Gamma (γ) Glutamyl Transpeptidase (GGT), Gamma glutamyl transferase
- The venous blood is needed to prepare the serum.
- The serum is stable for one month at 4 °C.
- The serum can be stored for one year at -20 °C.
- Heparinized samples interfere with various methods.
Purpose of the test (Indications)
- This test is done for liver dysfunction.
- This is also useful to detect alcohol-induced liver cell injury and chronic alcoholics.
- This test can detect the slightest degree of cholestasis.
- GGT is very sensitive to biliary obstruction, cholangitis, and cholecystitis.
- GGT is a good marker for pancreatic cancer, prostatic carcinoma, and liver cell carcinoma.
- GGT level indicates remission and recurrence.
- Keep in mind that value may be low in late pregnancy.
- Drugs that decreased the value are Clofibrate and oral contraceptives.
- Drugs which increased the value are Alcohol, Dilantin, and Phenobarbital.
- GGT is raised in patients who are taking antiepileptic drugs.
- (γ) Glutamyl Transpeptidase is one of many peptidases cleaving terminal peptide bonds of proteins or peptides.
- The C-terminal amino acid must be glutamic.
- Specificity resides in the (γ) Glutamyl portion of the substrate.
- Three different reactions have been attributed to this enzyme:
- Internal transpeptidation.
- External transpeptidation.
- Glutathione is the common substrate of this enzyme in the body.
- This enzyme participates in amino acid transport by transferring the (γ) Glutamyl portion of glutathione to other amino acids, enabling them to cross cell membranes more easily.
- According to concentration, GGT is present in:
- The proximal tubule of the kidney.
- GGT is found in the biliary tree’s epithelial cells and mostly in the interlobular bile ducts and bile ductules. This is the reason that it is susceptible to biliary injury.
- GGT is present in the kidney, pancreas, spleen, heart, intestine, brain, and prostate gland.
- GGT level is higher in the men because of the additional amount due to the prostate.
- The kidney has a maximum amount, but the liver is considered the normal source of serum activity.
- It is found throughout the hepatobiliary system and other tissues.
- GGT is present in the microsomes of the cytoplasm and the cell membrane.
- GGT takes part in the transfer of the amino acid and peptides across the cell membrane.
- The Minimal amount detected in the endothelium of capillaries.
- This test has been useful in detecting a male in nearly-risk drinkers (Not in females).
- This is most applicable as part of an alcoholic screening program.
- It is a more sensitive indicator of liver disease in children than is alkaline phosphatase.
- This is a susceptible test to tell liver cell injury and its correlation with the alkaline phosphatase level.
- GGT is raised in acute myocardial infarction, and the mechanism is not clear.
- If it occurs in the first 7 days, then it may be due to liver insult.
- Otherwise, it is raised usually in 1 to 2 weeks.
- However, its raised level is nonspecific because it is raised in cardiac, pulmonary, pancreatic, renal disorders, diabetes, and alcoholism.
- GGT correlates with alkaline phosphatase in obstructive jaundice, and metastatic infiltrate in the liver.
- In such a case, GGT is more sensitive and specific.
- The overall clinical significance is limited.
- GGT normal with raised alkaline phosphatase indicates skeletal muscle disease.
- GGT raised with alkaline phosphatase indicates hepatobiliary disease.
- Male and female age 45 years and older = 8 to 38 units/L (8 to 38 IU/L)
- Female younger than 45 years = 5 to 27 units/L (5 to 27 IU/L)
- Older people = Slightly higher than the adults
- Newborn = 5 times higher than adults.
- Child = Similar to adult level.
- Male = 7 to 47 U/L.
- Female = 5 to 25 U/L.
- Newborn = 5 times higher than an adult.
- Another reference
- Adult male = up to 55 U/L.
- Adult female = 38 U/L.
- The newborn is 6 to 7 times higher than the adults.
- It is like an adult after 5 to 7 months.
- Another reference
Raised levels are seen in:
- Obstructive liver disease and posthepatic obstruction.
- This may reach 5 to 30 times the normal value.
- Infectious hepatitis where the rise is 2 to 5 times the normal value.
- Liver diseases like cirrhosis, space-occupying lesion.
- The mild increase in the fatty liver.
- Infectious mononucleosis,
- Renal transplant.
- It may be increased in renal failure.
- Diabetes mellitus.
- The increase maybe 5 to 15 times the normal value.
- Myocardial infarction.
- The increase is mild and may occur after the fourth day of infarction and peak reaches in the next 4 days (another reference).
- Alcohol ingestion
- EBV infection in Infectious mononucleosis, cytomegalic viral infection, and Reye syndrome.
- Drugs like Warfarin, Barbiturates, Valproic acid, Dilantin, and alcohol.
The decreased level is seen in:
γ-GT values normal:
- Bone disorder and bone growth.
- Skeletal muscle disease.
- Renal failure.
- GGT is the choice of the enzyme in the case of Alcoholism.
- Very good at monitoring liver disease. Its return to normal in liver disease is an excellent indicator.