Pepsin

Pepsin
thumb|Konverze pepsinogenu na pepsin

Pepsin is a general name for a number of proteinases (pepsin A, B, C - EC 3.4.23.1,2,3), pepsinogens are their precursors (proenzymes). Activation of pepsinogen A to pepsin A takes place in an acidic environment, the resulting pepsin A is capable of further activation of pepsinogen and leads to the so-called autocatalysis. 8 gastric mucosal proteases can be separated Electrophoretically in an agar gel, pepsinogens PG1 – PG5 form a group of immunologically identical proteins - pepsinogen I (PG-I, PGA), pepsinogens PG6 and PG7 form a group of pepsinogen II (PG-II, PGC), the last protein is cathepsin E (SMP, s low m oving p proteinase ). Molecular weight of pepsinogen I is 42,500.

Pepsin is an endopeptidase, so it hydrolyzes peptide bonds within the molecule, breaking it down into smaller fragments. In gastric juice, it hydrolyzes bonds near amino acids that have large side chains (amino acids with aromatic residues, branched chains and methionine).

The clinical significance
thumb|Produkce pepsinogenů v žaludku The determination of pepsin in the insulin test and the serum level of pepsinogens A and C are of clinical importance. The RIA methodology with 125 I-pepsinogen in a competitive setting is used for the determination. Pepsinogen A is a marker of mucosal atrophy and is used in genetic studies as a subclinical marker of duodenal ulcer disease. Pepsinogen C is used as a marker of gastric mucosal status (possibly in the PG-A / PG-C ratio) and also as a marker of eradication and Helicobacter pylori infection. We show a decrease in the level of pepsinogen A in patients with achlorhydria, eg in pernicious anemia. Recent studies have shown a significant reduction in pepsinogen-I and at the same time an increase in the level of IgA antibodies to Helicobacter pylori in gastric cancer.

thumb|Pepsinogen I/II v séru Determining the ratio of the levels of both pepsinogens (PG-I: PG-II) is today considered the most advantageous variant of serological markers.he ratio of PG-I: PG-II decreases significantly depending on the histological risk or the presence of vacA + positivity of Helicobacter pylori infection. The combination of determination of pepsinogen-I, gastrin-17 and antibodies to Helicobacter pylori is tested as a so-called serological biopsy, GastroPanel, in the differential diagnosis of gastritis. Screening testing of atrophic gastritis risk, resp. The risk of gastric cancer, combined with Helicobacter pylori positivity, is another area of gastrointestinal tumor screening.

Used literature

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 * VÄÄNÄNEN, H, et al. Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study. Eur J Gastroenterol Hepatol. 2003, vol. 15, no. 8, s. 885-91, ISSN 0954-691X (Print), 1473-5687 (Electronic). PMID: 12867799.


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 * BODGER, K, et al. Variation in serum pepsinogens with severity and topography of Helicobacter pylori-associated chronic gastritis in dyspeptic patients referred for endoscopy. Helicobacter. 2001, vol. 6, no. 3, s. 216-24, ISSN 1083-4389 (Print), 1523-5378 (Electronic). PMID: 11683924.


 * BERMEJO, F, et al. Basal concentrations of gastrin and pepsinogen I and II in gastric ulcer: influence of Helicobacter pylori infection and usefulness in the control of the eradication.. Gastroenterol Hepatol. 2001, vol. 24, no. 2, s. 56-62, ISSN 0210-5705. PMID: 11247290.