title: Creatine kinase gene mutation in a patient with muscle creatine kinase deficiency.
abstract: BACKGROUND
  We describe a 56-year-old woman admitted to the hospital with a diagnosis of acute myocardial infarction without an increase of serum creatine kinase (CK) activity during her clinical course. She died on the 11th hospital day, and the diagnosis was confirmed by autopsy. The patient had had no previous muscular symptoms.
  
  
  METHODS
  Expression of the CK-muscle (CK-M) protein in cardiac tissue was examined by immunoblotting and immunochemical staining. CK-M mRNA expression was estimated by semiquantitative reverse transcription-PCR. Gene structure of CK-M was determined by Southern blotting and direct sequencing of 2251 bp. Existence of a point mutation in the CK-M gene was examined by restriction fragment length polymorphism analysis of PCR products (PCR-RFLP) in the patient and in 108 controls.
  
  
  RESULTS
  CK-M protein in the myocardial tissue of the patient was substantially lower (103 +/- 7 ng/mg protein) than in control myocardial tissue (35 800 +/- 2860 ng/mg protein). Immunoreactive CK-M in the patient tissue sample was 0.3% of the value for the control sample. CK-M mRNA was 53-fold less in the patient sample compared with the control. This very low expression of CK-M mRNA was considered to be the primary reason for CK-M deficiency. Direct sequencing revealed a point mutation at residue 54 in exon 2, which was specific for the patient. No other abnormalities were found in the CK-M gene of the patient.
  
  
  CONCLUSIONS
  This report identifies a molecular abnormality in human CK deficiency and discusses the physiologic relevance of CK-M.
authors.affiliation: Department of Clinical Pathology, Kobe City General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe 650-0046, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamamichi
authors.forename: S
authors.initials: S
authors.lastname: Kasakura
authors.forename: S
authors.initials: S
authors.lastname: Yamamori
authors.forename: R
authors.initials: R
authors.lastname: Iwasaki
authors.forename: T
authors.initials: T
authors.lastname: Jikimoto
authors.forename: S
authors.initials: S
authors.lastname: Kanagawa
authors.forename: J
authors.initials: J
authors.lastname: Ohkawa
authors.forename: S
authors.initials: S
authors.lastname: Kumagai
authors.forename: M
authors.initials: M
authors.lastname: Koshiba
mesh_terms: D015139:Blotting, Southern; D003402:Creatine Kinase / Q000172:deficiency / Q000235:genetics*; D052283:Creatine Kinase, MM Form; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007118:Immunoassay; D015151:Immunoblotting; D007527:Isoenzymes / Q000172:deficiency / Q000235:genetics*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D009206:Myocardium / Q000201:enzymology; D017354:Point Mutation; D012150:Polymorphism, Restriction Fragment Length; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase; D052283:Creatine Kinase, MM Form