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Pathobiochemistry of Zinc Metabolism and Diagnostic Principles in Zinc Deficiency.

Zinc plays an important role in numerous biological processes of the human organism. As a result, zinc deficiency is often associated with a decline in enzymatic and immunological reactions that frequently improve dramatically after zinc substitution (e.g. acrodermatitis enteropathica).The manifold biological roles of zinc often prevent a clear understanding of the pathogenesis of diseases depending on or connected with zinc deficiencies. The bivalent character of zinc means that it cannot deliver an additional electron in contrast to copper and iron. This is the reason why it does not take part in redox reactions. It is, however, a strong electron acceptor and has a high affinity for electron donators. Like most of the trace elements, it prefers to form complexes with amino, carboxy or thiol groups of amino acids and proteins. The binding of zinc stabilizes the conformation of structural domains in some macromolecules important for genetic expression, cell division and growth. Above all, its special role bases on its function as partner of numerous enzyme-controlled metabolic processes. More than 300 enzymatic reactions are known to depend on the presence of zinc. Zinc containing metallo-proteins like metallothionein, thymulin, steroid receptors and gene regulatory proteins take part in the metabolism of carbohydrates, lipids and proteins and in the synthesis and catabolism of nucleic acids. Clinically a zinc deficit is often associated with diarrhea and growth retardation. The typical skin manifestations, acrodermatitis enteropathica, are characterized by psoriasis-like, erythematous, vesiculobullous and crusty inflammations of the skin near the orifices. At the same time multiple perionyxes can be found at the aeral area (paronychia).