For the determination of creatine kinase isoenzyme catalytic concentrations in serum two methods based on immunological reactions are presented: One method uses inhibiting antibodies, which selectively block the activity of creatine kinase M subunits ("Inhibition Test*'). This test is used for routine measurements of creatine kinase MB catalytic concentration; Another method uses precipitating antibodies, which allows a quantitative differentiation of creatine kinase isoenzymes MM, MB and BB ("Precipitation Test"). This test is used as a control for the Inhibition Test for the possible presence of creatine kinase BB activities in doubtful cases. Procedures, specificity, correlation and application of these methods are discussed. Quantitative Bestimmung der katalytischen Konzentrationen von Creatinkinase-Isoenzymen im Serum mit Hilfe immunologischer Methoden Zusammenfassung: Für die Bestimmung der katalytischen Konzentrationen von Creatinkinase-Isoenzymen im Serum werden zwei Methoden auf immunologischer Basis beschrieben: Eine Methode unter Verwendung inhibierender Antikörper, welche die Aktivität der Creatinkinase-M-Untereinheiten selektiv hemmen ("Hemmtest"). Diese Methode wird zur routinemäßigen Bestimmung der katalytischen Konzentrationen von Creatinkinase-MB verwendet; Eine zweite Methode unter Verwendung präzipitierender Antikörper, welche die quantitative Differenzierung der Creatinkinäse-Isoenzyme MM, MB und BB erlaubt. Diese Methode wird in Zweifelsfällen als Kontrolle auf eventuelle Creatinkinase-BB-Aktivitäten verwendet. Die Methoden, ihre Spezifität, Korrelation und Anwendungsmöglichkeiten werden diskutiert.
A new method for the determination of creatine kinase-MB activity in the serum is presented. The principle of this method is the direct measurement of the activity of creatine kinase M subunits by inhibiting antibodies. The total test procedure takes 15 min. In the sera of all the 83 patients tested, who have clinically proven myocard infarction, creatine kinase-MB activity can be measured between the 6th and 28th hour after infarction. At the time of maximum total creatine kinase activity the percentage of creatine kinase-MB activity is between 6 and 17%, the mean value being 8%. In cases of emergency this method can be used for the differential diagnosis of elevated total creatine kinase activities of unknown origin.
Creatine kinase MB isoenzyme was measured (using antibody inhibition) in serum of patients with exogenous intoxication, acute pancreatitis, cerebrovascular accidents, meningitis, encephalitis, skeletal muscle disease, shock, postoperative states and after coronary arteriography, cardiac catherisation of cardioversion. CK-MB activity was revealed only in sera of patients with exogenous intoxication (severity III and IV), polymyositis, scleroderma, after operation or after coronary arteriography, cardiac catherisation or cardioversion. As it is not possible to differentiate between CK-MB and CK-BB using inhibiting antibodies against CK-M subunit, CK-isoenzyme activity was determined in parallel, using precipitating antibodies. No CK-BB was found in any case. The determination of CK-MB isoenzyme after blocking of the CK-MB subunit by means of inhibiting antibodies is suitable for clinical diagnosis. The method significantly increases the value of creatine kinase measurement.
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