Creatine Kinase Isoenzymes: Pathophysiology and Clinical Application

ISBN-13: 9783540107149 / Angielski / Miękka / 1981 / 317 str.

H. Lang

Opis

No one has counted the enzymes in the human organism, and probably their profuse number can only be estimated from the restrictions the finite mass of genetic material imposes. Still, nu merous catalytic activities have been identified and investigated for their clinical relevance. After one century of such research, surprisingly, only a handful of enzymes has survived the stern trial of clinical application to find regular medical use. Dis regarding genetic defects, most of the diagnostically used en zymes participate in metabolic conversions fundamental to life: the utilization, transfer or fixation of vital nutrients or of cheJ, llical energy. Creatine kinase is central to the function of the mitochond rion, the cellular power generator. The wider distribution of this enzyme is linked to tissues whose physiology crucially relies on an adaptable supply of energy, notably skeletal muscle, the brain, and the heart. Just as these three tissues vary in their pre ference for different energy sources, each produces a different isoenzyme of creatine kinase. Accordingly, the finding of elevat ed creatine kinase activity in blood can lead to a variety of interpretations, but in practice the diagnosis of acute myocardial infarction is the major consideration."

Spis treści

1 Introduction.- 1.1 Creatine Kinase in Muscular Metabolism.- 1.2 Creatine Kinase in Clinical Chemistry.- 1.3 Creatine Kinase Isoenzymes.- 1.4 Scope and Summary of this Book.- 2 Creatine Kinase Isoenzymes.- 2.1 The Cytoplasmic Isoenzymes from Human Tissues.- 2.1.1 Preparation of CK Isoenzymes.- 2.1.2 Properties of CK Isoenzymes.- 2.2 The Mitochondrial Isoenzyme from Human Heart Muscle.- 2.2.1 Introduction.- 2.2.2 CK Isoenzymes in Human Heart Muscle.- 2.2.3 Purification and Characterization of the Mitochondrial Isoenzyme from Human Heart Muscle.- 2.2.4 Concluding Remarks.- 3 Methods for Differentiation and Quantitation of Creatine Kinase Isoenzymes.- 3.1 Methods for Determination of Creatine Kinase Activity.- 3.1.1 “Forward” Reaction.- 3.1.2 “Reverse” Reaction.- 3.1.3 Reactivators.- 3.1.4 Interferences.- 3.1.5 Fluorescence and Bioluminescence.- 3.2 Differentiation of Isoenzymes by Non Immunological Methods..- 3.2.1 Electrophoresis.- 3.2.2 Ion Exchange Chromatography.- 3.2.3 Other Physicochemical Methods.- 3.2.4 Biochemical Methods.- 3.2.5 Evaluation of Non Immunological Methods.- 3.3 Measurement of Isoenzyme Activity by Immunological Methods..- 3.3.1 Immunoprecipitation.- 3.3.2 Immunoinhibition.- 3.3.3 Comparison of Immunoprecipitation with Immunoinhibition.- 3.3.4 Discussion.- 3.4 Experimental Comparison of Methods for Differentiation of Isoenzymes.- 3.4.1 Ion Exchange Chromatography vs. Immuno-inhibition.- 3.4.2 Differential Activation vs. Immunoinhibition.- 3.4.3 Electrophoresis vs. Immunoinhibition.- 3.4.4 Summary.- 3.5 Measurement of Isoenzyme Concentration by Immunoassay..- 3.5.1 Scope.- 3.5.2 Methodology.- 3.5.3 Methodological Criteria.- 3.5.4 Comparison of Methods.- 3.5.5 Clinical Results.- 3.5.6 Summary.- 4 Tissue Specific and Subcellular Distribution of Creatine Kinase Isoenzymes.- 4.1 Tissue Specific Distribution.- 4.1.1 Investigations with Non Immunological Methods.- 4.1.2 Investigations with Immunological Methods.- 4.1.3 Results Obtained with Radioimmunoassay.- 4.1.4 Summary.- 4.2 Subcellular Distribution.- 4.2.1 Introduction.- 4.2.2 Cell Nucleus.- 4.2.3 Microsomes.- 4.2.4 Myofibrillar Localization.- 4.2.5 Other Subcellular Localizations.- 4.3 Ontogeny.- 4.3.1 Introduction.- 4.3.2 CK Isoenzymes in Developing Human Tissue.- 4.3.3 Concluding Remarks.- 5 Clinical Results: Myocardium.- 5.1 Myocardial Infarction.- 5.1.1 Activity Kinetics of CK-MB Isoenzyme after Myocardial Infarction.- 5.1.2 Differential-Diagnostic Validity of CK-MB Determination in Suspected Myocardial Infarction.- 5.2 Infarct Size Estimation from Serial Analyses of CK and Isoenzyme Activity..- 5.3 Perioperative Infarction.- 5.3.1 Work with Non Immunological Methodology.- 5.3.2 Work with Immunological Methodology.- 5.4 Complications, Differential Diagnosis, and Diagnostic/ Therapeutic Procedures Associated with Myocardial Infarction..- 5.4.1 Cardiogenic Shock.- 5.4.2 Shock (Other than Cardiogenic).- 5.4.3 Pulmonary Embolism and Bronchial Asthma.- 5.4.4 Diagnostic and Therapeutic Procedures.- 5.5 Heart Failure and Inflammation..- 5.5.1 Introduction.- 5.5.2 Patients and Methods.- 5.5.3 Results.- 5.5.4 Discussion.- 6 Clinical Results: Skeletal Muscle.- 6.1 Direct Skeletal Muscle Damage..- 6.1.1 Exercise.- 6.1.2 Intramuscular Injections.- 6.1.3 Surgical Operations.- 6.1.4 Multiple Trauma.- 6.1.5 Cerebral Arterial Embolism and Convulsive Diseases.- 6.1.6 Malignant Hyperthermia.- 6.1.7 Summary.- 6.2 Muscular Dystrophies..- 6.2.1 Screening.- 6.2.2 Diagnosis.- 6.2.3 Possibilities for Determination of the Carrier.- Status.- 6.2.4 Prenatal Diagnosis of Duchenne Muscular Dystrophy.- 6.2.5 Possible Importance of Estimation of CK Isoenzymes for Diagnosing some Other Diseases..- 6.3 Hypothyroidism..- 6.3.1 CK in Hypothyroidism.- 6.3.2 Results of CK-MB Investigations.- 6.4 Various Muscular Diseases..- 6.4.1 Myasthenia Gravis.- 6.4.2 Myositis (Associated with Infectious or Parasitic Disease).- 6.4.3 Acute Rhabdomyolysis.- 6.4.4 Degenerative Diseases of the Nervous System.- 6.4.5 Sarcoidosis.- 6.4.6 Acromegaly.- 6.5 Collagen Diseases..- 6.5.1 Introduction.- 6.5.2 Patients and Methods.- 6.5.3 Results.- 6.5.4 Discussion.- 7 Clinical Results: Central Nervous System.- 7.1 Cerebral Diseases..- 7.1.1 CK Isoenzyme Activity in Serum.- 7.1.2 CK Isoenzyme Activity in Cerebrospinal Fluid.- 7.1.3 Reye’s Syndrome.- 7.2 Acute Psychosis..- 7.2.1 Introduction.- 7.2.2 Patients and Methods.- 7.2.3 Results.- 7.2.4 Discussion.- 8 Clinical Results: Gastrointestinal Tract, Liver, and Pancreas..- 8.1 Gastrointestinal Tract Diseases.- 8.2 Liver Diseases.- 8.3 Pancreatic Diseases.- 9 Clinical Results: Kidney and Urogenital Tract..- 9.1 Renal Diseases.- 9.2 Prostatic Carcinoma.- 10 Clinical Results: Intoxication.- 10.1 Exogenous Intoxication..- W. Prellwitz.- 10.1.1 Serum CK Isoenzyme Activity in Patients with Exogenous Intoxication.- 10.1.2 Serum CK-MB as Measure of Myocardial Damage in Patients with Exogenous Intoxication.- 10.1.3 Other Complications of Exogenous Intoxication.- 10.2 Alcoholism..- 10.2.1 Introduction.- 10.2.2 Patients and Methods.- 10.2.3 Results.- 10.2.4 Discussion.- 11 Clinical Results: Perinatal Period..- 11.1 Enzymes in Pregnancy.- 11.2 Myometrium and Placenta.- 11.3 Maternal Serum During Pregnancy, Labor, and After Delivery.- 11.4 Cord Blood.- 11.5 Discussion.- 11.6 Summary.- 12 The Creatine Kinase 242 BB Isoenzyme..- 12.1 Distribution ofCK-BB in Human Tissues.- 12.2 Problems in Evaluation of Published Data.- 12.3 Serum CK-BB Activity.- 12.4 CK-BB in Cerebrospinal Fluid.- 12.5 “Idiopathic” and “Macro” Serum CK-BB.- 12.6 Genetic Variants.- 12.7 Summary.- References.- List of Abbreviations.