Brain biomarkers for identifying excited delirium as a cause of sudden death
| Autor: | Yujing Qin, Charles V. Wetli, Henrik Druid, Steven B. Karch, W. Lee Hearn, John Pablo, Deborah C. Mash, Nikhil Adi, Linda Duque, Bruce A. Hyma |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Forensic Genetics Male Forensic pathology medicine.medical_specialty Pathology Transcription Genetic Blotting Western Poison control Autopsy Violence Sudden death Polymerase Chain Reaction Pathology and Forensic Medicine Death Sudden Cocaine Dopamine Uptake Inhibitors Dopamine Internal medicine medicine Humans HSP70 Heat-Shock Proteins Forensic Pathology Dopamine transporter Retrospective Studies Brain Chemistry Dopamine Plasma Membrane Transport Proteins biology business.industry Amphetamines Brain Delirium Case-Control Studies biology.protein Cardiology Biomarker (medicine) Female medicine.symptom business Law Biomarkers medicine.drug |
| Zdroj: | Forensic science international. 190(1-3) |
| ISSN: | 1872-6283 |
| Popis: | Excited delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety excited delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 degrees C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8-4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in excited delirium. When combined with descriptions of the decedents' behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the excited delirium syndrome at autopsy. |
| Databáze: | OpenAIRE |
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