Lactate dehydrogenase isoenzymes in myocardial disease

Serum lactate dehydrogenase (LD) is elevated in various myocardial diseases. A certain pattern of LD isoenzyme elevation occurs in myocardial disease. Since LD is an ubiquitous enzyme, it is not surprising that serum LD is increased in a wide variety of other diseases, which are analyzed in this article.     

A case of immunoglobulin G conjugated with lactate dehydrogenase, producing both loss of enzyme activity and an abnormal isoenzyme pattern

We present a patient with an inhibitor of lactate dehydrogenase (LD; EC 1.1.1.27) in serum, who had pericarditis and myocardial hypertrophy. The patient's LD activity in serum was low and the LD isoenzyme pattern was abnormal. The relative molecular mass of this abnormal LD-IgG complex was approximately 490 000. The patient's IgG reacted with all five LD isoenzymes.     

The PM distribution: a model for interpreting LD isoenzyme patterns

We present a method for inferring from the lactate dehydrogenase (LD) isoenzyme pattern in serum or interstitial fluid the estimated distribution of a cellular parameter PM in the cell population from which LD was released. PM is defined as the fraction of M monomer (one of two gene products which may serve as subunits of the LD tetramer) available in a particular cell. The distribution of PM represents a more fundamental characterization of cellular biochemistry than the serum LD pattern. We apply the method to LD patterns from the literature and illustrate the advantage of this approach over simple inspection or piece-by-piece statistical analysis of LD patterns.     

Lactate dehydrogenase inhibition by immunoglobulin G in human serum

Low lactate dehydrogenase (LD; EC 1.1.1.27) activity and an abnormal LD pattern in electrophoretograms of LD isoenzymes in the sera of two patients were caused by inhibition of LD by immunoglobulin G. One of these showed inhibitor activity in the serum upon direct analysis, while the other showed activity only after the immunoglobulin was stripped from the LD. As judged from the LD isoenzyme patterns in serum, the LD inhibitor appeared to act against M subunits. However, quantification of binding affinities to each isolated isoenzyme showed that the LD inhibitor had a stronger effect on LD isoenzymes 2 and 3 (H3M1 and H2M2, respectively).     

Alterations in lactate dehydrogenase isoenzyme patterns after therapy with streptokinase or streptococcal infection

Serum samples from patients receiving intravenous streptokinase were examined for evidence of interaction in vivo between streptokinase and lactate dehydrogenase (EC 1.1.1.27; LD). We found that this treatment produced a band of LD activity that remained at the electrophoretic origin of LD isoenzyme analysis. Treatment with tissue plasminogen activator produced no such band. The streptokinase-LD complex could be removed from serum by ultracentrifugation. It remained in the circulation for as long as 48 h after streptokinase infusion. A similar phenomenon was observed in a case of pneumococcal sepsis. Examination of supernates from both cultures of several species of Gram-positive cocci revealed interactions between human LD and Streptococcus groups A and C and also Streptococcus pneumoniae. Evidently streptokinase can form complexes with LD in vivo after either streptokinase therapy or infection, with consequent alteration of the LD isoenzyme pattern.     

Lactate dehydrogenase isoenzyme patterns in serum of patients with metastatic liver disease

Total lactate dehydrogenase (LD, EC 1.1.1.27) and LD isoenzymes were determined in serum of 170 patients with metastatic liver disease, 35 of whom had multiple metastatic sites. Overall, values of LD were above normal for 78% of the 170 patients. Half of the patients had an isomorphic pattern of LD isoenzymes (i.e., relative increase in all five isoenzymes); the other half had an increased LD-4,5 pattern, mostly a solitary increase in LD-5 only. Of those patients with normal LD values, 92% had the increased LD-4,5 pattern, whereas 70% of patients with LD values greater than 350 U/L had an isomorphic pattern of LD isoenzymes. All 35 patients with multiple metastatic sites had LD activity greater than 350 U/L; in the majority of them (74%) it was greater than 500 U/L; in 31 (89%), the increase was isomorphic. The diagnostic efficiency of the combined LD greater than 225 U/L (upper limit of normal) and increased LD-4,5 test results was much better than that of LD greater than 225 U/L alone (93% vs 74%). We conclude that serum LD and LD isoenzymes should be determined in every patient with suspected liver metastatic disease. The isomorphic pattern of LD isoenzymes is apparently associated with higher values for total LD and was common among the patients with multiple metastatic sites.     

Increase in lactate dehydrogenase isoenzyme-1 in plasma in pediatric malignancy

We investigated 28 cases of pediatric malignancy in which total lactate dehydrogenase (LD, EC 1.1.1.27) activities were increased and isoenzyme LD-1 exceeded LD-2 (flipped pattern). Of these, 11 had a flipped pattern at presentation and 17 showed a flipped pattern during chemotherapy. Those with flipped patterns at presentation were four with germ-cell tumors, one with acute lymphocytic leukemia, and six with nephroblastomas (Wilms tumor). Four of five nephroblastoma homogenates contained predominantly LD-1; one revealed a structurally normal LD-1 with normal kinetics. We conclude that an increase in LD with a flipped pattern is common in nephroblastoma and, in addition, may develop in cancer patients treated with chemotherapy.     

Atypical patterns of lactate dehydrogenase isoenzymes in acute myocardial infarction

Total lactate dehydrogenase (LD; EC 1.1.1.27) activity in serum and LD isoenzymes were quantified in 190 patients with acute myocardial infarction (AMI) 24, 48, and 72 h after admission. In 90% of the 570 blood specimens an LD isoenzyme pattern typical of AMI (LD-1/LD-2 greater than 0.76) was found. The other 56 blood specimens showed an LD isoenzyme pattern atypical of AMI (LD-1/LD-2 less than 0.76). They were divided into three groups: 28 specimens with isomorphic pattern (relative increase in all five LD isoenzymes); 18 with relatively increased LD-3 proportion (greater than 35%); and 10 specimens with increased LD-5 proportion (greater than 10%). No difference was found in mean total LD activity in serum between the typical isoenzyme group and the three atypical groups. The LD isomorphic pattern was found in 60% of AMI patients complicated by cardiogenic shock. Fifty percent of AMI patients admitted with pulmonary edema showed increased LD-3 proportion and half of the patients with AMI and congestive heart failure, predominant right, demonstrated increased LD-5 proportion. We conclude that although most patients with AMI present at diagnosis with a typical LD isoenzyme pattern, it is important to recognize that some may present with atypical LD isoenzyme patterns, which may be associated with specific AMI complications.     

Increased activities of creatine kinase and lactate dehydrogenase isoenzymes in a patient with metastatic ovarian tumor

A 50-year-old woman with metastatic rhabdomyosarcoma of the ovary had increased activities of creatine kinase (CK; EC 2.7.3.2), CK-MB isoenzyme, lactate dehydrogenase (LD; EC 1.1.1.27), and LD-2 isoenzyme in her serum. The isoenzyme activities did not show a pattern of increasing, then decreasing. Clinical findings, including electrocardiograms, did not support the diagnosis of myocardial infarction. We suggest that high activities of CK-MB and LD-2 in serum may serve as a marker of rhabdomyosarcoma.     

An abnormal macro lactate dehydrogenase isoenzyme not due to immunologlobulin binding

We report here on the lactate dehydrogenase (LD) of a patient who presented with an additional LD isoenzyme band between LD 3 and LD4 found during routine examination. The abnormal LD was found to be of increased molecular size, which was not due to complexing with immunoglobulins. The abnormal LD was purified by affinity chromatography, labelled and electrophoresed on a SDS-polyacrylamide gel. Autoradiography suggested abnormal aggregation as the cause of increased molecular size.     

Abnormal lactate dehydrogenase isoenzyme pattern in a critically ill patient

We have described a patient who had an abnormal isoenzyme of lactate dehydrogenase in both serum and tissue. The presence of LD6 is indicative of a poor prognosis. Some of the biochemical characteristics of the isoenzyme are (1) LD6 is not an artifact, (2) it contains an M subunit but not an H subunit, and (3) it is not an immunoglobulin complex. We believe LD6 may arise during episodes of severe shock as lysosomes rupture and is either a previously sequestered lysosomal LD or is a lysosomal modification of LD5.     

Increased lactate dehydrogenase isoenzyme 1 in serum and tumor tissue of a patient with small-cell carcinoma

Histological examination of supraclavicular lymph node tissue obtained at biopsy from a 63-year-old man disclosed metastatic small-cell carcinoma. On admission and for four days subsequently, total lactate dehydrogenase (LD; EC 1.1.1.27) activity in serum was 6.5 times normal; studies of LD isoenzyme showed persistently increased LD-1, with LD-1 greater than LD-2. Isoenzyme electrophoresis of tissue homogenates prepared from the patient's tumor also showed the LD-1 greater than LD-2 pattern. Isoenzyme studies for supraclavicular lymph node tissue from five control subjects showed contrasting isoenzyme patterns as compared with the patients in whom LD-2, LD-3, and LD-4 predominated. Because these abnormalities were persistent, they differ from the temporal sequence for LD usually seen in myocardial infarction. This emphasizes the importance of repetitive sampling for clinical interpretation of data on this enzyme.     

Reversible loss of lactate dehydrogenase isoenzymes and lactate dehydrogenase activity in patient's serum

An abnormal lactate dehydrogenase (LD; EC 1.1.1.27) electrophoretogram (only one band, at the application site) and a low LD activity (7 U/L) was seen for a patient's serum during storage at 22 and 4 degrees C. Both reverted to normal when the serum was incubated at 37 degrees C.     

A novel in-frame deletion mutation in a case of lactate dehydrogenase (LD) H subunit deficiency showing an atypical LD isoenzyme pattern in serum and erythrocytes

OBJECTIVE: We report a case showing an atypical lactate dehydrogenase (LD) isoenzyme pattern involving deficiency only of LD-1 and LD-2 in serum and erythrocytes. LD activity in serum from this patient was extremely low, similar to complete LD-H deficiency, and also that in erythrocytes was low. DESIGN: The DNA fragment containing exon 1 through 7 of the LD-H gene were amplified by PCR and directly sequenced. Total RNA was prepared from venous blood and the proportion of LD-H cDNA to total LD cDNA was semiquantified. RESULTS: Genetic analysis by DNA sequencing detected a three base deletion (AAT) at codon 220 of exon 5, which caused a deletion of one asparagine. The present case did not show reduced LD-H expression at the mRNA level in whole blood. Residue 220 is involved in turning beta-J to alpha1-G and is not buried in the interior of the protein. The novel homozygous in-frame deletion mutation at codon 220 may cause a three-dimensional change of the subunit-binding domain.     

Cardiac enzyme changes in myxedema coma

A 74-year-old man with myxedema and hypothermia had increased activities in plasma of creatine kinase (CK; EC 2.7.3.2), aspartate aminotransferase (AST; EC 2.6.1.1), and lactate dehydrogenase (LD; EC 1.1.1.27) and increased proportions of CK-MB (up to 20% of total CK) and LD1 isoenzymes, but no clinical or investigational evidence of associated myocardial infarction. This case illustrates that plasma enzyme activity and isoenzyme profiles in such clinical settings should be interpreted with caution, because increases in CK-MB and LD1 may relate to myxedema coma or hypothermia (or both) rather than to myocardial infarction.     

Increased serum lactate dehydrogenase isoenzyme 1 and macro creatine kinase type 2 in a patient with lung cancer

A 72-yr-old man, having a lung tumor with metastatic spread to liver and bone, was hospitalized with a lactate dehydrogenase (LD; EC 1.1.1.27) activity and a creatine kinase (CK; EC 2.7.3.2) activity in serum of 30 and 2 times the upper reference limit (URL), respectively. The LD isoenzyme-1/LD activity ratio was 62% (2 times URL). This ratio was maintained throughout hospitalization, during which LD activity increased up to 90 times URL. Macro CK type 2 activity represented almost all of the CK activity, which increased up to 4 times URL during hospitalization. The patient died the 29th day after admission. The enzyme abnormalities were thought to stem from tumor tissue.     

Serum isoenzyme pattern of creatine kinase and lactate dehydrogenase in various animal species

The creatine kinase and lactate dehydrogenase isoenzyme pattern were determined in the serum of normal and untreated rats, rabbits, dogs, monkeys and pigs. The relative distribution of all isoenzymes in the serum and an electrophoretic pattern for each animal species are presented. The isoenzyme serum pattern showed a great variation between the species. The diagnostic value of serum creatine kinase isoenzyme MB and lactate dehydrogenase isoenzymes 1 and 2 in predicting cardiac lesions in different animal species is briefly discussed.     

The significance of matrix effects on the measurement of lactate dehydrogenase (LD) activity using Kodak dry slide technology in the Ontario Laboratory Proficiency Testing Program

A recent lactate dehydrogenase (LD) survey of the Laboratory Proficiency Testing Program (LPTP) of Ontario showed interlaboratory coefficients of variation ranging from 6.5% to 40% for five lyophilized vials on the 12 Kodak analyzers. All the LPTP survey samples had similar protein and LD isoenzyme electrophoretic patterns which remained unchanged after reconstitution and storage for 5 days at 4 degrees C, although the total LD activities fell. Four Ektachem 700 analyzers were subsequently tested using LPTP material and no difference in LD activity between instruments or between two LD slide lot numbers was shown. Generation 9 slides gave higher LD activities than generation 10 on all the reconstituted lyophilized proficiency testing samples. There was no significant difference between slide generations when 19 liquid human sera were analyzed, indicating that the variability on LPTP samples was due to a matrix effect. Definition of the matrix effect of lyophilized proficiency testing material is essential before any proficiency testing program can use such material to reflect analytical performance on patient specimens.     

Effect of reticulocytosis on lactate dehydrogenase isoenzyme distribution in serum: in vivo and in vitro studies

We investigated the effect of reticulocytosis on the lactate dehydrogenase (LD; EC 1.1.1.27) isoenzyme LD1/LD2 ratio in patients with and without evidence of hemolytic disease. Analysis of sera from patients with reticulocytosis and in vivo hemolysis showed a mean LD1/LD2 ratio of 0.92 compared with a ratio of 0.69 in patients with in vivo hemolysis and normal reticulocyte counts. Determination of LD isoenzymes in erythrocyte lysate revealed significantly increased LD1/LD2 ratios for patients with marked reticulocytosis compared with those for patients with normal-to-minimal increases in reticulocytes. Finally, separation of mature erythrocytes and reticulocytes by flow cytometry revealed marked differences in the LD1/LD2 isoenzyme distribution between these two cell types. The ability of hemolysis to cause a "flipped" LD1/LD2 ratio is dependent on the proportion of the hemolyzed cells that are reticulocytes.     

Lactate dehydrogenase, isoenzyme patterns and cation levels in human breast gross cyst fluid

In order to investigate the diagnostic and/or prognostic value of total activity and isoenzymatic patterns of lactate dehydrogenase, 24 human breast gross cystic fluids were studied. A comparison of total lactate dehydrogenase activity to the serum level revealed an increased activity in about 63% of the cases examined; moreover, a significant increase in the slow-moving lactate dehydrogenase 4 and 5 isoenzymes was observed in some cyst fluids. The levels of Na+ and K+ concentrations were also analyzed and two classes of cysts were identified: one presenting Na+ and K+ levels similar to those found in extracellular compartment; the other with high K+ and low Na+ levels, characteristic of an intracellular fluid. This latter pattern could indicate an active metabolism of the epithelial cells lining the cysts. This breast cyst fluid also showed increased levels of lactate dehydrogenase 4 and 5 isoenzymes. The correlation between an increased activity of lactate dehydrogenase 4 and 5 isoenzymes and high K+ and low Na+ levels could be the expression of a high biosynthetic activity and of an anaerobic metabolism in some cysts, suggesting the evolution of the breast gross cyst lesion to malignancy. The importance of these observations is discussed.