View this article in RussianEnzymes, specific biological catalysts of protein nature, play a crucial role in accelerating chemical reactions within cells. The absence of enzyme synthesis or persistent functional insufficiency of enzymatic systems in organs and tissues can lead to the development of pathological processes. In the realm of medicine, enzyme preparations find extensive applications, both diagnostically (enzyme diagnostics) and therapeutically (enzyme therapy)[1, 90].
Enzyme diagnostics involves diagnosing diseases or syndromes based on the determination of enzyme activities in human biological fluids. The principles of enzyme diagnostics are rooted in several key aspects:
- Cellular Damage Indicators: When cells are damaged in blood or other biological fluids, the concentration of intracellular enzymes from these damaged cells increases.
- Detectable Enzyme Amount: The amount of released enzyme is sufficient for detection.
- Stability of Enzyme Activity: The activity of enzymes in biological fluids, detectable during cell damage, remains stable over a considerable period, differing from normal values.
- Organ-Specificity: Certain enzymes predominantly or exclusively localize in specific organs, demonstrating organ-specificity.
- Intracellular Localization Differences: Various enzymes exhibit differences in intracellular localization.
Enzyme diagnostics progresses along two main paths:
- Selective Reagent Path: Utilizing enzymes as selective reagents to identify and quantitatively determine normal or abnormal chemical substances in blood serum, urine, gastric juice, etc. Examples include detecting glucose, protein, or other substances in urine that are normally not present.
- Enzyme Quantification Path: Directly identifying and quantifying enzymes in biological fluids in pathological conditions. Certain enzymes, termed “necrotic enzymes,” appear in serum during cell breakdown. Numerous enzyme tests, based on the quantitative determination of enzyme (and isoenzyme) activity, are applied in clinical diagnostics.
Key Enzymes in Clinical Diagnostics
Several enzymes are pivotal in clinical diagnostics, including:
- Aspartate Aminotransferase (AST)
- Alanine Aminotransferase (ALT)
- Amylase
- γ-Glutamyltranspeptidase (GGT)
- Creatine Kinase (CK)
Enzyme Therapy
Despite the challenges posed by their high immunogenicity, enzymes are actively employed in therapeutic capacities, primarily in two directions:
Substitute Therapy: Utilizing enzymes when their natural synthesis is insufficient.
Component of Comprehensive Therapy: Employing enzymes in conjunction with other therapeutic methods. [2, 336]
Substitute enzyme therapy proves effective in gastrointestinal diseases associated with insufficient secretion of digestive juices. For instance, pepsin is used in achlorhydria, hypo- and anacidic gastritis. Deficiency of pancreatic enzymes can be compensated significantly by orally administering preparations containing key pancreatic enzymes (e.g., Festal, Enzistal, Mezim-forte).
Beyond substitute therapy, enzymes serve as additional therapeutic agents for various conditions. Proteolytic enzymes like trypsin and chymotrypsin are locally applied to treat purulent wounds, aiding in the breakdown of proteins from dead cells. Enzyme preparations are widely employed in thrombosis and thromboembolism cases, utilizing fibrinolysin, streptolysin, streptodecase, urokinase, among others.
For the treatment of tumor diseases, plant enzymes and complexes of animal and plant enzymes were previously proposed; currently, asparaginase is used for leukemia. Drugs for the treatment of the cardiovascular system are unique. The cytochrome C drug, which is in short supply in Russia, is produced in a number of countries for the treatment of cerebral circulation and coronary atherosclerosis, and immobilization of newborns. The technique allows you to improve tissue respiration in case of disorders of the oxidative process in tissues; the presence of an antihypoxic effect and the absence of side effects make it more significant.
Enzyme preparations are drugs with low toxicity, are well tolerated by patients for a long time, have pronounced effects caused by enzymes, are observed in a small number of patients and are quickly transmitted after taking the drugs. The use of enzymes for medicinal purposes is a developing area and occupies an indispensable place in the complex of modern therapy.
In conclusion, enzymes, with their diagnostic and therapeutic potentials, significantly contribute to modern medical practices. Their precise application aids in the accurate diagnosis and effective treatment of a spectrum of conditions, showcasing the versatility and importance of these biological catalysts in the field of medicine.
References
- Radzicka A, Wolfenden R (January 1995). “A proficient enzyme”. Science. 267 (5194)
- Voet D, Voet J, Pratt C (2016). Fundamentals of Biochemistry. Hoboken, New Jersey: John Wiley & Sons, Inc.