Creatine Kinase MB Isoenzyme Is a Complementary Biomarker in Amyotrophic Lateral Sclerosis

Abstract

Amyotrophic lateral sclerosis (ALS) is an invariably fatal neurodegenerative disease with limited therapeutic options. There is an urgent need for novel biomarkers to be used as surrogates for new therapeutic trials and disease monitoring. In this study, we sought to systematically study creatine kinase isoenzyme MB (CK-MB) in a real-world cohort of ALS patients, assess the diagnostic performance, and evaluate its association with other laboratory and clinical parameters. We reviewed data from 194 consecutive patients that included 130 ALS patients and 64 disease control patients (primary lateral sclerosis [PLS], benign fasciculations syndrome [BFS], Huntington’s disease [HD] and Alzheimer’s disease [AD]). CK-MB was elevated in the sera of more than half of all patients with ALS. In patients with spinal-onset ALS, CK-MB levels were significantly higher than in patients with other neurodegenerative diseases. Patients with slower rates of functional decline had a significantly higher baseline CK-MB. Furthermore, CK-MB elevations correlated with cardiac troponin T (cTnT) and with revised ALS Functional Rating Scale (ALSFRS-R) bulbar subcategory. We posit that measuring CK-MB in ALS patients in a complimentary fashion could potentially aid in the diagnostic workup of ALS and help discriminate the disease from some ALS mimics and other neurodegenerative diseases. CK-MB levels also may provide valuable prognostic information regarding disease aggressiveness as well as correlations with specific phenotypic presentations.

Diagnostic value of neurofilaments in differentiating motor neuron disease from multifocal motor neuropathy

“…However, we cannot exclude that disease duration may impact Nf concentrations in MMN and limit diagnostic accuracy in early disease stages. Moreover, clinical characteristics (gender, site of onset, ALSFRSr) of our MND cohort were similar to three recently published large German ALS cohorts [ 37 , 62 , 63 ]. Even though MND patients in our cohort were younger—most likely due to inclusion at time of diagnosis and not later during the disease course—our results should be applicable to the German ALS/MND population.…”

“…However, as source of potential bias, selection bias has to be considered, as we recruited patients exclusively at a tertiary referral hospital, which might have led to an overestimation/underestimation of disease severity and Nf concentrations. Further, it would have been desirable to evaluate a complementary role of Troponin T and Creatine Kinase MB isoenzyme for the differential diagnosis of MND and MMN, especially as recent studies suggest that these biomarkers represent lower motor neuron involvement and correlate with bulbar involvement [ 63 , 64 ]. However, this was out of the scope of this study.…”

Photodynamic Therapy for Atherosclerosis

“…While CK-MB is primarily associated with cardiac muscle, atherosclerosis is a condition that involves the buildup of plaques in the arteries, and its direct involvement in atherosclerosis is not as prominent. The release of CK-MB into the bloodstream can occur when there is damage to the heart muscle, which may happen in the context of ischemia or infarction associated with advanced atherosclerosis [73][74][75][76].…”