Serum creatine kinase isoenzymes behavior in hepatic failure with encephalopathy

Abstract

Serum creatine kinase isoenzymes were determined in 24 patients with hepatic failure. Hepatic failure was due to severe acute and chronic liver disease. The 24 patients presented different degrees of coma. Nineteen cases (seven hepatitis and 12 cirrhosis) in coma grades III and IV showed the presence in serum of BB, brain and MB, myocardial isoenzymes. Follow up in six of these cases demonstrated that worsening or improvement was accompanied by an increase or decrease of this brain isoenzyme concentration. The leakage from their respective tissues of the brain and myocardial creatine kinase isoenzymes is probably due to the toxic and surface activity properties of serum free fatty acids, bile salts, and bilirrubin, which increase, among other factors, in these pathological entities.

Identification of Blood–Brain Barrier-Permeable Proteins Derived from a Peripheral Organ: In Vivo and in Vitro Evidence of Blood-to-Brain Transport of Creatine Kinase

“…Although CK-BB is generally absent in serum under normal conditions, it has been reported to be elevated in hepatic failure patients with encephalopathy . In addition, the blood concentration of CK-MM is increased by around 100-fold in Duchenne muscular dystrophy (DMD) patients, who show cognitive dysfunction as a major feature, , compared to that under normal conditions (around 40 ng/mL).…”

“…Although CK-BB is generally absent in serum under normal conditions, it has been reported to be elevated in hepatic failure patients with encephalopathy. 48 In addition, the blood concentration of CK-MM is increased by around 100-fold in Duchenne muscular dystrophy (DMD) patients, 49 who show cognitive dysfunction as a major feature, 10,50 compared to that under normal conditions (around 40 ng/mL). Thus, the circulating blood-to-brain transport system of CKs across the BBB is likely to have a functional impact on peripheral organto-brain communications, especially in patients with peripheral organ injuries.…”