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Nursing - 4


Enzymes
• Enzymes
• Are protein catalysts that
  increase the rate of reactions
  without being change in the
  overall process.
• All reactions in the body are
  mediated by enzymes.
2
Nomenclature of enzymes

• Each enzyme is assigned two names.
• The first is its short, recommended
  name, convenient for every day use.
• The second is the more complete
  systematic name, which is used when an
  enzyme must be identified without
  ambiguity.
  3
A.Recommended name:
• Most commonly used enzyme names have the
  suffix “-ase” attached to the substrate of the
  reaction (e.g. urease),
• Or to description of the action performed (e.g.
  lactate dehydrogenase).
• Note: Some enzymes retain their original trivial
  names, which give no hint of the associated
  enzymatic reaction, e.g. trypsin and pepsin.



 4
B. Systematic name:
• In the systematic naming system, enzymes are
  divided into six major classes, each with numerous
  subgroups.
• For a give enzyme, the suffix –ase is attached to a
  fairly complete description of the chemical reaction
  catalyzed, including the names of all the substrates.
• For example, lactate: NAD+ oxi-dehydrogenase.
• Note: Each enzyme is also assigned a classification
  number.
• The systematic names are informative, but are
  frequently too cumbersome to be general use.
  5
Classification of enzymes
According to its function
• Class 1. Oxidoreductase:
Transfer of hydrogen, catalyze oxidation-reduction
  reaction as conversion of lactate to pyruvate by
  lactate dehydrogenase.
• Class 2. Transferase:
Catalyze transfer of C-, N-, or P- containing groups.
  Such as conversion of serine to glycine by serine
  hydroxy methyl transferase
• Class 3. Hydrolases:
Catalyze cleavage of bonds by addition of water,
  e.g. Urease convert urea to CO2 and NH3
  6
• Class 4. Lyases:
Cleave without adding water, catalyze cleavage of
 C-C, C-S and certain C-N bonds, such as cleavage
 of pyruvate by pyruvate decarboxylase into
 acetaldehyde.
• Class 5. Isomerases:
Catalyze racemization of optical or geometric
 isomers, such as conversion of methylmalonyl CoA
 to Succinyl CoA by methylmalonyl CoA mutase.


  7
• Class 6. Ligases:
ATP dependent condensation of two
molecules, e.g. acetyl CoA carboxylase. It
catalyze formation of bonds between
carbon and O, S, N coupled to hydrolysis
of high-energy phosphatases, such as
conversion of pyruvate to oxaloacetate by
pyruvate carboxylase.


8
Properties of Enzymes
• Enzymes are protein catalysts that increase the
  velocity of a chemical reaction, and are not
  consumed during the reaction.
• Note: Some RNAs can act like enzymes, usually
  catalyzing the cleavage and synthesis of
  phosphodiester bonds.
• RNAs with catalytic activity are called
  ribozymes, and are much less commonly
  encountered than protein catalysts.

 9
A.Active sites:
• Enzyme molecules contain a special pocket or
  cleft called the active site.
• The active site contains amino acid chains that
  participate in substrate binding and catalysis.
• The substrate binds the enzyme, forming an
  enzyme-substrate (ES) complex.
• Binding is thought to cause a conformational
  change in the enzyme (induced fit) that allows
  catalysis.
• ES is converted to an enzyme-product (EP)
  complex that subsequently dissociates to enzyme
  and product.
  10
Active Site




11
B. Catalytic efficiency:
• Enzyme-catalyzed reactions are highly
  efficient, proceeding from 103-108 times
  faster than uncatalyzed reactions.
• The number of molecules of substrate
  converted to product per enzyme molecule
  per second is called the turnover number, or
  kcat and typically is 102-104s-1.



 12
C. Specificity:
• Enzymes are highly specific, interacting with
  one or a few substrates and catalyzing only
  one type of chemical reaction.
• Note: The set of enzymes made in a cell
  determines which metabolic pathways occur
  in that cell.




 13
D. Holoenzymes:
• Some enzymes require molecules other than proteins
  for enzymatic activity.
• The term holoenzyme refers to the active enzyme
  with its nonprotein component.
• The term apoenzyme is inactive enzyme without
  its nonprotein part.
• If the nonprotein part is a metal ion such as Zn 2+ or
  Fe2+, it is called a cofactor.
• If it is a small organic molecule, it is termed a
  coenzyme.
  14
• Coenzymes that only transiently associate with the
  enzyme are called co-substrates.

• If the coenzyme is permanently associated with the
  enzyme and returned to its original form, it is
  called a prosthetic group as FAD.

• Coenzymes frequently are derived from vitamins.

• Example, NAD+ contains niacin and FAD contains
  riboflavin.
  15
16
E. Regulation:
Enzyme activity can be regulated, that is, increased
or decreased, so that the rate of product formation
responds to cellular need.
F. Location within the cell:
• Many enzymes are localized in specific
  organelles within the cell.
• Such compartmentalization serves to isolate the
  reaction substrate or product from other
  competing reactions.

 17
How Enzymes Work
• The mechanism of enzyme action can be viewed
  from two different perspectives.

• The first treats catalysis in terms of energy
  changes

• The second perspective describe how the active
  site chemically facilitates catalysis.


  18
B. Chemistry of the active site

Active site is a complex molecule that
facilitate the conversion of substrate to
                 product.




 19
20
Factors influencing enzyme activity
1- Enzyme concentration:
• Velocity of reaction is increased proportionately
  with the concentration of enzyme, when substrate
  concentration is unlimited.
2- Substrate concentration:
• As substrate concentration is increased, the
  velocity is also correspondingly increased in the
  initial phases; but the curve flattens afterwards.
  The maximum velocity thus obtained is called
  Vmax.
3- Effect of concentration of products:
• When product concentration is increased, the
  reaction is slowed, stopped or even reversed.
 21
Substrate concentration




  22
4. Temperature




23
Effect of temperature:
• The velocity of enzyme reaction increases when
  temperature of the medium is increased; reaches a
  maximum and then falls.
• As temperature is increased, more molecules get
  activation energy, or molecules are at increased rate of
  motion. So their collision probabilities are increased
  and so the reaction velocity is enhanced.
• But when temperature is more than 50°C, heat
  denaturation and consequent loss of tertiary structure
  of protein occurs. So activity of the enzyme decreased.
• Most human enzymes have the optimum temperature
  around 37°C. Certain bacteria living in hot springs will
   24
  have enzymes with optimum temperature near 100°C.
5. Effect of pH
• Each enzyme has an optimum pH.
• Usually enzymes have the optimum pH between 6
  and 8.
• Some important exceptions are Pepsin (with
  optimum pH 1-2), alkaline phosphatase (optimum
  pH 9-10) and acid phosphatase (4-5).




  25
Michaelis-Menten Equation
A. Reaction model:
• This also called enzyme-substrate complex
  theory.
• The enzyme (E) combines with the substrate (S),
  to form an enzyme-substrate (ES) complex, which
  immediately breaks down to the enzyme and the
  product (P).
           k1                     k2
• E + S ↔ E-S complex → E + P
           k-1
Where, K1, k-1 and k2 are rate constants.
  26
27
B. Michaelis-Menten Equation:
              Vmax [S]
     V0 = --------------------
               Km + [S]
Where,
• V0 = initial reaction velocity
• Vmax = maximal velocity
• Km = Michaelis = (k-1 + k2)/k1
• [S] = substrate concentration


  28
Inhibition of enzyme activity
• Inhibitor is any substance that can diminish the
  velocity of an enzyme-catalyzed reaction.
• Types of inhibitors:
1. Irriversible inhibitors bind to enzyme through
covalent bonds.
2. Reversible inhibitors typically bind to enzyme
through noncovalent bonds, thus dilution of the
enzyme-inhibitor complex results in dissociation of
the reversibly bound inhibitor, and recovery of enzyme
activity.
• Reversible inhibition are competitive and
  noncompetitive.
  29
A. Competitive inhibition:
• In this type, the inhibitor there will be similarity in
  three-dimensional structure between substrate (S)
  and inhibitor (I).

• The inhibitor molecules are competing with the
  normal substrate molecules for attaching with the
  active site of the enzyme.

•        E + S → E-S → E + P
•   30
         E + I → E-I
31
32
• If substrate concentration is high when
  compared to inhibitor, then the inhibition is
  reversed.

• For example, the succinate dehydrogenase
  reaction is inhibited by malonate, which are
  structural analogs of succinate.


  33
B- Noncompetitive inhibition
• A variety of poisons, such as iodoacetate, heavy
  metal ions (silver, mercury) and oxidizing agents act
  as irreversible noncompetitive inhibitors.

• The inhibitor usually binds to different domain on
  the enzyme, other than the substrate binding site.

• Since these inhibitors have no structural
  resemblance to the substrate, an increase in the
  substrate concentration generally does not relieve
  this inhibition.
  34
35
• Cyanide inhibits cytochrome oxidase. Fluoride
  will remove magnesium ions and will inhibit
  the enzyme, enolase, and consequently the
  glycolysis.
• The velocity of the reaction is reduced.
• Increasing substrate concentration will not
  abolish non-competitive inhibition.



  36
37
Enzyme Inhibitors as Drugs

• The widely prescribed β-lactan
  antibiotics, such as penicillin and
  amoxicillin, act by inhibiting enzymes
  involved in bacterial cell wall synthesis.



  38
Allosteric enzyme:
• Allosteric enzyme has one catalytic site where
  the substrate binds and another separate
  allosteric site where the modifier binds
  (allo=other).
• Allosteric enzymes are utilized by the body for
  regulating metabolic pathways. Such a
  regulatory enzyme in a particular pathway is
  called the key enzyme or rate limiting
  enzyme.
  39
40
Enzymes in Clinical Diagnosis
• Plasma enzymes can be classified into two major
  groups.
• First, a relatively small group of enzymes are
  actively secreted into the blood by certain cell
  types.
• For example, the liver secretes zymogens (inactive
  precursors) of the enzymes involved in blood
  coagulation.
• Second, a large number of enzyme species are
  released from cells during normal cell turnover.
  41
• These enzymes almost always function
  intracellularly, and have no physiologic use in the
  plasma.
• In healthy individuals, the levels of these enzymes
  are fairly constant, and represent a steady state in
  which the rate of release from damaged cells into
  the plasma is balanced by an equal rate of removal
  of the enzyme protein from the plasma.
• Increased plasma levels of these enzyme may
  indicate tissue damage.


  42
A. Alteration of plasma enzyme levels
in disease states
• Many diseases that cause tissue damage result in an
  increased release of intracellular enzymes into the
  plasma.
• The activities of many of these enzymes are routinely
  determined for diagnostic purposes in diseases of the
  heart, liver, skeletal muscle, and other tissues.
• The level of specific enzyme activity in the plasma
  frequently correlates with the extent of tissue damage.
• Thus, determining the degree of elevation of a particular
  enzyme activity in the plasma is often useful in
  evaluating the prognosis for the patient.
   43
B. Plasma enzymes as diagnostic tools:
• Some enzymes show relatively high activity in only one
  or a few tissues.
• The presence of increased levels of these enzymes in
  plasma thus reflects damage to the corresponding tissue.
• For example, the enzyme alanine aminotransferase
  (ALT) is abundant in the liver.
• The appearance of elevated levels of ALT in plasma
  signals possible damage to hepatic tissue.
• Note: Measurement of ALT is part of the liver function
  test panel.
• Increases in plasma levels of enzymes with a wide
  tissue distribution provide a less specific indication of
  the site of cellular injury and limits their diagnostic
  value.
   44
C. Isoenzymes and diseases of the heart:
• Most isoenzymes (also called isozymes) are
  enzymes that catalyze the same reaction.
• However, they do not necessarily have the same
  physical properties because of genetically
  determined differences in amino acid sequence.
• For this reason, isoenzymes may contain different
  numbers of charged amino acids and may, therefore,
  be separated from each other by electrophoresis.


  45
• Different organs frequently contain characteristic
  properties of different isoenzymes.
• The pattern of isoenzymes found in the plasma may,
  therefore, serve as a means of identifying the site of
  tissue damage.
• For example, the plasma levels of creatine kinase
  (CK) are commonly determined in the diagnosis of
  myocardial infarction.
• They are particularly useful when the
  electrocardiogram is difficult to interpret, such as
  when there have been previous episodes of heart
  disease.
  46
1. Quaternary structure of isoenzymes
• Many isoenzymes contain different subunits in various
  combinations.
• For example, creatine kinase (CK) occurs as three
  isoenzymes.
• Each isoenzyme is a dimer composed of two
  polypeptides (called B and M subunits) associated in
  one of three combinations: CK1 = BB, CK2 = MB, and
  CK3 = MM.
• Each CK isoenzyme shows a characteristic
  electrophoretic mobility.
• Note: Virtually all CK in the brain is the BB isoform,
  whereas in skeletal muscle it is MM. In cardiac muscle,
  about one-third is MB with the rest as MM
   47
2. Diagnosis of myocardial infarction
• Measurement of blood levels of proteins with
  cardiac specificity is used in diagnosis of myocardial
  infarction (MI) because myocardial muscle is the
  only tissue that contains more than 5% of the total
  CK activity as the CK2 (MB) isoenzyme.
• The most sensitive and earlier marker of acute
  myocardial infarction (AM) is either Troponin I or
  Troponin T.



  48

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Lec 4 level 3-nu (enzymes)

  • 2. • Enzymes • Are protein catalysts that increase the rate of reactions without being change in the overall process. • All reactions in the body are mediated by enzymes. 2
  • 3. Nomenclature of enzymes • Each enzyme is assigned two names. • The first is its short, recommended name, convenient for every day use. • The second is the more complete systematic name, which is used when an enzyme must be identified without ambiguity. 3
  • 4. A.Recommended name: • Most commonly used enzyme names have the suffix “-ase” attached to the substrate of the reaction (e.g. urease), • Or to description of the action performed (e.g. lactate dehydrogenase). • Note: Some enzymes retain their original trivial names, which give no hint of the associated enzymatic reaction, e.g. trypsin and pepsin. 4
  • 5. B. Systematic name: • In the systematic naming system, enzymes are divided into six major classes, each with numerous subgroups. • For a give enzyme, the suffix –ase is attached to a fairly complete description of the chemical reaction catalyzed, including the names of all the substrates. • For example, lactate: NAD+ oxi-dehydrogenase. • Note: Each enzyme is also assigned a classification number. • The systematic names are informative, but are frequently too cumbersome to be general use. 5
  • 6. Classification of enzymes According to its function • Class 1. Oxidoreductase: Transfer of hydrogen, catalyze oxidation-reduction reaction as conversion of lactate to pyruvate by lactate dehydrogenase. • Class 2. Transferase: Catalyze transfer of C-, N-, or P- containing groups. Such as conversion of serine to glycine by serine hydroxy methyl transferase • Class 3. Hydrolases: Catalyze cleavage of bonds by addition of water, e.g. Urease convert urea to CO2 and NH3 6
  • 7. • Class 4. Lyases: Cleave without adding water, catalyze cleavage of C-C, C-S and certain C-N bonds, such as cleavage of pyruvate by pyruvate decarboxylase into acetaldehyde. • Class 5. Isomerases: Catalyze racemization of optical or geometric isomers, such as conversion of methylmalonyl CoA to Succinyl CoA by methylmalonyl CoA mutase. 7
  • 8. • Class 6. Ligases: ATP dependent condensation of two molecules, e.g. acetyl CoA carboxylase. It catalyze formation of bonds between carbon and O, S, N coupled to hydrolysis of high-energy phosphatases, such as conversion of pyruvate to oxaloacetate by pyruvate carboxylase. 8
  • 9. Properties of Enzymes • Enzymes are protein catalysts that increase the velocity of a chemical reaction, and are not consumed during the reaction. • Note: Some RNAs can act like enzymes, usually catalyzing the cleavage and synthesis of phosphodiester bonds. • RNAs with catalytic activity are called ribozymes, and are much less commonly encountered than protein catalysts. 9
  • 10. A.Active sites: • Enzyme molecules contain a special pocket or cleft called the active site. • The active site contains amino acid chains that participate in substrate binding and catalysis. • The substrate binds the enzyme, forming an enzyme-substrate (ES) complex. • Binding is thought to cause a conformational change in the enzyme (induced fit) that allows catalysis. • ES is converted to an enzyme-product (EP) complex that subsequently dissociates to enzyme and product. 10
  • 12. B. Catalytic efficiency: • Enzyme-catalyzed reactions are highly efficient, proceeding from 103-108 times faster than uncatalyzed reactions. • The number of molecules of substrate converted to product per enzyme molecule per second is called the turnover number, or kcat and typically is 102-104s-1. 12
  • 13. C. Specificity: • Enzymes are highly specific, interacting with one or a few substrates and catalyzing only one type of chemical reaction. • Note: The set of enzymes made in a cell determines which metabolic pathways occur in that cell. 13
  • 14. D. Holoenzymes: • Some enzymes require molecules other than proteins for enzymatic activity. • The term holoenzyme refers to the active enzyme with its nonprotein component. • The term apoenzyme is inactive enzyme without its nonprotein part. • If the nonprotein part is a metal ion such as Zn 2+ or Fe2+, it is called a cofactor. • If it is a small organic molecule, it is termed a coenzyme. 14
  • 15. • Coenzymes that only transiently associate with the enzyme are called co-substrates. • If the coenzyme is permanently associated with the enzyme and returned to its original form, it is called a prosthetic group as FAD. • Coenzymes frequently are derived from vitamins. • Example, NAD+ contains niacin and FAD contains riboflavin. 15
  • 16. 16
  • 17. E. Regulation: Enzyme activity can be regulated, that is, increased or decreased, so that the rate of product formation responds to cellular need. F. Location within the cell: • Many enzymes are localized in specific organelles within the cell. • Such compartmentalization serves to isolate the reaction substrate or product from other competing reactions. 17
  • 18. How Enzymes Work • The mechanism of enzyme action can be viewed from two different perspectives. • The first treats catalysis in terms of energy changes • The second perspective describe how the active site chemically facilitates catalysis. 18
  • 19. B. Chemistry of the active site Active site is a complex molecule that facilitate the conversion of substrate to product. 19
  • 20. 20
  • 21. Factors influencing enzyme activity 1- Enzyme concentration: • Velocity of reaction is increased proportionately with the concentration of enzyme, when substrate concentration is unlimited. 2- Substrate concentration: • As substrate concentration is increased, the velocity is also correspondingly increased in the initial phases; but the curve flattens afterwards. The maximum velocity thus obtained is called Vmax. 3- Effect of concentration of products: • When product concentration is increased, the reaction is slowed, stopped or even reversed. 21
  • 24. Effect of temperature: • The velocity of enzyme reaction increases when temperature of the medium is increased; reaches a maximum and then falls. • As temperature is increased, more molecules get activation energy, or molecules are at increased rate of motion. So their collision probabilities are increased and so the reaction velocity is enhanced. • But when temperature is more than 50°C, heat denaturation and consequent loss of tertiary structure of protein occurs. So activity of the enzyme decreased. • Most human enzymes have the optimum temperature around 37°C. Certain bacteria living in hot springs will 24 have enzymes with optimum temperature near 100°C.
  • 25. 5. Effect of pH • Each enzyme has an optimum pH. • Usually enzymes have the optimum pH between 6 and 8. • Some important exceptions are Pepsin (with optimum pH 1-2), alkaline phosphatase (optimum pH 9-10) and acid phosphatase (4-5). 25
  • 26. Michaelis-Menten Equation A. Reaction model: • This also called enzyme-substrate complex theory. • The enzyme (E) combines with the substrate (S), to form an enzyme-substrate (ES) complex, which immediately breaks down to the enzyme and the product (P). k1 k2 • E + S ↔ E-S complex → E + P k-1 Where, K1, k-1 and k2 are rate constants. 26
  • 27. 27
  • 28. B. Michaelis-Menten Equation: Vmax [S] V0 = -------------------- Km + [S] Where, • V0 = initial reaction velocity • Vmax = maximal velocity • Km = Michaelis = (k-1 + k2)/k1 • [S] = substrate concentration 28
  • 29. Inhibition of enzyme activity • Inhibitor is any substance that can diminish the velocity of an enzyme-catalyzed reaction. • Types of inhibitors: 1. Irriversible inhibitors bind to enzyme through covalent bonds. 2. Reversible inhibitors typically bind to enzyme through noncovalent bonds, thus dilution of the enzyme-inhibitor complex results in dissociation of the reversibly bound inhibitor, and recovery of enzyme activity. • Reversible inhibition are competitive and noncompetitive. 29
  • 30. A. Competitive inhibition: • In this type, the inhibitor there will be similarity in three-dimensional structure between substrate (S) and inhibitor (I). • The inhibitor molecules are competing with the normal substrate molecules for attaching with the active site of the enzyme. • E + S → E-S → E + P • 30 E + I → E-I
  • 31. 31
  • 32. 32
  • 33. • If substrate concentration is high when compared to inhibitor, then the inhibition is reversed. • For example, the succinate dehydrogenase reaction is inhibited by malonate, which are structural analogs of succinate. 33
  • 34. B- Noncompetitive inhibition • A variety of poisons, such as iodoacetate, heavy metal ions (silver, mercury) and oxidizing agents act as irreversible noncompetitive inhibitors. • The inhibitor usually binds to different domain on the enzyme, other than the substrate binding site. • Since these inhibitors have no structural resemblance to the substrate, an increase in the substrate concentration generally does not relieve this inhibition. 34
  • 35. 35
  • 36. • Cyanide inhibits cytochrome oxidase. Fluoride will remove magnesium ions and will inhibit the enzyme, enolase, and consequently the glycolysis. • The velocity of the reaction is reduced. • Increasing substrate concentration will not abolish non-competitive inhibition. 36
  • 37. 37
  • 38. Enzyme Inhibitors as Drugs • The widely prescribed β-lactan antibiotics, such as penicillin and amoxicillin, act by inhibiting enzymes involved in bacterial cell wall synthesis. 38
  • 39. Allosteric enzyme: • Allosteric enzyme has one catalytic site where the substrate binds and another separate allosteric site where the modifier binds (allo=other). • Allosteric enzymes are utilized by the body for regulating metabolic pathways. Such a regulatory enzyme in a particular pathway is called the key enzyme or rate limiting enzyme. 39
  • 40. 40
  • 41. Enzymes in Clinical Diagnosis • Plasma enzymes can be classified into two major groups. • First, a relatively small group of enzymes are actively secreted into the blood by certain cell types. • For example, the liver secretes zymogens (inactive precursors) of the enzymes involved in blood coagulation. • Second, a large number of enzyme species are released from cells during normal cell turnover. 41
  • 42. • These enzymes almost always function intracellularly, and have no physiologic use in the plasma. • In healthy individuals, the levels of these enzymes are fairly constant, and represent a steady state in which the rate of release from damaged cells into the plasma is balanced by an equal rate of removal of the enzyme protein from the plasma. • Increased plasma levels of these enzyme may indicate tissue damage. 42
  • 43. A. Alteration of plasma enzyme levels in disease states • Many diseases that cause tissue damage result in an increased release of intracellular enzymes into the plasma. • The activities of many of these enzymes are routinely determined for diagnostic purposes in diseases of the heart, liver, skeletal muscle, and other tissues. • The level of specific enzyme activity in the plasma frequently correlates with the extent of tissue damage. • Thus, determining the degree of elevation of a particular enzyme activity in the plasma is often useful in evaluating the prognosis for the patient. 43
  • 44. B. Plasma enzymes as diagnostic tools: • Some enzymes show relatively high activity in only one or a few tissues. • The presence of increased levels of these enzymes in plasma thus reflects damage to the corresponding tissue. • For example, the enzyme alanine aminotransferase (ALT) is abundant in the liver. • The appearance of elevated levels of ALT in plasma signals possible damage to hepatic tissue. • Note: Measurement of ALT is part of the liver function test panel. • Increases in plasma levels of enzymes with a wide tissue distribution provide a less specific indication of the site of cellular injury and limits their diagnostic value. 44
  • 45. C. Isoenzymes and diseases of the heart: • Most isoenzymes (also called isozymes) are enzymes that catalyze the same reaction. • However, they do not necessarily have the same physical properties because of genetically determined differences in amino acid sequence. • For this reason, isoenzymes may contain different numbers of charged amino acids and may, therefore, be separated from each other by electrophoresis. 45
  • 46. • Different organs frequently contain characteristic properties of different isoenzymes. • The pattern of isoenzymes found in the plasma may, therefore, serve as a means of identifying the site of tissue damage. • For example, the plasma levels of creatine kinase (CK) are commonly determined in the diagnosis of myocardial infarction. • They are particularly useful when the electrocardiogram is difficult to interpret, such as when there have been previous episodes of heart disease. 46
  • 47. 1. Quaternary structure of isoenzymes • Many isoenzymes contain different subunits in various combinations. • For example, creatine kinase (CK) occurs as three isoenzymes. • Each isoenzyme is a dimer composed of two polypeptides (called B and M subunits) associated in one of three combinations: CK1 = BB, CK2 = MB, and CK3 = MM. • Each CK isoenzyme shows a characteristic electrophoretic mobility. • Note: Virtually all CK in the brain is the BB isoform, whereas in skeletal muscle it is MM. In cardiac muscle, about one-third is MB with the rest as MM 47
  • 48. 2. Diagnosis of myocardial infarction • Measurement of blood levels of proteins with cardiac specificity is used in diagnosis of myocardial infarction (MI) because myocardial muscle is the only tissue that contains more than 5% of the total CK activity as the CK2 (MB) isoenzyme. • The most sensitive and earlier marker of acute myocardial infarction (AM) is either Troponin I or Troponin T. 48