Lviv clinical bulletin 2020, 2(30): 8-13

Activity of Arginine/Citruline Cycle Enzymes and Their Association with Laboratory-Biochemical Indicators of Liver Injury in Patients with Acute Lymphoblastic Leukemia

G. Maslova, I. Skrypnyk, T. Lymanets

Ukrainian Medical Stomatological Academy

Introduction. The onset of acute lymphoblastic leukemia (ALL) is accompanied by liver injury, which may be due to chemotherapy, tumor infiltration of liver tissue, intoxication. The study of pathogenetic features of liver injury development in patients with oncohematological diseases may be important for their management.

The aim  of the study. To investigate the activity of arginine/citrulline cycle enzymes and their association with laboratory and biochemical indicators of liver injury in patients with acute lymphoblastic leukemia.

Materials and methods. The study involved 30 patients with ALL, who were hospitalized in hematology department of ME “Poltava Regional Clinical Hospital of Poltava regional council” for the period 2010–2019 (main group). The study included newly diagnosed ALL patients with a body mass index (BMI) >25 kg/m2, of which 11 (36.7 %) were women and 19 (63.3 %) – men, aged 16-77 years. The control group consisted of 20 almost healthy individuals, including 9 (45.0 %) women, 11 (55.0 %) men, aged 22-26 years. The complete blood test and following indicators of biochemical blood test were evaluated: alanine (ALT) and asparagine (AST) aminotransferases, total protein, total bilirubin, alkaline phosphatase (AP), gammaglutamyltranspeptidase (GGTP) and urea. The argynase and ornithine decarboxylase (ODC) activity, citrulline content were measured in the blood serum.

Results. In patients with ALL, the ALT activity was 2.4-fold higher, AST – 2-fold, AP – 2.8-fold, GGTP – 3.6-fold higher in the main group of patients compared with almost healthy individuals in the control group (p < 0.05). The urea content in the patients’ blood serum of the main group was 1.43-fold higher than the control group indicator (p < 0.05). In patients with ALL BMI correlated strongly with AP activity (r = +0.38; p < 0.05) and an inverse correlation was found between BMI and total bilirubin level (r = -0.4; р < 0.05).

In the main group patients, the ALL onset was accompanied by an increased argynase activity in 2.19 times, ODC – in 1.95 times (p < 0.05). The direct correlation between AP and argynase activities (r = +0.61; p < 0.05) in the blood serum of ALL patients was established.

Patients in the main group showed a 7.22-fold increase in serum citrulline content, when ALL manifested, which was accompanied by a 3.5-fold reduction of Argynase/citrulline ratio (p < 0.05). An inverse correlation was found between the contents of total protein and citrulline in the blood serum (r = -0.47; p < 0.05), as well as a direct correlation between the total protein and the Argynase/citrulline ratio (r = +0,51; р < 0.05).

Conclusions. A significant role in the liver injury pathogenesis is played by ALL progression, against which there are increased argynase and ODC activities and citrulline content in the blood serum.


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