Immunohistochemistry in postmortem diagnosis of acute cerebral hypoxia and ischemia

Abstract

Background : Discovery of evidence of acute brain ischemia or hypoxia and its differentiation from agonal hypoxia represents a task of interest but extremely difficult in forensic neuropathology. Generally, more than 50% of forensic autopsies indicate evidence of brain induced functional arrest of the organ system, which can be the result of a hypoxic/ischemic brain event. Even if the brain is the target organ of hypoxic/ischemic damage, at present, there are no specific neuropathological (macroscopic and histological) findings of hypoxic damage (such as in drowning, hanging, intoxication with carbon monoxide) or acute ischemia. In fact, the first histological signs appear after at least 4 to 6 hours. Numerous authors have pointed out how an immunohistochemical analysis could help diagnose acute cerebral hypoxia/ischemia. Data sources: This review was based on articles published in PubMed and Scopus databases in the past 25 years, with the following keywords “immunohistochemical markers,” “acute cerebral ischemia,” “ischemic or hypoxic brain damage,” and “acute cerebral hypoxia”. Objectives : Original articles and reviews on this topic were selected. The purpose of this review is to analyze and summarize the markers studied so far and to consider the limits of immunohistochemistry that exist to date in this specific field of forensic pathology. Results : We identified 13 markers that had been examined (in previous studies) for this purpose. In our opinion, it is difficult to identify reliable and confirmed biomarkers from multiple studies in order to support a postmortem diagnosis of acute cerebral hypoxia/ischemia. Microtubule-associated protein 2 (MAP2) is the most researched marker in the literature and the results obtained have proven to be quite useful. Conclusion: Immunohistochemistry has provided interesting and promising results, but further studies are needed in order to confirm and apply them in standard forensic practice.

The Usefulness of Serum Brain Damage Biomarkers in Detection and Evaluation of Hypoxic Ischemic Encephalopathy in Calves with Perinatal Asphyxia

“…Histopathological examinations and immunohistochemical detection of HIF-1α were reported to be useful in demonstrating hypoxic tissue damage in the brain [ 38 , 39 , 40 ]. Immunohistochemical findings were found to be interesting and promising in the post-mortem diagnosis of acute cerebral hypoxia and ischemia [ 41 ]. Histopathologically, it was determined that more than 20% of infants with perinatal asphyxia developed lethal hypoxic-ischemic encephalopathy, and more than 25% developed permanent nervous system disorder [ 10 ].…”

Effects of Prolactin on Brain Neurons under Hypoxia

“…As a result of hypoxia/ischemia in the brain, brain edemas and inflammation occur, leading to hypoxic-ischemic encephalopathy (HIE) [22]. In forensic autopsy cases, HIE can be caused by multiple conditions, such as traumatic or chemical events, respiratory and cardiac arrest, asphyxiation, or obstruction of the cerebral or cervical vessels [23,24]. In addition, neonatal HIE is one of the major causes of neurodegeneration and death in the neonatal period [25].…”

New Trends in Immunohistochemical Methods to Estimate the Time since Death: A Review

“…One of the most studied fields to define the time since death is immunohistochemistry. Many authors have recently performed immunohistochemical (IHC) tests on human samples to evaluate the morphological changes to soft tissue that occur after death, with an attempt to identify the expression of specific markers useful for the determination of PMI [ 27 , 28 , 29 , 30 ]. Barrios Mello et al [ 30 ] reported that different IHC stains could be very useful in estimating the age at death, by evaluating the preserved bone collagen fibers and endothelial cells.…”