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Clinical Chemistry 43: 2006-2007, 1997;
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(Clinical Chemistry. 1997;43:2006-2007.)
© 1997 American Association for Clinical Chemistry, Inc.

Letters to the Editor

Ectopic Production of Creatine Kinase MB: Updated Evaluation by Mass Assays

Alan H. B. Wu1,a, Yue-Jin Feng1, Jeremy Nadelman2, Matthew Acampora2 and Paul N. Fiedler2

1 Depts. of Pathol. and Lab. Med., Hartford Hospital, Hartford, CT 06105,
2 Dept. of Pathol., Hospital of St. Raphael, New Haven, CT 06511
a Author for correspondence. Fax 860-545-5206; e-mail awu@harthosp.org.


To the Editor:

There have been several reports of apparently high concentrations of creatine kinase (CK)-MB in the sera of cancer patients (1)(2)(3)(4). In several of these cases, the high activity resulted from the presence of macro CK types 1 and 2 (5). False-positive results for CK-MB can occur if nonspecific assays such as immunoinhibition are used (6). These atypical isoenzymes are not inhibited by anti-CK-B antibodies, and high apparent CK-MB activities are produced. Macro CK type 1 (CK-BB bound to IgG) migrates between CK-MM and -MB, whereas type 2 (polymeric mitochondrial CK) migrates cathodic to CK-MM and can be readily differentiated from CK-MB by electrophoresis (7). However, macro CK-BB linked to IgA can comigrate with CK-MB, and false-positive detection of MB is possible even with electrophoresis (8).

Annesley and McKenna (9) published the one clear case of ectopic CK-MB production by a tumor, by demonstrating high concentrations of CK-MB in homogenized tumor tissue and ruling out the presence of macro CK forms by heat stability tests. We describe a second case in which persistently high concentrations of CK-MB were detected in a patient with metastatic cancer. CK isoforms, myoglobin, lactate dehydrogenase isoenzymes, and cardiac troponins T and I were used to rule out the presence of acute myocardial injury.

A 71-year-old white man with a past medical history of coronary artery disease, acute myocardial infarction (AMI), hypertension, congestive heart failure, cerebrovascular accident, carotid stenosis, and atrial fibrillation presented to the . . . [Full Text of this Article]


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