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CM-MM and ACE genotypes and physiological prediction of the creatine kinase response to exercise

Departments of ¹Military and Emergency Medicine and of ²Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda; and ³Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Bethesda, Maryland

Submitted 17 January 2007 ; accepted in final form 2 May 2007

Exertional rhabdomyolysis (ERB) is a syndrome of severe skeletal muscle breakdown. Blood levels of creatine kinase (CK) are widely used as a marker to reflect muscle breakdown. Some individuals exhibit extreme increases in blood CK after exercise and have been characterized as high responders (HR), but no clinical definition of HR exists and reasons for the HR phenomenon are not understood. This study investigated possible associations between the magnitude of the CK response to exercise and polymorphisms of two genes: muscle-specific creatine kinase (CK-MM) NcoI and angiotensin-converting enzyme (ACE) I/D. An exercise test for defining HR was also investigated. Participants (n = 88) underwent an exercise test that included stepping up and down two stairs for 5 min followed by 15 squats while wearing a backpack weighted at 30% of their body weight. CK levels were measured before, immediately after, and 48 and 72 h after the test. Nine participants (10.2%) were defined as HR. Participants with the CK-MM NcoI AA genotype had a sixfold higher risk of being HR compared with GG and AG genotypes (P = 0.031). No significant differences were found for the ACE I/D polymorphism. Percent body fat was an independent predictor of being a HR. We conclude that the CK-MM AA genotype and percent body fat may be part of the constellation of mechanisms that explain susceptibility to ERB. A physiological test that may assist in predicting ERB is also presented.

exertional rhabdomyolysis; high responder; polymorphisms

This article has been cited by other articles:

				C. Yamin, O. Amir, M. Sagiv, E. Attias, Y. Meckel, N. Eynon, M. Sagiv, and R. E. Amir ACE ID genotype affects blood creatine kinase response to eccentric exercise J Appl Physiol, December 1, 2007; 103(6): 2057 - 2061. [Abstract] [Full Text] [PDF]