[JNUS]

THE ANSWER İS MACRO- CK , İT İS GENERALLY RELATED WİTH MALİGNANCY AND AUTOİMMUNİTY.

Two types of macro CK have been described. Macro CK type 1 is an isoenzyme–Ig complex created via an antigen–antibody reaction. The most common form of type 1 macro CK is a CKBB–IgG complex. Less is known about the composition of macro CK type 2. It is believed to be of mitochondrial rather than cytoplasmic origin.

Diagnosis can most readily be made by CK electrophoresis , immunoinhibition and chromatographic techniques.
Most studies published to date have reported the prevalence rate for macro CK type 1 to be 0.43–1.2% Macro CK type 2 has a reported prevalence rate of 0.5–3.7%

Macro CK type 1 may occur in healthy individuals and in children and is most commonly found in women and patients over the age of 50 yr . The clinical relevance of this enzyme is not clearly established and there are several reported associations, including hypothyroidism, neoplasia, autoimmune disease, myositis and cardiovascular disease. The last two have been the strongest reported associations , but this may in part be explained by a higher frequency of requests for CK levels in these groups of patients

Unlike type 1, macro CK type 2 has been reported in predominantly ill patients , most commonly in association with malignancy (colonic carcinoma ) and liver disease . It is associated with high mortality and when present in children can be a marker of myocardial disease . three-fold higher incidence of malignancy in patients with macro CK type 2 compared with patients having type 1.

One proposed mechanism for the association of macro CK type 2 with malignancy is the direct release of the enzyme from malignant or necrotic cells. the mitochondrial macroenzyme in fractions of primary and metastatic prostatic tumours examined at necropsy, and suggested that the neoplasm and its metastases can release macro CK type 2 directly.