Year : 1991 | Volume
: 39 | Issue : 2 | Page : 44--47
Lactate dehydrogenase (LDH) isoenzymes patterns in ocular tumours
Rajendra Singh1, OPS Kaurya1, PK Shukla2, Rewanund Ramputty1,
1 Department of Ophthalmology, Banaras Hindu University, Varanasi-221 005, India
2 Department of Pathology Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India
Department of Ophthalmology, Banaras Hindu University, Varanasi-221 005
Estimation of lactate dehydrogenase (LDH) isoenzymes in the serum and aqueous humor was carried out in 15 cases of benign ocular tumour, 15 cases of malignant tumor and 15 normal cases. Cases of both sexes aged between 1 year and 75 years were included. LDH, isoenzymes specially LDH4 and LDH5 are higher and LDH1 and LDH2 lower in sera of patients with malignant tumor specially retinoblastoma as compared to benign tumor cases and control cases. LDH isoenzymes in aqueous humor are significantly higher and show a characteristic pattern in retinoblastoma cases, the concentration was presumably too low in the control, malignant tumor other than retinoblastoma and benign tumor cases as its fractionation was not possible.
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Singh R, Kaurya O, Shukla P K, Ramputty R. Lactate dehydrogenase (LDH) isoenzymes patterns in ocular tumours.Indian J Ophthalmol 1991;39:44-47
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Singh R, Kaurya O, Shukla P K, Ramputty R. Lactate dehydrogenase (LDH) isoenzymes patterns in ocular tumours. Indian J Ophthalmol [serial online] 1991 [cited 2023 Feb 5 ];39:44-47
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Since the introduction of lactate dehydrogenase (LDH) and its subsequent fractionation (the isoenzymes) analysis to clinical medicine in 1955, LDH as well as characteristic isoenzymes pattern have been found to be elevated in various conditions e.g. serum LDH 2 and LDH 3 in patients with myocardial infarction, LDH 2 in haemolytic anaemias, LDH 1 in megaloblastic anaemias, LDH 4 and LDH 5 in liver disorders. Kabak and Romano sub found that retinoblastoma need not always be associated with raised total lactate dehydrogenase (LDH) activity in aqueous humor, but instead shows a peculiar isoenzymes pattern even before the total lactate dehydrogenase (LDH) becomes elevated. From these observations it is evident that there is some correlation between lactate dehydrogenase (LDH) isoenzymes and ocular tumors. However, except for a few reports in retinoblastoma and malignant melanoma, not much work on other ocular tumors and lactate dehydrogenase (LDH) isoenzymes has been reported.
The present investigation was therefore carried out with the object of correlating a possible relationship between serum and aqueous humor lactate dehydrogense (LDH) isoenzymes pattern and ocular tumors.
MATERIAL AND METHODS
In the present study lactate dehydrogenase (LDH) isoenzymes in the serum and aqueous humor were estimated in 30 cases of ocular tumors and 15 normal cases used as control. Patients of both sexes were included, and apes varied from 1 year to 75 years. For study purposes, cases in the series were divided into three groups: Group A, control cases (Normal cases); Group B, cases of malignant tumors of the eye; and Group C, cases having benign tumors of the eye.
Group A (Control cases) : These cases were patients who came to Bhuwalika Eye Hospital for cataract, glaucoma or pterygium. They had no ocular infection.
Group B (Malignant tumors of the eye) : These patients were admitted to the eye ward for surgery with or without radio-therapy or referred to the radiotherapy department if surgery was not feasible or if the patient refused surgery.
Group C (Benign tumors of the eye) : Most of these patients had dermoid, haemangioma or neurofibromatosis. They attended the out patient department for the treatment of refractive errors or for cosmetic reasons.
In all these groups, only those who did not suffer from diseases like myocardial infarction, pulmonary infarction, diseases of the liver, or systemic malignancy were included. Before proceeding further for detection of serum and aqueous lactate dehVdrogenase (LDH) isoenzymes all these patients were subjected to detailed ocular examinations including oblique illumination, visual acuity with and without glasses, intraocular tension and biomicroscopic examination. Routine investigation like TLC, DLC, Hb, ESR, blood sugar, blood urea, urine - routine and microscopic and stool for ova and cyst were done. Special investigations, such as X-ray of skull, orbit, optic foramina and chest, estimation of LDH isoenzymes in serum and in aqueous and biopsy were done. Estimation of LDH isoenzymes in serum and aqueous humor was conducted in the pathology department, Institute of Medical Sciences, Banaras Hindu University, Varanasi, by electrophoretic method as described by Nerenberg and Pogojeff .
Lactate dehydrogenase (LDH) isoenzymes pattern in serum in Group A (Control cases):
The range of the serum isoenzymes were as follows LDH1 0.0 - 80.1 % LDH2 0.0 - 55.0% LDH3 0.0 - 70.6%; LDH4 0.0 - 52.3% and LDH5 0.0 - 38.6%. The respective mean values were 23.67 ± 21.89%; 27.19 ± 16.28%;, 21.35 ± 18.11 %; 13.58 ± 14.50% and 13.46 ± 12.16%` [Table 1].
Lactate Dehydrogenase (LDH) isoenzymes pattern in serum in Group B (Malignant tumors of the eye) :
The range of the serum isoenzymes were LDH1 0.0 41.1 %; LDH2 0.0 - 27.3%; LDH3 0.0 - 45.2%; LDH4 6.1 - 62.0% and LDH5 4.7 - 60.0%. The mean values of serum isoenzymes were 4.96 ±.11.23%; 7.57 ± 13.57%; 18.39 ± 15.13; 36.41 ± 14.68% and 35.65 ± 17.15% respectively [Table 1]
Among the cases of malignant tumors of the eye (Group B), 9 patients were of retinoblastoma (Group B1) and 6 patients were of malignant tumors others than retinoblastoma (Group B 2 ).
In Retinoblastoma cases (Group B 1 ) : The mean values of serum LDH isoenzymes were - LDH, 6.62 ± 14.30%, LDH2 4.37 ± 9.47; LDH3 13.60 ± 14.48%; LDH4 37.50 ± 178.22% and LDH5 39.90 ± 11.86% [Table 1].
In Malignant tumors other than retinoblastoma (Group B 2 ) : The mean values of serum LDH isoenzymes were LDH1 0.62 ± 1.63%; LDH2 3.22 ± 5.09%; LDH3 25.17 ± 18.32%, LDH4 39.78 ± 7.34%; and LDH5 31.17 ± 18. 58% [Table 1].
Lactate Dehydrogenase (LDH) isoenzymes pattern in serum in benign tumors of the eye (Group C) : The range of the serum LDH isoenzymes were as follows - LDH1 00.0-82.4%; LDH20.0-60.6%, LDH3 0.0 - 58.0%; LDH4 0.0 - 50.6% and LDH5 0.0 - 53.3%. The mean values of serum lactate dehydrogenase (LDH) isoenzymes were -LDH1 21.49 ± 23.72%; LDH2 21.51 ± 18.89%, LDH3 22.43±18.72%; LDH4 19.88 ± 19.14% and LDH5 14.72 ± 17.00 [Table 1]
Lactate dehydrogenase (LDH) isoenzymes pattern in aqueous humor in different groups :
As the concentration of lactate dehydrogenase (LDH) isoenzymes in the aqueous humor of control cases (Group A), benign cases (Group C) and malignant tumor cases other than retinoblastoma (Group B2) were presumably too low, it could not be fractionated into its isoenzymes [Table 2]. In 8 cases of stage I retinoblastoma of group B, from which the aqueous humor was taken from the tumor bearing eyes showing an amaurotic cats eye reflex, the isoenzymes mean values were LDH, 2.43 ± 2.36%, LDH210.01 ±8.36%; LDH322.86±7.20%; LDH4 30.28 ± 12.95% and LDH5 34.43 ± 4.69% [Table 2].
The range of the isoenzymes in aqueous humor were LDH1 0.0 - 6.3%, LDH2 0.0 - 24.7%; LDH3 10.4 - 30.4%; LDH4 4.4 - 48.3% and LDH5 21.3 - 46.5% [Table 2].
Lactate dehydrogenase (LDH) and its isoenzymes are distributed throughout human tissues and body fluids. It has also been demonstrated by Wroblewski  that the fluid in which a neoplasm is bathed shows higher LDH activity with an even more specific isoenzymes pattern.
In this series we observed that in serum LDH4 and LDH5 isoenzymes are much higher and LDH1 and LDH2 fractions much lower in the malignant tumor group (Group B) as compared to the benign tumor group (Group C) and control group (Group A), as shown in [Table 1]. The mean serum LDH isoenzymes values in different groups were as follows -
In malignant tumor group (% ± S.D) - LDH 1 4.96 ± 11.23; LDH 2 7.57 ± 13.57; LDH 3 18.39 ± 15.13; LDH4 36.41 ± 14.68 and LDH 5 14.72 ± 17.15.
In benign tumor group (% ± S.D.) = LDH 1 21.49 ± 23.72; LDH 2 21.51 ± 18.89; LDH 3 22.43 ± 18.72; LDH 4 19.88 ± 19.14 and LDH 5 14.72 ± 17.00.
In control group (% ± S.D.) - LDH 1 23.67 ± 21.89; LDH 2 27.19 ± 16.28; LDH 3 21.35 ± 18.11; LDH 4 13.58 ± 14.50 and LDH 5 13.46 ± 12 16 [Table 1]
On statistical analysis [Table 3] when serum LDH isoenzymes of malignant tumors (Group B) were compared with benign tumor (Group C) the p value for LDH 1 was , meaning thereby that it was highly significant and for LDH 2 , LDH 4 and LDH 5 was showing it was significant, but was not significant for LDH 3 (P 0.5).
When serum isoenzymes of malignant tumors (Group B) were compared with control cases (Group A) the 'p' value for LDH1 and LDH 4 was meaning it was highly significant; while for LDH 4 and LDH 5 `p' value was showing it was significant; whereas for LDH 3 `p' value was 0.5 meaning thereby that it was not significant.
When serum isoenzymes of benign tumors (Group C) was compared with controls (Group A); a value for all give isoenzymes was 0.5 showing it was not significant.
Lactate dehydrogenase (LDH) isoenzymes pattern was done.in aqueous humor of benign, malignant and control cases but as the concentration of the enzyme in aqueous humor was presumably too low in control, benign and malignant cases other than retinoblastoma, its fractionation into its isoenzymes was not possible. Only in retinoblastoma (Stage 1) cases (Group B 1 ) the isoenzymes pattern was obtained and the mean values were found to be as follows (% ± S.D.) -
LDH 1 2.43 ± 2.36; LDH 2 10.01 ± 8.36; LDH 3 22.86 ± 7.20; LDH 4 30.28 ± 12.95 and LDH 5 34.43 ± 4.69 as shown in [Table 2]. These observations agree with the observations of Kabak et al. sub Kabak et al. in their study revealed that aqueous humor LDH isoenzymes in 3 retinoblastoma cases showed a similar pattern and that the LDH3/LDH1 ratio 5. They were of the opinion that aqueous humour LDH in retinoblastoma need neither be constantly elevated nor be related to the serum LDH. There was, however, the characteristic isoenzymes pattern which may suggest retinoblastoma even before the total aqueous humor LDH becomes elevated.
Thus, from these observations it is quite evident that in malignant tumors the serum LDH4and LDH, fractions are markedly raised while LDHiand LDH2 fractions are lower than in control and benign groups whereas in the aqueous humor of retinoblastoma cases the isoenzymes show the following ascending pattern: LDH 1 LDH 2 LDH 3 LDH 4 LDH 5 .
Thus from the present study it is concluded that LDH isoenzymes pattern are significantly higher in the serum of the malignant tumors. Hence, LDH isoenzymes pattern is one of the parameters in the early diagnosis of malignant tumors specially in retinoblastoma cases.
|1||Kabak J. and Romano P.E.: Aqueous humor lactic dehydrogenase isoenzymes in retinoblastoma. Brit. J. Ophthalmol. 59: 268, 1975.|
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|3||Wrobleswki F. : Clinical significance of alteration in LDH activity of body fluids. Am. J. Med. Sci. 234 : 301, 1957.|