Clinical applications of enzymes MCQs With Answer

This blog presents a focused question bank on Clinical Applications of Enzymes tailored for M.Pharm students preparing for advanced pharmaceutical biotechnology examinations. The set emphasizes diagnostic, therapeutic and biopharmaceutical aspects of enzymes used in clinical practice — including enzyme replacement therapies, thrombolytics, diagnostic biomarkers, enzyme assays and formulation challenges such as immunogenicity and delivery. Each multiple-choice question is designed to probe mechanistic understanding, clinical indications, biochemical rationale and pharmaceutical considerations that are critical for rational therapeutic use and product development. Regular practice with these clinically oriented MCQs will strengthen your ability to apply biochemical concepts to patient care and enzyme-based drug design.

Q1. Which enzyme replacement therapy uses mannose-6-phosphate tagging to facilitate uptake into lysosomes for treatment of lysosomal storage disorders?

• PEGylated asparaginase for acute lymphoblastic leukemia
• Recombinant glucocerebrosidase with mannose residues
• Tissue plasminogen activator (tPA)
• Recombinant DNase I for cystic fibrosis

Correct Answer: Recombinant glucocerebrosidase with mannose residues

Q2. Which serum enzyme is most specific and widely used for diagnosing acute myocardial infarction in the first 24 hours?

• Lactate dehydrogenase (LDH)
• Aspartate aminotransferase (AST)
• Creatine kinase-MB (CK-MB)
• Alkaline phosphatase (ALP)

Correct Answer: Creatine kinase-MB (CK-MB)

Q3. Streptokinase and urokinase exert their thrombolytic effect primarily by which mechanism?

• Direct enzymatic degradation of fibrin without plasminogen involvement
• Activation of plasminogen to plasmin leading to fibrin degradation
• Inhibition of plasmin to prevent bleeding
• Cross-linking fibrin to stabilize clots

Correct Answer: Activation of plasminogen to plasmin leading to fibrin degradation

Q4. Which therapeutic enzyme is indicated for acute lymphoblastic leukemia and acts by depleting circulating asparagine?

• Alglucosidase alfa
• PEGylated L-asparaginase
• Dornase alfa
• Tissue plasminogen activator (alteplase)

Correct Answer: PEGylated L-asparaginase

Q5. Which property of therapeutic enzymes is most improved by PEGylation?

• Specific catalytic activity per molecule
• Oral bioavailability through gut absorption
• Circulatory half-life and reduced immunogenicity
• Ability to enter cell nucleus

Correct Answer: Circulatory half-life and reduced immunogenicity

Q6. Dornase alfa (recombinant DNase I) benefits cystic fibrosis patients mainly by:

• Enhancing pancreatic enzyme activity to improve digestion
• Hydrolyzing extracellular DNA to reduce sputum viscosity
• Replacing deficient lysosomal enzymes in the lung
• Acting as a systemic anti-inflammatory enzyme

Correct Answer: Hydrolyzing extracellular DNA to reduce sputum viscosity

Q7. Which diagnostic application relies on measuring isoenzyme patterns rather than total enzyme activity to localize tissue damage?

• Serum creatinine for kidney function
• CK isoenzymes (CK-MB vs CK-MM) for myocardial vs skeletal injury
• Amylase for acute pancreatitis only
• ALT for bone disease

Correct Answer: CK isoenzymes (CK-MB vs CK-MM) for myocardial vs skeletal injury

Q8. A major clinical limitation of enzyme replacement therapy is:

• Complete oral bioavailability of enzymes
• High risk of enzyme-mediated carcinogenesis
• Immune responses and neutralizing antibodies reducing efficacy
• Unlimited tissue penetration of large enzymes

Correct Answer: Immune responses and neutralizing antibodies reducing efficacy

Q9. Which enzyme assay principle is most commonly used in clinical laboratories for quantifying serum enzymes?

• Radioactive labeling of substrates exclusively
• Chromogenic or spectrophotometric measurement of product formation
• Direct visualization under electron microscopy
• Mass spectrometry of whole blood without prior separation

Correct Answer: Chromogenic or spectrophotometric measurement of product formation

Q10. Which therapeutic enzyme is an approved recombinant agent for Pompe disease (acid alpha-glucosidase deficiency)?

• Alglucosidase alfa
• Imiglucerase
• Agalsidase beta
• Cerliponase alfa

Correct Answer: Alglucosidase alfa

Q11. In the management of acute ischemic stroke, which factor is a contraindication to thrombolytic enzyme therapy with tPA?

• Onset of symptoms within 2 hours
• Recent major surgery or active internal bleeding
• Mild, stable hypertension controlled with medication
• Isolated facial droop without other deficits

Correct Answer: Recent major surgery or active internal bleeding

Q12. Which formulation consideration is critical for maintaining activity of therapeutic enzymes during storage and administration?

• Excessive exposure to strong oxidizing agents to sterilize
• Maintaining proper pH, stabilizers and cold-chain to prevent denaturation
• Heating above 60°C before injection to improve solubility
• Removing glycosylation to increase stability

Correct Answer: Maintaining proper pH, stabilizers and cold-chain to prevent denaturation

Q13. Which enzyme is commonly measured as a biomarker for acute pancreatitis?

• Alkaline phosphatase
• Serum amylase and lipase
• Gamma-glutamyl transferase (GGT)
• Creatine kinase

Correct Answer: Serum amylase and lipase

Q14. Which strategy is used to target recombinant lysosomal enzymes to macrophages in Gaucher disease?

• PEGylation to mask mannose residues
• Mannose-terminated glycosylation to target macrophage mannose receptors
• Increasing molecular weight to prevent cellular uptake
• Encapsulation in liposomes without receptor targeting

Correct Answer: Mannose-terminated glycosylation to target macrophage mannose receptors

Q15. Which adverse effect is most commonly associated with systemic thrombolytic enzyme therapy?

• Hypoglycemia
• Major bleeding, including intracranial hemorrhage
• Severe hyperkalemia
• Renal tubule obstruction due to enzyme precipitates

Correct Answer: Major bleeding, including intracranial hemorrhage

Q16. CRIM (cross-reactive immunologic material) status is clinically relevant before starting enzyme replacement therapy because:

• CRIM-positive patients never develop antibodies
• CRIM-negative patients are at higher risk for high-titer neutralizing antibodies
• CRIM status predicts oral absorption of enzymes
• It determines the enzyme’s catalytic efficiency

Correct Answer: CRIM-negative patients are at higher risk for high-titer neutralizing antibodies

Q17. Which enzyme inhibitor class is used as an antihypertensive by preventing angiotensin II formation?

• ACE inhibitors
• Protease inhibitors used in HIV
• Phosphodiesterase inhibitors
• Beta-lactam antibiotics

Correct Answer: ACE inhibitors

Q18. For therapeutic proteins including enzymes, glycosylation affects clinical performance by influencing:

• Only the enzyme’s active site amino acids
• Circulatory half-life, immunogenicity and receptor-mediated uptake
• Ability to pass the blood-brain barrier in all cases
• Elimination of the need for cold-chain storage

Correct Answer: Circulatory half-life, immunogenicity and receptor-mediated uptake

Q19. Which laboratory marker pattern best suggests resolution of acute myocardial injury over several days?

• Rising CK-MB then return to baseline while troponin I remains elevated longer
• LDH remains low while CK-MB and troponin never rise
• Immediate normalization of troponin within hours
• Alkaline phosphatase spikes and stays elevated

Correct Answer: Rising CK-MB then return to baseline while troponin I remains elevated longer

Q20. Which approach can reduce immunogenicity of a therapeutic enzyme intended for chronic administration?

• Use of non-human glycosylation patterns to increase recognition
• Administration with immune tolerance induction protocols or immunosuppression and PEGylation
• Repeated high-dose boluses without premedication
• Avoiding any glycoengineering to preserve foreign epitopes

Correct Answer: Administration with immune tolerance induction protocols or immunosuppression and PEGylation

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