Circulating lysosomal enzymes and acute hepatic necrosis

Area of Science:

• Biochemistry
• Hepatology
• Clinical Chemistry

Background:

• Fulminant hepatic failure (FHF) is a critical condition with high mortality.
• Accurate prognostic markers are crucial for timely intervention and management.
• Lysosomal enzymes are implicated in cellular damage during liver injury.

Purpose of the Study:

• To investigate the role of lysosomal enzyme activities, specifically acid protease (cathepsin D), in patients with FHF.
• To assess the prognostic value of serum cathepsin D activity in FHF, comparing paracetamol overdose and viral hepatitis etiologies.
• To evaluate the correlation between cathepsin D activity and other clinical markers like prothrombin time.

Main Methods:

• Measurement of serum lysosomal enzyme activities including acid protease (cathepsin D), neutral protease, N-acetylglucosaminidase, and acid phosphatase.
• Comparison of enzyme activities between FHF patients who survived and those who died.
• Analysis of enzyme activity trends over time and correlation with prothrombin time and aspartate aminotransferase levels.

Main Results:

• Serum acid protease (cathepsin D) activity was significantly elevated in FHF patients, particularly those with fatal outcomes after paracetamol overdose.
• Increased cathepsin D activity was observed in viral hepatitis-induced FHF, irrespective of survival.
• A positive correlation was found between serum cathepsin D activity and prothrombin time; cathepsin D levels remained elevated longer than aspartate aminotransferase.

Conclusions:

• Serum acid protease (cathepsin D) activity may serve as a valuable prognostic indicator in fulminant hepatic failure.
• The sustained elevation of cathepsin D offers a potential advantage over rapidly fluctuating markers like AST for assessing prognosis.
• Monitoring circulating lysosomal proteases could aid in predicting outcomes and guiding clinical management in FHF.