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Research Article| Volume 6, ISSUE 3, P547-576, September 1986

Creatine Kinase Isoenzymes

  • John A. Lott
    Correspondence
    Corresponding Author: Department of Pathology, The Ohio State University, 410 West 10th Avenue, Columbus, Ohio 43210-1228.
    Affiliations
    Professor of Pathology, and Director of Outpatient Clinic Laboratory, University Hospitals, The Ohio State University, Columbus, Ohio
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  • Lenox B. Abbott
    Affiliations
    Assistant Professor of Pathology, West Virginia University, School of Medicine, and Associate Director of Clinical Chemistry, West Virginia University Hospitals, Inc., Morgantown, West Virginia
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      This paper is only available as a PDF. To read, Please Download here.
      Creatine kinase (CK), a widely distributed enzyme in the body, has its highest activities in skeletal muscle and myocardium; when serum CK activities are abnormally increased, injury to these organs must be part of the differential diagnosis. The isoenzyme CK-MB is the most important biochemical test in the diagnosis of acute myocardial infarction.
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      References

        • Abbott L.B.
        • Lott J.A.
        Reactivation of serum creatine kinase isoenzyme BB in patients with malignancies.
        Clin. Chem. 1984; 30: 1861-1863
        • Allen K.R.
        • Woodrup P.
        • Hewitt J.V.
        Effect of macro creatine kinase on results of Hybritech CK-MB kit.
        Clin. Chem. 1985; 31: 1075-1076
        • Alvarez F.V.
        • Geijo S.A.
        • Sanchez A.C.
        Abnormal electrophoretic mobility of creatine kinase isoenzyme in serum of an otherwise healthy person.
        Clin. Biochem. 1983; 16: 299-302
        • Appel S.H.
        • Roses A.D.
        The muscular dystrophies.
        in: Wyngaarden J.B. Fredrickson D.S. The Metabolic Basis of Inherited Disease. Edition 5. McGraw-Hill, New York1983: 1470-1476
        • Apple F.S.
        Presence of creatine kinase MB isoenzyme during marathon training.
        N. Engl. J. Med. 1981; 305: 764-765
        • Apple F.S.
        • Rogers M.A.
        • Sherman W.M.
        • et al.
        Profile of creatine kinase isoenzymes in skeletal muscles of marathon runners.
        Clin. Chem. 1984; 30: 413-416
        • Apple F.S.
        • Rogers M.A.
        • Sherman W.M.
        • et al.
        Comparison of serum creatine kinase MB activities post marathon race versus post myocardial infarction.
        Clin. Chim. Acta. 1984; 133: 111-118
        • Bark C.J.
        Mitochondrial creatine kinase: A poor prognostic sign.
        J.A.M.A. 1980; 243: 2058-2060
        • Baur H.R.
        • Steele B.W.
        • Preimesberger K.F.
        • et al.
        Serum myocardial creatine kinase (CK-MB) after coronary arterial bypass surgery.
        Am. J. Cardiol. 1979; 44: 679-686
        • Bendz R.
        • Strom S.
        Diagnostic significance of serum CK-MB elevations following surgical damage to skeletal muscles.
        Scand. J. Thorac. Cardiovasc. Surg. 1981; 15: 199-204
        • Berg A.
        • Haralambie G.
        Changes in serum creatine kinase and hexosephosphate isomerase activity with exercise duration.
        Eur. J. Appl. Physiol. 1978; 39: 191-201
        • Bernstein L.H.
        • Sachs E.
        • Jonas A.
        Timed sequential measurements of creatine kinase MB in diagnosis of myocardial infarction.
        Clin. Chem. 1984; 30: 1588-1589
        • Biswas C.K.
        • Milligan D.A.
        • Agle S.D.
        • et al.
        Acute renal failure and myopathy after treatment with aminocaproic acid.
        Br. Med. J. 1980; 281: 115-116
        • Blum H.E.
        • Weber B.
        • Deus B.
        • et al.
        The mitochondrial creatine kinase isoenzyme from human heart muscle.
        in: Lang H. Creatine Kinase Isoenzymes. Springer-Verlag, New York1981: 19-30
        • Blum H.E.
        • Deus B.
        • Gerok W.
        Mitochondrial creatine kinase from human muscle: Purification and characterization of the crystallized isoenzyme.
        J. Biochem. 1983; 94: 1247-1257
        • Bohan A.
        • Peter J.B.
        Polymyositis and dermatomyositis.
        N. Engl. J. Med. 1975; 292: 403-407
        • Bohner J.
        • Stein W.
        • Steinhart R.
        • et al.
        Macro creatine kinases: Results of isoenzyme electrophoresis and differentiation of the immunoglobulin-bound type by radioassay.
        Clin. Chem. 1982; 28: 618-623
        • Briem H.
        • Lindquist L.
        • Lundbergh P.
        • et al.
        Creatine kinase isoenzyme BB in cerebrospinal fluid from patients with meningitis and encephalitis.
        1. Infect. Dis. 1983; 148: 180
        • Brown P.R.
        • Chiu R.C-J.
        Operative myocardial protection: Does an elevated level of creatine phosphokinase-MB isoenzyme always indicate myocardial necrosis?.
        Can. J. Surg. 1984; 27: 80-83
        • Carney D.N.
        • Zweig M.H.
        • Ihde D.C.
        • et al.
        Elevated serum creatine kinase BB levels in patients with small cell lung cancer.
        Cancer Res. 1984; 44: 5399-5403
        • Chan D.W.
        • Taylor E.
        • Frye R.
        • et al.
        Immunoenzymetric assay for creatine kinase MB with subunit-specific monoclonal antibodies compared with an immunochemical method and electrophoresis.
        Clin. Chem. 1985; 31: 465-469
        • Chandler W.L.
        • Clayson K.J.
        • Longstreth Jr., W.T.
        • et al.
        Creatine kinase isoenzymes in human cerebrospinal fluid and brain.
        Clin. Chem. 1984; 30: 1804-1806
        • Chapelle J.-P.
        • Heusghem C.
        Futher heterogeneity demonstrated for serum creatine kinase isoenzyme MM.
        Clin. Chem. 1980; 26: 457-462
        • Chemnitz G.
        • Schmidt E.
        • Schmidt F.W.
        • et al.
        Das Creatinkinase Isoenzym MB im Serum bei extrakardialen Erkrankungen.
        Verh. Dtsch. Ges. Inn. Med. 1978; 84: 1587-1590
        • Chemnitz G.
        • Nevermann L.
        • Schmidt E.
        • et al.
        Creatine kinase (EC No. 2.7.3.2) and creatine kinase isoenzymes during pregnancy and labor and in cord blood.
        Clin. Biochem. 1980; 13: 277-281
        • Cherian A.B.
        • Hill J.G.
        Age dependence of serum enzymatic activities (alkaline phosphatase, aspartate aminotransferase and creatine kinase) in healthy children and adolescents.
        Am. J. Clin. Pathol. 1978; 70: 783-789
        • Chevrot M.
        • Hesson S.
        • Piton A.
        • et al.
        Atypical serum creatine kinase MM and myeloma during dermatomyositis.
        Clin. Chem. 1982; 28: 1980-1981
        • Coolen R.B.
        • Pragay D.A.
        • Nosanchuk J.S.
        • et al.
        Elevation of brain-type creatine kinase in serum from patients with carcinoma.
        Cancer. 1979; 44: 1414-1418
        • Cornbleet P.J.
        • Evans M.D.
        Creatine kinase BB isoenzyme activity in patients with hematologic disorders.
        Clin. Chem. 1980; 26: 1635-1636
        • Davies B.
        • Watt D.A.L.
        • Daggett A.
        Serum creatine kinase and creatine kinase MB isoenzyme responses of post-infarction patients after a graded exercise test.
        Br. Heart. J. 1983; 50: 65-69
        • Delahunty T.J.
        Cathodally migrating creatine kinase in sera of patients treated with theophylline, and its diagnostic implications.
        Clin. Chem. 1983; 29: 1484-1487
        • Delva E.
        • Maille J.G.
        • Solymoss B.C.
        • et al.
        Evaluation of myocardial damage during coronary artery grafting with serial determinations of serum CPK-MB isoenzyme.
        J. Thorac. Cardiovasc. Surg. 1978; 75: 467-475
        • Demos M.A.
        • Gitin E.L.
        • Kagan L.J.
        Exercise myoglobinemia and acute exertional rhabdomyolysis.
        Arch. Intern. Med. 1975; 134: 669-673
        • Desjardins P.R.
        • Pesclovitch R.
        Subcellular localization of human heart atypical creatine kinase.
        Clin. Chim. Acta. 1983; 135: 35-40
        • Devine J.E.
        • McDaniel R.C.
        The detection of creatine kinase isoenzyme CK-1 in serum.
        Ann. Clin. Lab. Sci. 1979; 9: 80-83
        • Devine J.E.
        Macro-creatine kinase as an interference in CK isoenzyme determinations.
        Enzyme. 1983; 30: 139-144
        • Dillon M.C.
        • Calbreath D.F.
        • Dixon A.M.
        • et al.
        Diagnostic problem in acute myocardial infarction.
        Arch. Intern. Med. 1982; 142: 33-38
        • DiSilvio T.V.
        Alcoholic myopathy and changes of serum enzyme activity.
        Clin. Chem. 1978; 24: 1653
        • Dixon S.H.
        • Limbird L.S.
        • Roe C.R.
        • et al.
        Recognition of post-operative acute myocardial infarction.
        Circulation. 1973; 47: 137-140
        • Docherty I.
        • Harrop J.S.
        • Hine K.R.
        • et al.
        Myoglobin concentration, creatine kinase activity, and creatine kinase B subunit concentrations in serum during thyroid disease.
        Clin. Chem. 1984; 30: 42-45
        • Edwards R.J.
        • Watts D.C.
        Human “creatine kinase conversion factor” identified as carboxypeptidase.
        Biochem. J. 1984; 221: 465-470
        • Farah S.Y.
        • Moss D.W.
        • Ribeiro P.
        • et al.
        Interpretation of changes in the activity of creatine kinase MB in serum after coronary artery bypass grafting.
        Clin. Chim. Acta. 1984; 141: 219-225
        • Feld R.D.
        • Witte D.L.
        Presence of creatine kinase BB isoenzyme in some patients with prostatic carcinoma.
        Clin. Chem. 1977; 23: 1930-1932
        • Feld R.D.
        • Van Steirteghem A.C.
        • Zweig M.H.
        The presence of creatine kinase BB isoenzyme in patients with prostatic cancer.
        Clin. Chim. Acta. 1980; 100: 267-273
        • Fenton J.J.
        • Brunstetter S.
        • Gordon W.C.
        • et al.
        Diagnostic efficacy of a new enzyme immunoassay for creatine kinase MB isoenzyme.
        Clin. Chem. 1984; 300: 1399-1401
        • Frölich J.
        Prolonged illness and creatine kinase activity.
        Clin. Chem. 1975; 21: 1343-1344
        • Gabow P.A.
        • Kaehny W.D.
        • Kelleher S.P.
        The spectrum of rhabdomyolysis.
        Medicine. 1982; 61: 141-152
        • Gambino S.R.
        • Schneller J.
        Creatine kinase MB isoenzymes in serum of patients who undergo cardiac surgery.
        Clin. Chem. 1984; 30: 1114-1115
        • George S.
        • Ishikawa Y.
        • Perryman M.B.
        Purification and characteristics of naturally occurring and in vitro induced multiple forms of MM creatine kinase.
        J. Biol. Chem. 1984; 259: 2667-2674
        • Gerhardt W.
        • Waldenstrom J.
        Creatine kinase B-subunit in serum after immuno-inhibition of M-subunit activity.
        Clin. Chem. 1979; 25: 1274-1280
        • Giampietro O.
        • Clerico A.
        • Buzzigoli G.
        • et al.
        Detection of hypothyroid myopathy by measurement of various serum muscle markers—myoglobin, creatine kinase, lactate dehydrogenase and their isoenzymes. Correlations with thyroid hormone levels (free and total) and clinical usefulness.
        Horm. Res. 1984; 19: 232-242
        • Gimenez M.
        • Florentz M.
        Serum enzyme variations in men during an exhaustive “square-wave” endurance exercise test.
        Eur. J. Appl. Physiol. 1984; 52: 219-224
        • Goldsmith B.M.
        • Hicks J.M.
        Rhabdomyolysis: Two pediatric case reports.
        Clin. Chem. 1985; 31: 314-317
        • Golf S.W.
        • Kaul-Kunz C.
        • Roka L.
        Creatine kinase isoenzyme MB determination on the ACA: Dependence on serum matrix and other effectors.
        J. Clin. Chem. Clin. Biochem. 1984; 22: 751-758
        • Graeber G.M.
        • Snyder R.J.
        • Zajtchuk R.
        • et al.
        A comparison of serum isoenzyme levels of creatine phosphokinase and lactic dehydrogenase in patients undergoing thoracic operations and patients admitted to a coronary care unit.
        Ann. Thorac. Surg. 1980; 30: 364-369
        • Griffiths J.C.
        Creatine kinase isoenzyme 1.
        Clin. Lab. Med. 1982; 2: 493-506
        • Guslits B.G.
        • Jacobs H.K.
        Investigation of the heterogeneity of the MM isoenzyme of creatine kinase.
        Clin. Chim. Acta. 1983; 130: 55-69
        • Hackenberry L.E.
        • Miner M.E.
        • Rea G.L.
        • et al.
        Biochemical evidence of myocardial injury after severe head trauma.
        Crit. Care. Med. 1982; 10: 641-644
        • Hackl J.M.
        • Haid B.
        • Puschendorf B.
        • et al.
        Differentialdiagnose von Skelettmuskelund Herzmuskeltrauma by polytraumatischen Verletzungen durch Bestimmung der herzspezifischen Kreatinphosphokinase (CK-MB).
        Wien. Klin. Wochenschr. 1978; 90: 595-598
        • Hackshaw B.T.
        Myocardial infarction and serum enzymes.
        Clin. Chem. 1984; 30: 1285
      1. Hammond, S., Lott, J.A.: An unusual CK pattern in MI: Marker of autoimmune disease? Diagn. Med., January, 1985, pp. 8-9.

        • Hans P.
        • Born J.D.
        • Chapelle J.P.
        • et al.
        Creatine kinase isoenzymes in severe head injury.
        J. Neurosurg. 1983; 53: 689-692
        • Heinz J.A.
        • O’Donnel N.J.
        • Lott J.A.
        Apparent mitochondrial creatine kinase in the serum of a patient with metastatic cancer to the liver.
        Clin. Chem. 1980; 26: 1908-1911
        • Hill R.P.
        • Worth H.G.J.
        Serum creatine kinase MB in polymyositis.
        Clin. Chem. 1985; 31: 350
        • Hoag G.
        • Amies D.R.
        • Colquhoun B.D.P.
        The production of creatine kinase isoenzyme BB in sera of a patient with prostatic carcinoma and in tumor homogenates.
        Clin. Biochem. 1978; 11: 38-41
        • Hoag G.N.
        • Singh R.
        • Franks C.R.
        • et al.
        Creatine kinase isoenzymes in testiclar tissue of normal subjects and in a case of lymphoblastic lymphosarcoma.
        Clin. Chem. 1980; 26: 1360-1361
        • Hoag G.N.
        • Franks C.R.
        • Smith C.
        • et al.
        Creatine kinase isoenzyme patterns in normal smooth muscle and smooth muscle neoplasms.
        Clin. Biochem. 1980; 13: 149-150
        • Housinger T.A.
        • Green L.
        • Shahangian S.
        • et al.
        A prospective study of myocardial damage in electrical injury.
        J. Trauma. 1985; 25: 122-124
        • Ingwall J.S.
        • Kramer M.F.
        • Fifer M.A.
        • et al.
        The creatine kinase system in normal and diseased human myocardium.
        N. Engl. J. Med. 1985; 313: 1050-1054
        • Innes R.K.R.
        • Stromme J.H.
        Rise in serum creatine phosphokinase associated with agents used in anaesthesia.
        Rr. J. Anaesth. 1973; 45: 185-190
        • Irvin R.G.
        • Cobb F.R.
        • Roe C.R.
        Acute myocardial infarction and MB creatine phosphokinase.
        Arch. Intern. Med. 1980; 140: 329-334
        • Itano M.
        The detection of CPK1 (BB) in serum. A summary of sixteen cases.
        Am. J. Clin. Pathol. 1976; 65: 351-355
        • Jackson A.P.
        • Siddle K.
        • Thompson R.J.
        Two-site monoclonal antibody assays for human heart- and brain-type creatine kinase.
        Clin. Chem. 1984; 30: 1157-1162
        • Jaffe A.S.
        • Garfinkel B.T.
        • Ritter C.S.
        • et al.
        Plasma MB creatine kinase after vigorous exercise in professional athletes.
        Am. J. Cardiol. 1984; 53: 856-858
        • Jansson E.
        • Sylven C.
        Creatine kinase MB and citrate synthase in type I and type II muscle fibres in trained and untrained men.
        Eur. J. Appl. Physiol. 1985; 54: 207-208
        • Jenkins D.J.
        An investigation into creatine kinase and other plasma enzymes in thyroid disorders.
        Clin. Chim. Acta. 1978; 35: 197-204
        • Jockers-Wretou E.
        • Plessing E.
        Atypical serum creatine kinase isoenzyme pattern caused by complexing of creatine kinase-BB with immunoglobulins G and A.
        J. Clin. Chem. Clin. Biochem. 1979; 17: 731-737
        • Jockers-Wretou E.
        The cell nucleus as a possible source of cathodally migrating serum creatine kinase.
        Clin. Chem. 1984; 30: 1268-1269
        • Johnston C.J.
        • Bolton E.C.
        Cardiac enzymes.
        Ann. Emerg. Med. 1982; 11: 28-35
        • Jorgensen F.B.
        • Badskjaer J.
        • Sahlholt B.
        • et al.
        Creatine kinase isoenzymes in serum from children—especially focusing on CK-BB.
        Scand. J. Clin. Lab. Invest. 1984; 44: 429-432
        • Kanemitsu F.
        • Kawanishi I.
        • Mizushima J.
        Characteristics of mitochondrial creatine kinases from normal human heart and liver tissues.
        Clin. Chim. Acta. 1982; 119: 307-317
        • Kanemitsu F.
        • Kawanishi I.
        • Mizushima J.
        The origin of a cathode-migrating creatine kinase found in serum from a cancer patient.
        Clin. Chim. Acta. 1982; 122: 377-383
        • Kaste M.
        • Hernesniemi J.
        • Somer H.
        • et al.
        Creatine kinase isoenzymes in acute brain injury.
        J. Neurosurg. 1981; 55: 511-515
        • Keshgegian A.A.
        • Feinberg N.V.
        Serum creatine kinase MB isoenzyme in chronic muscle disease.
        Clin. Chem. 1984; 30: 575-578
        • Kettunen P.
        • Kala R.
        • Rehunen S.
        Creatine, kinase and its isoenzymes in skeletal muscle of athletes.
        Lancet. 1982; 2: 611
        • Kielblock A.J.
        • Manjoo M.
        • Booyens J.
        • et al.
        Creatine phosphokinase and lactate dehydrogenase levels after ultra long-distance running.
        S. Afr. Med. J. 1979; 55: 1061-1064
        • Koven I.H.
        • Freedman M.
        • Miller D.
        • et al.
        Macro-creatine kinase 2: A possible marker of gastrointestinal cancer?.
        Surgery. 1983; 94: 631-635
        • Krafft J.
        • Fink R.
        • Rosalki S.
        Serum enzymes and isoenzymes after surgery.
        Ann. Clin. Biochem. 1977; 14: 294-296
        • Krahn J.
        Upper reference limit for creatine kinase.
        Clin. Chem. 1985; 31: 158
        • Kuby S.A.
        • Keutel H.J.
        • Okabe K.
        • et al.
        Isolation of human ATP-creatine transphosphorylases from tissues of patients with Duchenne muscular dystrophy.
        J. Biol. Chem. 1977; 252: 8382-8387
        • Kwong T.C.
        • Arvan D.A.
        How many creatine kinase isoenzymes are there and what is their clinical significance?.
        Clin. Chim. Acta. 1981; 115: 3-8
        • Lederer W.H.
        • Gerstbrein H.L.
        Creatine kinase isoenzyme BB activity in serum of a patient with gastric cancer.
        Clin. Chem. 1976; 22: 1748-1749
        • Lee B.J.
        • Bach P.M.
        • Horton J.D.
        • et al.
        Elevated CK-MB and CK-BB in serum and tumor homogenate of a patient with lung cancer.
        Clin. Cardiol. 1985; 3: 233-236
        • Leroux M.L.
        • Rabson J.
        • Desjardins P.R.E.
        Clinical effectiveness of the duPont aca measurement of creatine kinase MB in serum from patients in a coronary care unit.
        Clin. Chem. 1984; 30: 1552-1554
        • Lindsey D.
        • Navin T.R.
        • Finley P.R.
        Transient elevations of serum activity of MB isoenzymes of creatine phosphokinase in drivers involved in automobile accidents.
        Chest. 1978; 74: 15-18
        • Liu T.Z.
        • Shen J.T.
        • Lee Y.-T.N.
        • et al.
        Atypical cathode-migrating creatine kinase isoenzyme and human breast carcinoma: A specific marker?.
        Clin. Chem. 1980; 26: 1765
        • Liu T.Z.
        Unusually high proportion of creatine kinase MB isoenzyme, evidently of nonmyocardial origin, in serum of a patient with cancer of the prostate.
        Clin. Clin. 1983; 29: 2127
        • Ljungdahl L.
        • Gerhardt W.
        Creatine kinase variants in human serum.
        Clin. Chem. 1978; 24: 832-834
        • Lott J.A.
        • Stang J.M.
        Serum enzymes and isoenzymes in the diagnosis and differential diagnosis of myocardial ischemia and necrosis.
        Clin. Chem. 1980; 26: 1241-1250
        • Lott J.A.
        • Heinz J.W.
        Creatine kinase in serum.
        in: Meites S. Faulkner W. Selected Methods for the Small Clinical Chemistry Laboratory. Am. Assoc. Clin. Chem., Washington, D.C.1982: 185-190
        • Lott J.A.
        Creatine kinase isoenzymes in serum.
        in: Meites S. Faulkner W. Selected Methods for the Small Clinical Chemistry Laboratory. Am. Assoc. Clin. Chem., Washington, D.C.1982: 191-199
        • Lott J.A.
        • Heinz J.W.
        Transformation of creatine kinase-BB isoenzyme in vitro: Effect of carboxylic acids, thiols, pH, and chelators.
        Clin. Chem. 1982; 28: 2414-2417
        • Lott J.A.
        • Pappas T.N.
        • Stang J.M.
        • et al.
        Electroconvulsive therapy does not change serum CK, LD, or LD isoenzymes.
        J. Clin. Psychiatry. 1982; 43: 169-170
        • Lott J.A.
        • Landesman P.W.
        The enzymology of skeletal muscle disorders.
        CRC Crit. Rev. Clin. Lab. Sci. 1984; 20: 153-190
        • Lott J.A.
        Serum enzyme determinations in the diagnosis of acute myocardial infarction: An update.
        Hum. Pathol. 1984; 15: 706-716
        • Lundar T.
        • Stokke O.
        Total creatine kinase activity in cerebrospinal fluid as an indicator of brain damage during open-heart surgery.
        Scand. J. Thor. Cardiovasc. Surg. 1983; 17: 157-161
        • Mall Th.
        • Scholer A.
        • Burckhardt D.
        Aktivitaet von Kreatinkinase (CK) und ihres Isoenzyms MB im Serum unausgewaehlter Patienten ohne akute koronare Herzkrankheit.
        Schweiz. Med. Wochenschr. 1982; 112: 1039-1045
        • Marmor A.
        • Margolis T.
        • Alpan G.
        • et al.
        Regional distribution of the MB isoenzyme of creatine kinase in the human heart.
        Arch. Pathol. Lab. Med. 1980; 104: 425-427
        • McBride J.H.
        • Rodgergson D.O.
        • Diamond L.J.
        Creatine kinase isoenzyme MB as measured by anion-exchange chromatography, immunoradiometric assay, and immunoenzymometric assay.
        Clin. Chem. 1985; 31: 1099-1100
        • McGregor C.G.A.
        • MacLeod M.D.
        • Muir A.L.
        • et al.
        Myocardial infarction related to valve replacement surgery.
        Br. Heart J. 1984; 51: 612-617
        • Medeiros L.J.
        • Greco F.A.
        • Walsh D.
        • et al.
        Macro-CK type I with electrophoretic mobility identical to CK-MB: A case report.
        Clin. Chem. 1985; 31: 1393-1396
        • Meitzer H.Y.
        Factors affecting serum creatine phosphokinase levels in the general population: The role of race, activity, and age.
        Clin. Chim. Acta. 1971; 33: 165-172
        • Mercer D.W.
        Separation of tissue and serum creatine kinase isoenzymes by ion exchange column chromatography.
        Clin. Chem. 1974; 20: 36-40
        • Miller W.G.
        • Chinchilli V.M.
        • Gruemer H.D.
        • et al.
        Sampling from a skewed population distribution as exemplified by estimation of the creatine kinase upper reference limit.
        Clin. Chem. 1984; 30: 18-23
        • Miyake S.
        • Taketa K.
        • Izumi M.
        • et al.
        Cathodic isoenzyme of serum creatine kinase in a case of stomach cancer complicated by disseminated intravascular coagulation.
        Clin. Chim. Acta. 1980; 108: 323-328
        • Miyazawa K.
        • Fukuyama H.
        • Yamaguchi I.
        • et al.
        Serial determinations of serum enzymes following aorta-coronary bypass surgery and acute myocardial infarction.
        Jpn. Heart J. 1985; 26: 45-52
        • Morelli R.L.
        • Carlson C.J.
        • Emilson B.
        • et al.
        Serum creatine kinase MM isoenzyme sub-bands after acute myocardial infarction in man.
        Circulation. 1983; 67: 1283-1289
        • Morin L.G.
        Creatine kinase: Re-examination of optimum reaction conditions.
        Clin. Chem. 1977; 23: 1569-1575
        • Nagashima T.
        • Kamegai M.
        • Hirose K.
        • et al.
        Creatine kinase (CK)-linked IgA in Isaacs’ syndrome. An immune complex disease?.
        J. Neurol. Sci. 1985; 67: 269-276
        • Nanji A.A.
        Serum creatine kinase isoenzymes: A review.
        Muscle Nerve. 1983; 6: 83-90
        • Nanji A.A.
        • Filipenko J.D.
        Non-myocardial source of CK-MB in a patient with electrical burn injury.
        Burns Inch Therm. Inj. 1984; 10: 372-373
        • Nealon D.A.
        • Henderson A.R.
        Lability of human creatine kinase isoenzymes at 37°C: A complication of electrophoretic separation.
        J. Clin. Pathol. 1975; 28: 834-836
        • Nealon D.A.
        • Henderson A.R.
        Measurement of brain-specific creatine kinase isoenzyme activity in serum.
        Clin. Chem. 1975; 21: 1663-1666
        • Neri B.
        • Cataliotti L.
        • Distante V.
        • et al.
        Serum activity of creatine kinase isoenzyme-BB as marker of human breast cancer. A case-control study.
        J. Exp. Clin. Cancer Res. 1984; 3: 229-233
        • Neufeld H.N.
        • Rabinowitz B.
        • Clejan S.
        • et al.
        Isoenzymes of creatine phosphokinase in acute myocardial infarction.
        Angiology. 1977; 28: 853-864
        • Neumeier D.
        Tissue specific and subcellular distribution of creatine kinase isoenzymes.
        in: Lang H. Creatine Kinase Isoenzymes. Springer-Verlag, New York1981: 85-109
        • Noakes T.D.
        • Kotzenberg G.
        • McArthur P.S.
        • et al.
        Elevated serum creatine kinase MB and creatine kinase BB-isoenzyme fractions after ultra-marathon running.
        Eur. J. Apph Physiol. 1983; 52: 75-79
        • Nordby H.K.
        • Urdal P.
        The diagnostic value of measuring creatine kinase BB activity in cerebrospinal fluid following acute head injury.
        Acta Neurochirurgica. 1982; 65: 93-101
        • Nuttall F.Q.
        • Jones B.
        Creatine kinase and glutamic oxaloacetic transaminase activity in serum. Kinetics of change with exercise and effect of physical conditioning.
        J. Lab. Clin. Med. 1968; 71: 847-854
        • Ogunro E.A.
        • Hearse D.J.
        • Shillingford J.P.
        Creatine kinase isoenzymes: Their separation and quantitation.
        Cardiovasc. Res. 1977; 11: 94-102
        • Oldham H.N.
        • Roe C.R.
        • Young W.G.
        • et al.
        Intraoperative detection of myocardial damage during coronary artery surgery by plasma creatine phosphokinase isoenzyme analysis.
        Surgery. 1974; 74: 917-925
        • Parienta E.A.
        • Nouel O.
        • Bernuau J.
        • et al.
        Acute rhabdomyolysis in alcoholic patients.
        Presse Med. 1983; 12: 339-343
        • Perryman M.B.
        • Knell J.D.
        • Roberts R.
        Carboxypeptidase-catalyzed hydrolysis of C-terminal lysine: Mechanism for in vivo production of multiple forms of creatine kinase in plasma.
        Clin. Chem. 1984; 30: 662-664
      2. Pesce, M. A.: The CK and LD macroenzymes. Lab. Manag., November 1984, pp. 29–41.

        • Pfeiffer F.E.
        • Homburger H.A.
        • Yanagihara T.
        Creatine kinase BB isoenzyme in CSF in neurologic diseases.
        Arch. Neurol. 1983; 40: 169-172
        • Pfeiffer F.E.
        • Homburger H.A.
        • Yanagihara T.
        Serum creatine kinase B concentrations in acute cerebrovascular diseases.
        Arch. Neurol. 1984; 41: 1175-1178
        • Phornphutkul K.S.
        • Anuras S.
        • Koff R.S.
        • et al.
        Causes of increased plasma creatine kinase activity after surgery.
        Clin. Chem. 1974; 20: 340-342
        • Ploetz J.
        • Braun J.
        Failure of “self-taming” doses of succinylcholine to inhibit increases in postoperative serum creatine kinase activity in children.
        Anesthesiology. 1982; 56: 207-209
        • Prellwitz W.
        • Neumeier D.
        Creatine kinase and CK-MB isoenzyme activity in serum of patients after surgical operations, polytrauma and other damage to skeletal muscle.
        Clin. Biochem. 1980; 13: 225
        • Pudek M.R.
        • Jacobson B.E.
        • Urquhart N.
        • et al.
        Effect of macro creatine kinase BB on results of different creatine kinase isoenzyme methods.
        Clin. Chem. 1982; 28: 1400
        • Pyle R.B.
        • Blomberg D.J.
        • Burke M.D.
        • et al.
        CK-MB isoenzyme: Use in diagnosis in acute myocardial infarction in the early postoperative period.
        J. Thorac. Cardiovasc. Surg. 1976; 71: 884-890
        • Reinhart W.H.
        • Staeubli M.
        • Koechli H.P.
        • et al.
        Creatine kinase and MB-fraction after a long distance race.
        Clin. Chim. Acta. 1982; 125: 307-310
        • Roberts R.
        Where, oh where has the MB gone?.
        N. Engl. J. Med. 1985; 313: 1081-1083
        • Rock R.C.
        • Dreskin R.
        • Kickler T.
        • et al.
        Creatine kinase isoenzymes in serum of patients with Reye’s syndrome.
        Clin. Chim. Acta. 1975; 62: 159-162
        • Roe C.R.
        • Wagner G.S.
        • Young W.G.
        • et al.
        Relation of creatine kinase isoenzyme MB to postoperative electrocardiographic diagnosis in patients undergoing coronaryartery bypass surgery.
        Clin. Chem. 1979; 25: 93-98
        • Rosalki S.B.
        An improved procedure for serum creatine phosphokinase determination.
        J. Lab. Clin. Med. 1967; 69: 696-705
        • Rubery E.D.
        • Doran J.F.
        • Thompson R.J.
        Brain-type creatine kinase BB as a potential tumor maker. Serum levels measured by radioimmunoassay in 1015 patients with histologically confirmed malignancies.
        Eur. J. Cancer Clin. Oncol. 1982; 18: 951-956
        • Rude R.E.
        • Poole W.K.
        • Muller J.E.
        • et al.
        Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients.
        Am. J. Cardiol. 1983; 52: 936-942
        • Rutledge J.
        • Clayson P.E.
        • Strandjord P.E.
        Effect of physical conditioning on serum creatine kinase after exercise.
        J.A.M.A. 1978; 240: 2633
        • Ryan W.
        • Karlinger J.S.
        • Gilpin E.A.
        • et al.
        The creatine kinase curve area and peak creatine kinase after myocardial infarction: Usefulness and limitations.
        Am. Heart J. 1981; 101: 162-168
        • Savory J.
        • Brody J.
        Measurement and diagnostic value of cerebrospinal fluid enzymes.
        Ann. Clin. Lab. Sci. 1979; 9: 68-79
        • Savory J.
        • Stallings R.G.
        • Bruns D.E.
        • et al.
        Optimization and evaluation of cardiac enzymes and isoenzymes measured on a random access analyzer.
        Ann. Clin. Lab. Sci. 1985; 15: 400-405
        • Sax S.M.
        • Moore J.J.
        • Giegel J.L.
        • et al.
        Further observation on the incidence and nature of atypical creatine kinase activity.
        Clin. Chem. 1979; 25: 535-541
        • Schiff H.B.
        • MacSearraigh E.T.M.
        • Kallmeyer J.C.
        Myoglobinuria, rhabdomyolysis and marathon running.
        Q. J. Med. 1978; 47: 463-472
        • Schwab W.
        Diagnosis of rhabdomyolysis in alcoholism.
        Acta Med. Austria. 1982; 9: 159-162
        • Shahangian S.
        • Ash K.O.
        • Walstrom Jr., N.O.
        • et al.
        Creatine kinase and lactate dehydrogenase isoenzymes in serum of patients suffering burns, blunt trauma, or myocardial infarction.
        Clin. Chem. 1984; 30: 1332-1338
        • Shell W.E.
        • Kligerman M.
        • Rorke M.P.
        • et al.
        Sensitivity and specificity of MB creatine kinase activity determined with column chromatography.
        Am. T. Cardiol. 1979; 44: 67-75
        • Sheenan M.
        • Haythorn P.
        Evaluation of an immunoenzymetric assay for creatine kinase isoenzyme MB (CK-MB).
        Clin. Chem. 1985; 31: 160-161
        • Siegel A.J.
        • Silverman L.M.
        • Holman B.L.
        Elevated creatine kinase MB isoenzyme levels in marathon runners.
        J.A.M.A. 1981; 246: 2049-2051
        • Siegel A.J.
        • Silverman L.M.
        • Evans W.J.
        Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners.
        J.A.M.A. 1983; 250: 2835-2837
        • Silverman L.M.
        • Caruso L.M.
        • Irwin L.E.
        • et al.
        Creatine kinase BB isoenzyme activity in bone-marrow serum.
        Clin. Chem. 1978; 24: 1423-1424
        • Silverman L.M.
        • Dermer G.B.
        • Zweig M.H.
        • et al.
        Creatine kinase BB: A new tumor-associated marker.
        Clin. Chem. 1979; 25: 1432-1435
        • Simon H.B.
        • Steinhaus D.M.
        Creatine kinase levels after jogging in patients with cardiac disease.
        Am. J. Med. 1984; 77: 497-500
        • SiragEldin E.
        • Klapdor R.
        Creatine kinase isoenzymes: Biochemical findings after therapeutic embolization of the hepatic artery in two patients with liver metastasis of an islet cell carcinoma or a carcinoid tumor.
        Klin. Wochenschr. 1985; 63: 257-261
        • Sitzmann F.C.
        • Orth H.
        N-acetyl-cystein-(NAC)-activated creatine kinase (CK) and isoenzyme CK-MB in the serum of children.
        Monatsschr. Kinderheilkd. 1983; 131: 509-512
        • Snow N.
        • Richardson J.D.
        • Flint Jr., L.M.
        Myocardial contusion: Implications for patients with multiple traumatic injuries.
        Surgery. 1982; 92: 744-750
        • Speer M.E.
        • Ou C.N.
        • Buffone G.J.
        • et al.
        Creatine phosphokinase BB isoenzyme in very-low-birth-weight infants. Relationship with mortality and intraventricular hemorrhage.
        J. Pediatr. 1983; 103: 790-793
        • Spincemaille J.
        • Delanghe J.
        • De Buyzere M.
        • et al.
        Evaluation of three current methods for the determination of creatine kinase-MB catalytic activity.
        J. Clin. Chem. Clin. Biochem. 1984; 22: 603-607
        • Stein B.S.
        • Dalai F.R.
        Creatine kinase isoenzymes and prostatic carcinoma: Metastatic disease or acute myocardial infarction?.
        J. Urol. 1984; 132: 142-143
        • Stein W.
        • Bohner J.
        Immunoglobulin-bound creatine kinase BB (“macro-CK”) in three patients with different diseases.
        Clin. Chem. 1979; 25: 1513-1514
        • Stein W.
        • Bohner J.
        • Steinhart R.
        • et al.
        Macro creatine kinase: Determination and differentiation of two types by their activation energies.
        Clin. Chem. 1982; 28: 19-24
        • Stein W.
        • Bohner J.
        Influence of autoantibodies to creatine kinase-BB on assays for MB isoenzyme.
        Clin. Chem. 1985; 31: 1189-1192
        • Storm T.L.
        Raised CK-MB isoenzyme after exercise in a patient with alcoholic myopathy.
        Clin. Chim. Acta. 1984; 143: 291-293
        • Strauss R.H.
        • Lott J.A.
        • Bartels R.
        • et al.
        Creatine kinase MB isoenzyme among competitive swimmers.
        N. Engl. J. Med. 1982; 306: 1180
        • Swenson R.D.
        • Golper T.A.
        • Bennett W.M.
        Acute renal failure and rhabdomyolysis after ingestion of phenylpropanolamine containing diet pills.
        J.A.M.A. 1982; 248: 1216
        • Sylven J.C.H.
        • Bomfim V.
        • Ivert T.
        • et al.
        Myocardial and non-myocardial release of myoglobin and creatine kinase MB following cardiac operations with hypothermic potassium cardioplegia.
        Cardiovasc. Res. 1982; 16: 151-157
        • Szasz G.
        • Gruber W.
        • Bernt E.
        Creatine kinase in serum: 1. Determination of optimum reaction conditions.
        Clin. Chem. 1976; 22: 650-656
        • Szasz G.
        • Gerhardt W.
        • Gruber W.
        Creatine kinase in serum: 5. Effect of thiols on isoenzyme activity during storage at various temperatures.
        Clin. Chem. 1978; 24: 1557-1563
        • Takahashi K.
        • Shutta K.
        • Matsuo B.
        • et al.
        Serum creatine kinase isoenzymes in Duchenne muscular dystrophy.
        Clin. Chim. Acta. 1977; 75: 422-435
        • Tietz N.W.
        • Wekstein D.R.
        • Shuey D.F.
        • et al.
        A two-year longitudinal reference range study for selected serum enzymes in a population more than 60 years of age.
        J. Am. Geriatr. Soc. 1984; 32: 563-570
        • Tsung S.W.
        Creatine kinase isoenzyme patterns in human tissue obtained at surgery.
        Clin. Chem. 1976; 22: 173-175
        • Tsung S.W.
        Creatine kinase activity and isoenzyme pattern in various normal tissues and neoplasms.
        Clin. Chem. 1983; 29: 2040-2043
        • Tzevtanova E.
        Serum creatine kinase isoenzymes in progressive muscular dystrophy.
        Enzyme. 1978; 23: 238-245
        • Urdal P.
        • Landaas S.
        Macro creatine kinase BB in serum, and some data on its prevalence.
        Clin. Chem. 1979; 25: 461-465
        • Urdal P.
        • Urdal K.
        • Stromme J.H.
        Age-related reference intervals for creatine kinase BB in serum.
        Scand. J. Clin. Lab. Invest. 1982; 42: 621-625
        • Urdal P.
        • Urdal K.
        • Stromme J.H.
        Cytoplasmic creatine kinase isoenzymes quantitated in tissue specimens obtained at surgery.
        Clin. Chem. 1983; 29: 310-313
        • Vergnon I.M.
        • Guidollet J.
        • Louisot P.
        • et al.
        Small cell pulmonary cancer. Creatine phosphokinase isoenzyme BB in the serum, pleural fluid and neoplastic tissue.
        Presse Med. 1983; 12: 364-365
        • Vergnon J.M.
        • Guidollet J.
        • Louisot P.
        • et al.
        Creatine kinase BB isoenzyme in a case of small cell lung carcinoma.
        Pathol., Biol. 1984; 32: 185-187
        • Vladutiu A.O.
        • Venuto R.C.
        Creatine kinase MB and lactate dehydrogenase 5 isoenzymes in rhabdomyolysis.
        Clin. Chem. 1977; 23: 1366
        • Warren S.G.
        • Wagner G.S.
        • Bethea C.F.
        • et al.
        Diagnostic and prognostic significance of electrocardiographic and CPK isoenzyme changes following coronary bypass surgery.
        Am. Heart J. 1977; 93: 189-196
      3. Wenger, W. C.: Release of creatine kinase from mitochondria. Ph.D. thesis, The Ohio State University, 1984.

        • Wevers R.A.
        • Wolters R.J.
        • Soons J.B.J.
        Isoelectric focusing and hybridisation experiments on creatine kinase.
        Clin. Chim. Acta. 1977; 78: 271-276
        • Wevers R.A.
        • Olthuis H.P.
        • VanNiel J.C.C.
        • et al.
        A study on the dimeric structure of creatine kinase.
        Clin. Chim. Acta. 1977; 75: 377-385
        • Wevers R.A.
        • Jansen P.H.P.
        • VanWoerkom L.M.J.
        • et al.
        The significance of total creatine kinase activity and isozyme determinations in cerebrospinal fluid of neurological patients.
        Clin. Chim. Acta. 1984; 143: 193-201
        • Whelan P.V.
        • Malkus H.
        A macro creatine kinase isoenzyme in serum of apparently healthy individuals.
        Clin. Chem. 1983; 29: 1411-1414
        • Wong E.T.
        • Cobb C.
        • Umehara M.K.
        • et al.
        Heterogeneity of serum creatine kinase activity among racial and gender groups of the population.
        Am. J. Clin. Pathol. 1983; 79: 582-586
        • Wu A.H.B.
        • Bowers Jr., G.N.
        Evaluation and comparison of immunoinhibition and immunoprecipitation methods for differentiating MB from BB and macro forms of creatine kinase isoenzymes in patients and healthy individuals.
        Clin. Chem. 1982; 28: 2017-2021
        • Wu A.H.B.
        • Gornet T.G.
        • Bretaudiere J.P.
        • et al.
        Comparison of enzyme immunoassay and immunoprecipitation for creatine kinase MB in diagnosis of acute myocardial infarction.
        Clin. Chem. 1985; 31: 470-474
        • Yagiela J.A.
        • Beneit P.W.
        • Buoncristian R.D.
        • et al.
        Comparison of myotoxic effect of lidocaine with epinephrine in rats and humans.
        Anesth. Ann. 1981; 60: 471-480
        • Yasmineh W.G.
        • Ibrahim G.A.
        • Abbasnezhad M.
        • et al.
        Isoenzyme distribution of creatine kinase and lactate dehydrogenase in serum and skeletal muscle in Duchenne muscular dystrophy, collagen disease, and other muscular disorders.
        Clin. Chem. 1978; 24: 1985-1989
        • Yasmineh W.G.
        • Lewis L.A.
        • Apple F.S.
        Chromatographic behavior of immunoglobulin-bound creatine kinase on DEAE-Sephadex A-50.
        Clin. Chim. Acta. 1984; 144: 29-37
        • Yuu H.
        • Ishizawa S.
        • Takagi Y.
        • et al.
        Macro creatine kinase: A study on CK-linked immunoglobulin.
        Clin. Chem. 1980; 26: 1816-1820