Plasma acidic glycohydrolases in insulin-dependent diabetes mellitus

Low levels of occupational exposure to arsenic and antimony: effects on lysosomal glycohydrolase levels in plasma of exposed workers and in lymphocyte cultures

BACKGROUND

Heavy metals have been shown to alter the mechanism and release of lysosomal enzymes. In the present study, the activities of lysosomal glycohydrolases were determined in order to evaluate the asymptomatic toxic effects of low levels of exposure to arsenic (As) and antimony (Sb) in art glass workers.

METHODS

N-acetyl-beta-D-glucosaminidase (NAG), beta-D-glucuronidase (GCR), alpha- and beta-D-galactosidase, alpha-D-glucosidase, and alpha-D-mannosidase were determined by a fluorimetric assay in the plasma of 26 art glass workers. Lymphocytes cultured in the presence of different species of As and Sb served as an in vitro model for the study of the protective action of selenium and zinc.

RESULTS

No significant difference in the plasma levels of the various enzymes was detected in art glass workers or control subjects. The in vitro experiments demonstrated that secretion of lysosomal glycohydrolases was increased by Sb (225%) and decreased by As (57%) at the same concentration of elements (200 microg/L). The addition of bivalent selenium to the culture neutralized the effects of both metals, while zinc chloride did not show any protective effect.

CONCLUSIONS

As for the plasma glycohydrolases, no praecox signs of toxicity related to a low concentration of As and Sb was evident in art glass workers. This may be due to the antagonistic effects demonstrated by these two metals in vitro. Their different mechanism of action on release of glycohydrolases is being discussed.

Alterations in the activity of several glycohydrolases in red blood cell membrane from type 2 diabetes mellitus patients

The erythrocyte membrane in 71 patients with type 2 diabetes mellitus was assessed for glycohydrolase activity: N-acetyl-beta-D-glucosaminidase, beta-D-glucuronidase, alpha- and beta-D-galactosidase, alpha- and beta-D-glucosidase, alpha-D-mannosidase, and alpha-L-fucosidase. Only beta-D-glucuronidase, alpha-D-glucosidase, and beta-D-glucosidase showed markedly elevated levels with respect to the controls regardless of the presence of complications. Among the examined patients, those with good metabolic control (not yet submitted to any therapy) showed the same enzyme levels as the reference subjects, while the levels in patients with unsatisfactory metabolic control (treated with oral hypoglycemic and/or insulin) significantly differed from the control levels. For alpha-D-glucosidase and beta-glucosidase, a correlation with glycemia and the parameters of metabolic control was also evidenced. Alterations of beta-D-glucuronidase, alpha-D-glucosidase, and beta-D-glucosidase were also ascertained in the plasma of the same diabetic patients according to the literature; each enzyme correlated with the other, either in plasma or in the erythrocyte membrane. This study shows a correlation between plasma and erythrocyte membrane levels for these three enzymes. The strict parallelism of the glycohydrolases in the two different compartments provides a profile of these enzymes in the pathology of diabetes.

Plasma lysosomal glycohydrolases in a general population

In this study we evaluated the differences in plasma levels of some glycohydrolases of lysosomal origin that appear to be the most interesting for possible usefulness for diagnosis (N-acetyl-beta-D-glucosaminidase, beta-D-glucuronidase, alpha-D-galactosidase, beta-D-galactosidase, alpha-L-fucosidase and alpha-D-mannosidase) in a general population of 417 subjects, as related to age and sex and also to body mass and to some habits, such as smoking and consumption of alcohol. The enzymatic activities were assayed by fluorimetric techniques with 4-methylumbelliferyl-glycosides as substrates. Particular attention was given to some technical aspects. Enzymatic activity was preserved by addition of ethylene glycol and stable liquid material was employed for calibration purposes. Blood was sampled rigorously at the same time of day and all the samples were obtained within a short period of time to exclude effects of the circadian and circannual rhythms. beta-Glucuronidase levels were the most affected by sex and body mass. beta-D-Galactosidase was not affected by differences in age, sex, body mass or by smoking, but appeared to be the most sensitive to modification by alcohol consumption. The data in this report emphasize that, whenever changes or differences in the levels of lysosomal enzymes in body fluids are studied, it is essential to have a reference population rigorously correlated with the study population. When possible, repetitive measurements in the same subject could better indicate a clinical trend.

Automated fluorimetric assay procedure for glucohydrolases using a routine centrifugal analyser assay of enzymes of lysosomal origin in plasma, II

The manual fluorimetric procedure, considered as a reference method for the determination of N-acetyl-beta-D-glucosaminidase, beta-D-glucuronidase and beta-D-galactosidase in human plasma, was automated as a routine method, using the IL Monarch centrifugal analyser. Using a liquid standard with a known enzyme content, the automated assay correlated fairly well with the reference manual method (r values very close to 1). Its analytical imprecision was much lower than that of the manual method. The automated assay of N-acetyl-beta-D-glucosaminidase, beta-D-glucuronidase and beta-D-galactosidase gave coefficients of variation of 5.7-6.9, 3.6-5.0 and 3.8-4.2%, respectively, detection limits of 4, 2 and 1 mU/l plasma respectively, and linear responses of up to 73, 8.4 and 0.9 U/l of plasma respectively. Furthermore, the method required only small volumes of undiluted plasma (4-10 microliters). This method appears to be reliable, sensitive, simple enough for routine analyses and as cost effective as the most common routine serum enzyme assays.

The lysosomal N-acetyl-beta-D-glucosaminidase (NAG) isoenzymes in plasma: study of distribution in a general population by a simple routine chromatofocusing procedure

We have adapted for routine analysis a pre-existing method for separating the three major N-acetyl-beta-D-glucosaminidase (NAG) isoenzyme forms--A, B+I1 and I2--by chromatofocusing followed by fluorimetric assay of the enzyme activity. This method combines good resolution, accurate quantification of the different isoenzymes and high reproducibility with an acceptable degree of analytical precision. We have applied it to studying the isoenzyme levels in the plasma of a general population of 417 subjects and have analysed these enzyme activities as functions of age, sex, body mass and declared alcohol consumption. Unlike the levels of unfractionated enzyme, levels of all the isoenzymes were higher in men than in women at all ages except in the 20-29 year group. Isoenzyme I2 showed the greatest sex difference. On the whole, with increasing age, both sexes showed more or less regular increases in plasma levels of all the isoenzymes. We also found significant correlations for the population as a whole with age and with body mass index. The only significant correlation with alcohol consumption was for B+I1 in men.

Enzymes of lysosomal origin in plasma of twin neonates

The levels of some enzymes of lysosomal origin were assayed during days 2 and 5 of life in plasma from 11 sets of twin neonates and from 25 neonates from single pregnancies (13 of weight appropriate for gestational age and 12 small for their gestational age) as controls. The plasma enzyme levels were also determined in the correspondent twin and control mothers 2 days after delivery. N-Acetyl-beta-D-glucosaminidase isoenzymes were assayed after chromatofocusing separation. All the plasma enzyme levels were higher in the group of twin neonates and of their mothers than in the respective control groups with differences highly statistically significant for two enzymes, beta-D-galactosidase and alpha-D-glucosidase. In neonate plasma lysosomal enzymes are increased at the fifth day of life with respect to the second day. Full term control neonates showed the same enzyme trend. For the N-acetyl-beta-D-glucosaminidase the more significant differences concerned the isoenzyme I2-P (pregnancy). The pattern of the lysosomal enzymes in the twins resembled that of neonates of diabetic mothers who had had no insulin therapy. Since lysosomal enzymes are considered to be particularly sensitive indicators of carbohydrate metabolism abnormalities, we conclude that twin pregnancies are more at risk for these abnormalities than single ones.

Preparation of a stable liquid material for calibration and quality control for lysosomal enzymes in plasma. Assay of enzymes of lysosomal origin in plasma, I

Several lysosomal enzymes present in human plasma (N-acetyl-beta-glucosaminidase, beta-glucuronidase, beta-galactosidase, alpha-galactosidase, alpha-L-fucosidase, alpha-mannosidase, beta-glucosidase) were maintained in a fully active state for at least 8 months by the addition of ethylene glycol (300 milligrams final concentration) to freshly prepared plasma and storage at -20 degrees C. Pools of human plasma from healthy humans, stabilized and stored as above, and containing a low, medium or high content of the above enzymes, were used to establish the analytical imprecision (within-run, day-to-day and total imprecision) of the fluorimetric assay. Ten replicates in ten different analytical series, covering a period of two months, were performed. The total imprecision (expressed as coefficient of variation) was in general lower than 10%; in a few cases, particularly plasma samples with a low enzyme content, the total imprecision was 18%. The isozymes A, B, I1, and I2 of N-acetyl-beta-glucosaminidase displayed the same stability upon storage as the unfractionated enzyme. It is concluded that pools of human plasma containing known amounts of lysosomal enzymes, stabilized by the addition of 300 micrograms ethylene glycol and stored at -20 degrees C, are suitable liquid materials for calibration and quality control for the assay of the same enzymes.

Enzymes of lysosomal origin in the serum of infants of diabetic mothers behavior in the first days after birth

The serum levels of the two enzymes of lysosomal origin, beta-N-acetyl-D-glucosaminidase and beta-D-glucuronidase, and the isozyme pattern of the former, were determined in control infants and in infants of diabetic mothers (IDM) on the 1st and 5th day after birth. IDM were divided into three groups. Group 1: class A diabetic mothers treated dietetically; Groups 2 and 3: class A and classes B, C, D diabetic mothers, respectively, treated with insulin. All, but one, diabetic mothers were in excellent metabolic control. In the controls the serum levels of both enzymes were quite elevated on the 1st day after birth, reflecting the condition of the mothers at the end of pregnancy, and increased further on the 5th day, presumably as a result of the concurrent burst of antiinsulin hormones. In Group 1 IDM the serum levels of the two enzymes were higher than in controls, on the 1st day, probably reflecting the higher concentrations present in the mothers at the end of pregnancy than in controls, but equalling the condition of normal neonates on the 5th day. This indicates that IDM of this group had a normal post-natal response of the lysosomal apparatus to hormone stress. In Groups 2-3 IDM the enzyme levels on the 1st day could not be distinguished from those of controls, while on the 5th day a decrease was seen, suggesting reduced effect of the antiinsulin hormone burst on the lysosomal apparatus. The isozyme pattern of beta-N-acetyl-D-glucosaminidase in all IDM was similar to that of controls. The behavior of serum lysosomal enzymes of Groups 2-3 IDM is a further indication that the lysosomal apparatus is extremely sensitive to even small metabolic perturbations occurring in diabetic mothers during pregnancy.

Behaviour of some lysosomal enzymes in the plasma of insulin dependent diabetic patients during artificial pancreas treatment

The plasma levels of three lysosomal enzymes, beta-D-N-acetylglucosaminidase, beta-D-glucuronidase, and alpha-L-fucosidase, were fluorimetrically determined in seven insulin-dependent diabetic patients one day before, one day after, and during a two-day treatment with the artificial pancreas, at 4 to 5 h intervals. A statistically significant decrease of the plasma level of each enzyme was observed during artificial pancreas treatment. The extent of decrease was 30 to 35% for beta-N-acetylglucosaminidase, 35 to 40% for beta-D-glucuronidase, and 20 to 25% for alpha-L-fucosidase. The decrease occurred earlier (at the first day of treatment) for beta-D-N-acetylglucosaminidase, and later (at the second day of treatment, and lasting to the first day after treatment) for the other two enzymes. These results suggest a direct connection between the lysosomal apparatus and insulin-controlled metabolic pathways, and a potential role for lysosomal enzymes as indicators of the metabolic compensation in diabetes.

Serum enzymes of lysosomal origin as indicators of the metabolic control in non-insulin-dependent diabetics

Several lysosomal enzymes (beta-N-acetyl-D-glucosaminidase, beta-D-glucuronidase, alpha-D-galactosidase, beta-D-galactosidase, alpha-D-glucosidase, beta-D-glucosidase, alpha-L-fucosidase and alpha-D-mannosidase) were determined in the serum of 54 non-insulin-dependent diabetics with different degrees of metabolic control and without complications and in 18 non-insulin-dependent diabetics with complications. The serum levels of beta-N-acetyl-D-glucosaminidase, beta-D-glucuronidase, alpha-D-galactosidase, and alpha-D-mannosidase were significantly (p less than 0.01) higher in the diabetics without complications. The levels of beta-N-acetyl-D-glucosaminidase and beta-D-glucuronidase were inversely proportional to the degree of metabolic control, in a statistically significant manner. Moreover the levels of these enzymes decreased to normal values during a 2-month period of controlled oral hypoglycemic drug-diet therapy resulting in metabolic compensation. The presence of complications was indicated by a further increase of serum beta-N-acetyl-D-glucosaminidase and beta-D-glucuronidase; however the portion of lysosomal enzyme activities due to complications remained unchanged after controlled therapy aimed at compensating the metabolism. The conclusion is drawn that in non-insulin-dependent diabetics, as already shown for insulin dependent-diabetics, serum lysosomal enzymes, especially beta-N-acetyl-D-glucosaminidase and beta-D-glucuronidase, are good intraindividual indicators of the metabolic control of the disease.

Serum enzymes of lysosomal origin as indicators of the metabolic control in diabetes: comparison with glycated hemoglobin and albumin

Several lysosomal enzymes (beta-N-D-acetylglucosaminidase, beta-D-glucuronidase, alpha-D-galactosidase, beta-D-galactosidase, alpha-L-fucosidase, alpha-D-glucosidase, alpha-D-mannosidase, beta-D-glucosidase), glycated albumin and glycated hemoglobin (HbA1c) were determined in the serum of 81 insulin-dependent diabetics with different degrees of metabolic control (optimal, 21 patients; good, 39 patients; poor, 21 patients) and without signs of complications, and in 42 control subjects. All parameters examined increased in serum in inverse proportion to the degree of metabolic control. A highly significant correlation (p less than 0.01) was found between lysosomal enzymes and both glycated albumin and HbA1c. All parameters correlated with hyperglycemia, glycated albumin having the highest r-value (0.586) and lysosomal enzymes the lowest one. Unlike glycated albumin and HbA1c, serum levels of lysosomal enzymes in patients with optimal metabolic control were undistinguishable or even lower than those of controls. A 2-month longitudinal monitoring of a patient who was hospitalized in conditions of poor metabolic control and adequately treated, proved that lysosomal enzymes diminished in serum parallel to glycated albumin and HbA1c in relation to improvement of the metabolic situation. The conclusion is drawn that serum lysosomal enzymes are good indicators of the metabolic control of diabetic patients probably reflecting the overall metabolic state connected with insulin action rather than hyperglycemia.

Behaviour of several enzymes of lysosomal origin in human plasma during pregnancy

The following enzymes of lysosomal origin were fluorimetrically determined in maternal plasma from the second to the ninth month of pregnancy at 1-mth intervals: beta-D-N-acetylglucosaminidase (EC 3.2.1.30), beta-D-glucuronidase (EC 3.2.1.31), beta-D-glucosidase (EC 3.2.1.21), beta-D-galactosidase (EC 3.2.1.22), alpha-D-galactosidase (EC 3.2.1.23), alpha-L-fucosidase (EC 3.2.1.51) and alpha-D-mannosidase (EC 3.2.1.24) (pH 4.0). As reference microsomal alpha-D-mannosidase (pH 5.7) was also studied. Thirty-eight healthy women, aged 18-37 yr, who had a normal pregnancy followed by normal parturition, were studied. All enzymes, with the only exception of beta-D-galactosidase, showed a progressive and statistically significant increase of activity throughout pregnancy. At the end of pregnancy, the increase ranged from a maximum of 5.6-fold for beta-D-N-acetylglucosaminidase to a minimum of 0.55-fold for alpha-D-mannosidase, pH 5.7. In the case of beta-D-N-acetylglucosaminidase, the level at the fifth month of pregnancy was significantly higher than that at the third month, and from the sixth to the ninth month each level significantly differed from that of the month immediately preceding.

Influence of streptozotocin- and alloxan-induced diabetes on the metabolism of glycosaminoglycans

GAG metabolism was investigated in rats with experimentally induced diabetes. In comparison to control animals, the uptake of 35S-sulfate was diminished in tissues of diabetic animals. Streptozotocin-induced diabetes showed a significant decrease in the content of GAG fractions except that of non-sulfated GAG in liver and kidney which was unchanged as compared to the control group. In rats rendered diabetic by alloxan, non-sulfated GAG increased appreciably in liver and kidney whereas highly sulfated GAG remained unchanged. In the skins of alloxan-diabetic rats both total and sulfated GAG decreased significantly. The activities of liver beta-glucuronidase, beta-N-acetyl glucosaminidase and cathepsin D were significantly increased in rats treated with streptozotocin and alloxan. In streptozotocin-diabetic rats, renal beta-glucuronidase and beta-N-acetyl glucosaminidase activities were reduced while cathepsin D activity was similar to that of controls. The renal beta-N-acetyl glucosaminidase and cathepsin D activities of alloxan-treated rats were not significantly different from normal but their beta-glucuronidase was significantly increased. In the spleen of streptozotocin-diabetic rats all the enzymes were increased except beta-N-acetyl glucosaminidase which remained unaltered. Increased excretion of uronic acid was observed in diabetic groups. These results collectively indicate that both streptozotocin- and alloxan-induced diabetes altered the synthesis and catabolism of GAG.

Total fasting serum bile acids and beta-hexosaminidase in alcoholic liver disease

Total serum bile acid levels and beta-hexosaminidase activity were studied in 22 normal subjects, 35 non-cirrhotic patients with acute alcohol intoxication, 45 patients with alcoholic liver cirrhosis and 11 patients with alcoholic liver cirrhosis and surgical portal-systemic shunts. Comparison was made with traditional liver function tests. beta-Hexosaminidase was most frequently elevated in acute alcohol intoxication (94%) while total serum bile acids were elevated in all patients with alcoholic liver cirrhosis. Total serum bile acid levels were found to discriminate most efficiently between acute alcohol intoxication and liver cirrhosis. The combined determination of serum beta-hexosaminidase and total serum bile acids is proposed for evaluating alcoholic liver disease.

Serum and urinary activities of beta-N-acetylglucosaminidase and beta-glucuronidase in diabetic patients

Serum and urinary activities of two acid glycohydrolases, beta-n-acetyl-glucosaminidase and beta-glucuronidase, were significantly higher in a group of diabetic patients when compared to a control group. No significant differences were found between patients without vascular complications and those with retinopathy and/or large vessel disease, while the highest enzyme levels were present in diabetics in poor metabolic control. In diabetics with nephropathy, urinary excretion of both enzymes was further increased, so that the serum/urine activity ratio (greater than 1 in normal subjects and in diabetics without nephropathy) was inverted (less than 1). These data seem to show that the high activity of these enzymes, commonly observed in diabetes mellitus, is related to the illness rather than to its vascular complications, being higher in patients in poor metabolic control. Furthermore serum/urine activity ratio may be a useful indicator in the monitoring of diabetic nephropathy.