Journal of the Chinese Medical Association
Volume 73, Issue 1 , Pages 35-39, January 2010

Macroenzyme Creatine Kinase in the Era of Modern Laboratory Medicine

  • Chun-Yu Liu

      Affiliations

    • Division of Hematology and Oncology, I-Lan, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, I-Lan, Taiwan, R.O.C.
    • ,
  • Yi-Chun Lai

      Affiliations

    • Department of Medicine, I-Lan, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, I-Lan, Taiwan, R.O.C.
    • Department of Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan, R.O.C.
    • ,
  • Yi-Chi Wu

      Affiliations

    • Section of Biochemistry, Department of Laboratory Medicine and Pathology, Taipei Veterans General Hospital, I-Lan, Taiwan, R.O.C.
    • ,
  • Cheng-Hwai Tzeng

      Affiliations

    • Division of Hematology and Oncology, I-Lan, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, I-Lan, Taiwan, R.O.C.
    • ,
  • Shou-Dong Lee

      Affiliations

    • Division of Gastroenterology, I-Lan, Taiwan, R.O.C.
    • Department of Medicine, I-Lan, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, I-Lan, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Shou-Dong Lee, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 16 June 2009; accepted 11 September 2009.

Article Outline

Among the conditions in which creatine kinase (CK)-MB activity is elevated in the absence of myocardial injury or infarction, macroenzyme (macro) CK merits special attention from clinicians. We present 2 cases, 1 with macro CK type 1 and the other with macro CK type 2, to stress the common clinical situations and diagnostic dilemma that clinicians encounter when evaluating patients with macro CK. Moreover, the rare conditions associated with macro CK, and the phenomenon of spuriously high CK-MB activity out of proportion to total CK, are discussed. The biochemical characteristics, clinical significance and potential implications of macro CK are reviewed within the scope of modern laboratory medicine.

Key Words:  creatine kinase , hepatitis C virus , isoenzymes , macro creatine kinase , myocardial infarction

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References 

  1. Saenger AK , Jaffe AS . Requiem for a heavyweight: the demise of creatine kinase-MB . Circulation . 2008;118:2200–2206
  2. Robinson DJ , Christenson RH . Creatine kinase and its CKMB isoenzyme: the conventional marker for the diagnosis of acute myocardial infarction . J Emerg Med . 1999;17:95–104
  3. Wang HC , Lu JY , Ting YM . Elevated serum CK-MB and CKBB isoenzymes in a patient with small cell lung cancer: a case report . J Chin Med Assoc . 1995;55:270–273
  4. Galasso PJ , Litin SC , O'Brien JF . The macroenzymes: a clinical review . Mayo Clin Proc . 1993;68:349–354
  5. Sturk A , Sanders GT . Macro enzymes: prevalence, composition, detection and clinical relevance . J Clin Chem Clin Biochem . 1990;28:65–81
  6. Remaley AT , Wilding P . Macroenzymes: biochemical characterization, clinical significance, and laboratory detection . Clin Chem . 1989;35:2261–2270
  7. Mifflin TE, Bruns DE, Wrotnoski U, MacMillan RH, Stallings RG, Felder RA, et al. University of Virginia case conference. Macroamylase, macro creatine kinase, and other macroenzymes . Clin Chem . 1985;31:1743–1748
  8. Lee KN , Csako G , Bernhardt P , Elin RJ . Relevance of macro creatine kinase type 1 and type 2 isoenzymes to laboratory and clinical data . Clin Chem . 1994;40(7 Pt 1):1278–1283
  9. Grace AM , Perryman MB , Roberts R . Purification and characterization of human mitochondrial creatine kinase. A single enzyme form . J Biol Chem . 1983;258:15346–15354
  10. Lang H , Wurzburg U . Creatine kinase, an enzyme of many forms . Clin Chem . 1982;28:1439–1447
  11. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, et al  National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes . Clin Chem . 2007;53:552–574
  12. Wu CJ, Liang HL, Chiou KR, Mar GY, Tseng SJ, Lin SL, et al  Significance of cardiac troponin I and creatine kinase release after coronary intervention . J Chin Med Assoc . 2001;64:343–350
  13. Loshon CA , McComb RB , Bowers GN . Immunoprecipitation and electrophoresis used to demonstrate and evaluate interference by CK-BB and atypical-CKs with CK-MB determinations by immunoinhibition . Clin Chem . 1984;30:167–168
  14. Bohner J , Stein W , Steinhart R , Wurzburg U , Eggstein M . Macro creatine kinases: results of isoenzyme electrophoresis and differentiation of the immunoglobulin-bound type by radioassay . Clin Chem . 1982;28(4 Pt 1):618–623
  15. Bohner J , Stein W , Renn W , Steinhart R , Eggstein M . Stability of macro creatine kinases and creatine kinase isoenzymes compared: heat inactivation test for determination of thermostable creatine kinases . J Clin Chem Clin Biochem . 1981;19:1021–1026
  16. Stein W , Bohner J , Steinhart R , Eggstein M . Macro creatine kinase: determination and differentiation of two types by their activation energies . Clin Chem . 1982;28:19–24
  17. Galarraga B , Sinclair D , Fahie-Wilson MN , McCrae FC , Hull RG , Ledingham JM . A rare but important cause for a raised serum creatine kinase concentration: two case reports and a literature review . Rheumatology (Oxford) . 2003;42:186–188
  18. Jap TS , Wu YC , Ho DM , Chiang H . Spuriously high CK-MB isoenzyme activity mimicking acute myocardial infarction in a patient with adenocarcinoma of the rectum . J Chin Med Assoc . 2000;63:413–417
  19. Laureys M, Sion JP, Slabbynck H, Steenssens L, Cobbaert C, Derde MP, et al. Macromolecular creatine kinase type 1: a serum marker associated with disease . Clin Chem . 1991;37:430–434
  20. Hsiao JF , Ning HC , Gu PW , Lin WY , Chu PH . Clinical role of recurrently elevated macro creatine kinase type 1 . J Clin Lab Anal . 2008;22:186–191
  21. Gallucci F , Madrid E , Esposito P , Uomo G . Association of macroamylasemia and type I macro-creatine kinasemia. A case report . JOP . 2007;8:605–608
  22. Pascarella F , Caropreso M , Miele E , Fortunato G , Vajro P , Staiano A . Macro-creatine kinase and macro-lactate dehydrogenase in a girl with ulcerative colitis . Dig Liver Dis . 2007;39:780–781
  23. Stein W , Bohner J , Renn W , Maulbetsch R . Macro creatine kinase type 2: results of a prospective study in hospitalized patients . Clin Chem . 1985;31:1959–1964
  24. Stein W , Bohner J , Bahlinger M . Analytical patterns and biochemical properties of macro creatine kinase type 2 . Clin Chem . 1985;31:1952–1958
  25. Grobbel MA , Lawson NS , Calam RR . Cathodal creatine kinase band, a poor prognostic sign in malignancy . Clin Chem . 1982;28:1995–1996

PII: S1726-4901(10)70019-8

doi:10.1016/S1726-4901(10)70019-8

Journal of the Chinese Medical Association
Volume 73, Issue 1 , Pages 35-39, January 2010

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