Previous analysis of the muscle creatine kinase (MCK) gene indicated that control elements required for transcription in adult mouse muscle differed from those required in cell culture, suggesting that distinct modes of muscle gene regulation occur in vivo. To examine this further, we measured the activity of MCK transgenes containing E-box and promoter deletions in a variety of striated muscles. Simultaneous mutation of three E boxes in the 1,256-bp MCK 5 region, which abolished transcription in muscle cultures, had strikingly different effects in mice. The mutations abolished transgene expression in cardiac and tongue muscle and caused a reduction in expression in the soleus muscle (a muscle with many slow fibers) but did not affect expression in predominantly fast muscles: quadriceps, abdominals, and extensor digitorum longus. Other regulatory sequences with muscle-type-specific activities were found within the 358-bp 5-flanking region. This proximal region conferred relatively strong expression in limb and abdominal skeletal muscles but was inactive in cardiac and tongue muscles. However, when the 206-bp 5 enhancer was ligated to the 358-bp region, high levels of tissue-specific expression were restored in all muscle types. These results indicate that E boxes and a proximal regulatory region are differentially required for maximal MCK transgene expression in different striated muscles. The overall results also imply that within skeletal muscles, the steady-state expression of the MCK gene and possibly other muscle genes depends on transcriptional mechanisms that differ between fast and slow fibers as well as between the anatomical and physiological attributes of each specific muscle.Creatine kinase catalyzes the regeneration of ATP from creatine phosphate and provides energy for contraction in all striated muscle types. The muscle creatine kinase (MCK) gene is transcriptionally activated during differentiation of myoblasts to myocytes (8, 31) and encodes the predominant creatine kinase isoform expressed in mammalian skeletal and cardiac muscle. While it seems likely that intrinsic differences in striated muscle anatomy and physiology would affect MCK gene expression, little is known concerning the steady-state mechanisms of MCK transcription in diverse muscle types. This transgenic study seeks to identify regulatory regions and elements within the MCK gene that are involved in controlling muscle-type-specific expression.Several regions within the mouse MCK gene 5Ј-flanking sequence are required for muscle-specific expression in cultured myocytes and cardiomyocytes (1, 32, 64). Of particular interest is a 206-bp enhancer located approximately 1 kb upstream of the transcription start site. This region functions in an orientation-independent manner and drives the expression of heterologous promoters in skeletal myocytes (32). The 5Ј MCK enhancer contains a number of sequence motifs-including the E box, CArG, and AT-rich sites-which are recognized by tissue-specific and ubiquitous transcription factors. Mutation...