Glycogen phosphorylase isoenzyme BB in diagnosis of myocardial ischaemic injury and infarction.

This review deals with glycogen phosphorylase (GP) and its isoenzyme BB in the diagnosis of ischaemic myocardial injury. Early identification and confirmation of acute myocardial infarction is essential for correct patient care and disposition decision in the emergency department. In this respect, glycogen phosphorylase isoenzyme BB (GPBB) based on its metabolic function is an enzyme for early laboratory detection of ischaemia. In the aerobic heart muscle GPBB together with glycogen is tightly associated with the vesicles of the sarcoplasmic reticulum. Release of GPBB, the main isoform in the human myocardium, essentially depends on the degradation of glycogen, which is catalyzed by GP. Ischaemia is known to favour the conversion of bound GP in the b form into GP a, thereby accelerating glycogen breakdown, which is the ultimate prerequisite for getting GP into a soluble form being able to move freely in the cytosol. The efflux of GPBB into the extracellular fluid follows if ischaemia-induced structural alterations in the cell membrane become manifest. The clinical application of GPBB as a marker of ischaemic myocardial injury is a very promising tool for extending our knowledge of the severity of myocardial ischaemic events in the various coronary syndromes. The rational roots of this development were originated from Albert Wollenberger's research work on the biochemistry of cardiac ischaemia and the transient acceleration of glycogenolysis mainly brought about by GP activation.

Immunoenzymometric assay of human glycogen phosphorylase isoenzyme BB in diagnosis of ischemic myocardial injury.

With a new immunoenzymometric assay we measured human glycogen phosphorylase isoenzyme BB (GPBB) in 116 healthy individuals, 14 patients with stable angina, 107 nontraumatic chest pain patients on admission to the emergency department [45 acute myocardial infarction (AMI), 49 unstable angina, 13 other diseases], and in serial samples from 41 AMI patients. GPBB was compared with creatine kinase (CK), CKMB mass, myoglobin, and cardiac troponin T. Receiver-operating characteristic plots demonstrated the significantly greater (P < or = 0.012) discriminatory power of GPBB to detect acute ischemic coronary syndromes compared with all other tested markers. GPBB was the most sensitive marker for detection of AMI during the first 4 h after onset of chest pain, and only GPBB was increased above the upper reference limit (7 micrograms/L) on admission in patients who had unstable angina at rest and reversible ST-T alterations. This and the high early sensitivity of GPBB are most likely explained by its function as a key enzyme of glycogenolysis.

Early release of glycogen phosphorylase in patients with unstable angina and transient ST-T alterations.

OBJECTIVE: To determine whether transient ST-T alterations in patients with unstable angina are associated with an increase in plasma glycogen phosphorylase BB concentrations on admission to hospital. DESIGN: Prospective screening of patients with unstable angina for markers of myocardial cell damage. SETTING: Accident and emergency department of university hospital. PATIENTS: 48 consecutive patients admitted for angina pectoris (18 with transient ST-T alterations). None of the patients had acute myocardial infarction according to standard criteria. MAIN OUTCOME MEASURES: Creatine kinase and creatine kinase MB activities, creatine kinase MB mass concentration, and myoglobin, cardiac troponin T, and glycogen phosphorylase BB concentrations on admission. RESULTS: All variables except for creatine kinase and creatine kinase MB activities were significantly higher on admission in patients with unstable angina and transient ST-T alterations than in patients without. However, glycogen phosphorylase BB concentration was the only marker that was significantly (p = 0.0001) increased above its discriminator value in most patients (16). In the 18 patients with transient ST-T alterations creatine kinase MB mass concentration and troponin T and myoglobin concentrations were significantly (p = 0.0001) less commonly increased on admission (in five, three, and two patients, respectively). CONCLUSIONS: The early release of glycogen phosphorylase BB may help to identify high risk patients with unstable angina even on admission to an emergency department. Glycogen phosphorylase BB concentrations could help to guide decisions about patient management.

Glycogen phosphorylase isoenzyme BB mass release after coronary artery bypass grafting.

Glycogen phosphorylase isoenzyme BB mass release was studied in 20 patients undergoing coronary artery bypass grafting. In 16 patients with uneventful coronary artery bypass grafting, glycogen phosphorylase isoenzyme BB mass concentrations showed a significant, transient increase in the post cross-clamping period and decreased to baseline values within 20 hours (peak concentrations ranged from 12.7 micrograms/l to 47.5 micrograms/l, median 40 micrograms/l). One patient did not fulfil criteria for perioperative myocardial infarction, but clinical data indicated myocardial injury after aortic unclamping. In this patient only glycogen phosphorylase isoenzyme BB mass concentration and not creatine kinase isoenzyme MB catalytic concentration was increased, compared with uneventful patients. In 2 patients with emergency coronary artery bypass grafting for evolving myocardial infarction, glycogen phosphorylase isoenzyme BB mass concentrations, but not creatine kinase isoenzyme MB catalytic concentrations, correlated with clinical evidence of myocardial ischaemia. Our data indicate that glycogen phosphorylase isoenzyme BB mass concentration is a very sensitive laboratory marker of perioperative myocardial injury in patients undergoing coronary artery bypass grafting.

[Base activity of glycogen phosphorylase b in human serum. Study of reference and discrimination values]. / Basalaktivität der Glycogenphosphorylase b im menschlichen Serum. Referenz- und Diskriminationswert-Studie.

Serum glycogen phosphorylase activity as one of the sensitive indicators for the diagnosis of acute heart infarction was determined at 216 healthy probands using a standardized fluorometric procedure with a detection range from 0.03 to 6 nmol/s x l serum. Basal activity was averaged at 1.22 +/- 0.39 nmol/s x l serum with a confidence interval of C.I.95 1.168 ... 1.272. Due to the estimated Gaussian distribution of the individual activity values (n = 216) the reference range was calculated from 0.5 to 2.0 nkat/l (2.5- to 97.5-percentile, respectively), the latter one being equal to the reference value of the glycogen phosphorylase activity in healthy human beings. The reference value was found to be independent of age (16-65 years) and sex. Using the discrimination value for serum glycogen phosphorylase activity at 3 nkat/l serum two groups of patients suffering either from acute myocardial infarction (n = 79) or chronic ischemic heart disease (n = 92) were separated with a diagnostic sensitivity and specificity of 0.91 and 0.93, respectively, of this diagnostic tool.

Immunenzymometric assay for the heart specific glycogen phosphorylase BB in human serum using monoclonal antibodies.

An enzyme-linked immunosorbent assay for the determination of the human glycogen phosphorylase isoenzyme BB (GP BB) using two murine monoclonal antibodies was developed. A series of hybridoma clones producing monoclonal antibodies to GP BB were obtained by the standard lymphocyte hybridoma technique. Two of the selected clones synthesizing monoclonal antibodies, which recognize different epitopes, were employed for the immunenzymometric assay. The first monoclonal antibody was immobilized on microtiter plates and the bound glycogen phosphorylase BB was detected with the second monoclonal antibody conjugated with horse radish peroxidase. This assay enables a specific and sensitive measurement of GP BB in the range of 0.5-150 ng/ml phosphate-buffered saline containing 0.5% bovine serum albumin in less than 3 hours. The lower limit in human serum amounts about 3 ng/ml. Preliminary data obtained with human sera from patients after aorto-coronary artery bypass surgery are demonstrated.

On the release of glycogen phosphorylase from heart muscle: effect of substrate depletion, ischemia and of imipramine.

The release of glycogen phosphorylase from isolated, perfused rabbit heart was studied after substrate depletion and after global ischemia. The assayed efflux of the enzyme was found to be not only related to alterations in membrane integrity but also to the amount of glycogen in the injured heart tissue. The differential efflux profile of phosphorylase as a constituent of the sarcoplasmic reticulum-glycogenolysis complex in cardiac cells in comparison to cytosolic creatine kinase was found to be more pronounced employing K+-arrested, hypothermically perfused hearts exposed to imipramine (0.4 to 0.6 mM), known for altering specifically membrane integrity. Under these conditions only a rise in the release of creatine kinase occurs, whereas both glycogen content and the efflux of phosphorylase remains uneffected. It is suggested that the metabolical dependence of phosphorylase efflux from the injured heart muscle is of importance for its high sensitivity being a marker of acute heart infarction.

Immunoinhibition assay of the serum activity of human glycogen isophosphorylase BB in the diagnosis of the acute myocardial ischaemia.

Polyclonal rabbit anti-human isophosphorylases inhibit selectively the isoenzyme activities of the BB and MM isoenzyme of the human glycogen phosphorylase b with high sensitivity and without crossreactivities. On this basis a serological immunoinhibition assay of the BB isoenzyme in the range of 1-125 nmol s-1 l-1 is described. Preliminary clinical results indicate the BB isoenzyme as a sensitive and specific marker of the acute myocardial ischaemia including bypass surgery and suggest a substantial improvement of the differential diagnosis of infarction.