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Kutlu E, Avci E, Acar K. Postmortem biochemistry in deaths from ischemic heart disease. J Forensic Leg Med 2023; 100:102599. [PMID: 37839363 DOI: 10.1016/j.jflm.2023.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/05/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
Ischemic heart disease (IHD) is one of the leading causes of morbidity and sudden cardiac death worldwide and is an important public health problem. The presence of ischemia in clinical applications can be detected by ECG, biochemical markers, and radiological methods. Myocardial infarction is also frequently encountered in forensic autopsies. Postmortem diagnosis is determined as a result of histopathological examinations and additional exclusionary examinations (toxicology, microbiology, etc.). However, routine histopathological examinations are insufficient, especially when death occurs in the early period of ischemia. It creates a problem for forensic pathologists and forensic medicine specialists in such cases of sudden cardiac death. Postmortem biochemistry is one of the important and promising disciplines in which forensic applications work in order to diagnose these cases correctly. The issue of whether biomarkers used in the diagnosis of myocardial infarction in clinical studies can be used reliably in postmortem cases has been discussed by forensic medicine researchers for some time. This manuscript aims to review and summarize biomarkers belonging to various categories that have been studied in IHD-related deaths, in biological fluids taken at autopsy, or in animal experiments. Our study shows that the postmortem use of biochemical markers in the diagnosis of IHD yields promising results. However, it should not be forgotten that postmortem biochemistry is different from clinical applications due to its dynamics and that the body causes unpredictable changes in markers in the postmortem process. Therefore, comprehensive studies are needed to evaluate the postmortem stability of these markers in different biological fluids, their significance among various causes of death, and whether they are affected by any variable (Cardiopulmonary resuscitation, Postmortem interval, medications, etc.) before they are routinely applied. It is suggested by the authors that the cut-off values of biomarkers whose significance has been proven by these studies should be determined and that they should be used in this way in routine applications.
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Affiliation(s)
- Erdi Kutlu
- Department of Forensic Medicine, Ministry of Health Harakani State Hospital, Kars, Turkey.
| | - Esin Avci
- Department of Biochemistry, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Kemalettin Acar
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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Wu SH, Zhao H, Zhang Y, Luo J, Tian M, Zhu B, Cao Z. Postmortem biochemical analysis of soluble ST2 in the pericardial fluid of patients with sudden cardiac death caused by ischemic heart disease: a pilot study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00677-4. [PMID: 37450171 DOI: 10.1007/s12024-023-00677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Soluble growth stimulation expressed gene 2 protein (sST2) is a myocardial protein induced by biomechanical stress. sST2 is widely present in the serum of patients with heart failure and is recommended as an important indicator to predict adverse outcomes in these patients. However, no postmortem biochemical analysis of sST2 in forensic practice has been reported. The present pilot study aimed to investigate the expression of sST2 in the pericardial fluid of patients with sudden cardiac death (SCD) caused by ischemic heart disease (IHD). In addition, to explore the relationship of sST2 with CK-MB, cTnT, and NT-proBNP, which have been proven to be auxiliary biomarkers for the diagnosis of SCD, we analyzed CK-MB, cTnT, NT-proBNP, and sST2 levels in twenty-one pericardial fluid samples from the Center of Forensic Investigation, China Medical University, with a Roche cobas e 411 electrochemiluminescence automatic immunoassay system and ST2/IL-33R Valukine™ enzyme-linked immunosorbent assay kit. The levels of sST2 in the pericardial fluid of patients with SCD caused by IHD were significantly increased (P < 0.01) and positively correlated with CK-MB and NT-proBNP (P < 0.0001). Receiver operating characteristic curve analysis indicated that the combined measurement of sST2 and NT-proBNP has a higher diagnostic value for SCD caused by IHD than the measurement of either indicator alone. This study preliminarily demonstrated that sST2 in the pericardial fluid was significantly increased in patients with SCD caused by IHD and might be used as a novel auxiliary biomarker for postmortem diagnosis of SCD in forensic practice.
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Affiliation(s)
- Shao-Huang Wu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77, Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, People's Republic of China
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Sciences, Shenyang, 110122, People's Republic of China
- China Medical University Center of Forensic Investigation, Shenyang, 110122, People's Republic of China
| | - Hao Zhao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77, Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, People's Republic of China
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Sciences, Shenyang, 110122, People's Republic of China
- China Medical University Center of Forensic Investigation, Shenyang, 110122, People's Republic of China
| | - Yuming Zhang
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77, Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, People's Republic of China
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Sciences, Shenyang, 110122, People's Republic of China
- China Medical University Center of Forensic Investigation, Shenyang, 110122, People's Republic of China
| | - Jiawei Luo
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77, Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, People's Republic of China
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Sciences, Shenyang, 110122, People's Republic of China
- China Medical University Center of Forensic Investigation, Shenyang, 110122, People's Republic of China
| | - Meihui Tian
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Sciences, Shenyang, 110122, People's Republic of China
- China Medical University Center of Forensic Investigation, Shenyang, 110122, People's Republic of China
- Department of Forensic Genetics and Biology, China Medical University, Shenyang, 110122, People's Republic of China
| | - Baoli Zhu
- Judicial Authentication Center of Liaoning University, Shenyang, 110031, People's Republic of China
| | - Zhipeng Cao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77, Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, People's Republic of China.
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Sciences, Shenyang, 110122, People's Republic of China.
- China Medical University Center of Forensic Investigation, Shenyang, 110122, People's Republic of China.
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Kutlu E, Çil N, Avci E, Bir F, Kiliç İD, Dereli AK, Acar K. Significance of postmortem biomarkers and multimarker strategy in sudden cardiac death. Leg Med (Tokyo) 2023; 61:102212. [PMID: 36738552 DOI: 10.1016/j.legalmed.2023.102212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/25/2022] [Accepted: 01/29/2023] [Indexed: 02/02/2023]
Abstract
The most common cause in the etiology of sudden cardiac death (SCD) is ischemic heart disease due to atherosclerosis. Postmortem diagnosis can be made by histopathological examinations, but routine histopathological examinations are limited, especially in the early period of postmortem ischemia. For this reason, many methods are being investigated for the postmortem diagnosis of ischemia, and postmortem biochemical studies are promising. In our study, we evaluated the biochemical markers; hs-cTnT, NT-proBNP, H-FABP, pentraxin-3, copeptin, ischemic modified albumin (IMA), and PAPP-A in postmortem serums. In forensic pathology practice, it was investigated whether it would be useful to go to the diagnosis by measuring more than one marker in a single biological fluid in SCD cases. The study included 35 sudden cardiac death cases and 24 control cases and as a result of our study, hs-cTnT, NT-proBNP, and H-FABP values were found to be significantly higher in the SCD group than in the control group. Within the scope of the multi-marker strategy, models were tried to be developed in which the markers were used together, and it was concluded that the model consisting of the myocardial ischemia marker hs-cTnT, the myocardial stress marker NT-proBNP, and the inflammation marker pentraxin 3 was the most accurate combination by correctly classifying the cases at a rate of 94.9%. As a result, it was thought that it would be appropriate to use the multi-marker strategy which is widely used in clinical applications, also in forensic medicine applications.
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Affiliation(s)
- Erdi Kutlu
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey
| | - Nazlı Çil
- Department of Histology, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
| | - Esin Avci
- Department of Biochemistry, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
| | - Ferda Bir
- Department of Pathology, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
| | - İsmail Doğu Kiliç
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey
| | - Ayşe Kurtuluş Dereli
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey
| | - Kemalettin Acar
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Kınıklı Kampüsü, 20200 Denizli, Turkey.
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Zhao R, Cao Z, Wang T, Wu SH, Liao Z, Zhu B. Analyses of N-Terminal pro-brain natriuretic peptide, cardiac troponin T, and creatine kinase MB in pericardial fluid in sudden cardiac death caused by ischemic heart disease. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_124_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Goryacheva OA, Ponomaryova TD, Drozd DD, Kokorina AA, Rusanova TY, Mishra PK, Goryacheva IY. Heart failure biomarkers BNP and NT-proBNP detection using optical labels. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2021.116477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wiklund L, Sharma A, Patnaik R, Muresanu DF, Sahib S, Tian ZR, Castellani RJ, Nozari A, Lafuente JV, Sharma HS. Upregulation of hemeoxygenase enzymes HO-1 and HO-2 following ischemia-reperfusion injury in connection with experimental cardiac arrest and cardiopulmonary resuscitation: Neuroprotective effects of methylene blue. PROGRESS IN BRAIN RESEARCH 2021; 265:317-375. [PMID: 34560924 DOI: 10.1016/bs.pbr.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Oxidative stress plays an important role in neuronal injuries after cardiac arrest. Increased production of carbon monoxide (CO) by the enzyme hemeoxygenase (HO) in the brain is induced by the oxidative stress. HO is present in the CNS in two isoforms, namely the inducible HO-1 and the constitutive HO-2. Elevated levels of serum HO-1 occurs in cardiac arrest patients and upregulation of HO-1 in cardiac arrest is seen in the neurons. However, the role of HO-2 in cardiac arrest is not well known. In this review involvement of HO-1 and HO-2 enzymes in the porcine brain following cardiac arrest and resuscitation is discussed based on our own observations. In addition, neuroprotective role of methylene blue- an antioxidant dye on alterations in HO under in cardiac arrest is also presented. The biochemical findings of HO-1 and HO-2 enzymes using ELISA were further confirmed by immunocytochemical approach to localize selective regional alterations in cardiac arrest. Our observations are the first to show that cardiac arrest followed by successful cardiopulmonary resuscitation results in significant alteration in cerebral concentrations of HO-1 and HO-2 levels indicating a prominent role of CO in brain pathology and methylene blue during CPR followed by induced hypothermia leading to superior neuroprotection after return of spontaneous circulation (ROSC), not reported earlier.
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Affiliation(s)
- Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Zhang T, Xu C, Zhao R, Cao Z. Diagnostic Value of sST2 in Cardiovascular Diseases: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:697837. [PMID: 34368254 PMCID: PMC8342767 DOI: 10.3389/fcvm.2021.697837] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022] Open
Abstract
Biomarkers such as B-type natriuretic peptide (BNP), N-terminal pro-BNP (NT-proBNP), cardiac troponin (cTn), and CK-MB contribute significantly to the diagnosis of cardiovascular disease (CVD). Recent studies have demonstrated that suppression of tumorigenicity 2 (ST2) is associated with CVD, but a meta-analysis of ST2 levels in different CVDs has yet to be conducted. Therefore, the present study aimed to investigate soluble ST2 (sST2) levels in patients with ischemic heart disease (IHD), myocardial infarction (MI), and heart failure (HF). A total of 1,425 studies were searched across four databases, of which 16 studies were included in the meta-analysis. The Newcastle-Ottawa Quality Assessment Scale (NOS) values of all 16 studies were ≥7. The meta-analysis results indicated that the sST2 level was not correlated with IHD (standard mean difference [SMD] = 0.58, 95% confidence interval [95% CI] = 0.00 to 1.16, p = 0.05) or MI (weighted mean difference [WMD] = 0.17, 95% CI = -0.22 to 0.55, p = 0.40) but was significantly associated with HF (WMD = 0.21, 95% CI = 0.04 to 0.38, p = 0.02; I 2 = 99%, p < 0.00001). sST2 levels did not differ significantly between patients with IHD or MI and healthy individuals; however, we believe that ST2 could be used as an auxiliary diagnostic biomarker of HF.
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Affiliation(s)
- Tianyi Zhang
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, China.,Department of Forensic Pathophysiology, School of Forensic Medicine, China Medical University, Shenyang, China.,Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Chengyang Xu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, China.,Department of Forensic Pathophysiology, School of Forensic Medicine, China Medical University, Shenyang, China
| | - Rui Zhao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, China.,Department of Forensic Pathophysiology, School of Forensic Medicine, China Medical University, Shenyang, China
| | - Zhipeng Cao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, China.,Department of Forensic Pathophysiology, School of Forensic Medicine, China Medical University, Shenyang, China
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Tian M, Xue J, Dai C, Jiang E, Zhu B, Pang H. CircSLC8A1 and circNFIX can be used as auxiliary diagnostic markers for sudden cardiac death caused by acute ischemic heart disease. Sci Rep 2021; 11:4695. [PMID: 33633191 PMCID: PMC7907149 DOI: 10.1038/s41598-021-84056-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/11/2021] [Indexed: 12/16/2022] Open
Abstract
Sudden cardiac death (SCD) caused by acute ischemic heart disease (IHD) is a major cause of sudden death worldwide. Circular RNAs (circRNAs) are abundant in the heart and play important roles in cardiovascular diseases, but the role of circRNAs as biomarkers in the forensic diagnosis of SCD caused by acute IHD remains poorly characterized. To investigate the potential of two heart-enriched circRNAs, circNFIX and circSLC8A1, we explored the expression of these two circRNAs in different kinds of commonly used IHD models, and further verified their expressions in forensic autopsy cases. The results from both the IHD rat and H9c2 cell models revealed that circSlc8a1 level was upregulated, while the circNfix level was elevated in the early stage of ischemia and subsequently downregulated. The time-dependent expression patterns of the two circRNAs suggested their potential as SCD biomarkers. In autopsy cases, the results showed that the expression of these two circRNAs in the myocardium with acute IHD-related SCDs corresponded to the observations in the ischemic models. Further analysis related to myocardial ischemia indicated that circSLC8A1 showed high sensitivity and specificity for myocardial infarction and was positively correlated with creatine kinase MB in pericardial fluid. Downregulated circNFIX level could indicate the ischemic myocardial damage, and it was negatively correlated with the coronary artery stenosis grade. The combination of circSLC8A1 and circNFIX had better performance to discriminate IHD-related SCDs. The results suggested that circSLC8A1 and circNFIX may be used as auxiliary diagnostic markers for SCD caused by acute IHD in forensic medicine.
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Affiliation(s)
- Meihui Tian
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Jiajia Xue
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Cuiyun Dai
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Enzhu Jiang
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Baoli Zhu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Hao Pang
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China.
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Yang Z, Zhang Q, Yu H, Li L, He Y, Zhu S, Li C, Zhang S, Luo B, Gao Y. A Novel COX10 Deletion Polymorphism as a Susceptibility Factor for Sudden Cardiac Death Risk in Chinese Populations. DNA Cell Biol 2020; 40:10-17. [PMID: 33180568 DOI: 10.1089/dna.2020.6086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Identifying common genetic variations that are related to sudden cardiac death (SCD) is crucial since it can facilitate the diagnosis and risk stratification of SCD. It has been reported that COX10 mutations might be related with SCD. In this study, we performed a systematic variant screening on the COX10 to filter potential functional genetic variations. Based on the screening results, an insertion/deletion polymorphism (rs397763766) in 3'untranslated regions of COX10 was selected as the candidate variant. We conducted a case-control study to investigate the association between rs397763766 and SCD susceptibility in Chinese populations. Logistic regression analysis showed that the deletion allele of rs397763766 was associated with an increased risk for SCD (odds ratio = 1.61, 95% confidence interval = 1.25-2.07, p = 1.87 × 10-4) susceptibility than insertion allele. Further genotype-phenotype analysis using human cardiac tissue samples suggested that COX10 expression level in genotypes containing deletion allele was higher than that in ins/ins genotype. The results were further reinforced by RNA sequencing data from 1000 Genomes Project. Luciferase activity assay indicated that COX10 expression could be regulated by rs397763766 through interfering binding with miR-15b, thus conferring risk of SCD. In conclusion, the novel rs397763766 polymorphism might be a potential marker for molecular diagnosis and genetic counseling of SCD.
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Affiliation(s)
- Zhenzhen Yang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China.,Institute of Forensic Sciences, Henan University of Economics and Law, Zhengzhou, China
| | - Qing Zhang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Huan Yu
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Lijuan Li
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Yan He
- Department of Epidemiology, Medical College of Soochow University, Suzhou, China
| | - Shaohua Zhu
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Chengtao Li
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Sciences, Ministry of Justice, Shanghai, China
| | - Suhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Sciences, Ministry of Justice, Shanghai, China
| | - Bin Luo
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
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