Ketohexokinase (EC 2.7.1.3) was purified to homogeneity from human liver, and fructose-bisphosphate aldolase (EC 4.1.2.13) was partially purified from the same source. Ketohexokinase was shown, by column chromatography and polyacrylamide-gel electrophoresis, to be a dimer of Mr 75000. Inhibition studies with p-chloromercuribenzoate and N-ethylmaleimide indicate that ketohexokinase contains thiol groups, which are required for full activity. With D-xylulose as substrate, ketohexokinase and aldolase can catalyse a reaction sequence which forms glycolaldehyde, a known precursor of oxalate. The distribution of both enzymes in human tissues indicates that this reaction sequence occurs mainly in the liver, to a lesser extent in the kidney, and very little in heart, brain and muscle. The kinetic properties of ketohexokinase show that this enzyme can phosphorylate D-xylulose as readily as D-fructose, except that higher concentrations of D-xylulose are required. The kinetic properties of aldolase show that the enzyme has a higher affinity for D-xylulose 1-phosphate than for D-fructose 1-phosphate. These findings support a role for ketohexokinase and aldolase in the formation of glycolaldehyde. The effect of various metabolites on the activity of the two enzymes was tested to determine the conditions that favour the formation of glycolaldehyde from xylitol. The results indicate that few of these metabolites affect the activity of ketohexokinase, but that aldolase can be inhibited by several phosphorylated compounds. This work suggests that, although the formation of oxalate from xylitol is normally a minor pathway, under certain conditions of increased xylitol metabolism oxalate production can become significant and may result in oxalosis.

ObjectiveTo investigate trends in renal stone formation in the South Australian population, between 1977 and 1991 (3634 stones), with respect to age, sex and seasonal variation. ResultsThe frequency of the different stone types was: calcium oxalate (with or without phosphate), 68%; uric acid, 17%; infection stones (magnesium ammonium phosphate), 12%; and pure calcium phosphate, 3%. No significant seasonal variation was observed with calcium oxalate or calcium phosphate stones. The incidence of uric acid stones increased significantly during summer and autumn (P < 0.001 and P < 0.01 respectively), and that of infection stones decreased significantly during spring and summer (P < 0.05 and P < 0.01 respectively). Calcium oxalate, uric acid and calcium phosphate stones were more frequent in male subjects; male to female ratio 2.8:1, 3.7:1 and 1.4:1 respectively. However, there was an increased frequency of calcium oxalate stones in women 20 to 25 years of age; male to female ratio 0.7:1. Infection stones were more common in female subjects; male to female ratio 0.7:1. ConclusionsThis study demonstrates significant seasonal variation in uric acid and infection stones. Men are at a higher risk of forming stones than women, with the exception of infection stones. Additionally, with calcium oxalate stones, women may have distinct periods of higher risk. This study confirms that calcium oxalate stones are the most common stone type, which is in accordance with studies from other industrialised countries. (Med J Aust 1993; 159: 390‐392)

Depending on the selected reference population for troponin, there is likely to be variability in the 99th centile as shown in this study. Some differences in sample concordance at the 99th centile cut-off were observed between cTn methods and may result in different clinical classification.

Human lactate dehydrogenase is a tetramer made up of two types of subunits, either H (heart) or M (muscle). Combination of these subunits gives rise to the five isoenzymes of lactate dehydrogenase which are found in mammalian tissues. The relative proportions of the individual isoenzymes found in serum of patients is related to the severity of the lesion in the organ or tissue from which they originate and the half-life of the individual tissue-specific enzymes. Thus, one cannot predict the relative proportions of the different isoenzymes in any one patient sample. Lactate dehydrogenase catalyses the reversible oxidation of lactate to pyruvate and either reaction can be measured readily. However, in this method, the lactate to pyruvate reaction has been selected because of the following reasons; the time-course of the reaction is more linear, the reaction results in an increase in absorbance and optimization of substrates is possible (see appendix A). The principles applied in the selection of the conditions of measurement are those stated in previous publications by the IFCC’s Committee on Enzymes [1]. Human serum and tissue extracts have been used as the sources of enzymes. The final concentration of substrates and the pH have been selected on the basis of experiments and empirical optimization techniques and have been confirmed by calculation from rate equations. The catalytic and physical properties of the isoenzymes differ, but because of the importance of the heart specific isoenzyme (LD1) in the assessment of coronary heart disease and as a tumour marker, this method has been optimized for this isoenzyme. However, the method is also suitable, although less optimally, for the determination of the other isoenzymes of lactate dehydrogenase which may be present in serum.

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During starvation for 72 h, tumour-bearing rats showed accelerated ketonaemia and marked ketonuria. Total blood [ketone bodies] were 8.53 mM and 3.34 mM in tumour-bearing and control (non-tumour-bearing) rats respectively (P less than 0.001). The [3-hydroxybutyrate]/[acetoacetate] ratio was 1.3 in the tumour-bearing rats, compared with 3.2 in the controls at 72 h (P less than 0.001). Blood [glucose] and hepatic [glycogen] were lower at the start of starvation in tumour-bearing rats, whereas plasma [non-esterified fatty acids] were not increased above those in the control rats during starvation. After functional hepatectomy, blood [acetoacetate], but not [3-hydroxybutyrate], decreased rapidly in tumour-bearing rats, whereas both ketone bodies decreased, and at a slower rate, in the control rats. Blood [glucose] decreased more rapidly in the hepatectomized control rats. Hepatocytes prepared from 72 h-starved tumour-bearing and control rats showed similar rates of ketogenesis from palmitate, and the distribution of [1-14C] palmitate between oxidation (ketone bodies and CO2) and esterification was also unaffected by tumour-bearing, as was the rate of gluconeogenesis from lactate. The carcinoma itself showed rapid rates of glycolysis and a poor ability to metabolize ketone bodies in vitro. The results are consistent with the peripheral, normal, tissues in tumour-bearing rats having increased ketone-body and decreased glucose metabolic turnover rates.

Creatine kinase is present in significant concentrations in skeletal muscle and cardiac muscle and to a lesser extent in gastrointestinal tract and brain tissue. The enzyme has been purified from a variety of tissues and an examination of its kinetic and physical properties reveal that the enzyme consists of two subunits and can exist as three isoenzymes containing essential cysteine residues. These properties are important in understanding its stability, the assay conditions, and the techniques used to identify the different isoenzymes. The relationship between the properties and the determination of the enzyme in biological fluids will be a main thrust of the review. Creatine kinase activity in serum rises rapidly in conditions such as acute myocardial infarction and trauma to skeletal muscle. However, the interpretation of such increases is dependent upon a sound knowledge of the factors which influence both the total and isoenzyme activities. The nature of these factors will be discussed in detail.

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