Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid-binding protein.

BACKGROUND Myoglobin and fatty acid-binding protein (FABP) each are useful as early biochemical markers of muscle injury. We studied whether the ratio of myoglobin over FABP in plasma can be used to distinguish myocardial from skeletal muscle injury. METHODS AND RESULTS Myoglobin and FABP were assayed immunochemically in tissue samples of human heart and skeletal muscle and in serial plasma samples from 22 patients with acute myocardial infarction (AMI), from 9 patients undergoing aortic surgery (causing injury of skeletal muscles), and from 10 patients undergoing cardiac surgery. In human heart tissue, the myoglobin/FABP ratio was 4.5 and in skeletal muscles varied from 21 to 73. After AMI, the plasma concentrations of both proteins were elevated between approximately 1 and 15 to 20 hours after the onset of symptoms. In this period, the myoglobin/FABP ratio was constant both in subgroups of patients receiving and those not receiving thrombolytics and amounted to 5.3 +/- 1.2 (SD). In serum from aortic surgery patients, both proteins were elevated between 6 and 24 hours after surgery; the myoglobin/FABP ratio was 45 +/- 22 (SD), which is significantly different from plasma values in AMI patients (P < .001). In patients with cardiac surgery, the ratio increased from 11.3 +/- 4.7 to 32.1 +/- 13.6 (SD) during 24 hours after surgery, indicating more rapid release of protein from injured myocardium than from skeletal muscles. CONCLUSIONS The ratio of the concentrations of myoglobin over FABP in plasma from patients with muscle injury reflects the ratio found in the affected tissue. Since this ratio is different between heart (4.5) and skeletal muscle (20 to 70), its assessment in plasma allows the discrimination between myocardial and skeletal muscle injury in humans.

[1]  J. Veerkamp,et al.  Cytoplasmic fatty acid-binding proteins: their structure and genes. , 1995, Progress in lipid research.

[2]  J. Chapelle,et al.  Fast determination of myoglobin in serum using a new radial partition immunoassay. , 1994, Clinical Biochemistry.

[3]  A. Van der Laarse,et al.  Enzymatic assessment of myocardial necrosis after cardiac surgery: differentiation from skeletal muscle damage, hemolysis, and liver injury. , 1985, American heart journal.

[4]  M. Waterman,et al.  Serum myoglobin level as diagnostic test in patients with acute myocardial infarction. , 1977, British heart journal.

[5]  G. J. van der Vusse,et al.  A sandwich enzyme linked immuno-sorbent assay for the determination of rat heart fatty acid-binding protein using the streptavidin-biotin system. Application to tissue and effluent samples from normoxic rat heart perfusion. , 1991, Biochimica et biophysica acta.

[6]  W. Hermens,et al.  Fatty-acid-binding protein as a plasma marker for the estimation of myocardial infarct size in humans. , 1994, British heart journal.

[7]  G. Nicolaysen,et al.  Interstitial fluid volume: local regulatory mechanisms. , 1981, Physiological reviews.

[8]  A. Katz.  Physiology of the heart , 1977 .

[9]  R. Rabkin,et al.  Renal Uptake and Disposal of Proteins and Peptides , 1993 .

[10]  K. Wodzig,et al.  Monoclonal antibodies to human heart fatty acid-binding protein. , 1995, Journal of immunological methods.

[11]  Thomas J. Raub,et al.  Biological Barriers to Protein Delivery , 1993, Pharmaceutical Biotechnology.

[12]  Y. Hirota,et al.  Serum and urinary human heart fatty acid-binding protein in acute myocardial infarction. , 1991, Clinical biochemistry.

[13]  C. Sylvén,et al.  Myoglobin content in human skeletal muscle and myocardium: relation to fibre size and oxidative capacity. , 1984, Cardiovascular research.

[14]  M. Waterman,et al.  Radioimmunoassay of myoglobin in human serum. Results in patients with acute myocardial infarction. , 1975, The Journal of clinical investigation.

[15]  P. Brecher,et al.  Rabbit Heart Fatty Acid-Binding Protein Isolation, Characterization, and Application of a Monoclonal Antibody , 1989, Circulation research.

[16]  T. Ono,et al.  Immunohistochemical distribution of heart‐type fatty acid‐binding protein immunoreactivity in normal human tissues and in acute myocardial infarct , 1993, The Journal of pathology.

[17]  J. Chapelle,et al.  Quantitative Turbidimetric Assay for Determining Myoglobin Evaluated , 1991, Annals of clinical biochemistry.

[18]  H. Morita,et al.  Human heart-type cytoplasmic fatty acid-binding protein in serum and urine during hyperacute myocardial infarction. , 1993, International journal of cardiology.

[19]  J. Veerkamp,et al.  Immunochemical quantitation of fatty acid-binding proteins. Tissue distribution of liver and heart FABP types in human and porcine tissues. , 1990, The International journal of biochemistry.

[20]  A. Jaffe,et al.  Biochemical Markers of Myocardial Injury Is MB Creatine Kinase the Choice for the 1990s? , 1993, Circulation.

[21]  E. Stein,et al.  Age-, sex-, and race-related differences in myoglobin concentrations in the serum of healthy persons. , 1980, Clinical chemistry.

[22]  A. Kleine.  Fatty acid-binding protein as diagnostic marker of acute myocardial infarction in man , 1993 .

[23]  I. Shapira,et al.  Serum myoglobin levels in patients with ischemic myocardial insult. , 1988, Archives of internal medicine.

[24]  F. Spener,et al.  Subcellular distribution of cardiac fatty acid-binding protein in bovine heart muscle and quantitation with an enzyme-linked immunosorbent assay. , 1989, Biochimica et biophysica acta.