IMMUNOCHEMICAL METHOD AND ANALYTICAL COMPOSITION AND ELEMENT FOR DETERMINATION OF CREATINE KINASE-MB

Abstract: An analytical composition and element and an im­ munochemical method using them, are useful for the determination of creatine kinase-MB in biological fluids. Specific amounts of a P¹, P⁵-di(adenosine-5′)polyphosphate, adenosine-5′-monophosphate (AMP) and adenosine-5′-­ diphosphate (ADP) are used to significantly reduce interfer­ ence by adenylate kinase, especially the liver isoenzyme, in the determination.

Description: IMMUNOCHEMICAL METHOD AND ANALYTICAL COMPOSITION AND ELEMENT FOR DETERMINATION OF CREATINE KINASE-MB The present invention relates to clinical chemistry. In particular, it relates to a method for the determination of creatine kinase-MB in aqueous liquids, e.g. biological fluids. This invention also relates to an analytical composition and element which is useful in such method. The determination of the activity of creatine kinase (abbreviated herein to CK, but also known as creatine phosphokinase, CPK, or ATP:creatine phosphotransferase E.C.2.7.3.2.) in human serum is considered one of the most sensitive laboratory methods for diagnosing diseases of skeletal muscles, such as diseases of the myocardium. CK determination is useful, for example, for diagnosis of progressive muscular dystrophy, dermatomyositis, and especially myocardial infarctions. CK occurs in human body fluids and tissue in the form of three isoenzymes: CK-MM, for example in muscles, CK-BB, for example in the brain, and CK-MB, for example in the myocardium. The CK activity occurring in healthy human blood serum is normally due to the CK-MM isoenzyme, because CK-3B does not generally pass into the blood stream. In a healthy individual, CK-MB is generally restricted to certain organs, for example the myocardium. However, when the myocardium is damaged, as in the case of a cardiac infarction, CK-MB is released into the blood serum and can be detected therein. A potential difficulty encountered in methods for determining CK-MB in biological fluids is interference from the other two isoenzymes For practical purposes, the amount of CK-BB in the fluid is considered negligible in most determinations. In methods for determining CK-MB, it is known to precipitate or inhibit the M subunit with specific antibodies to eliminate the interference of CK-MM and then to measure the remaining hybrid isoenzyme CK-MB. Standard assays for total creatine kinase (i.e. assay for all isoenzymes) generally use either the forward or reverse reaction illustrated by the following equation: creatine + adenosine-5'-triphosphate (ATP) EMI2.1 creatine phosphate + adenosine-5'-diphosphate (ADP). Both the forward and reverse reactions have been used in analytical procedures, but use of the reverse reaction is preferred because it is about six twines faster than the forward reaction. The presence of ATP can then be determined by a number of colorimetric or potentiometric methods. A recognized interferent in the deters, ination of total CK using equation (I) is adenylate kinase (AK) which is always present in normal human sera, but especially in hemolyzed samples of sera. AK is also present as a number of isoenzymes which are identified as to their source, e.g. erythrocyte, muscle and liver. AK catalyzes the formation of ATP according to the following equation taken in the forward direction: EMI2.2 wherein AMP is adenosine-5'-monophosphate. Thus, the presence of AK causes a detectable apparent increase in the amount of ATP in a serum sample, and consequently would give an erroneous apparent increase in CK activity according to the reverse of equation (I). In one standard creatine kinase or creatine kinase-MB assay, most adenylate kinase activity is suppressed by means of an AMP:ADP ratio of at least 10:1 in combination with 5 to 8 millimolar fluoride ion. Another known AK inhibitor, P1, p -di(adenosine-5')pentaphosphate (DAPP) is known to provide insufficient AK inhibition. Solution CK-MB assays require blanking, whereby AK activity is separately measured and subtracted from the test assay results, because complete AK inhibition is not obtained with the combination of AMP and DAPP. A blanking procedure is highly dis-advantageous, however, for use in highly automated clinical chemistry analyzers and procedures because it complicates equipment and procedures and increases the likelihood of error. The use of fluoride ion as an AK inhibitor has its disadvantages. Fluoride tends to precipitate as a salt in the presence of magnesium ion, a common enzyme cofactor used in CK assays. Its inhibition of AK is slow, requiring up to ten minutes which is an undesirably long time. Further,^fluoride tends to inhibit CK activity as well. As a result, a number of researchers have avoided fluoride ion and turned to DAPP and AMP to inhibit AK activity. Szasz et al, in Clin. Chem., 22 (11), pp. 1806-1811 (1976), describe investigations of AK inhibition in total CK assays. This reference teaches that erythrocyte and muscle AK are 97% inhibited by means of 0.01 millimolar DAPP. However, only 80% of the liver isoenzyme is inhibited. An AMP:ADP molar ratio of 10:1 inhibits 95% of total AK, but it also reduces the activity of the analyte, total CK, by 15-20%. With 0.5-1 millimolar DAPP alone, up to 975 of the activity of liver AK is inhibited, but only at the expense of a 5% reduction in CK activity. Further, the researchers discourage use of DAPP because of its high cost at the higher concentrations. Hence, these researchers concluded that, for total CK determinations, a suitable compromise for AK inhibition would be 0.01 millimolar DAPP and a 5:2 molar ratio of AMP to ADP. This research became the basis for the total CK assay standard adopted in recent years. This standard assay reduces the interference by erythro- cyte and muscle AK by 97%, but liver AK is reduced only by 90-95%. At the same time, 5% of CK activity is sacrificed. In order to overcome this serious defect, serum blanks are generally run to determine' the residual AK activity. However, running serum blanks is tedious, complicates the assay and increases the likelihood of error. The levels of inhibitors (e.g. 0.01 DAPP and 5:2 molar ratio AMP:ADP) taught in the noted art are often sufficient to reduce AK interference to sufficient levels for total CK determinations. However, in an assay for CK-MB in which other creatine kinase isoenzymes are rendered inactive, the amount of CK available for reaction is considerably smaller. Hence, determination (i.e. quantification) of the remaining CK is much more sensitive to interference by adenylate kinase or any reagent which would significantly affect the CK measurement. According to the teaching of the art, to reduce AK interference 97%, a worker in the art would use 0.5-1 millimolar DAPP as an AK inhibitor. However, this level of DAPP also reduces the activity of CK-MB by at least 5% which is an unacceptable amount. Combining a lower amount of DAPP with a molar ratio of AMP:ADP of 10:1 reduces CK activity even further. It appears that the art would suggest avoiding high DAPP levels and high AMP:ADP ratios. Yet, in the determination of CK-MB, it would be highly desirable to eliminate at least 99% of all AK interference, especially liver AK, without a decrease in CK activity in order to render the assay highly accurate and sensitive to the CK-MB isoenzyme. The problems noted above have been overcome with an analytical composition for the determination of creatine kinase-MB comprising creatine phosphate and an indicator composition which is capable of providing a detectable change in response to reaction of creatine phosphate or its reaction product, the composition being characterized by comprising adenosine-5'-diphosphate in an amount of from 1 to 3 millimolar, and a combination of adenylate kinase inhibitors consisting essentially of: P1 P5¯di(adenosine-5')polyphosphate (a) P ,P -di(adenosine-5')polyphosphate present in an amount of at least 0.3 millimolar, and (b) adenosine-5'-monophosphate present in a molar ratio to adenosine-5'-diphosphate of at least 10:1. A dry analytical element for the determination of creatine kinase-MB comprises an absorbent carrier material and contains the analytical composition described above. This invention further provides a method for the determination of creatine kinase-MB in an aqueous liquid comprising the steps of: (A) in the presence of at least one antibody for creatine kinase-MM, contacting a sample of a liquid suspected of containing creatine kinase-MB with the analytical composition described above, and (B) determining the detectable change resulting from the presence of creatine kinase-MB. The present invention provides an assay and element for creatine kinase-MB in aqueous liquids which overcomes the problems noted above. In particular, the assay of this invention is not susceptible to interference by adenylate kinase to any significant degree, thereby rendering it highly accurate and sensitive to CK-MB. In particular, at least 99% of liver AK activity is inhibited with this invention. Further, it is simple to use, The assay of this invention can be carried out with undiluted samples if desired and sample blanking is unnecessary. These advantages are achieved by use of critical amounts of the AK inhibitors P1,P5-di(adenosine-5')polyphos- phate, e.g. DAPP, and AMP in the assay. The present invention relates to the determination (qualitative or quantitative measurement) of creatine kinase-MB in aqueous liquids. In particu lar, the invention can be used to assay biological fluids of either animals or humans, but preferably of humans. Such fluids include, but are not limited to, whole blood, plasma, sera, lymph, bile, urine, spinal fluid, sputum, perspiration and the like as well as stool secretions. It is also possible to assay fluid preparations of human or animal tissue such as skeletal muscle, heart, kidney, lungs, brains, bone marrow, skin and the like. The preferred biological fluid for practice of the invention is human blood serum. Advantageously, the test sample can be diluted or undiluted. In particular, the present invention relates to an immunochemical method for selectively determining creatine kinase-MB in a biological fluid which also possibly contains CK-MM and CK-BB. Generally, the method comprises contacting the liquid to be assayed with the analytical composition of this in vention, the details of which are provided below. Prior to or simultaneously with that contact, the liquid sample is contacted with one or more antibodies which are capable of either preferentially reacting with or preferentially inhibiting the enzymatic activity of the M subunits in the CK and CK-MB isoenzymes present in the sample. The B subunits of the CK-MB isoenzyme are ideally uneffected by the presence of the antibodies, and therefore, are free to react in any of a number of reaction schemes to produce a detectable change. The amount of CK-BB is generally considered negligible in such assays. The detectable change produced is then directly correlated to the amount of CK-MB in the fluid sample. The detectable change can be either a potentiometric change or an optical density change as long as the change results from the reaction of creatine phosphate or its reaction product according to the reaction (1) in the forward direction: (1) Creatine phosphate + ADP EMI7.1 creatine + ATP. In its simplest form, the assay can measure either the disappearance of creatine phosphate, or the appearance of creatine as described, for example, in PCT Application 82/2213. Generally, however, reaction (1) is coupled with one or more other enzymatic reactions which provide a potentiometric change or an optical density change as a result of further reaction of ATP or its reaction product. If a potentiometric change is generated, CKMB is determined by measuring the rate of change in electrical output with an ion-sensing electrode. For example, U.S. Patent 4,042,462 describes a potentiometric means for measuring the uptake of oxygen as a result of the following sequence of enzymatic reactions (2)-(4) used in combination with reaction (1) above: (2) ATP + glucose EMI7.2 glucose-6phosphate + ADP (3) glucose-6-phosphate + NADP+ EMI7.3 6-phosphogluconate + NADPH + EMI7.4 wherein NADP (NADPH) is nicotinamide adenine dinucleotide phosphate (same, reduced form), G6-DPH is glucose-6-phosphodehydrogenase and ETA is an electron transfer agent. 0200541 Preferably, CK-MB is determined in the present: invention by measuring an optical density change. This change can be colorimetric, fluorometric, or photometric, and is meant to include the rate of appearance of light, the rate of increase or decrease in optical density, and the rate of a shift in ah sorbance from one wavelength to another. For example, a photometric assay is described in U.S. Patent 4,235,961 wherein reaction (1) above is com bined with the following reaction (5) to produce detectable emissions of light: (5) ATP + luciferin + O2 EMI8.1 oxyluciferin + CO2 + AMP + PPi + light wherein PPi is pyrophosphate. More particularly, CKIIB is determined by colorimetric means whereby an optical density change is measured at a wavelength between 200 and 900 nm. At wavelengths below 400 nm, the measurements are generally in the ultraviolet regions of the electron magnetic spectrum, as when NADH (i.e. nicotinamide adenine dinucleotide, reduced form) or NADPH are measured according to the following coupled enzymatic reaction schemes. Reactions (1), (2) and (3) noted above can be used together, as described in J. Clin. Chem. Clin. Biochem., 15, pp. 255-260 (1977) and U.S. Patent 4,220,714. A similar sequence of coupled reactions beginning with reaction (1) and using NADH in reactions (6) and (7) below is described in U.S. Patent 4,352,881: (6) ATP + 3-phosphoglycerate EMI8.2 ADP + 1,3-diphosphoglycerate (7) l,3diphosphoglycerate + NADH EMI8.3 glyceraldehyde-3-phosphate + NAD Other colorimetric assays carry either reaction (3) or (7) further by reducing a colorless tetrazolium salt and forming a colored dye according to reaction(8): (8) NADH (or NADPH) + tetrazolium salt (colorless) EMI9.1 NAD (or NADP+) + formazan dye diaphorase Such assays are described, for example, in U.S. Patents 4,012,286 and 4,247,633. The reagents and enzymes needed for the assays described above are commercially available. In each case, the indicator composition comprises the nonenzymatic reagents needed for the assay. In a preferred embodiment of the present invention, creatine kinase-MB (CK-MB) activity is determined by the following sequence of reactions: (1) Creatine phosphate + ADP EMI9.2 creatine + ATP (9) ATP + glycerol EMI9.3 L-a-glycerophosphate + ADP (10) L-a-glycerophosphate + electron acceptor EMI9.4 colorimetrically detectable species. In these combined reactions, the rate of formation of the colorimetrically detectable species is directly proportional to the rate of creatine kinase-MB activity in the liquid sample. The details of this sequence of reactions are provided in EP Application 116,307. The first reaction in the above-described sequence is the reaction of creatine phosphate and ADP to form creatine and ATP in the presence of creatine kinase-MB in the aqueous liquid sample. As is well known in the art, this reaction usually proceeds in the presence of an enzyme cofactor, such as a divalent metal ion. Exemplary cofactors are described below. Creatine phosphate is a biological compound commercially available from any of a number of sources. Creatine phosphate is used in the practice of invention in an amount in excess of that needed stoichiometrically to make the reaction proceed. ADP is the hydrolyzed form of the nucleotide ATP. The amount of ADP used in the assay is discussed in more detail below. As shown in reaction (2) above, glycerol kinase catalyzes the phosphorylation of glycerol to L- -glycerophosphate in the presence of ATP. Generally, any glycerol kinase is useful in the successful practice of the present invention although those obtained from E. coli and Candida mycoderma are preferred. Glycerol kinase enzymes from other sources are well known in the art. The glycerol useful in the practice of this invention can also be readily obtained commercially or prepared using techniques well known in the art. Glycerol can be provided either in free form or as a fatty acid ester of glycerol (e.g. triglycerides). The next step in the reaction sequence involves the oxidation of L-a-glycerophosphate and, generally, an electron acceptor to produce a colorimetrically detectable species. This species is quantitatively related to the creatine kinase-MB contained in the liquid sample. L--a;;-g lycerophosphate oxidase is a microbial enzyme which can be derived from a variety of sources. A detailed description of this enzyme and exemplary sources are provided in U.S. Patent 4,241,178 The oxidation of L-a-glycerophosphate occurs in the presence of an electron acceptor. -Any electron acceptor which will permit oxidation of the phosphate by the oxidase with the concomitant production of a colorimetrically detectable species is suitable for use in this invention In one embodiment, the electron acceptor can be an indicator composition containing a chromogen (which is defined in more detail below). Such chromogen can be reduced to provide an optical density change (as defined above). The rates of any of these changes can then be monitored to measure creatine kinase-MB activity. Certain indophenols, potassium ferricyanide and certain tetrazolium salts are useful as electron acceptors in the practice of this embodiment. For example, 2,6-dichlorophenolindophenol alone or in combination with phenazine methosulfate or phenazine ethosulfate (i.e. an electron transfer agent), and 2-(-indophenyl )-3-(-nitrophenyl )-5- phenyl-2H-tetrazolium chloride either alone or in combination with phenazine methosulfate is especially useful. In an alternative and preferred embodiment, the electron acceptor oxidizes the phosphate to produce an intermediate species which then reacts with an indicator composition to produce a colorimetrically detectable species according to the following reactions: (l0a) L-a-glycerophosphate + electron acceptor EMI11.1 d ihydroxyace tone phosphate + intermediate species (e.g. H202) (lOb) Intermediate species + colorimetric indicator composition EMI11.2 colorimetrically detectable species. Quantification of creatine kinase in the practice of this preferred embodiment is achieved using oxygen as the electron acceptor and a colored metric indicator composition which comprises: (1) a substance having peroxidative activity, and (2) a chromogen. In such a case, reaction (lOa) produces dihydroxyacetone phosphate and hydrogen peroxide. Colorimetric indicator compositions which react with hydrogen peroxide in reaction (lOb) are well known in the art. Generally, such compositions comprise a substance which has peroxidative activity. Preferably, this substance is peroxidase. A peroxidase is an enzyme which will catalyze a reaction wherein hydrogen peroxide oxidizes another substance. The peroxidases are generally conjugated proteins containing iron porphyrin. Peroxidase occurs in horseradish, potatoes, figtree sap and turnips (plant peroxidase), in milk (lacto peroxidase), and in white blood corpuscles (verdo peroxidase). It also occurs in microorganisms and can be produced by fermentation. Certain synthetic peroxidases, such as those disclosed by Theorell and Maehly in Acta chem. Scand., Vol. 4, pages 422-434 (1950), are also useful. A preferred peroxidase is that obtained from horseradish. Also, useful but to a lesser extent are such substances as hemin, methemoglobin, oxyhemoglobin, hemoglobin, hemochromogen, alkaline hematin, hemin derivatives, iron sulfocyanate, iron tannate, ferrous ferrocyanide, chromic salts (such as potassium chromic sulfate) absorbed in silica gel, etc. The colorimetric indicator composition also comprises a chromogen which is a colored or colorless substance which directly or indirectly provides a quantifiable colorimetric change the rate of which change can be quantitatively measured. The chromogen can be a dye, dye former or dye precursor. The color provided by the reaction of the chromogen is in the visible region of the electromagnetic spectrum (i.e. between 400 and 900 nm). Chromogens which provide color formation in the presence of hydrogen peroxide and peroxidase useful in the present invention include (with a color coupler where necessary): monoamines, diamines, phenols, polyphenols, aromatic acids, leuco dyes, triarylmethane dyes and the like. Other chromogens which contain a material oxidizable in the presence of peroxidase and which can provide a colorimetrically detectable species include certain dye-providing compositions. In one aspect, such chromogens can include a compound that, when oxidized by peroxidase, can couple with itself or with its reduced form to provide a dye. Such autocoupling compounds include a variety of hydroxylated compounds which are well known in the art. In another aspect, the detectable species can be provided by chromogens which include a peroxidase-oxidizable compound capable of undergoing oxidative condensation with couplers such as those containing phenolic groups or activated methylene groups, together with such a coupler. Representative of such oxidizable compounds are benzidene and its homologs, p-phenylenediamines, p-aminophenols, 4-aminoantipyrine, etc. A wide range of such couplers, including a number of autocoupling compounds, is described in the art. A wide range of color couplers, including autocoupling compounds, are known in the art, including N,Ndisubstituted toluidines, dihydroindoles and tetrahydroquinolines. In still another and preferred aspect, the colorimetrically detectable species can be provided by peroxidase-induced oxidation of a leuco dye to provide the corresponding dyestuff form. A variety of leuco dyes are useful as chromogens in the practice of this invention including those described in U.S. Patents 4,241,178. Leuco dyes most preferred for use in this invention are the triarylimidazoles of U.S. Patent 4,089,747. Particularly useful leuco dyes include 2-(3,5-dimethoxy-4-hydroxyphenyl)-4,5-bisf4-di- methylaminophenyl) imidazole 2-(4--hydroxy-3inethoxy- phenyl)-4,-bis(E-dimethylaminophenyl)-l and 2-(3-ethoxy-4-hydroxyphenyl-4,5-bis(2-dimethyl- aminophenyl )-lH-imidazole. The amounts of the components of the indicator compositions useful in the practice of this invention, including the preferred colorimetric indicator compositions, are dependent to a large extent upon the concentration of creatine kinase-MB in the sample, the sophistication of the detection apparatus, and the detectable change produced. The amounts are readily determinable by a worker skilled in clinical chemistry. The assay of this invention uses a critical combination of the adenylate kinase (AK) inhibitors: a) P1,P5di(adenosine-5')polyphosphate, and b) adenosine-5'-monophosphate (AMP), in proportions found to be effective to substantially reduce the activity of all (i.e. at least 99%) isoenzymes of endogenous adenylate kinase (AK) so that AK does not affect the determination of CK-MB. No other AK inhibitors (e.g. fluoride) are present in this combination. Fluoride is excluded from the combination because it also inhibits CK activity and tends to precipitate in the presence of magnesium ion, a common cofactor used in CK assays. Although the amounts to achieve the critical reduction in AK'activity can vary, generally, the polyphosphate is present in an amount of at least 0.3 millimolar, and preferably at least 0.5 millimolar. No upper limit is critical although for practical purposes, no more than 1 millimolar of the polyphosphate is used. Generally, AMP and ADP are present in a molar ratio of at least 10:1 with ADP present in an amount of from 1 to 3 millimolar. Preferably, the molar ratio is at least 12:1, and ADP is p'resent in an amount of from 1 to 2 millimolar. More preferably, the AMP to ADP molar ratio is at least 14:1 and ADP is present in an amount of 1.5 millimolar. The polyphosphate, which can be P1,P5-di-' (adenosine-5' )tetra-, penta- or hexaphosphate, and AMP and ADP are readily available commercially. PÚ,p5-di(adenosine-5')pentaphosphate is particularly useful in the practice of this invention. The analytical composition of this invention can also include other reagents or addenda generally used in total CK or CK-MB determinations, including CK activators, metal ioncofactors (e.g. magnesium; calcium and iron ions), solvents, buffers, surfact- ants, etc. It is particularly desirable to include one or more CK activators which promote full créatine kinase activity. Such activators include mercaptocontaining compounds (also known as thiol-cortaining or sulfhydryl compounds), such as thioglucose, di- thiothreitol, dithioerythritol, mercaptoethanaT, glutathione, N-acetylcysteine, cysteine, thiogiy- cerol, thioglycolic acid, etc. in amounts known to one skilled in clinical chemistry. The element also advantageously includes ethylenebis(oxyethylenenitrilo)tetraacetic acid in Åa suitable amount to improve CK sensitivity by sup- pressing the inhibitory effect of calcium ions. Antibodies useful in the practice of this invention which are specific to M subunits can be generated from antisera using known procedures. The antibodies can be isolated from the antisera before use, or unpurified antisera can be used. Antisera is generally obtained from suitably innoculated monkeys, pigs, horses, goats, rabbits, rats, mice, chickens, cattle, and other animals known to be useful for this purpose. A preferred source of antibodies are suitably innoculated goats. The antibodies are generally used in an immobilized form on a suitable carrier. In the assay of this invention, one or more antibodies can be immobilized within the element itself, if desired, without any additional carrier material or added prior to or simultaneously with the test sample to the element during the assay. Further details of useful antibodies and carrier materials are provided, for example, in U.S. Patents 4,237,044 and 4,260,678. The CK-MB assay of this invention can be carried out either in solution or using a dry analytical element. In solution assay, generally the analytical composition and liquid test sample are mixed, in the presence of one or more antibodies for CK-MH, in a suitable container (e.g. test tube, petri dish, beaker, cuvette, etc.). An activator for CK can also be added to the reaction mixture to obtain optimum activity. The resulting reaction mixture can be incubated for a period of time at a suitable temperature if desired. The reaction mixture is then evaluated by measuring the resulting detectable change, if any, using standard detection equipment and procedures. The amount of change observed is then correlated to the amount of CK-MB in the liquid sample using standard procedures The reaction mixture is generally buffered to a pH of 8 or less. Any suitable buffer or mixture thereof can be used in the practice of this invention. The analytical composition, antibodies and any articles needed for the practice of this invention can be provided as part of a diagnostic kit for either dry or solution assays. For solution assays, the kit components can be supplied, individually or in combination in a container means, as lyophilized reagents in individual packets having predetermined amounts. Alternatively, they can be provided in bottled or otherwise packaged solutions sufficient in size for one or more assays. Other reagents or nonreactive addenda can also be supplied in the kit along with suitable assay utensils or containers for performing the assay, if desired. A dry analytical element (described below) can also be included as part of a diagnostic kit. Alternatively, the reagents needed for theassay can be obtained from separate sources and brought together to provide an analytical composition. The method of this invention can also be practiced with a dry analyticWal element. The simplest element can be composed of an absorbent carrier material, e.g. a thin sheet (Of a self-supporting absorbent or bibulous material, such as filter paper or strips, which contains the analytical composition of this invention. The element. can be divided into two or more discrete zones with different reagents incorporated into individual zons of the carrier material. Such elements are kn(zwn in the art as test strips, diagnostic elements, dip sticks, diagnostic agents and the like. The element also preferably contains the antibodies for the M subunit described above. The analytical composition can be incorporated into the absorbent carrier material by imbibition, impregnation, coating or another suitable technique. Generally, the composition is incorporated into a coating composition, whereas the CK-MM antibodies are incorporated by imbibition or wash coating into an already coated zoo^. Useful absorbent carrier materials are insoluble and maintain their structural integrity when exposed to water or biological fluids such as whole blood or serum. Useful elements can be prepared from paper, porous particulate structures, porous polymeric films, cellulose, wood, glass fiber, woven and nonwoven fabrics (synthetic and nonsynthetic) and the like. Useful materials and procedures for making such elements are well known in the art as exemplified in U.S. Patents 3,092,465, 3,802,842, 3,915,647, 3,917,453, 3,936,357, 4,248,829, 4,255,384, 4,270,920 and 4,312,834, and U.K. Patent 2,052,057. Preferably, the absorbent carrier material of the dry analytical element of this invention is a porous spreading zone. This zone can be selfsupporting (i.e. composed of a material rigid enough to maintain its integrity), but preferably it is carried on a separate support. Such a support can be any suitable dimensiona:lly stable, and preferably, nonporous and transparer1t (i.e. radiation transmissive) material which trnsmits electromagnetic radiation of a wavelength between 200 and 900 nm. A support of choice for a particular element should be compatible with the intended mode of detection (fluorescence or colorimetric: spectroscopy). Useful supports can be prepared from paper, metal foils, polystyrene, polyesters e.g. polyçethylene terephthal ate)), polycarbonates, cellulose esters (e.g. cellulose acetate), etc. The porous spreading zone can be prepared from any suitable fibrous or non-fibrous material or mixtures of either or both. The void volume and average pore size of this zone can be varied depending upon the use intended. Useful spreading zones can be prepared using either fibrous or nonfibrous materials, either mixed with a suitable binder material or woven into a fabric, as described in U. S. Patents 4,292,272, 3,992,158, 4,258,001 and 4,430,436 and Japanese Patent Publication 57(1982)-101760. It is desirable that the spreading zone be isotropically porous, meaning that the porosity is the same in each direction in the zone as caused by interconnected spaces or pores between particles, fibers, polymeric strands, etc. The elements can have two or more discrete zones, either in the same layer or superimposed. At least one of which is preferably a porous spreading zone. The other zones can be reagent zones or registration zones as those zones are known in the art, additional spreading zones, radiation-blocking or filter zones, subbing zones, barrier zones, etc. The zones are generally in fluid contact with each other, meaning that fluids, reagents and reaction products (e.g. color dyes) can pass or be transported between superposed regions of adjacent zones. In other words, when the element is contacted with fluid, all reagents of the analytical composition of this invention become mixed and can readily move within the element as a composition. Preferably, each zone is a separately coated layer, although two or more zones can be a single layer of the element. A preferred embodiment of this invention is a multilayer element comprising a support having thereon, in order and in fluid contact, a first (e.g. registration) layer containing an indicator composition described herein (e.g. a colorimetric indicator composition) a second (e.g. reagent) layer containing creatine phosphate, AMP, ADP and a polyphosphate described herein, optionally a subbing layer, and a porous spreading layer which optionally contains either a OK activator or at least one antibody for the M subunits or both. The registration and reagent layers generally contain one or more hydrophilic binder materials (e.g. gelatin, vinyl pyrrolidone polymers, acrylamide polymers, etc.) surfactants, and other addenda. The subbing layer can comprise one or more subbing materials known to one skilled in the art, e.g. vinyl pyrrolidone polymers, acrylamide polymers, and the like. When the preferred colorimetric indicator composition described above is used, the registration layer also contains a-glycerophosphate oxidase, and the reagent layer also contains glycerol and glycerol kinase. The elements of this invention can also contain one or more other addenda commonly put in the elements for various manufacturing or operational advantages. Such addenda include surfactants, buffers, solvents, hardeners and the like. In the elements of this invention, the coating coverage of creatine phosphate is at least 2 0.5 glm , and preferably from 1 to 2 glm . The amounts of the various components of the indicator composition are readily determined by one skilled in the art. The coating coverages for the polyphosphate, AMP and ADP are as follows, corresponding to the millimolar amounts described above: polyphosphate (e.g. DAPP): at least 0.03 gmê , and preferably at least 0.05 g/mê, ADP: from 0.05 to 0.16 g/mê , and preferably from 0.05 to 0.1 glum . AMP: at least a 10:1 molar ratio with ADP, and preferably at least a 12:1 molar ratio and more preferably, at least a 14:1 molar ratio. A variety of different elements, depending on the method of assay, can be prepared in accordance with the present invention. Elements can be configured in a variety of forms, including elongated tapes of any desired width, sheets, slides or chips. The assay of this invention can be manual or automated. In general, in using the dry elements, CK-MB determination is made by taking the element from a supply roll, chip packet or other source and physically contacting it with a sample (e.g. 1-200 > 1) of the liquid to be tested. Such contact can be accomplished in any suitable manner, e.g. dipping or immersing the element into the sample or, preferably, by spotting the element by hand or machine with a drop of the sample with a suitable dispensing means. After sample application, the element is exposed to any conditioning, such as incubation; heating or the like, that may be desirable to quicken or otherwise facilitate obtaining any test result. Prior to incubation, a CK-activator and the antibodies for the M subunits can also be added to the element individually or together if they are not incorporated within the element. The CK-MB added to the element in the test sample then catalyzes reaction of the ADP with the creatine phosphate substrate at a rate based on the amount of CK-MB present in the sample. The rate of detectable change (e.g. dye formation) due to either reaction of creatine phosphate or formation of the reaction product (e.g. ATP) is quantifiable by passing the element through a zone in which suitable detection apparatus for reflection or transmission spectrophotometry, potentiometry or photometry, is provided. Suitable detection apparatus and procedures are known in the art. The following examples illustrate the practice of this invention. As used in the context of this disclosure and the claims. I.U. represents the International Unit for enzyme activity defined as one I.U. being the amount of enzyme activity required to catalyze the conversion of 1 micromole of substrate per minute under standard pH and temperature conditions for the enzyme. ExamPles 1 & 2 - AssaYs of CK-MB Using An Analvtical Element In this example, CK-MB was determined using dry analytical elements. Assays using Control elements outside of the scope of this invention were compared to assays using elements of this invention. All elements evaluated had the following format and components. Goat anti-human CK-MM 22,900 U/mê** TiO2 50 g/m2 Cellulose acetate 7 g/mê Spreading ESTANE polyurethane resin 2.5 g/mê Layer N-acetyl-L-cysteine 0.4 g/m TRITON X-405 surfactant 1'.7 g/m2 Ethylenebis(oxyethylene nitrilo)tetraacetic acid 0.65 g/mê Subbing Poly(N-isopropylacrylamide) 0.4 g/mê Layer 2 Gelatin (Hardened) 5.4 glm Magnesium acetate 0.65 g/mê TRITON X-200E surfactant 0.1 g/mê Adenosine-5'-diphosphate (ADP) * Glycerol kinase 4320 I.U./m2 Reagent Adenosine-5'-monophosphate (AMP) * Layer Creatine phosphate 1.6 g/mê 15 P ,P di(adenosine-5')- pentaphosphate (DAPP) * Glycerol 0.2 gm2 2-[Bis(2-hydroxyethyl)iminoj- 2-(hydroxymethyl)-1,3- propanediol 2 g/mê 2 Gelatin (Hardened) 5.4 gim 2-(Bis (2hydroxyethyl )- imino]- 2 -(hydroxymethyl) 1,3-propanediol 2 g/mê Registration ALKANOL XC surfactant 0.3 g/m Layer Peroxidase 32,400 I.U./m2 2-t3,5-dimethoxy-4-hydro- xyphenyl)-4,5-bis(4-dimethyl aminophenyl)lmidazole 0.2 g/a2 Ascorbic acid oxidase 10,800 I.U./m2 L-&alpha; ;-Glycerophosphate oxidase 3240 I.U./m2 Glycolic acid 0.3 g/mê 5, 5-Dimethyl-1,3-cyclohexane- dione 0.05 g/mê TRITON X-200E surfactant 0.1 g/m 2,4-Di-a-pentylphenol 2 g/m EMI24.1 <tb> / <SEP> / <SEP> / <SEP> Poly(ethylene <SEP> terephthalate) <SEP> // <tb> <SEP> Support <tb> * See Table I below for amounts ** The antisera level is given in Units (U) which are defined by the titer assay: (505 inhibition titer) (ml/0.093 m2) = U/m2. Table I AMP ADP AMP:ADP DAPP Element (g/mê) (g/mê) molar ratio (g/mê) Control A*** 1.08 0.08 14.7:1 0.054 Control B 0.22 0.16 1.5:1 0.Q01 Control C 0.22 0.16 1.5:1 0.004 Control D 1.08 0.08 14.7:1 0.004 Control E 1.08 0.08 14.7:1 0.010 Example 1 1.08 0.08 14.7:1 0.032 Example 2 1.08 0.08 14.7:1 0;054 *** This element also contained 0.025 g/m2 sodium fluoride which is not desirable in the practice of this invention. Determination of CK-MB was made using each element according to the following procedure: Test fluids containing 11.0-15.3 I.U./Q human CK-MB activity in a heat-treated human serum pool base were used. Adenylate kinase isoenzymes were added to individual pools as follows: 110 I.U./Q liver AK, 190 I.U./Q erythocyte AK and 190 I.U./Q muscle AK (final concentrations). Control fluids were serum pool base without AK. Aliquots (10 > 1) of each test fluid and control fluid were spotted on samples of the element illustrated above. Reflection densities produced from dye generated by the presence of CK-MB were monitored on a spectrophotometer over a period of 7 to 9 minutes at 37 C and 670 nm. CK-MB activities were predicted using a predetermined calibration curve. The net bias resulting from the presence of each AK isoenzyme was calculated by obtaining the difference in predicted CK-MB activity of the AKcontaining samples and a control using 5 replicates. For example, the predicted CK-MB activity in the sample containing liver AK was 10.68 I.U*SQ, while the predicted activity in the Control was 10.04 I.U./t. Therefore, the net bias was 0.64 I.U.lt. The net bias results of the determinations are provided in Table II below. The acceptable net bias is 1% of original AK activity. In this example, the acceptable net bias for each isoenzyme was: 1.1% for liver AK, 1.9% for each of muscle and erythrocyte AK. Table II Net Bias (I.U./Q) Element Liver AK Erythrocyte AK Muscle AK Control A 1.70 0.71 0.25 Control B 27.8 4.43 6.69 Control C 23.8 1.84 2.08 Control D 1.63 1.40 0.52 Control E 1.80 1.69 0.73 Example 1 0.64 1.43 0.11 Example 2 0.75 1.01 0.44 It is evident from the data that the assays using the analytical elements of this invention had acceptably low net biases (i.e. very low AK interference). That is, less than 1% of the original amount of each adenylate kinase isoenzyme, and especially liver AK remained effective in the assay. Control A, which contained sodium fluoride as an AK inhibitor, exhibited low interference from erythocyte and muscle isoenzymes, but the interference from liver AK was unacceptably high. Controls B-E, which contained insufficient amounts of AMP or DAPP, also exhibited unacceptably high AK interference from one or more of the isoenzymes.

Claims: Claims: 1. An analytical composition for the determination of creatine kinase-MB comprising creatine phosphate and an indicator composition which is capable of providing a detectable change in response to the reaction of creatine phosphate or its reaction product, the composition characterized as comprising adenosine-5'-diphosphate in an amount of from 1 to 3 millimolar, and a combination of adenylate kinase inhibitors consisting essentially of: a) PÚ ,P5 -di(adenosine-5')polyphosphate present in an amount of at least 0.3 milli- molar, and b) adenosine-5 '-monophosphate present in a molar ratio to adenosine-5'-diphosphate- of at least 10:1. 2. A dry analytical element for the determination of creatine kinase-MB comprising an absorbent carrier material, and containing an analytical composition comprising creatine phosphate, and an indicator composition which is capable of providing a detectable change in response to the reaction of creatine phosphate or its reaction product, the element characterized by comprising adenosine-5'diphosphate in an amount of from 1 to 3 millimolar, and a combination of adenylate kinase inhibitors consisting essentially of: 15 a) P ,P -di(adenosine-5')poly- phosphate present in an amount of at least 0.3 millimolar, and b) adenosine-5'-monophosphate present in a molar ratio to adenosine-5'-diphosphate of at least 10:1. 3. The element as claimed in claim 2 wherein the absorbent carrier material is a porous spreading zone carried on a support. 4. The element as claimed in claim 3 wherein the spreading zone contains antibodies for creatine kinase-MM. 5. A method for the determination of creatine kinase-MB in an aqueous liquid comprising the steps of: (A) in the presence of at least one antibody for creatine kinase-MM, contacting a sample of a liquid suspected of containing creatine kinase-MB with an analytical composition comprising creatine phosphate, an indicator composition which provides a detectable change in response to the reaction of creatine phosphate or its reaction product, adenosine-5'-diphosphate present in an amount of from 1 to 3 millimolar, and a combination of adenylate kinase inhibitors consisting essentially of: a) PÚ ,P5 -di(adenosine-5')polyphosphate present in an amount of at least 0.3 millimolar, and b) adenosine-5'-monophosphate present in a molar ratio to adenosine-5'-diphosphate of at least 10: :1, and (B) determining the detectable change resulting from the presence of creatine-MB. 6. The method as claimed in claim 5 wherein the detectable change is a colorimetric change. 7. The invention as claimed in any of claims 1 to 6 wherein the ,P di(adenosine5')polyphosphate is PÚ ,P5 -di(adenosine-5')- pentaphosphate present in an amount of at least 0.5 millimolar. 8. The invention as claimed in any of claims 1 to 7 wherein the indicator composition provides an optical density change in response to adenosine-5'-triphosphate or its reaction product. 9. The invention as claimed in any of claims 1 to 7 wherein the indicator composition is a colorimetric indicator composition comprising a substance having peroxidative activity and a leuco dye. 10. The invention as claimed in any of claims 1 to 9 wherein the adenosine-5'-diphosphate is present in an amount of from 1 to Z millimolar. 11. The invention as claimed in any of claims 1 to 10 wherein the molar ratio of adenosine5'-monophosphate to adenosine-5'-diphosphate is at least 14:1.

Inventors: FINDLAY, JOHN BRUCE, WU, ANNIE LIU
Applicants: EASTMAN KODAK COMPANY (A NEW JERSEY CORPORATION)
Application year: 1986
Main classification: G01N33
IPC codes: G01N33, C12Q1