Creatine kinase B-subunit activity in serum after immunoinhibition of M-subunit activity

Creatine kinase (EC 2.7.3.2) B-subunit activity in serum may be routinely measured as residual activity after specific immunoinhibition of the M-subunit. We assessed the inhibition kinetics, specificity, completeness of inhibition, and inhibitory capacity of three different anti-M preparations, with use of isolated human BB, MM, and MB isoenzymes. The Scandinavian-recommended reaction system was used. We suggest a set of tentative quality requirements for anti-M for use in diagnosing acute myocardial infarction. The need to measure and subtract sample residual adenylate kinase activity was demosntrated. We describe a routine photometric method for determining B-subunit activity in serum. With the Scandinavian CK method the upper reference value for total creatine kinase in serum was found to be 150 U/L for women, 270 U/L for men. By bioluminescence, we found the upper reference value for B-subunit activity to be 6 U/L for both sexes. We discuss three different modes for applying B-subunit determinations to the diagnosis of acute myocardial infarction.