of Asp and proceeds through a tetrahedral intermediate. As this point, the carboxylate groups of Asp are stabilized by the guanidinium groups of the enzyme's Arg386 and Arg 292 residues. Quinonoid formation: The hydrogen attached to the a-carbon of Asp is then abstracted (Lys258 is thought to be the proton acceptor) to form a quinonoid intermediate. Ketimine formation: The quinonoid is reprotonated, but now at the aldehyde carbon, to form the ketimine intermediate. Ketimine hydrolysis: Finally, the ketimine is hydrolyzed to form PMP and oxaloacetate. This mechanism is thought to have multiple partially rate-determining steps. However, it has been shown that the substrate binding step (transaldimination) drives the catalytic reaction forward. Clinical significance AST is similar to alanine transaminase (ALT) in that both enzymes are associated with liver parenchymal cells. The difference is that ALT is found predominantly in the liver, with clinically negligible quantities found in the kidneys, heart, and skeletal muscle, while AST is found in the liver, heart (cardiac muscle), skeletal muscle, kidneys, brain, and red blood cells. As a result, ALT is a more specific indicator of liver inflammation than AST, as AST may be elevated also in diseases affecting other organs, such as myocardial infarction, acute pancreatitis, acute hemolytic anemia, severe burns, acute renal disease, musculoskeletal diseases, and trauma. AST was defined as a biochemical marker for the diagnosis of acute myocardial infarction in 1954. However, the use of AST for such a diagnosis is now redundant and has been superseded by the cardiac troponins. Laboratory tests should always be interpreted using the reference range from the laboratory that performed the test. Example reference ranges are shown below: See also Alanine transaminase (ALT/ALAT/SGPT) Transaminases References Further reading External links AST - Lab Tests Online AST: MedlinePlus Medical Encyclopedia Liver function tests EC 2.6.1 Glutamate (neurotransmitter)