Skip to main content
SpringerLink
Log in

CK Isoforms

  • Chapter
Cardiac Markers

Part of the book series: Pathology and Laboratory Medicine ((PLM))

  • 308 Accesses

Abstract

In 1985, the TIMI* study group (1) conducted a 5-yr multicenter trial. The study concluded that patients with acute myocardial infarction (AMI) received maximum benefits when they received thrombolytic therapy within 4–6 h after onset of chest pain. Therefore, an early biochemical marker of AMI is crucial in diagnosis of myocardial injury. Currently, CK-MB isoforms are the only cardiac-specific markers satisfying these criteria, although other markers are being developed (see Chapter 17). The proceeding discussion is focused on review of pertinent biochemistry, approaches to analytical measurements, and the clinical applications of CK isoforms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. TIMI Study Group (1985) The thrombolysis in acute myocardial infarction (TIMI) trial. N. Engl. J. Med. 312:932–936.

    Google Scholar 

  2. Smith AF (1972) Separation of tissue and serum creatine kinase isoenzymes on poly-acrylamide gel slabs. Clin. Chim. Acta. 39: 351–359.

    Article  PubMed  CAS  Google Scholar 

  3. George S, Ishikawa Y, Perryman MB, and Roberts R (1984) Purification and characterization of naturally occurring and in vitro induced multiple forms of creatine kinase. J. Biol. Chem. 259:2667–2674.

    PubMed  CAS  Google Scholar 

  4. Perryman MB, Knell JD, and Roberts R (1984) Carboxypeptidase-catalyzed hydrolysis of C-terminal lysine; mechanism for in vivo production of multiple forms of creatine kinase in plasma. Clin. Chem. 30: 662–664.

    PubMed  CAS  Google Scholar 

  5. Panteghini M (1988) Serum isoforms of creatine kinase isoenzymes. Clin. Biochem. 21:211–218.

    Article  PubMed  CAS  Google Scholar 

  6. Wu AHB (1989) Creatine kinase isoforms in ischemic heart disease [Review]. Clin. Chem. 35:7–13.

    PubMed  CAS  Google Scholar 

  7. Schweisfurth H, Schmidt M, Brugger E, Maiwald L, and Thiel H (1985) Alterations of serum carboxypeptidases N and angiotensin-I-converting enzyme in malignant diseases. Clin. Biochem. 18:242–246.

    Article  PubMed  CAS  Google Scholar 

  8. Schweisfurth H, Pickert E, Gramer E, and Reiners C (1987) Alterations of carboxypeptidases N activities in patients with thyroid disease. Clin. Biochem. 20:43–46.

    Article  PubMed  CAS  Google Scholar 

  9. Wevers RA, Hagelauer U, Stein W, Bohner J, Faust U, van Landeghem AAJ, and Soons JBJ (1985) Indicies for the age of the creatine kinase M-chain in the blood. Clin. Chim. Acta 148:197–210.

    Article  PubMed  CAS  Google Scholar 

  10. Wevers RA, Delsing M, Klein Gebbink JAG, and Soons JBJ (1978) Post-synthetic changes in creatine kinase isozyme. Clin. Chem. Acta. 86:323–327.

    Article  CAS  Google Scholar 

  11. Green S and Wu A (1993) Immunoassays and electrophoresis for creatine kinase isoenzymes and isoforms in diagnosis and management of acute myocardial infarction. AACC Endo. Metabol. 11:329–344.

    Google Scholar 

  12. Prager NA, Suzuki T, Jaffe AS, Sobel BE, and Abendschein DR (1992) The nature and time course of generation of the isoforms of MB creatine kinase in vivo. J. Am. Coll. Car-diol. 20:414–419.

    Article  CAS  Google Scholar 

  13. Nguyen TM, Cartwright AJ, Osborne M, and Morris GE (1991) Structural changes in the C-terminal region of human brain creatine kinase studied with monoclonal antibodies. Biochim. Biophys. Acta. 1076:245–251.

    Article  Google Scholar 

  14. Grace AM, Strauss AW, and Sobel BE (1985) Sensitive quantification of isoforms of canine MM creatine kinase with an immunblot procedure suitable for large numbers of samples. Anal. Biochem. 149:209–217.

    Article  PubMed  CAS  Google Scholar 

  15. Chapelle JP and Hensghem C (1980) Further heterogeneity demonstrated for serum creatine kinase isoenzyme MM. Clin. Chem. 26:457–462.

    PubMed  CAS  Google Scholar 

  16. Kanemitsu F and Okigaki T (1994) Characterization of human creatine kinase BB and MB isoforms by means of isoelectric focusing. Clin. Chem. Acta. 231:1–9.

    Article  CAS  Google Scholar 

  17. Nohara R, Sobel BE, Jaffe AS and Abendschein DR (1988) Quantitative analysis of isoforms of MM creatine kinase in plasma by chromatofocusing with on-line monitoring of enzyme activity. Clin. Chem. 34:235–239.

    PubMed  CAS  Google Scholar 

  18. Hashimoto H, Grace AM, Billadelo JJ, Gross RW, Strauss AW, and Sobel BE (1984) Nondenaturing quantification of sub-forms of canine MM creatine kinase (isoforms) and their interconversion. J. Lab. Clin. Med. 103:470–484.

    PubMed  CAS  Google Scholar 

  19. Schlabach TD, Alpert AJ, and Regnier FE (1978) Rapid assessment of isoenzymes by high performance liquid chromatography. Clin. Chem. 24:1351–1360.

    PubMed  CAS  Google Scholar 

  20. Bhayana V, Cohoe S, and Henderson AR (1995) Evaluation of the cardio rep for creatine kinase isoforms analysis. Clin. Chem. 41:S184.

    Google Scholar 

  21. Laurino JP, Fischberg-Bender E, and Chang J (1995) An immunochemical mass assay for the direct measurement of creatine kinase MB2. Ann. Clin. Lab. Sci. 25:252–263.

    PubMed  CAS  Google Scholar 

  22. Laurino JP, Bender EW, Kessimian N, Chang J, Pelletier T, and Usategui M (1996) Comparative sensitivities and specificities of the mass measurements of CK-MB2, CK-MB, and myoglobin for diagnosing acute myocardial infarction. Clin. Chem. 42:1454–1459.

    PubMed  CAS  Google Scholar 

  23. Davies J, Reynolds T, and Penney MD (1992) Creatine kinase isoforms: investigation of inhibitors of in-vitro degradation and establishment of a reference range. Ann. Clin. Biochem. 29:202–205.

    PubMed  Google Scholar 

  24. Chapelle JP (1984) Serum creatine kinase MM sub-band determination by isoelectric focusing: a potential method for the moni-toring of myocardial infarction. Clin. Chim. Acta. 137:273–281.

    Article  PubMed  CAS  Google Scholar 

  25. Morelli RL, Emilson B, and Rapaport E (1987) MM-CK subtypes diagnose reperfu-sion early after myocardial infarction. Am. J. Med. Sci. 293:139–149.

    Article  PubMed  CAS  Google Scholar 

  26. Jaffe AS, Serota H, Grace A, and Sobel B (1986) Diagnostic changes in plasma creatine kinase isoforms early after the onset of acute myocardial infarction. Circulation 74: 105–109.

    Article  PubMed  CAS  Google Scholar 

  27. Morelli RL, Calson CJ, Emilson B, Abendschein DR, and Rapaport E (1983) Serum creatine kinase MM isoenzyme sub-bands after acute myocardial infarction in man. Circulation 67:1283–1289.

    Article  PubMed  CAS  Google Scholar 

  28. Keshgegian AA, Bhagat PK, Lease J, and Balocchi J (1988) Creatine kinase MM isoforms in serum after cardiac surgery. Clin. Chem. 34:1067–1070.

    PubMed  CAS  Google Scholar 

  29. Serena C, Stefini F, Turia C, Pagani F, and Panteghini M (1995) Evaluation of cardio rep analyzer for creatine kinase MB isoforms determination. 27 Congresso Nazionale della Societa Italiana di Biochim-ica Clinica, Riva del Garda (TN).

    Google Scholar 

  30. Peterson, E (1996) Personal communication, Helena Laboratories, Beaumont, TX.

    Google Scholar 

  31. Suzuki T, Shiraishi T, Tomita K, Totani M, and Murachi T (1990) Monoclonal antibody inhibiting creatine kinase MM3 but not isoform MM1. Clin. Chem. 36: 153–156.

    PubMed  CAS  Google Scholar 

  32. Wu AHB, Gornet TG, Wu VH, Brockie RE, and Nishikawa A (1987) Early diagnosis of acute myocardial infarction by rapid analysis of creatine kinase isoenzyme-3 (CK-MM) subtypes. Clin. Chem. 33:358–362.

    PubMed  CAS  Google Scholar 

  33. Armbrustwer DA (1991) The genesis and clinical significance of creatine kinase isoforms [Review]. Lab. Med. 22:325–334.

    Google Scholar 

  34. Yang XS and Meng QY (1993) Serum iso-forms of creatine kinase MM isoenzyme in acute myocardial infarction. Clin. Med. J. 106:410–414.

    CAS  Google Scholar 

  35. Wu AHB (1992) Creatine kinase MM and MB isoforms. Lab. Med. 23:303–305.

    Google Scholar 

  36. Puleo PR, Guadagno PA, Roberts R, Perryman MB (1989) Sensitive, rapid assay of subforms of creatine kinase MB in plasma. Clin. Chem. 35:1452–1455.

    PubMed  CAS  Google Scholar 

  37. Puleo PR, Guadagno PA, and Roberts R (1990) Early diagnosis of acute myocardial infarction based on an assay for subforms of creatine kinase-MB. Circulation 82: 759–764.

    Article  PubMed  CAS  Google Scholar 

  38. Gerhardt W, Katus H, Ravkilde J, Hamm C, Jorgensen PJ, Peheim E, Ljungdahl L, and Lofdahl P (1991) S-troponin T in suspected ischemic myocardial injury compared with mass and catalytic concentrations of S-creatine kinase isoenzyme MB. Clin. Chem. 37:1405–1411.

    PubMed  CAS  Google Scholar 

  39. Mair J, Morandell D, Genser N, Lechleitner P, Dienstl F, and Puschendorf B (1995) Equivalent early sensitivities of myoglobin, creatine kinase MB mass, creatine kinase isoform ratios, and cardiac troponins I and T for acute myocardial infarction. Clin. Chem. 41:1266–1272.

    PubMed  CAS  Google Scholar 

  40. Collinson PO, Rosalki SB, Kuwana T, Garratt HM, Ramhamadamy EM, Baird M, and Greenwood TW (1992) Early diagnosis of acute myocardial infarction by CK-MB mass measurements. Ann. Clin. Biochem. 29:43–47.

    PubMed  Google Scholar 

  41. Bhayana V, Cohoe S, Leung F, Jablansky G, and Henderson R (1993) Diagnostic evaluation of creatine kinase-2 mass and creatine kinase-3 and-2 isoform ratios in early diagnosis of acute myocardial infarction. Clin. Chem. 39:488–495.

    PubMed  CAS  Google Scholar 

  42. Wu AHB, Wang X-M, Gornet TG, and Ordonez-Lianos J (1992) Creatine kinase MB isoforms in patients with myocardial infarction and skeletal muscle injury. Clin. Chem. 38:2396–2400.

    PubMed  CAS  Google Scholar 

  43. Christenson R (1993) Specificity of an immunochemical reagent for quantifying the isoforms of creatine kinase-MB. J. Clin. Lab. Anal. 7:220–224.

    Article  PubMed  CAS  Google Scholar 

  44. Bernardoni C, Pravettoni G, Besomig et al. (1995) Rapid assay of isoforms of creatine kinase MB to diagnose acute myocardial infarction (AMI). J. Suisse. Med. 29:32s.

    Google Scholar 

  45. Christenson RH, Clemmenson P, Ohman EM, Toffaletti J, Silverman LM, Grande P, Vollmer RT, and Wagner GS (1990) Relative increase in creatine kinase MB isoenzyme during reperfusion after myocardial infarction is method dependant. Clin. Chem. 36: 1444–1449.

    PubMed  CAS  Google Scholar 

  46. Garabedian HD, Gold HK, Yasuda T, Johns JA, Finkelstein DM, Gaivin RJ, Cobbaert C, Leinbach RC, and Collen D (1988) Detection of coronary artery reperfusion with creatine kinase MB determinations during throm-bolytic therapy: correlation with acute angiography. J. Am. Coll. Cardiol. 729–734.

    Google Scholar 

  47. Grande P, Gromborg J, Clemmenson P, Sevilla DC, Wagner NB, and Wagner GS (1991) Indices of reperfusion in patients with acute myocardial infarction using characteristics of the CK-MB time-activity curve. Am. Heart J. 122:400–408.

    Article  PubMed  CAS  Google Scholar 

  48. Apple F (1992) Creatine kinase-MB. Lab. Med. 23:298–302.

    Google Scholar 

  49. Jaffe AS, Eisenberg PR, and Abendschein OR (1994) Conjoint use of MM and MB creatine kinase isoforms in detection of coronary recanalization. Am. Heart J. 127: 1461–1466.

    Article  PubMed  CAS  Google Scholar 

  50. Schofer J, Ress-Grigolo G, Voit KD, and Mathey DG (1992) Early detection of coronary artery patency after thrombolysis by determination of the MM creatine kinase isoforms in patients with acute myocardial infarction. Am. Heart J. 123:846–853.

    Article  PubMed  CAS  Google Scholar 

  51. Abe S, Nomoto K, Arima S, Miyata M, Yamashita T, Naruyama I, Toda H, Okino H, Atsuchi Y, Tahava M, Nakao S, Tanaka H, and Suzuki T (1993) Detection of reperfusion 30 and 60 minutes after coronary recanalization by a rapid new assay of creatine kinase isoforms in acute myocardial infarction. Am. Heart J. 125:649–656.

    Article  PubMed  CAS  Google Scholar 

  52. Green G, Hansen KN, Chan DW, Guerci AD, Fleetwood DH, Sivertson KT, and Kelen GD (1991) The potential utility of a rapid CK-MB assay in evaluating emergency department patients with possible myocardial infarction. Ann. Emerg. Med. 20:954–960.

    Article  PubMed  CAS  Google Scholar 

  53. Puleo PR, Wathen G, Roberts R, and Perryman MB (1992) Triaging of patients with chest pain guided by MB-CK subform assay. J. Am. Coll. Cardiol. 19:303a.

    Google Scholar 

  54. Puleo PR, Meyer D, Wathen C, Tawa CB, Wheelers, Hamburg RJ, Ali N, Obermueller SD, Triana JF, Zimmerman JL, Perryman MB, and Roberts R (1994) Use of a rapid assay of subforms of creatine kinase-MB to diagnose or rule out acute myocardial infarction. N. Engl. J. Med. 331:561–566.

    Article  PubMed  CAS  Google Scholar 

  55. Roberts R and Kleiman NS (1994) Earlier diagnosis and treatment of acute myocardial infarction necessitates the need for a “new diagnostic mind set” [Review]. Circulation 89:872–881.

    Article  PubMed  CAS  Google Scholar 

  56. Hossein-Nia M, Kallis P, Brown PA, Chester MR, Kaski JC, Murday AJ, Tresure T, and Holt DW (1994) Creatine kinase MB isoforms: sensitive markers of ischemic myocardial damage. Clin. Chem. 40: 1265–1271.

    PubMed  CAS  Google Scholar 

  57. Green G (1996) Personal communication, unpublished data.

    Google Scholar 

Download references

Authors
  1. Sol F. Green
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Hartford Hospital, Hartford, CT, USA

    Alan H. B. Wu

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media New York

About this chapter

Cite this chapter

Green, S.F. (1998). CK Isoforms. In: Wu, A.H.B. (eds) Cardiac Markers. Pathology and Laboratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-1806-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-1806-7_10

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-7292-2

  • Online ISBN: 978-1-4612-1806-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation