Lipase

Lipase is an enzyme that catalyzes the breakdown of fats into fatty acids and glycerol, essential for fat digestion and absorption. 

Found in various tissues such as the liver, stomach, fat cells, blood vessels, and small intestine, lipases play crucial roles in lipid metabolism, cholesterol transport, cell signaling, and inflammation. 

Elevated lipase levels are often associated with acute and chronic pancreatitis, pancreatic cancer, gallstones, infections, and other conditions, making lipase a vital biomarker for diagnosing and monitoring pancreatic and gastrointestinal health.

What is Lipase? [17.] 

Lipase is an enzyme that catalyzes the hydrolysis of fats (lipids), facilitating the breakdown of triglycerides into fatty acids and glycerol. This process is essential for the digestion and absorption of dietary fats as well as fat-soluble vitamins.

Lipases are also involved in cholesterol metabolism and are targeted by certain medications like orlistat, fibrates, and niacin to treat conditions related to fat digestion and cholesterol levels.

Locations of Lipase [17.] 

Lipases are found in various tissues, including the liver (hepatic lipase), stomach (gastric lipase), fat cells (hormone-sensitive lipase), blood vessels (lipoprotein lipase), and the small intestine (pancreatic lipase). 

Functions of Lipase

Functions of lipase may vary slightly depending on the type of lipase concerned. 

General functions of lipase include:

• Fat digestion: it catalyzes the breakdown of triglycerides into fatty acids and glycerol [5., 19.] 

• Lipid metabolism: helps in the processing and transport of dietary lipids [5., 19.] 

• Cell signaling: some lipases are involved in cell signaling pathways [5.] 

• Inflammation: certain lipases play a role in inflammatory processes [3., 7.] 

• Cholesterol transport: Lipoprotein lipase (LPL) plays a critical role in cholesterol metabolism by hydrolyzing triglycerides (TG) in lipoprotein particles, converting them into free fatty acids and glycerol. This process facilitates the uptake of these fatty acids into peripheral tissues for energy storage and consumption. [11., 19.] 

Types of Lipase

Pancreatic Lipase

Pancreatic lipase hydrolyzes most dietary fats: it is the primary enzyme responsible for fat digestion, hydrolyzing 50-70% of dietary triglycerides. [20.] 

It works optimally at pH 8-9 and requires colipase as a cofactor for efficient activity in the presence of bile salts. [20.] 

Pancreatic lipase deficiency can lead to steatorrhea and malabsorption of fat-soluble vitamins.

High serum lipase levels can indicate pancreatitis, while low levels may suggest pancreatic insufficiency. 

Gastric Lipase 

Gastric lipase digests triglycerides with short-chain fatty acids. It is active in the acidic environment of the stomach (pH 3-6) and accounts for up to 25% of fat digestion. [14.] 

Gastric lipase is essential in fat digestion in infants and in patients with pancreatic insufficiency. [14.] 

Hepatic Lipase 

Hepatic lipase (HL) is a multifunctional enzyme involved in lipoprotein metabolism and atherosclerosis. 

It hydrolyzes triglycerides and phospholipids in circulating plasma lipoproteins and serves as a ligand to facilitate lipoprotein uptake by cell surface receptors and proteoglycans.  [19.] 

Its roles in lipoprotein processing allows HL to significantly impact atherogenesis by affecting both plasma lipid metabolism and cellular lipid uptake. [13., 19.] 

Lipoprotein Lipase [10.] 

Lipoprotein lipase breaks down triglycerides in blood carried by lipoproteins. It is anchored to the luminal surface of capillary endothelial cells, primarily in adipose tissue and skeletal muscle.

It hydrolyzes triglycerides in chylomicrons and very-low-density lipoproteins (VLDL), releasing fatty acids for tissue uptake.

LPL activity is regulated by nutritional and hormonal factors such as feeding, fasting, insulin, and exercise. Additionally, LPL influences the uptake of esterified lipids and is involved in the metabolism of fat-soluble vitamins and atherosclerosis development.

Deficiency in lipoprotein lipase can lead to hypertriglyceridemia and increased risk of pancreatitis.

Lysosomal Lipoprotein Lipase

Lysosomal acid lipase regulates intracellular lipid stores. It is essential for the hydrolysis of cholesteryl esters and triglycerides in lysosomes.

It plays a crucial role in cellular cholesterol homeostasis and lipid metabolism.

This enzyme's normal functions are essential for regulating cholesterol metabolism and maintaining lipid homeostasis in various tissues, particularly in the liver, spleen, and macrophages. [4.] 

Deficiency of lysosomal acid lipase can cause Wolman disease in infants and cholesteryl ester storage disease in adults, both characterized by accumulation of lipids in various tissues. [4.] 

Lipase Blood Test: Why Test Lipase Levels? 

Lipase is considered an important biomarker due to its specific association with pancreatic function. 

Elevated levels of lipase in the blood are often indicative of pancreatic injury or inflammation, making it a key diagnostic tool for conditions such as acute pancreatitis. [15.]

Lipase levels rise quickly after pancreatic injury and remain elevated for a longer period than other pancreatic enzymes, such as amylase, providing a longer diagnostic window. [8.] 

Lipase levels can be altered in conditions including cystic fibrosis, celiac disease, and Crohn's disease. [15.] 

Alterations in levels of lipase can also be seen in other conditions including gallbladder or kidney disease, stomach or intestinal issues, and in cancers, infections, genetic issues, or alcohol use disorder. [15.] 

The measurement of lipase is less likely to be influenced by factors unrelated to pancreatic health, increasing its specificity as a biomarker for pancreatic conditions.

Health Implications of Lipase Levels

Conditions Associated with Elevated Lipase Levels

Elevated lipase levels, a condition known as hyperlipasemia, are most commonly associated with acute pancreatitis, and alcohol-induced acute pancreatitis. [8.] 

In this condition, lipase levels can rise significantly, often reaching several times the upper limit of the normal range. Acute pancreatitis is characterized by the sudden inflammation of the pancreas, which can cause severe abdominal pain, nausea, vomiting, and fever. 

Chronic pancreatitis, a long-term inflammation of the pancreas, can also result in elevated lipase levels, though the increase may be less pronounced than in acute cases. It may also result in decreased lipase levels, as the lipase-producing cells in the pancreas are destroyed. [16.] 

Additionally, other conditions such as pancreatic cancer, gallstones, certain infections including COVID-19, trauma, cancers, chronic kidney disease, organophosphate poisoning, inflammation of saliva glands, and certain gastrointestinal disorders including Crohn's disease, peptic ulcers and bowel obstruction can cause elevated lipase levels. [2., 6., 9., 15., 18.] 

Early detection of elevated lipase levels can lead to prompt diagnosis and treatment, improving patient outcomes.

Conditions Associated with Low Lipase Levels

Low lipase levels, or hypolipasemia, are less common but can indicate significant health issues. 

One of the primary conditions associated with low lipase levels is cystic fibrosis, a genetic disorder that affects the lungs and digestive system. 

In cystic fibrosis the pancreas is often damaged, leading to insufficient production of digestive enzymes including lipase. [12.] 

Other conditions that can cause low lipase levels include chronic pancreatitis with extensive damage to the pancreas and some forms of pancreatic insufficiency, where the pancreas fails to produce enough digestive enzymes. [16.] 

Lab Testing for Lipase

Test Information, Sample Collection and Preparation

Testing lipase is typically done in the blood, and is commonly performed to diagnose and monitor conditions affecting the pancreas. 

The test requires a blood draw via venipuncture. Fasting may be required prior to blood draw. 

Interpretation of Test Results

Optimal Levels of Lipase

Optimal levels of lipase may vary depending on age and gender.  Optimal levels are reported by one lab as: [1.] 

Male

0 to 6 m: 8−37 U/L

7 m to 1 y: 11−34 U/L

2 to 17 y: 11−38 U/L

≥18 y: 13−78 U/L

Female

0 to 6 m: 9−50 U/L

7 m to 1 y: 10−37 U/L

2 to 17 y: 12−45 U/L

18 to 70 y: 14−72 U/L

≥71 y: 14−85 U/L

Clinical Significance of Elevated Lipase Levels

Elevated lipase levels may be due to: 

• Acute pancreatitis

• Alcohol-induced acute pancreatitis

• Chronic pancreatitis (elevated or decreased lipase levels)

• Pancreatic cancer

• Gallstones

• Certain infections, including COVID-19

• Trauma

• Some cancers

• Chronic kidney disease

• Organophosphate poisoning

• Inflammation of the salivary glands

• Crohn's disease

• Peptic ulcers

• Bowel obstruction

Clinical Significance of Decreased Lipase Levels

Decreased lipase levels have been seen in chronic pancreatitis and cystic fibrosis.

Related Biomarkers to Test Alongside Lipase

While lipase is a critical biomarker for pancreatic function, testing for additional biomarkers can provide a more comprehensive assessment of pancreatic health and related conditions. 

Other Enzymes and Biomarkers for Pancreatic Function

In addition to lipase, other enzymes like amylase and trypsinogen are important biomarkers for assessing pancreatic function. 

Amylase is another digestive enzyme produced by the pancreas, and elevated levels can indicate pancreatic disorders such as pancreatitis or pancreatic cancer. Amylase levels can rise alongside lipase during pancreatic inflammation, providing corroborative evidence of pancreatic issues. 

However, testing both amylase and lipase together is not always recommended, as it can increase cost without significantly impacting diagnostic accuracy. [8.] 

Trypsinogen, a precursor to the enzyme trypsin, is also produced by the pancreas. Elevated levels of trypsinogen in the blood can signal acute pancreatitis and other pancreatic diseases. 

Together, these biomarkers provide a more complete picture of pancreatic health, enabling more accurate diagnoses.

Biomarkers for Liver Function

Given the close relationship between the pancreas and liver in digestive processes, assessing liver function is also important when evaluating pancreatic health. 

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are key liver enzymes that indicate liver function. 

Elevated levels of ALT and AST can signal liver damage or inflammation, which can be related to or exacerbate pancreatic conditions. 

For instance, gallstones, which can affect both the liver and pancreas, may cause elevated levels of these enzymes. 

Testing for liver function biomarkers provides additional context and helps differentiate between liver-related and pancreatic-related issues.

FAQ: Lipase

Lipase is an essential enzyme involved in the digestion of fats. This FAQ section addresses common questions about lipase, its functions, levels, and related health implications.

What is Lipase?

Lipase is an enzyme produced by the pancreas that helps break down dietary fats into smaller molecules that can be absorbed by the intestines. It plays a crucial role in the digestion and absorption of fats.

What is a Lipase Blood Test?

A lipase blood test measures the level of lipase in the blood. This test is often used to diagnose and monitor conditions related to the pancreas, such as pancreatitis.

What is the Function of Lipase?

The primary function of lipase is to manage appropriate lipid absorption and metabolism. 

What are Normal Lipase Levels?

Normal lipase levels in the blood typically range from 0 to roughly 90 units per liter (U/L). However, the exact range may vary slightly depending on the laboratory and the methods used for the test.

What Level of Lipase is Dangerous?

Lipase levels significantly higher than the normal range can indicate acute pancreatitis, pancreatic cancer, or other pancreatic disorders. 

Levels that are several times above the upper limit of normal are generally considered dangerous and require medical attention.

What are the Symptoms of Low Lipase Levels?

Symptoms of low lipase levels can include indigestion, bloating, and steatorrhea (fatty stools). Low lipase levels may indicate pancreatic insufficiency, where the pancreas does not produce enough enzymes for proper digestion.

What is Low Lipase?

Low lipase refers to below-normal levels of the enzyme in the blood. This can result from conditions like chronic pancreatitis, cystic fibrosis, or other diseases affecting the pancreas.

What is Elevated Lipase?

Elevated lipase refers to higher-than-normal levels of the enzyme in the blood. This is often a sign of acute pancreatitis or other pancreatic conditions.

What is High Lipase Milk?

High lipase milk refers to breastmilk that contains high levels of lipase. This can cause the milk to develop a soapy taste and smell after storage. While it is safe for babies to consume, some may refuse the milk due to the altered taste.

What is Lipase in Breastmilk?

Lipase in breastmilk helps break down fats into smaller components that are easier for the baby to digest and absorb. It plays an important role in the overall digestion and nutritional absorption for the infant.

What is a Lipase Supplement?

A lipase supplement is a dietary supplement that provides additional lipase enzyme to aid in the digestion of fats. These supplements are often used by individuals with pancreatic insufficiency or other digestive disorders.

Order Lipase Testing

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[1.] 1.001404: Lipase | Labcorp. www.labcorp.com. https://www.labcorp.com/tests/001404/lipase

[2.] Alvarez E, Persaud R, Soniega-Sherwood J, Rattray J, Richman M. Critical Illness Causing Marked Hyperlipasemia. The American Journal of Medicine. 2019;132(4):e540-e541. doi:https://doi.org/10.1016/j.amjmed.2018.12.006

[3.] Badellino KO, Wolfe ML, Reilly MP, Rader DJ. Endothelial Lipase Is Increased In Vivo by Inflammation in Humans. Circulation. 2008;117(5):678-685. doi:https://doi.org/10.1161/circulationaha.107.70734

[4.] Bernstein DL, Hülkova H, Bialer MG, Desnick RJ. Cholesteryl ester storage disease: Review of the findings in 135 reported patients with an underdiagnosed disease. Journal of Hepatology. 2013;58(6):1230-1243. doi:https://doi.org/10.1016/j.jhep.2013.02.014‌

[5.] Cerk IK, Wechselberger L, Oberer M. Adipose Triglyceride Lipase Regulation: An Overview. Curr Protein Pept Sci. 2018;19(2):221-233. doi: 10.2174/1389203718666170918160110. PMID: 28925902; PMCID: PMC7613786.

[6.] Chaffin, Hally M. MD; Trivedi, Shubham BS; Singh, Vijay P. MBBS, MD. S119 Prognostic Value of Elevated Lipase in Pancreatitis versus Non Pancreatitis Hyperlipasemia (NPHL) due to Non-Malignant Causes. The American Journal of Gastroenterology 117(10S):p e86, October 2022. | DOI: 10.14309/01.ajg.0000857116.42140.fb 

[7.] de Oliveira C, Khatua B, Noel P, Kostenko S, Bag A, Balakrishnan B, Patel KS, Guerra AA, Martinez MN, Trivedi S, McCullough A, Lam-Himlin DM, Navina S, Faigel DO, Fukami N, Pannala R, Phillips AE, Papachristou GI, Kershaw EE, Lowe ME, Singh VP. Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation. J Clin Invest. 2020 Apr 1;130(4):1931-1947. doi: 10.1172/JCI132767. PMID: 31917686; PMCID: PMC7108918.

[8.] Don’t test for amylase in cases of suspected acute pancreatitis. Instead, test for lipase. www.aafp.org. https://www.aafp.org/pubs/afp/collections/choosing-wisely/317.html

[9.] George J, Gnanamoorthy K, Suthakaran PK, Baliga KV. Hyperlipasemia Sans Pancreatitis: A Case Series. Cureus. 2023 Oct 27;15(10):e47781. doi: 10.7759/cureus.47781. PMID: 38021537; PMCID: PMC10679796.

[10.] Goldberg IJ, Eckel RH, Abumrad NA. Regulation of fatty acid uptake into tissues: lipoprotein lipase- and CD36-mediated pathways. J Lipid Res. 2009 Apr;50 Suppl(Suppl):S86-90. doi: 10.1194/jlr.R800085-JLR200. Epub 2008 Nov 24. PMID: 19033209; PMCID: PMC2674753.

[11.] Joon Ho Moon, Kim K, Sung Hee Choi. Lipoprotein Lipase: Is It a Magic Target for the Treatment of Hypertriglyceridemia. 2022;37(4):575-586. doi:https://doi.org/10.3803/enm.2022.402

[12.] Junglee D, Penketh A, Katrak A, Hodson ME, Batten JC, Dandona P. Serum pancreatic lipase activity in cystic fibrosis. Br Med J. 1983 May 28;286(6379):1693-4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1548188/pdf/bmjcred00555-0017.pdf

[13.] Kobayashi J, Miyashita K, Nakajima K, Mabuchi H. Hepatic Lipase: a Comprehensive View of its Role on Plasma Lipid and Lipoprotein Metabolism. Journal of Atherosclerosis and Thrombosis. 2015;22(10):1001-1011. doi:https://doi.org/10.5551/jat.31617

[14.] Lim SY, Steiner JM, Cridge H. Lipases: it’s not just pancreatic lipase! American Journal of Veterinary Research. 2022;83(8):ajvr.22.03.0048. doi:https://doi.org/10.2460/ajvr.22.03.0048

[15.] Lipase Tests: MedlinePlus Medical Test. medlineplus.gov. https://medlineplus.gov/lab-tests/lipase-tests/#:~:text=A%20very%20high%20level%20of

[16.] Nichols J. Lipase in the Diagnosis of Acute Pancreatitis.; 2021. https://documents.cap.org/documents/LipaseAcutePancreatitis_FullModule.pdf

[17.] Pirahanchi Y, Sharma S. Biochemistry, Lipase. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537346/

[18.] Ravi, Anupama MD*; Obideen, Kamil MD; Goldstein, Marney MD. Not All Hyperlipasemia Is Pancreatitis: 198. American Journal of Gastroenterology 103():p S77, September 2008. 

[19.] Santamarina-Fojo S, González-NavarroH, Freeman L, Wagner E, Nong Z. Hepatic Lipase, Lipoprotein Metabolism, and Atherogenesis. Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24(10):1750-1754. doi:https://doi.org/10.1161/01.atv.0000140818.00570.2d

[20.] Zhu G, Fang Q, Zhu F, Huang D, Yang C. Structure and Function of Pancreatic Lipase-Related Protein 2 and Its Relationship With Pathological States. Front Genet. 2021 Jul 5;12:693538. doi: 10.3389/fgene.2021.693538. PMID: 34290745; PMCID: PMC8287333.