Macro CK type 1 as a marker for autoimmunity in coronary heart disease

In a group of 3000 hospital patients the prevalence of immunoglobulin bound creatine kinase (macro CK type 1) was 4.3%. The relative frequency was greater in the older age categories. The highest prevalence was found in patients with rheumatic and cardiac diseases. In a group of 556 cardiac patients selected for coronary angiography a prevalence of 13.8% was observed. No significant correlation was obtained between the findings of the coronary angiography and the activity of macro CK type 1. CK MB results determined by ion-exchange or immuno-inhibition techniques in macro CK type 1 positive patients are falsely positive. Macro CK type 1 may be seen as an antigen-antibody complex against CK BB, which originates at least partly from the vascular wall.

Post-cardiac injury syndrome and an increased humoral immune response against the major contractile proteins (actin and myosin)

To better understand the pathogenesis of the post-cardiac injury syndrome (PCIS) 2 models of cardiac injury were studied. One hundred twenty-nine patients who underwent cardiac surgery and 80 patients with acute myocardial infarction (AMI) were prospectively followed and the levels of anti-heart antibodies (AHA), anti-actin antibodies (AAA) and anti-myosin antibodies (AMA) were determined. In the surgical group, PCIS developed in 27 patients (21%) and incomplete PCIS in 36 (28%). In the AMI group, PCIS did not develop in any patient, but incomplete PCIS developed in 11 patients (14%) (p less than 0.001). The surgical group showed a significantly higher humoral immune response than the AMI group when analyzed for AHA and anti-contractile protein antibodies. After cardiac surgery, AHA developed in 59 patients (46%), AAA developed in 33 (26%) and AMA developed in 49 (38%); in the AMI group, significant levels of AHA, AAA and AMA developed in 16 (20%), 7 (9%) and 13 patients (16%), respectively. These studies show a significant correlation between the PCIS clinical classification and auto-antibodies raised against heart contractile proteins.

Association between post-pericardiotomy syndrome and coronary occlusion after aortic valve replacement

Fever, leucocytosis, and pericardial and pleural effusions developed after the first postoperative week in a 56 year old man who had undergone aortic valve replacement. Four months later, coronary angiography showed bilateral proximal stenosis of the coronary arteries. In this patient post-pericardiotomy syndrome and subsequent coronary artery stenosis were thought to be associated and an immunological mechanism was suspected.

Effect of polyunsaturated isocaloric fat diets on plasma lipids, apolipoproteins and fatty acids

The effect of an increased polyunsaturated fatty acid concentration in the diet on the plasma lipoproteins from a normal group of healthy persons and from a group of hypercholesterolemic patients, consuming an isoenergetic and an isocholesterolemic diet, was examined and the changes in the plasma phospholipids were measured. Nine normal and 10 hypercholesterolemic patients were treated with a polyunsaturated diet for 1 month. Controls and hypercholesterolemic patients were screened on their lipid and lipoprotein profiles and their P/S ratio in the diet was calculated and increased with a factor 4. In the control group the P/S ratio was increased from 0.35 to 1.38 and in the hypercholesterolemic group from 0.46 to 1.59. They received the diet for at least 4 weeks before a second analysis of lipids and lipoproteins. The most important results are a decrease of plasma cholesterol, followed by a significant increase of HDL cholesterol. The cholesterol-lowering effect results largely from the plasma LDL decrease, especially in the patient group. Apo A-I is decreased accompanied by a significant increase of the ratio HDL-C/apo A-I. The observed changes are most pronounced in the hypercholesterolemic group. There is no change in apo B but a significant change in the linoleic acid concentration especially in the HDL cholesterol esters. The major phospholipids in plasma are identical in both groups and there is an identical change under the PUFA diet, sphingomyelin is increased and phosphatidylcholine is decreased, which may be related to an increase of the HDL2/HDL3 ratio.

Evaluation of three current methods for the determination of creatine kinase-MB catalytic activity

Three current methods for the determination of the creatine kinase-MB activity were evaluated: electrophoresis (Beckman Inst.), ion-exchange MB-Zyme (J.T. Baker) and ion-exchange on aca (Du Pont). Eighty patients were selected out of three groups: acute myocardial infarction, heart and vascular surgery patients and a number of noncardiac cases. The precision of the ion-exchange methods was comparable; CV 5.7% (aca) and CV 5.2% (MB-Zyme) for a high creatine kinase-MB pool. Electrophoresis overestimated the creatine/kinase-MB/activity and was less precise (CV 9.6%) and less sensitive than the ion-exchange methods. The aca (Du Pont) method was less specific than the MB-Zyme. The main source of discrepancy was samples from certain patients in the surgery unit, which gave falsely high value by the aca method, and showed altered mobility in electrophoresis, suggesting an atypical creatine kinase. Three macro creatine kinase type I included in this study were erroneously determined as creatine kinase-MB by both the ion-exchange methods.

Enzymic assay for phosphatidylcholine and sphingomyelin in serum

We describe a method for the direct enzymatic determination of phosphatidylcholine and sphingomyelin in serum. Phospholipase C (EC 3.1.4.3) and sphingomyelinase (EC 3.1.4.12) are used to hydrolyze phosphatidylcholine and sphingomyelin, respectively, with high specificity; alkaline phosphatase (EC 3.1.3.1) is used to cleave inorganic phosphorus. The choline group, after oxidation with choline oxidase (EC 1.1.3.17), is detected with 4-aminoantipyrine. Alternatively, phosphorus is assayed with metavanadate. The excellent agreement between results of this modification of a procedure described by Artiss et al. (Microchem. J. 26: 1017, 1980) for amniotic fluid and of the conventional thin-layer chromatographic method makes this an attractive method for determination of both phospholipid subclasses in serum.

Enzymic assay for phosphatidylcholine and sphingomyelin in serum

We describe a method for the direct enzymatic determination of phosphatidylcholine and sphingomyelin in serum. Phospholipase C (EC 3.1.4.3) and sphingomyelinase (EC 3.1.4.12) are used to hydrolyze phosphatidylcholine and sphingomyelin, respectively, with high specificity; alkaline phosphatase (EC 3.1.3.1) is used to cleave inorganic phosphorus. The choline group, after oxidation with choline oxidase (EC 1.1.3.17), is detected with 4-aminoantipyrine. Alternatively, phosphorus is assayed with metavanadate. The excellent agreement between results of this modification of a procedure described by Artiss et al. (Microchem. J. 26: 1017, 1980) for amniotic fluid and of the conventional thin-layer chromatographic method makes this an attractive method for determination of both phospholipid subclasses in serum.