Diagnostic Enzymology Flashcards

1
Q

How are Enzymes used in analysis?

A
  • As specific bio-reagents reacting with substrate/analyte and as means of producing observable signal
  • As removers of interferences
  • As signal amplifiers - ‘labels’ in immunoassay
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2
Q

How are enzymes used as specific bio-regeants and an example?

A
  • Examples is Glucose Oxidase is very specific for glucose, but peroxidase can react with many reagents.

[glucose oxidase]

Glucose + O2 → Gluconolactone + H2O2

[peroxidase]

H2O2 + o-toluidine → oxidized o-toluidine (coloured) + H2O

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3
Q

What is an example of enzymes as specific bioreagents in a reversal arrange?

A
  • A converse arrangement can also provide specificity.
  • A lack of specificity in the primary enzyme (hexokinase) can be compensated by a high specificity in secondary enzyme(G-6-Pi-DH) linked to detection of the initial product.

[hexokinase]

Glucose + ATP → Glucose-6-Pi + ADP

[G-6-Pi-DH]

Glucose-6-Pi + NADP → 6-Phosphogluconate + NADPH

  • The glucose-6-Pi-DH is very specific for its substrate
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4
Q

What are other clinical analytes where enzymes are used as reagents?

A
  • Urate
  • Creatinine
  • Cholesterol
  • Triglycerides
  • Lactate
  • Urea
  • Ammonia
  • Total CO2
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5
Q

What are advanatges of he enzymatic method over the jaffe method?

A
  • Enzymatic method for creatinine competes with the traditional ‘Jaffe’ method, which uses alkaline picrate as a colour reagent.
  • Jaffe method is long established and cheaper, but is more prone to interferences, particularly from bilirubin.

Modern analysers allow for both methods on the same instrument and can be programmed only to do an enzymatic creatinine analysis if a high bilirubin is detected.

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6
Q

What are types of enzyme mediated analysis?

A
  • End Point Assays
  • Kinetic Assays
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7
Q

What are features of End Point Assays?

A

Many assays using enzymes as reagents are ‘end point’ assays. The reactions are allowed to go to completion.

  • Zero order kinetics
  • Can demand relatively high amounts of enzyme reagents and they work best with enzymes with a low Km (high affinity)for the substrate which is the subject of the analysis.
  • Less sensitive to changes in assay conditions
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8
Q

What can be used when a reaction equilibrium is unfavourable?

A

Where a reaction equilibrium is unfavourable to the desired direction, a ‘trapping’ reagent may be used to ‘pull’ the equilibrium that way.

  • Example – Analysis of lactate

[LDH]

Lactate + NAD ←→→ Pyruvate + NADH

Pyruvate + Hydrazine → Hydrazone

As pyruvate is continually removed from the equilibrium by conversion to its hydrazone, the production of the detection chromophore, NADH, continues until all the lactate is used up.

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9
Q

What are features of Kinetic Assays?

A
  • In kinetic enzyme assays the rate of the reaction is used to assess the concentration of the analyte being measured. This will require several measurements over a period of time, rather than just measuring a change after completion, as in a fixed time/end point methods.l
  • Whereas in end point assays the idea is to reach the ‘end’ point as rapidly and completely as possible, in kinetic assays smaller amounts of the primary enzyme may allow a slower process which is then easier to monitor over time.
  • Also, the theory behind enzyme kinetics means that an enzyme with a high Km for the substrate being determined may be advantageous as it is desirable to work at substrate/analyte concentrations below 0.2 x Km.
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10
Q

When is the observed reaction velocit proportional to substrate concentration?

A
  • First-order kinetics.
  • To achieve a situation where the observed reaction velocity is proportional to the substrate concentration, ideally need to work at substrate concentrations below 0.2 x km.
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11
Q

What are advanatages and disadvantages of Kinetic Assays?

A

Advantages

  • Because there may be less need to wait for a reaction to achieve equilibrium, as in end point assays, kinetic assays may be ‘faster’.

Disadvantages

  • Since it is the reaction rate which is being monitored all factors which cause this to vary must be strictly controlled to give precise results.
  • Enzyme reagents employed as part of ‘product detection’ (coupled assays) must NOT be rate limiting – use in high concentrations relative to the enzyme reacting with analyte/substrate.
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12
Q

What are examples for Kinetic Assays?

A

Kinetic Assay example – Ethanol

[ADH]

Ethanol + NAD → Acetaldehyde + NADH

  • This example requires only a single enzyme which both reacts with substrate/analyte and also produces an observable product.
  • As with examples of end-point analysis, kinetic assays can also use multi-enzyme systems to produce a convenient spectrophotometric change if needed.
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13
Q

How are enzymes used as labels in immunoassays?

A
  • Immunoassay often analyse very low concentrations of analyte. As enzymes can cycle for as long as they have appropriate substrate, they can amplify the signal.
  • Enzymes with high turn-over numbers (kcat) are advantageous as they produce more signal per unit time. Peroxidase and ALP are often favoured as such labels.
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14
Q

What are two common techniques for use of labels in immunoassay?

A

Two common techniques are:

  • EMIT – a ‘homogeneous’ immunoassay where no separation step is needed
  • ELISA - a ‘heterogeneous’ immunoassay method
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15
Q

How does EMIT take place?

A
  • When the anibody is unbound to the enzyme drug conjugate, the enzyme is active and coverts NAD to NADH and the reaction is spectrometrically read at wavelength of 340nm
  • When the antibody binds to the enzyme drug conjuagte, the enzyme is inactive
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16
Q

How does ELISA take place?

A

Enzyme Linked Immunosorbant Assay

  • ELISA’s are usually two stage assays
  • A ‘capture’ antibody is used to bind analyte in the sample to a solid phase followed by a wash step
  • There is then addition of a second antibody for the analyte which is linked to an enzyme label.
17
Q

What are examples of dry reagent systems?

A
  • Enzyme reagents can be immobilised onto a solid support, e.g. cellulose and used in test ‘strips’.
  • Urine testing for glucose generally uses this method – the glucose oxidase, the peroxidase and dye (potassium iodide chomogen) are incorporated into the reagent pad.
  • ‘Dry’ reagent approaches are particularly prominent in Point of Care Testing.
18
Q

Why do we measre enzymes in investigation of disease?

A
  • They have potential ability to produce a large ‘signal’ despite being present at a low concentration
  • Enzyme detection can be relatively easy compared to purely structural proteins (not enzymes), which usually require immunoassay.
19
Q

Why do we measure enzymes?

A
  • Detection of suspected disease at pre-clinical stage
  • Confirmation of suspected disease and assessing severity
  • Localisation of disease to organs
  • Characterisation of organ pathology
  • Assessing the response to therapy
  • Organ function assessment
  • Assessing genetic susceptibility to drug side effects
20
Q

What factors determine enzyme activities in serum/plasma?

A
  • Age
  • Gender
  • Pregnancy
  • Genetics
  • Drugs
  • Disease process, treatment e.g. surgery

Generally, serum enzyme concentrations are low and rise only when there is damage to cells and release of contents.

21
Q

What processes trigger the release of enzymes?

A
  • Cellular damage due to chemicals, drugs
  • Physical damage due to trauma, surgery, burns, etc.
  • Immune disorders – anaphylaxis, autoimmune disease, etc
  • Microbiological agents – bacteria, viruses, etc
  • Genetic defects – many, e.g. Duchenne’s Muscular Dystrophy
  • Nutritional disorders – protein-calorie, vitamin status
22
Q

How oes ALP change within the body?

A
  • Congenital absence of ALP production (hypophophatasia) is very rare.
  • Biliary obstruction increases the rate of ALP production by the liver.
  • ALP is also present in bone osteoblast cells and increased levels are found during the adolescent growth spurt, in vitamin D deficiency and in Pagets disease and other bone diseases.
23
Q

How does AST and ALT differ diagnostically?

A
  • AST may be more sensitive for liver damage than ALT, but its presence in large concentrations in other tissues means that it is far less tissue specific.
24
Q

What are tissue sources of some serum enzymes?

A
  • Heart Muscle → [AST], [LDH], [CKMB]
  • Liver/biliary tract → [AST], [ALT], [γGT], [ALP]
  • Skeletal muscle → [AST], [CK] (total)
  • Pancreas → [Amylase], [lipase], [trypsin], [chymotrypsin]
  • Prostate gland → [Acid phosphatase], [PSA]
  • Bone → [ALP]
  • RBCs → [LDH]
25
Q

Why has the panel appraoch been developed?

A
  • Few enzymes have a ‘unique’ tissue source.
  • For many serum enzymes there is often a concern about source and this has led to a ‘panel’ approach.
  • For example if a patient has a raised ALP and a raised γ GTthen it is likely that the excess ALP has arisen from the liver and not from bone.
  • Isoenzyme analysis.
26
Q

What are isoform and isoenzyme definitions?

A
  • Isoenzyme: Multiple forms of an enzyme that possess the ability to catalyse the enzyme’s characteristic reaction but that differ in structure because they are encoded by distinct structural genes.
  • Isoform: Multiple forms of an enzyme that differ as a result of post-translational modification.
27
Q

What are isoenzymes of creatine kinase?

A

CK has a dimeric structure. Two types of subunit are found the ‘M’ (muscle) subunit and the ‘B’ (brain) subunit.

  • Muscle tissue CK is predominantly ‘M-M’
  • Brain tissue CK is predominantly ‘B-B’
  • Cardiac muscle tissue has a substantial fraction of structure ‘M-B’

All the forms have the same enzymatic activity, immunoassays were developed to measure CK-MB to help diagnose and monitor a heart attack, but troponin has replaced CK-MB in this role.

28
Q

When does CK rise?

A

Total CK useful in diagnosis of Rhabdomyolysis

  • Also raised by: fitting, exercise, prolonged coma, hypothyroidism, muscular dystrophies, statins.
29
Q

What are the isoenzymes of alkaline phosphatase?

A

Tissue-nonspecific - Gene on short arm of chromosome 1

Differential glycosylation - tissue-specific isoforms e.g. liver, bone

Chromosome 2 has these version

  • Intestinal
  • Placental
  • Germ-cell
30
Q

What are properties of circulating ALP isoenzymes?

A

Heat

  • At 56°C, bone ALP is more heat-labile than liver ALP
  • At 65°C, all isoenzymes except placental ALP are rapidly inactivated

Sialic Acid Content

  • Incubation with neuraminidase retards electrophoretic migration of all ALP isoenzymes except intestinal ALP
  • Wheat germ agglutinin (lectin) binds preferentially to bone ALP

Immunoassay

  • Bone ALP monoclonal antibodies now available
31
Q

How are liver function test enzymes?

A

Liver Function Test Enzymes - ALP, ALT and γGT

  • Hepatocellular – the result of direct damage to liver cells e.g. viral or toxic compound. ALT more likely to be raised.
  • Cholestatic – the result of an obstruction to the outflow of bile along the bile duct e.g. gall stones. ALP/γGT more likely to be raised.

Often both aminotransferases and ALP/ γGT enzymes are elevated

32
Q

What are enzymes used to assess drug side effect susceptibility?

A

Serum Cholinesterase (CE)

  • Used to assess suxamethonium and mivacurium sensitivity.
  • Suxamethonium is a muscle relaxant used during anaesthetic procedures and is usually short acting.
  • Certain CE phenotypes cannot degrade the drug efficiently and are therefore at risk of prolonged apnoea. Aside from CE, the activity in the presence of inhibitors: fluoride and dibucaine, is used to characterise phenotypes.
33
Q

What are the phenotypes susceptible to suxamethonium?

A
  • UU phenotype - no risk
  • UA or UF - phenotypes may carry a small risk
  • AA, AS, SS - phenotypes can experience prolonged paralysisof 2+ hours
  • FF, FS and AF - intermediate sensitivity to suxamethonium
34
Q

How is TPMT used clinically?

A
  • Thiopurine drugs (azathioprine) are widely used to treat inflammatory and autoimmune disease. Drug catabolised to inactive metabolites by TPMT, which reduces concentrations of the active metabolite, 6-thioguanine nucleotides (6TGN).
  • In a Caucasian population ~89% have normal enzyme activity, 11% low activity and 0.3% undetectable levels (deficient)
  • Measurement of TPMT activity prior to starting thiopurine drugs is now recommended. Patients with undetectable TPMT activity are not treated with thiopurine drugs due to risk of severe side effects, e.g. myelosuppression.
  • In patients with high activity, an increased dose may lead to accumulation of inactive metabolites and increased risk of hepatotoxicity.
35
Q

What are some other enzyme assays?

A

Plasma Renin (investigation of hypertension, ?Hyperaldosteronism)

  • Measured by either the plasma renin activity (PRA) assay or by plasma renin immunoassay.
  • PRA: renin-catalysed conversion of endogenous plasma angiotensinogen to angiotensin I (measured by mass spectrometry).

Angiotensin converting enzyme (ACE)

  • Investigation of sarcoidosis – elevated in 75% of cases

Neurone Specific Enolase (NSE)

  • Tumour marker, raised in neuroblastoma, carcinoid, melanoma and small cell lung cancer.