Na dependent secondary transport process and enters absorptive cells in the villi. Dipeptides and tripeptides are transported via secondary active transport with hydrogen ion. After this the amino acid move out of the absorptive cells and enter the blood capillary of the villus by diffusion. Amino acid is then transported in the blood to the liver through the hepatic portal system.

Lipids

• Digestion of lipids:- the most found lipid in the food are the triglycerides, which consist of one glycerol molecule bonded with 3 fatty acid molecules. Enzymes that splits triglycerides and phospholipids are known as lipases. The lipases used in digestion process of lipids are lingual lipase, gastric lipase and pancreatic lipase. Some of the lipid is digested in stomach by the action of lingual and gastric lipase but the major portion of lipids are digested by pancreatic lipase in small intestine. The triglycerides undergo breakdown into monoglycerides and fatty acids, where fatty acids can either be short chain fatty acids or long chain fatty acids.

Before the large lipid molecule containing triglycerides are digested, the undergo emulsification- a process by which large lipid molecules splits into several small lipid molecules. Bile contains bile salts which are amphipathic in nature that is it has a hydrophobic nature as well as hydrophilic nature. The hydrophobic region binds with large lipid molecule while the hydrophilic  region binds with the chyme. This results in breakdown of large lipid molecules in smaller one which makes digestion more effective.

• Absorption of lipids:- all the lipids produced from food are absorbed by simple diffusion. As the result of emulsification and digestion, the triglycerides splits into mono-glycerides and fatty acids in which fatty acids can either be short chain or long chain fatty acids. Short chain fatty acids are small in size because of which they easily enter the absorptive cells via simple diffusion n like amino acids then enter the blood capillary of the villus. But the long chain fatty acids and mono glycerides are large molecules and cannot be suspended and dissolved in chyme. The bile salts help these large molecule to increase their solubility in watery chyme and also help forming micelles which acts as a carrier. The micelles move out of the small intestine and reaches the absorptive cells and in this way mono glycerides and long chain fatty acids enters the absorptive cells. These molecules cannot directly enter the blood capillary because of their large size so they enter lymphatic vessels, reaches the thoracic duct and then through right subclavian vein enters into the blood.

Multiple choice question (MCQs)

1. Where do digestion of proteins takes place?
A. mouth B. stomach
C. small intestine D. stomach and small intestine

2. What is the function of aminopeptidase?
A. splits amino acids at amino end of peptide
B. splits in 2 amino acids
C. splits amino acid at the carboxyl end of peptide
D. break peptide bond between amino acid and its neighbor

3. Where do the digestion of lipids takes place?
A. small intestine B. stomach
C. small intestine mouth and stomach D. small intestine and stomach

4. which of the following enzymes participate in digestion of proteins?
A. trypsin B. chymotrypsin
C. elastase D. all of the above

5. Which of the following statement is true?
A. trypsin breaks peptide bond at carboxyl end
B. lipases include only pancreatic and lingual lipase
C. Bile salts are necessary of absorption of lipids
D. elastase enzyme is used for digestion of lipid

6. what helps the large molecules of lipids to increase their solubility in watery chyme?
A. bile salts B. fatty acids
C. micelles D. hydrophilic region

7. through which vein, the long chain fatty acids enters into the blood?
A. subclavian vein B. jugular vein
C. external carotid vein D. internal carotid vein

8. Match the following-
A. carboxypeptidase 1. breaks the peptide bond between amino acid and its                                                 neighbor
B. elastase                    2. Break peptide bond at carboxyl end
C. dipeptidase             3. Breaks dipeptide in each amino acid
D. lipases                      4. Used for digestion of lipid

9. what is emulsification?
A. small molecules of lipid combine to form large molecule
B. large molecule split into smaller molecules
C. it is a process which enhances solubility of lipid
D. none of the above

10. which method is used for the transport of amino acids?
A. simple diffusion B. facilitated diffusion
C. passive transport D. none of the above

ANSWERS:-

1. stomach and small intestine
2. splits amino acids at amino end of peptide
3. small intestine, mouth and stomach
4. all of the above
5. Bile salts are necessary of absorption of lipids
6. bile salts
7. subclavian vein
8. A – 1 B – 2 C – 3 D – 4
9. large molecule split into smaller molecules
10. none of the above

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REFERENCE:- Gerard  J. Tortora -Principles of anatomy and physiology;  edition twelfth ; page no.-: 954-958.

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