Biochemical Sleuthing

When doctors suspect disease in a deep-seated vital organ, e.g., the heart or liver, it may be dangerous or downright impossible to take a tissue sample (biopsy specimen) for microscopic examination. Biochemistry may supply a neat if not simple solution, says Dr. Felix Wroblewski of Manhattan's Sloan-Kettering Institute. Instead of cutting for a tissue sample, it may be enough for the doctor to get a little blood from the patient and analyze its enzymes.

Dozens of chemically complex enzymes serve the body as catalysts, usually in minute quantities. In disease, the relative concentration of some enzymes increases. After a heart attack, Dr. Wroblewski points out, there is a rise in several enzymes, including serum glutamic oxaloacetic transaminase (SGO-T) and lactic dehydrogenase (SLD). Liver diseases cause release into the blood of SGO-T and glutamic-pyruvic transaminase (SGP-T). Careful and repeated measuring of several enzymes can pinpoint disease in a particular organ. Examples: a high level of SGO-T, without elevation in SGP-T, gave an index of President Eisenhower's progress after his heart attack in September 1955. With cirrhosis of the liver there is a marked rise in SGO-T but little or no rise in SGP-T; in acute hepatitis, on the other hand, SGP-T rises sharply--usually more than the SGO-T.

Some diseases. Dr. Wroblewski believes, may signal their onset by changes in the enzyme system before any other symptoms appear. This has already proved valuable in early detection of hepatitis, and Dr. Wroblewski has evidence of it in mouse leukemia. If the phenomenon is confirmed in human leukemia, it would mean that more effective treatment of this and perhaps other malignant diseases could begin sooner.

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