Serum ornithine carbamyl transferase activities in Reye's syndrome

Clinical use of serum enzymes in liver disease

Some of the many enzymes found in hepatocytes can be measured in the serum and are used as tests of liver function. We now review the current knowledge of their physiology and pathophysiology and outline their clinical usefulness. We divide them into two categories: enzymes that primarily reflect cholestasis, such as the alkaline phosphatase, the 5'-nucleotidase, and the gamma-glutamyl transpeptidase, and those that primarily reflect hepatocellular necrosis, such as the aminotransferases. We also briefly discuss several enzymes of more limited usefulness.

Serum isocitrate dehydrogenase activity in Reye's syndrome

Serum levels of isocitrate dehydrogenase was determined in 12 Reye's syndrome patients and the enzyme levels were compared with serum ornithine carbamyl phosphate, glutamic oxaloacetic transaminase (aspartate aminotransferase), ammonia, and the stages of the disorder. Isocitrate dehydrogenase was elevated in 8 of the 12 patients and there was no direct correlation between elevated serum isocitrate dehydrogenase level and other clinical parameters.

Advances in the application of biochemical tests to diseases of the liver and biliary tract: their role in diagnosis, prognosis, and the elucidation of pathogenetic mechanisms

Despite the biochemical complexity of the liver, few laboratory tests provide discriminatory diagnostic information in patients with hepatobiliary disease. Recent efforts have concentrated upon tests which assess the function of the liver, the severity of the disease state, and underlying pathological processes. Bile Acids: The emergence of facile technology and widespread application has brought the realization that these assays are not as sensitive in detecting liver disease as previously believed, although the cholate/chenate ratio may be useful in distinguishing cholestasis from chronic liver disease. The presence of unusual bile acids in serum or urine may be helpful in some cases. Drug Metabolism: A number of tests provide good evidence about liver function, hepatic blood flow and portal shunting, but the aminopyrine breath tests is the most useful, giving prognostic information in acetaminophen overdose and alcoholic liver disease. The antipyrine half-life identifies surgical cases at risk from poor hepatic function. Proteins and Immunochemical Tests: Interest has developed in plasma proteins such as prealbumin and retinol-binding protein to monitor hepatic protein synthetic function. Secretory IgA is more elevated in biliary tract disease, unlike the native protein which is increased principally in cirrhosis. Type III procollagen can be measured in serum, and correlates with the activity of collagen synthesis and the degree of fibrosis in biopsy samples. Reye's Syndrome: Biochemical tests play an essential role in diagnosis of this recently discovered disease. These will be presented and discussed.

Ornithine carbamyl transferase in Reye's syndrome

Serum levels of ornithine carbamyl transferase activities were determined in the acutely ill and convalescent Reye's syndrome patients and in their parents. Acutely ill Reye's syndrome patients had elevated levels of serum ornithine carbamyl transferase activities as compared to those in controls. The convalescent Reye's syndrome patients and their parents had normal levels of serum ornithine carbamyl transferase activities. These results suggest that an inborn metabolic defect was not responsible for the increase in serum ornithine carbamyl transferase activities in Reye's syndrome.

Masking by enzyme inhibitor of raised serum glutamate dehydrogenase activity in Reye's syndrome

Serum glutamate dehydrogenase (GDH) activity was greatly raised (up to 830 times the upper limit of normal) in 16 patients with Reye's syndrome. The serum activity was masked by an inhibitor, and the rises were observed only after dialysis or sample dilution. Serum GDH values from 38 paediatric patients, including 10 with hyperammonaemia due to other causes, showed no such rise after dialysis. Only 1 of 13 adult patients with liver disease had high GDH activity, but this level was not increased after dialysis. Serum ornithine carbamyl transferase activity was also raised in patients with Reye's syndrome, but levels were not increased after dialysis. The ratio of dialysed/undialysed GDH activity clearly distinguished all Reye's patients from controls. The inhibition of a mitochondrial enzyme which regulates ammonia metabolism may contribute to the hyperammonaemia of Reye's syndrome. Serum GDH levels before and after dialysis would seem to be a useful diagnostic aid in Reye's disease.

Interactions of aspirin and other potential etiologic factors in an animal model of Reye syndrome

Recent studies of Reye syndrome (RS) patients have suggested aspirin treatment as a possible factor in the etiology of this often fatal childhood disorder. the relationship of aspirin treatment to other factors that have been strongly implicated (influenza, ammonia toxicity) cannot be examined directly in patients because aspirin treatment is usually initiated by family members in the prodromal period before RS is diagnosed. In this report we describe the use of an animal model for RS in examining the interactions of these several potential etiological factors. Hyperammonemia and coma were produced in young male ferrets by a brief feeding of an arginine-deficient diet. The effects of influenza infection or aspirin treatment (or both) of control and hyperammonemic ferrets on their serum levels of ammonia, glutamic-oxaloacetic transaminase (GOT;L-aspartate:2-oxoglutarate aminotransferase, EC 2.6.1.1), ornithine carbamoyltransferase (OCT; carbamoylphosphate:L-ornithine carbamoyltransferase, EC 2.1.3.3), bilirubin, and salicylate were studied. Liver levels of lipids, proteins, and several urea-cycle enzymes were also determined in the comatose ferrets and compared with those of untreated controls and of controls treated with influenza or aspirin, or both. Synergism of these three factors (hyperammonemia, influenza infection, and aspirin treatment) in causing RS-like alterations in these parameters was observed.