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Cardiac troponin for the forensic diagnosis of cardiac contusion
Forensic Science International 169 (2007) 276 www.elsevier.com/locate/forsciint
Letter to the Editor Cardiac troponin for the forensic diagnosis of cardiac contusion
Keywords: Cardiac troponin; Post-mortem; Cardiac contusion
To the Editor,, The recent study by Peter et al. [1] appears to support the use of serum cardiac troponin I levels in diagnosing cardiac contusion and their findings are concordant with other published data [2,3]. Cardiac troponin T (cTnT) and I (cTnI) are accepted markers of assessing cardiac necrosis in the living who present with acute coronary syndromes [4]. This study involved the use of post-mortem blood. The authors allude to the use of an experimental enzyme linked immunosorbent assay (ELISA) for the detection of ‘cardiac’ troponin C. The protein product of the troponin C gene (chromosome location: 3p21.3–p14.3) has an identical amino acid sequence in both cardiac and skeletal muscle tissue, unlike the gene products for troponin T or I which demonstrate organ specific expression [5–7]. As such, the high concentrations of ‘cTnC’ demonstrated in venous blood most probably represent troponin C derived from both cardiac and skeletal muscle tissue. The absence of cTnI data in this study would question the validity of the TnC data which demonstrated the highest significance between cases and controls ( p = 0.001). While several studies support the use of post-mortem blood and body fluid levels of cardiac troponin T and I as a marker of cardiac injury [8,9], in our opinion further research is required to determine the effects of post-mortem autolysis, microbial activity, metabolic derangement and the use of different sample matrices in autopsy cases [10]. References [1] J. Peter, A. Kirchner, E. Kuhlisch, M. Menschikowski, B. Neef, J. Dreßlern, The relevance of the detection of troponins to the forensic diagnosis of cardiac contusion, For. Sci. Int. 160 (2006) 127–133. [2] J.E. Adams, V. Davila-Roman, P. Bessey, Improved detection of cardiac contusion with troponin I, Am. Heart. J. 131 (1996) 308–312. [3] A. Obnibene, F. Mori, R. Santoni, Cardiac troponin I in myocardial contusion, Clin. Chem. 44 (1998) 889–890.
0379-0738/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.forsciint.2006.05.005
[4] Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction, Eur. Heart J. 21 (2000) 1502–1513. [5] T. Kobayashi, T. Takagi, K. Konishi, Amino acid sequence of porcine cardiac muscle troponin C, J. Biochem. 106 (1989) 55–59. [6] K.J. Dean, Biochemistry and molecular biology of troponin I and T, in: A.H.B. Wu (Ed.), Cardiac Markers, Humana Press, Totowa, NJ, 1998, pp. 193–204. [7] P.O. Collinson, F.G. Boa, D.C. Gaze, Measurement of cardiac troponins, Ann. Clin. Biochem. 38 (2001) 423–449. [8] B.L. Zhu, T. Ishikawa, T. Michinue, D.R. Li, D. Zhao, Y. Kamikodai, K. Tsuda, S. Okazaki, H. Maeda, Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2. Analysis for application in the diagnosis of sudden cardiac death with regard to pathology, Legal Med. 2 (2006) 94– 101. [9] S.J. Cina, D.J. Li, D.W. Chan, J.K. Boitnott, R.H. Hruban, J.E. Smialek, Serum concentrations of cardiac troponin I in sudden death, Am. J. For. Med. Pathol. 19 (1998) 324–328. [10] S.J. Davies, D.C. Gaze, P.O. Collinson, Investigating cardiac troponins in postmortem subjects. Comparing antemortem and postmortem levels, Am. J. For. Med. Pathol. 26 (2005) 213–215.
David C. Gaze* Paul O. Collinson Chemical Pathology, St. George’s Healthcare NHS Trust, London SW17 0RE, United Kingdom Susan J. Davies Department of Histopathology, University College and Royal Free Hospitals NHS Trust, Rockefeller Building, University Street, London WC1E 7AX, United Kingdom *Corresponding author. Tel.: +44 20 8725 5878; fax: +44 20 8682 0744 E-mail address: [email protected] (D.C. Gaze) 24 February 2006 Available online 13 June 2006
Letter to the Editor Cardiac troponin for the forensic diagnosis of cardiac contusion
Keywords: Cardiac troponin; Post-mortem; Cardiac contusion
To the Editor,, The recent study by Peter et al. [1] appears to support the use of serum cardiac troponin I levels in diagnosing cardiac contusion and their findings are concordant with other published data [2,3]. Cardiac troponin T (cTnT) and I (cTnI) are accepted markers of assessing cardiac necrosis in the living who present with acute coronary syndromes [4]. This study involved the use of post-mortem blood. The authors allude to the use of an experimental enzyme linked immunosorbent assay (ELISA) for the detection of ‘cardiac’ troponin C. The protein product of the troponin C gene (chromosome location: 3p21.3–p14.3) has an identical amino acid sequence in both cardiac and skeletal muscle tissue, unlike the gene products for troponin T or I which demonstrate organ specific expression [5–7]. As such, the high concentrations of ‘cTnC’ demonstrated in venous blood most probably represent troponin C derived from both cardiac and skeletal muscle tissue. The absence of cTnI data in this study would question the validity of the TnC data which demonstrated the highest significance between cases and controls ( p = 0.001). While several studies support the use of post-mortem blood and body fluid levels of cardiac troponin T and I as a marker of cardiac injury [8,9], in our opinion further research is required to determine the effects of post-mortem autolysis, microbial activity, metabolic derangement and the use of different sample matrices in autopsy cases [10]. References [1] J. Peter, A. Kirchner, E. Kuhlisch, M. Menschikowski, B. Neef, J. Dreßlern, The relevance of the detection of troponins to the forensic diagnosis of cardiac contusion, For. Sci. Int. 160 (2006) 127–133. [2] J.E. Adams, V. Davila-Roman, P. Bessey, Improved detection of cardiac contusion with troponin I, Am. Heart. J. 131 (1996) 308–312. [3] A. Obnibene, F. Mori, R. Santoni, Cardiac troponin I in myocardial contusion, Clin. Chem. 44 (1998) 889–890.
0379-0738/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.forsciint.2006.05.005
[4] Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction, Eur. Heart J. 21 (2000) 1502–1513. [5] T. Kobayashi, T. Takagi, K. Konishi, Amino acid sequence of porcine cardiac muscle troponin C, J. Biochem. 106 (1989) 55–59. [6] K.J. Dean, Biochemistry and molecular biology of troponin I and T, in: A.H.B. Wu (Ed.), Cardiac Markers, Humana Press, Totowa, NJ, 1998, pp. 193–204. [7] P.O. Collinson, F.G. Boa, D.C. Gaze, Measurement of cardiac troponins, Ann. Clin. Biochem. 38 (2001) 423–449. [8] B.L. Zhu, T. Ishikawa, T. Michinue, D.R. Li, D. Zhao, Y. Kamikodai, K. Tsuda, S. Okazaki, H. Maeda, Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2. Analysis for application in the diagnosis of sudden cardiac death with regard to pathology, Legal Med. 2 (2006) 94– 101. [9] S.J. Cina, D.J. Li, D.W. Chan, J.K. Boitnott, R.H. Hruban, J.E. Smialek, Serum concentrations of cardiac troponin I in sudden death, Am. J. For. Med. Pathol. 19 (1998) 324–328. [10] S.J. Davies, D.C. Gaze, P.O. Collinson, Investigating cardiac troponins in postmortem subjects. Comparing antemortem and postmortem levels, Am. J. For. Med. Pathol. 26 (2005) 213–215.
David C. Gaze* Paul O. Collinson Chemical Pathology, St. George’s Healthcare NHS Trust, London SW17 0RE, United Kingdom Susan J. Davies Department of Histopathology, University College and Royal Free Hospitals NHS Trust, Rockefeller Building, University Street, London WC1E 7AX, United Kingdom *Corresponding author. Tel.: +44 20 8725 5878; fax: +44 20 8682 0744 E-mail address: [email protected] (D.C. Gaze) 24 February 2006 Available online 13 June 2006