CREATINE PHOSPHOKINASE

Creatine kinase (CK), also known as creatine phosphokinase (CPK) or

phospho-creatine kinase (and sometimes incorrectly as creatinine
kinase), is an enzyme expressed by various tissues and cell types. CK
catalyses the conversion of creatine and consumes adenosine triphosphate
(ATP) to create phosphocreatine (PCr) and adenosine diphosphate (ADP).
This CK enzyme reaction is reversible, such that also ATP can be generated
from PCr and ADP.

In tissues and cells that consume ATP rapidly, especially skeletal muscle,
but also brain, photoreceptor cells of the retina, hair cells of the inner ear,
spermatozoa and smooth muscle, PCr serves as an energy reservoir for the
rapid buffering and regeneration of ATP, as well as for intracellular energy
transport by the PCr shuttle or circuit. Thus creatine kinase is an important
enzyme in such tissues.

Clinically, creatine kinase is assayed in blood tests as a marker of

myocardial infarction (heart attack), rhabdomyolysis (severe muscle
breakdown), muscular dystrophy, the autoimmune myositides and in acute
renal failure.

Types

In the cells, the "cytosolic" CK enzymes consist of two subunits, which can
be either B (brain type) or M (muscle type). There are, therefore, three
different isoenzymes: CK-MM, CK-BB and CK-MB. The genes for these
subunits are located on different chromosomes: B on 14q32 and M on
19q13. In addition to those three cytosolic CK isoforms, there are two
mitochondrial creatine kinase isoenzymes, the ubiquitous and sarcomeric
form. The functional entity of the latter two mitochondrial CK isoforms is an
octamer consisting of four dimers each.

While mitochondrial creatine kinase is directly involved in formation of

phospho-creatine from mitochondrial ATP, cytosolic CK regenerate ATP from
ADP, using PCr. This happens at intracellular sites where ATP is used in the
cell, with CK acting as an in situ ATP regenerator.

gene protein
CKB creatine kinase, brain, BB-CK
CKBE creatine kinase, ectopic expression
CKM creatine kinase, muscle, MM-CK
CKMT1A, creatine kinase mitochondrial 1; ubiquitous
CKMT1B mtCK; or umtCK
creatine kinase mitochondrial 2; sarcomeric
CKMT2
mtCK; or smtCK

Isoenzyme patterns differ in tissues. CK-BB is expressed in all tissues at low

levels and has little clinical relevance. Skeletal muscle expresses CK-MM
(98%) and low levels of CK-MB (1%). The myocardium (heart muscle), in
contrast, expresses CK-MM at 70% and CK-MB at 25–30%

How the Test is Performed

Blood is typically drawn from a vein, usually from the inside of the elbow or
the back of the hand. The site is cleaned with germ-killing medicine
(antiseptic). Wrap an elastic band around the upper arm to apply pressure
to the area and make the vein swell with blood.

Next, gently inserts a needle into the vein. The blood collects into an
airtight vial or tube attached to the needle. The elastic band is removed
from arm.

Once the blood has been collected, the needle is removed, and the puncture
site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to

puncture the skin and make it bleed. The blood collects into a small glass
tube called a pipette, or onto a slide or test strip. A bandage may be placed
over the area if there is any bleeding.

The blood sample is measured for the amount of CPK.

Normal Results

Total CPK normal values:

 10 - 120 micrograms per liter (mcg/L)

 CK has a very short half life, < 1 hour. Activity increases quickly
(peaks at 6-12 hours) and returns to normal within 24-48 hours after
acute, transient muscle injury. Persistent or ongoing muscle injury will
maintain high CK concentrations. In contrast, AST (which has a longer
half-life) will increase more gradually after muscle injury and stays
elevated for a longer period of time than CK
Precaution

Drugs that can increase CPK measurements include amphotericin B, certain

anesthetics, statins, fibrates, dexamethasone, alcohol, and cocaine.

Indication

When the total CPK level is very high, it usually means there has been injury
or stress to the heart, the brain, or muscle tissue. For example, when a
muscle is damaged, CPK leaks into the bloodstream. Determining which
specific form of CPK is high helps doctors determine which tissue has been
damaged.

This test may be used to:

 Diagnose heart attack

 Evaluate cause of chest pain

 Determine if or how badly a muscle is damaged

 Detect early dermatomyositis and polymyositis

 Tell the difference between malignant hyperthermia and postoperative

infection

 Determine if you carry a gene for muscular dystrophy (Duchenne)

The pattern and timing of a rise or fall in CPK levels can be diagnostically
significant, particularly if a heart attack is suspected.

What Abnormal Results Mean

High CPK levels may be seen in patients who have:

 Brain injury or stroke

 Convulsions

 Delirium tremens

 Dermatomyositis or polymyositis

 Electric shock

 Heart attack

 Inflammation of the heart muscle (myocarditis)

  Lung tissue death (pulmonary infarction)

 Muscular dystrophies

 Myopathy

Additional conditions may give positive test results:

 Hypothyroidism

 Hyperthyroidism

 Pericarditis following a heart attack

 Rhabdomyolysis

Risks

There is very little risk involved with having your blood taken. Veins and
arteries vary in size from one patient to another and from one side of the
body to the other. Taking blood from some people may be more difficult than
from others.

Other risks associated with having blood drawn are slight but may include:

 Excessive bleeding

 Fainting or feeling light-headed

 Hematoma (blood accumulating under the skin)

 Infection (a slight risk any time the skin is broken)

Considerations

Factors that may affect test results include cardiac catheterization,

intramuscular injections, trauma to muscles, recent surgery, and heavy
exercise. Other tests should be done to determine the exact location of
muscle damage.