An increase in serum creatine kinase-MB (CK-MB) isoenzyme is regarded as a specific indication of acute myocardial infarction. Recently, increased concentrations of various types of creatine kinase isoenzymes (mostly CK-BB and macro CK type 2 isoenzymes) have been found in the blood of some patients with malignancies. However, highly elevated serum CK-MB isoenzyme associated with malignancy has rarely been reported previously. Herein a case of extensive small cell lung cancer is presented in which the elevated serum levels of CK were detected throughout the three weeks of hospitalization. Fractionation of its isoenzymes by gel electrophoresis displayed elevated CK-MB and CK-BB isoenzymes. The proportion of serum CK-MB and CK-BB isoenzyme activities was persistently above normal (CK-MB 50-53%, normal < 5%). Clinical examination showed no evidence of myocardial infarction or injury, or tumor involvement of the heart. The tumor was the probable source of most circulating CK-MB isoenzyme. In clinical practice, markedly elevated levels of CK-MB, or increased levels of CK-MB in combination with CK-BB may point away from a myocardial origin and toward the existence of a malignancy.

Activity of creatine kinase (CK) and its isoenzymes was studied in blood serum of 32 patients with alcohol abstinent syndrome of various severity as well as in persons with long-term remission (from 1 to 14 years) as compared with the enzymatic activity in healthy volunteers. The severity of alcohol abstinent syndrome correlated with an increase in the total enzyme activity in blood, where content of the all three CK isoenzymes (MM, MB and BB), especially of BB-CK, was elevated. Content of MB and BB isozymes was increased in blood of patients with long-term remission, while activity of each of the isozyme constituted up to 20-30% of total CK activity, which was by one decimal order higher as compared with control values. Importance of the alterations observed in activity of creatine kinase and its isoenzymes for diagnosis of alcoholism, especially under conditions of alcohol abuse and long-term alcohol abstinence, is discussed.

The authors report the case of an 80-year-old man with prostatic disease whose serum contained an aberrant band in the MB position on agarose gel electrophoresis of creatine kinase (CK) isoenzymes. The authors demonstrated that the band probably was CK BB; the patient had no evidence of myocardial infarction. Contrary to most previous reports of such cases, the aberrant enzyme did not appear to be linked with IgG, IgA, or IgM; it also did not behave as if attached to a chelatable cation. Care must be taken to avoid mistaking such bands for CK MB.

We examined the time course of CK and its isoenzymes in 15 patients with severe ischemic stroke. Patients with cerebral transtentorial herniation (n = 7) had the highest CK-BB activity during herniation (1.54 +/- 0.6 U/L, mean +/- SD; range: 1.0-2.6 U/L). These values were distinctly above the values of a control group of 20 patients with non-neurological diseases (0.39 +/- 0.2 U/L, mean +/- SD). In patients with smaller lesions without herniation (n = 8) the maximum CK-BB increase was lower (0.56 +/- 0.26 U/L, mean +/- SD).

We have previously demonstrated that rat bone in vivo and rat bone cells in vitro, responded sex-specifically to gonadal steroids in stimulation of the specific activity of the BB isozyme of creatine kinase (CK), a marker for hormonal responsiveness. Pre-treatment with vitamin D analogs up-regulated the sex-specific responsiveness and sensitivity to gonadal steroids. We also found that mice cultured femoral bone marrow (BM) in the presence of dexamethasone (DEX) and 1,25(OH)2D3 (1,25D) or both differentiated into osteoblast-like cells (Obs), which acquired sex-specific responsiveness to gonadal steroids. This response was significantly augmented in the presence of both agents. In the present study, we examined the effect of age, sex and vitamin D non-hypercalcemic analogs on the differentiation of rat derived femoral BM into Obs. In female or male derived BM from intact but not gonadectomized rats DEX and DEX+1,25D increased the constitutive levels of CK. BM derived from old females showed lower stimulation of CK than BM originated from young females by estradiol (E2) or raloxifene (Ral) in the presence of both DEX and 1,25D. The non-hypercalcemic analogs of vitamin D: CB 1093 (CB), EB 1089 (EB) and MC 1288 (MC) were more effective than 1,25D in both age groups in stimulating CK in the absence of DEX. In the presence of DEX, there was a further increase in CK with the same differential effectiveness. BM from gonadectomized male or female rats lost the sex-specific response, responding to both E2 and dihydrotestosterone (DHT). BM derived from both intact and gonadectomized males and females, growing with DEX or DEX+1,25D showed increased specific activity of constitutive levels of alkaline phodphatase (AP). No significant stimulation of AP was seen in any BM by gonadal steroids. These findings suggest that manipulation of the hormonal milieu in early stages of differentiation sequence of Obs determines the subsequent selective responsiveness of the developing bone tissue to sex steroids. Also non-calcemic vitamin D analogs were more effective in this process than 1,25D and showed activity even in the absence of DEX and may be applied to the differentiation process for bone tissue engineering.

Fifty-nine patients with stage D carcinoma of the prostate under different modalities of treatment were studied for creatine phosphokinase isoenzyme BB (CK-BB) and prostatic acid phosphatase (PAP) levels in serum by radioimmunoassay (RIA) technique, in order to study the possible use of CK-BB as a follow-up marker compared to PAP. Thirty-three patients were in stable, 19 in progressive, and seven in regressive clinical state. CK-BB was above normal level in 52 (88%) out of 59 patients with no statistically significant difference between the three clinical states. On the other hand, PAP was above normal level in only 23 patients (38.98%) with statistically significant difference between the three clinical states (P less than 0.001). The PAP/CK-BB index was below 1 in stable and regressive condition, while it was above 1 in eight out of 19 patients with progressive disease. The PAP/CK-BB index may be of prognostic importance. CK-BB by RIA was abnormal in more cases than PAP. In this way CK-BB reflects the presence of the tumor and may be used for diagnosis; however, it does not reflect the clinical response as PAP does.

Creatine kinase BB has been described to be elevated in the serum of patients with prostate cancer. The incidence of abnormal serum levels correlates with the degree of differentiation of the tumor; that is, the more poorly differentiated tumors are associated most frequently with elevated CK-BB levels. We have recently described two additional findings which involve CK-BB in prostate cancer: 1) the finding of abnormally migrating CK-BB bands reported to be IgG-CK-BB complexes in several Stage D patients and in 2/3 Stage B patients following 125I implants, and 2) significant differences between CK-BB purified from prostatic fluid from CK-BB of brain origin. In particular, we find two bands of prostatic CK-BB following purification as compared to a single band from brain, when the same purification protocol is used. While further characterization of these differences is proceeding, the two bands of CK-BB are being used to develop a prostate-specific antiserum for use in immunoassays to detect prostate cancer in conjunction with other traditional markers such as prostatic acid phosphatase. If serum detection of tumor markers is to be efficacious, tumor marker panels such as CK-BB and prostatic acid phosphatase may provide a significant advantage over individual markers.

Retrograde cerebral perfusion (RCP) is used to prolong the safe period of circulatory arrest under profound hypothermia. However, this technique now varies in some maneuvers at different institutions. This study investigated the effects on cerebral metabolism of clamping blood flow through the IVC cannula during RCP using fourteen adult mongrel dogs. During circulatory arrest, RCP by way of the bilateral internal maxillary vein was performed. In seven dogs, blood flow was drained through IVC cannula (IVC-drained group) and in the other seven dogs, the blood flow was clamped during RCP (IVC-clamped group). During RCP, the percent of returned blood volume, oxygen consumption, exudation of carbon-dioxide, and oxygen saturation of the returned blood were significantly higher in the IVC-clamped group than in the IVC-drained group, and the concentration of serum CK-BB in the IVC-clamp group was significantly lower than in the IVC-drained group. However, there was no statistical difference between the two groups concerning the regional cerebral blood flow or water content of the cerebral tissue. Concerning about these results, a part of perfused blood passed through not only the extra cranial veno-venous connection but also the intra cranial veno-capillary-venous connection. We concluded that clamping of the venous blood flow through the IVC cannula during RCP is a more protective procedure for cerebral tissue.

By using a recently developed highly sensitive enzyme immunoassay method, concentrations of the 3 forms of cytoplasmic creatine kinases (CK-BB, CK-MB and CK-MM) were determined in blood samples serially taken from 18 patients who received mitral valve replacement. Blood CK-BB levels, 0.64 +/- 0.32 ng/ml at the beginning of anesthesia, rose sharply after reperfusion reaching the peak level (23.3 +/- 7.56 ng/ml) 2 hours after reperfusion, and then fell rapidly. The response of CK-BB in blood was rapider and more sensitive than that of CK-MB or CK-MM. The CK-BB concentrations were significantly higher in coronary sinus samples than in arterial samples. These results suggest that the major portion of elevated blood CK-BB level in the early phase after reperfusion are derived from the heart muscle.

Creatine kinase (CK) activity in plasma obtained non-invasively from adult healthy, Sprague-Dawley, male rats was found to be 528 +/- 270 U/L (N = 17), a value which was 7 times that obtained in human specimens. Agarose gel electrophoresis revealed that the only detectable CK isoenzyme present was CK-BB, in contrast to the human serum isoenzyme which was CK-MM. Furthermore, it was found that the rat CK-BB could be detected using an RIA technique designed to quantitate human CK-BB occasionally present in blood after brain injury (rat CK-BB = 84.5 +/- 55.2 micrograms/L, N = 17, human CK-BB: Not detectable). It was thus possible to calculate the CK-BB specific activity (SA) in rat plasma using total CK assay and RIA (rat CK-BB SA = 6.25 +/- 3.87 U/micrograms, N = 17). When six rats (156 +/- 23 g) were treated with lead acetate in the drinking water (26 mM) for 3 weeks, the CK-BB SA rose to 18 +/- 5.8 U/micrograms (P less than .02). At this point the electrophoresis pattern of the CK-BB showed a transient change from a single band to a doublet. The dose was then increased to 52 mM for 6 weeks, during which time the CK-BB SA declined steadily to 1.6 +/- 0.6, a level significantly less than that of the untreated animals (p less than .02). The results suggest that chronic lead treatment evokes a biphasic response in CK-BB SA with the initial release of enzyme of high SA from tissues. Further treatment apparently results in an inactivation of the enzyme within lead sensitive tissues.

A comparison of cranial ultrasonography, CK-BB and neurological assessment was undertaken in 30 (16 severely, 14 moderately) asphyxiated newborns. In the 16 severely asphyxiated newborns, cranial ultrasonography proved to be of value when changes of 'cerebral oedema' persisted for longer than 48 hrs. Although the mean creatine-kinase (CK-BB) activity at 12-33 hrs after birth was higher compared with that in controls of the same age, the numbers were too small in the different age categories for statistical analysis. The 81.25% specificity of ultrasound as compared with 76.47% of CK-BB suggests that the former investigation is a better indicator of cerebral injury. Phenobarbitone administered as an anticonvulsant in eight patients did not influence the CK-BB levels and the outcome in these babies. The persistence of neurological signs for more than 2 weeks predicted a poor outcome. Sixty-two per cent of the severely asphyxiated babies were light-for-dates, indicating that a chronic condition may have contributed to the poor overall prognosis in these neonates. From a combination of persisting abnormal appearances on cranial ultrasonography, elevated CK-BB activity and neurological impairment, death or significant neurological damage in nearly 90% of the severely asphyxiated babies could be predicted.

A wide variety of tumour markers has been described in bronchial carcinoma. Clinical studies have been most frequently conducted with the substances CEA, NSE, CK-BB and for the peptid hormones ACTH, calcitonin and ADH. The serum levels for CEA, NSE and CK-BB correlate to a certain extent with the stage of the tumour disease, the prognosis and the survival time. On the other hand, the peptid hormones have no clinical significance on account of their low sensitivity and specificity. Outside of clinical studies the determination of tumour markers in bronchial carcinoma is clinically irrelevant.

Total CK and iso-enzyme CK-BB activity was measured in serum from four sheep with scrapie and in serum from four healthy control sheep. Blood samples were taken weekly for about six months. There was a clear overlap between the total CK and CK-BB activity in serum from sheep with scrapie and that in serum from control sheep. Thus measurement of these enzymes does not aid the clinical diagnosis of scrapie.

A total of 712 Shigella strains were studied with the use of dysentery diagnostic phages DD II, DD VI and DD VII in order to reveal the systems of host DNA specificity. The study comprised 4 tests: mass screening by the intensity of phagolytic reaction of phages in various strains; and the determination of the parameters of adsorption. As a result, an effective modification and restriction systems were revealed in Sh. sonnei 311 with the use of phage DD II. Bacteriophage DD VII was effectively restricted in E. coli CK, BB and BB/T4. Cross titration showed that the modification and restriction systems of E. coli BB and BB/T4 differed from the specificity system of E. coli CK. Phage DD VI had an exceptionally broad spectrum of activity and was not sensitive to any known restriction system.

CK-MB protein is an important marker for the diagnosis of acute coronary syndromes. In the present study, we evaluated the basal performance of recently developed CK-MB mass kit "L-type wako CK-MB mass". Within-run and between-day precision were obtained with 1.4-4.7% and 2.7-5.2%, respectively. Diluted linearity and lower limit of detection were obtained with 180.0 ng/mL and 2.1 ng/mL, respectively. Zone phenomenon was able to detect until 25,600.0 ng/mL. Analysis of interferent showed that only CK-BB positively influenced the assay results. CK-MB protein levels decreased to 82% at 72 hours in the room temperature, but it was stable at 4 degrees C and -20 degrees C. The correlation coefficient(r) between this assay and conventional assay was 0.999. However, discrepancy of the two cases was observed in the comparison between the two methods. In the case 1, CK isoenzyme analysis using electrophoresis indicated that CK-MB was not present and absorption test showed a 68% absorption effect of CK-MB protein values not by anti human IgG, anti human IgA, and animal serums, but anti human IgM. In the case 2, CK isoenzyme analysis indicated that there is not only CK-MB but CK-BB. CK-MB protein values between the two methods were fitted after decreasing CK-BB. Thus, Value discrepancy for CK-MB protein was resulting from IgM and CK-BB. We have to pay attention to such phenomenon when detecting an unlikely higher levels that could not be explained by clinical information.

Nine hundred and forty patients (1023 samples) were analyzed by cellulose acetate electrophoresis for creating kinase MB (MB CK) in the routine clinical chemistry laboratory during screening for acute myocardial infarction. Thirty patients showed the presence of BB CK and the associated disease states were identified. Rigid criteria were applied to demonstrate the activity observed was genuinely BB CK. It is noted and demonstrated that careful attention must be paid to the methodology used to distinguish CK isoenzymes, because some assays do not differentiate between BB CK and MB CK. It was shown by us that the false positive rate for MB CK could be as great as 19 percent in laboratories using non-discriminant assays for MB CK. Thus, the laboratory must know the limitations of the assays employed to avoid potential errors in MB CK results that could be misused as biochemical evidence of a myocardial infarction.

The case histories of two children (aged two months) affected by myocarditis showing an atypical band of serum creatine kinase (EC 2.7.3.2; CK) in the CK isoenzyme electrophoretic pattern are reported. The electrophoretic mobility on cellulose acetate of the atypical iso-CK band and its greater relative molecular mass, the lack of binding with immunoglobulins and the result of CK-BB determination by RIA, allowed us to identify the band with an oligomeric form of the mitochondrial isoenzyme. One child died 2 days after admission, while in the other it was possible to demonstrate reduction and disappearance of the atypical band in concomitance with a marked clinical improvement. Our findings suggest that the oligomeric form of mitochondrial-CK is released in conditions of serious heart muscle damage, and that it may be an indicator of myocardial cellular necrosis in pediatric patients.

In the early phase of acute myocardial infarction the determination of the creatinkinase-isoenzyme CK-MB has a high diagnostic value. In everyday laboratory routine the CK-MB-immunoinhibition test is most widely used. In rare cases it can lead to spuriously high and therefore false positive CK-MB values. Two patients with suspected acute myocardial infarction are presented. The laboratory findings showed in both cases very high CK-MB-activities, values significantly above the differential diagnostic borderline of 6%. The course of the CK-activity and additional qualitative laboratory tests led to the diagnosis of macro-CK-BB-emia.

Measurement of serum myoglobin, CK-MM isoforms and CK-MB isoenzyme protein are useful for diagnosis and therapy of acute myocardial infarction (AMI). As latex agglutination turbidimetry of serum myoglobin is an easy and rapid assay method, it can be applied for early diagnosis of AMI and its observation of progress after break out of AMI. CK-MM isoforms also can be applicable for early diagnosis of AMI. The assay method of CK-MB isoenzyme protein by immunochemiluminescence is useful for anticipating the infarct size of AMI since this format is not influenced by CK-BB, myokinase, or mitochondria CK.

The article presents the results of the analysis of total CK enzyme activity and CK isoenzymes in the cerebrospinal fluid of 148 patients with acute stroke, treated at the Intensive Care Unit of the Department of Neurology and Department of Neuropathology of the Clinical Hospital Center Rebro. The aim of the study was to determine the reliability of the applied methods in the prognosis of the outcome of cerebrovascular diseases. Greatly increased total CK enzyme activity is more frequently encountered in patients with ICH than in those with ISI. Great elevation of total CK activity can be considered a bad prognostic sign in patients with ICH, while in those with ISI only moderately increased total CK enzyme activity can be regarded as a bad prognostic sign. The greatest incidence of pathological CK isoenzyme profile, that is the presence of both MM and BB fractions together, was found in the group of patients who died with ICH, while the greatest frequency of BB fraction alone was observed in the group of patients who survived with ISI. In the group of the deceased with ISI the greatest frequency was that of MM and BB fractions together. Therefore, the occurrence of BB fraction alone can be considered a good prognostic sign, while the occurrence of MM and BB fractions together a bad one. The presence of MM and BB fraction together, as well as the simultaneous presence of all three fractions of isoenzymes, are most frequently associated with elevated total CK enzyme activity. The occurrence of BB isoenzyme fraction alone is most frequently accompanied by normal value of total CK activity, rarely with slightly to moderately, and very rarely with greatly increased total CK enzyme activity. The determination of total CK activity and of CK isoenzyme profile is performed by means of two complementary investigations which should be performed simultaneously.

The affinity of the estrogen-induced protein, IP, for reconstituted F-actin in uterine homogenates was investigated. The results demonstrate that a significant proportion of a 46 K protein, of which the rate of synthesis is increased by estrogen, two properties of BB-CK, co-sedimented with in vitro re-polymerized actin.

This study concerns the prognostic value of total cord-blood CK-BB activity measured with a new method in preterm infants at risk of PIVH. Twenty-six patients with gestational age less than 36 weeks were studied. The presence of PIVH was proved by either ultrasound scans or autopsy. Total CK-BB values in cord-blood of infants who developed PIVH were significantly higher than those of patients without cerebral bleeding (P less than 0.001).