Global areas of enzyme application
In modern medical and laboratory practice, enzymes are used extremely widely. Their use is traditionally divided into three main categories, each addressing specific tasks:
- Enzyme diagnostics — the search for and evaluation of enzymes as diagnostic markers of pathological processes.
- Enzyme therapy — the direct administration of enzymes to a patient as medicinal products.
- Specific reagents — the use of enzymes in vitro for the precise quantitative determination of various metabolites.
Enzymes as specific analytical reagents
Although enzyme therapy focuses on treatment, it is important to understand the role of enzymes in laboratory diagnostics. Due to their high specificity, they serve as ideal reagents for detecting the concentration of specific substances in the body's biological fluids.
Classic examples of using enzyme reagents:
- Glucose oxidase — essential for the quantitative determination of glucose levels in blood and urine samples.
- Urease — used to accurately assess urea content in various biological fluids.
- Various dehydrogenases — used to detect and measure their respective substrates, such as pyruvate, lactate, as well as ethanol and other chemical compounds.
Main areas of enzyme therapy
The clinical use of enzymes as drugs is based on two main principles. The physician chooses the approach depending on the pathology and the patient's general condition.
- Replacement therapy. This approach is used in physiological or pathological deficiency of the body's own enzymes. The administered drugs take over the function of missing or poorly functioning enzymes.
- Elements of combination therapy. In this case, enzymes do not simply replace a function, but are combined with other treatments to achieve the maximum therapeutic effect.
Replacement enzyme therapy in gastroenterology
The efficacy of replacement enzyme therapy is most pronounced in the treatment of diseases of the gastrointestinal tract (GIT). This primarily concerns pathologies accompanied by insufficient secretion of digestive juices.
Treatment of gastric pathologies If a patient is diagnosed with gastritis accompanied by reduced secretory function, the enzyme pepsin is used as a replacement agent. It helps break down proteins, compensating for the lack of the endogenous enzyme.
Treatment of pancreatic pathologies The deficiency of own pancreatic enzymes occurring in pancreatic diseases is effectively compensated by taking specialized drugs. They contain a set of essential enzymes necessary for full digestion. Such well-known medicinal products include: Festal, Enzistal, Mezim forte and their analogs.
Briefly: answers to topical questions
Which proteolytic enzymes are used in combination therapy to cleanse purulent wounds and necrosis?
To cleanse purulent wounds and necrosis in combination therapy, proteolytic enzyme preparations are used. They lyse necrotic tissue and fibrin. The following enzymes are used:
- Trypsin — a drug of animal origin.
- Chymotrypsin — a drug of animal origin.
- Elastase — used alone or in a mixture with others.
- Collagenase — an enzyme of animal origin.
- Terrilytin — an enzyme of bacterial origin.
- Streptokinase — a drug of bacterial origin.
- Clostridiopeptidase A (Clostridium histolyticum) — an enzyme in Iruxol ointment.
- Papain — an enzyme of plant origin.
- Bromelain — a drug of plant origin.
Which enzyme preparations are used to treat thrombosis and dissolve blood clots?
Fibrinolytic drugs that ensure thrombus destruction are used to treat thrombosis and thromboembolism. The sources indicate the following agents:
- Fibrinolysin.
- Streptokinase (streptolyase) — a drug of bacterial origin.
- Streptodekase.
- Urokinase (Urokinase) — a drug derived from a culture of human embryonic kidney cells; directly converts plasminogen to plasmin.
- Saruplase (Saruplase) — a recombinant single-chain urokinase preparation with higher specificity for thrombus fibrin.
- Tenecteplase — characterized by high specificity for thrombus fibrin and lacks antigenic properties.
- Recombinant tissue plasminogen activator (rt-PA).
- Anistreplase — a modified streptokinase preparation, a "streptokinase + acylated lys-plasminogen" complex.
Which enzyme is used in oncology to treat acute leukemias?
In oncology for leukemias, the enzyme asparaginase is used. This drug catalyzes the breakdown of asparagine to form aspartate and ammonia. The biochemical basis of therapy is that leukemic cells are unable to synthesize asparagine independently and depend on its supply from blood plasma. The administration of asparaginase creates an asparagine deficiency, resulting in the cessation of protein synthesis in tumor cells, disruption of their growth and division, leading to the death of leukemic cells.
In what cases is the enzyme hyaluronidase (lidase) used in medicine?
The enzyme hyaluronidase is used in medicine due to its ability to catalyze the breakdown of hyaluronic acid. In clinical practice, the drug is used in the following cases:
- Resorption of adhesions and scars — treatment of the consequences of burns and surgeries (Lidase is administered subcutaneously and intramuscularly).
- Adhesiolysis — a method of treating persistent or recurrent postoperative radicular pain (performed under image guidance using hyaluronidase and hypertonic saline).
To recall popular drugs for pancreatic function compensation, use the abbreviation FEM: Festal, Enzistal, Mezim forte.
Class and exam questions
In which situations is replacement enzyme therapy most commonly used?
It is most effective in gastrointestinal diseases associated with insufficient secretion of digestive juices.
Which enzyme is used as a reagent to determine urea?
To assess the urea content in biological fluids, the specific enzyme urease is used.
What is prescribed to patients with gastritis characterized by reduced secretion?
In such cases, a pepsin-based drug is prescribed to compensate for gastric function.
For the detection of which substrates are dehydrogenases used?
Various dehydrogenases are used as reagents to detect pyruvate, lactate, ethanol, and other metabolites.
What else to study on this topic
- Basics of enzyme diagnostics: enzymes as markers of tissue damage
- Mechanism of action of pepsin in protein digestion
- Biochemical composition and working principles of complex medications (Festal, Meзим-forte)
- Chemical reactions involving dehydrogenases: pyruvate and lactate metabolism
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