10 year old boy presented with abdominal pain, muscle weakness and fatigue. On investigations, serum lead levels were found increased in blood. Activity of which of following enzyme in the liver is increased
## **Core Concept**
The question revolves around the effects of lead poisoning on the body, particularly on liver enzymes. Lead poisoning can cause a variety of symptoms including abdominal pain, muscle weakness, and fatigue. It affects several biochemical pathways, notably those involved in heme synthesis.
## **Why the Correct Answer is Right**
Lead inhibits several steps in the heme biosynthetic pathway. One of the key enzymes affected is **aminolevulinic acid dehydratase (ALAD)**, also known as porphobilinogen synthase. Lead inhibits this enzyme, which is crucial for the production of aminolevulinic acid (ALA) and subsequently heme. As a result, the body tries to compensate for this inhibition by increasing the production of ALA through feedback mechanisms. This leads to an increase in the activity of **aminolevulinate synthase**, the rate-limiting enzyme in heme synthesis, which is located in the liver. Therefore, in response to lead poisoning, the activity of **aminolevulinate synthase** in the liver is increased.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because while lead does affect the heme pathway, the direct effect is on **aminolevulinic acid dehydratase (ALAD)**, not on this enzyme's activity being increased as a direct result.
- **Option B:** This option does not directly relate to the primary effect of lead on heme synthesis. Lead poisoning's hallmark is not the increase in this enzyme's activity.
- **Option C:** While **ferrochelatase** is another enzyme in the heme synthesis pathway that can be affected by lead (lead inhibits it), the question specifically asks for an enzyme whose activity is increased in response to lead poisoning.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that lead poisoning can cause **abdominal pain**, **muscle weakness**, and **fatigue**, alongside hematological effects. Lead inhibits **aminolevulinic acid dehydratase (ALAD)** and **ferrochelatase**, leading to increased levels of **aminolevulinic acid (ALA)**. A classic lab finding is **microcytic hypochromic anemia**.
## **Correct Answer:** . Aminolevulinate synthase