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Application of Enzymes in Disease Diagnosis

Enzymes play a key role in the metabolic activities of all organisms, whether human, animal, plant or microbial, enzyme has a wide range of applications in microbial biotechnology and its diagnosis process. The abnormality of enzyme metabolism system leads to many metabolic diseases. Studies have shown that many diseases are related to many components of enzyme metabolism system, and have been widely used in clinical examination as a specific marker of disease. Researchers in the last two decades have concentrated more on enzymes such as creatine kinase MB, alanine transaminase, aspartate transaminase, acid phosphatase, alkaline phosphatase, etc. for clinical applications. Enzymes are the preferred markers in various disease states such as myocardial infarction, jaundice, pancreatitis, cancer, neurodegenerative disorders, etc. They provide insight into the disease process by diagnosis, prognosis, and assessment of response therapy.

Bone Diseases, Autoimmune and Inflammatory Disorders

Application of Enzymes in Disease Diagnosis Alkaline phosphate (ALP) is correlated with the rate of bone growth. The increase in the level of serum ALP indicates an increased osteoblastic activity or when there is active bone formation as in the case of PAGET’s disease or rheumatoid arthritis. Other pathological conditions that may result in high levels of ALP also include rickets, osteomalacia, hyperthyroidism, and hyperparathyroidism. Cathepsin D level is significantly increasing with progression of rheumatoid arthritis. Serum levels of lysozyme are elevated in rheumatoid arthritis patients, which serve as an indicator of monocyte/macrophage activity. Gelatinase B (Matrix metalloproteinase-9, MMP-9) is involved in a variety of pathologic process occur in autoimmune diseases. Human MMP-9 is a marker enzyme for rheumatoid arthritis. MMP-9 plays a role in the pathogenesis of systemic lupus erythematosus. Detection of leukocyte esterase in synovial fluid is an extremely valuable addition to the physician’s armamentarium for the diagnosis of periprosthetic joint infection. Tartrate-resistant acid phosphatase (TRAP) is found in osteoclasts and released into circulation during bone resorption. TRAP level is increased in rheumatoid arthritis, osteoporosis and metabolic bone disorders.


Application of Enzymes in Disease Diagnosis Acid phosphatase (ACP) level in male prostate gland is 100 times more than in any other body tissue. Prostatic acid phosphatase (PAP) is strongly expressed by prostate cancer cells, especially in bone metastases. Abnormal expression of genetically-distinct alkaline phosphatase (ALP) isoenzymes is valuable in monitoring cancers, particularly germ-cell tumors. Elevated alanine transaminase (ALT) levels are also associated with an increased risk of hepatocellular carcinoma. Cathepsin D in brease tissue may be useful in predicting women with breast cancer who are at risk for early recurrence. Enhanced expression of cysteine cathepsins (CCs) has been demonstrated in many human tumors, including breast, ovary, uterine cervix, lung, brain, gastrointestinal, head, neck and melanoma. The expression of cyclooxygenase-2 (COX-2) is an early event in tumorigenesis and it plays a role in tumor progression. Overexpression of glucose-6-phosphate dehydrogenase (G6PD) is closely related to progression of gastric cancer and might be regarded as an independent predictor of prognosis for gastric cancer.


In addition to conventional risk factors such as age, diabetes and female sex, higher levels of alkaline phosphatase (ALP) may be considered as a risk factor linked to hepatic fibrosis in patients with non-alcoholic steatohepatitis (NASH) and type 2 diabetes.

Liver Disease

Increased serum level alanine transaminase (ALT) indicates a severe liver disease, usually viral hepatitis and toxic liver necrosis. The increase in the level of serum alkaline phosphatase (ALP) indicates an increased hepatocytic activity in hepatobiliary disease. Significant increase in the serum level (10-100 times normal) of aspartate transaminase (AST) indicates severe damage to liver (viral hepatitis or toxic liver necrosis) or heart cells (MI). Hepatobiliary disease is the predominant source of increased serum gamma glutamyl transferase (GGT) activity. Increases are associated with all forms of primary and secondary hepatobiliary disorders.

Dental Disorders

Periodontal disease is one of the most common inflammatory diseases of the oral cavity, characterized by the progressive destruction of the alveolar bone and soft tissues surrounding the teeth. Higher levels of aspartate transaminase (AST) are noticed in the gingival crevicular fluids of diseased sites. The relationship between AST levels in saliva and gingival crevicular fluid (GCF) with periodontal disease progression has been studied in a large number of patients.


Butyrylcholinesterase (BChE) is an enzyme that has been investigated for its putative role in neurodegenerative and neuropsychiatric disorders. Patients with schizophrenia have higher plasma BChE activity than controls.

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