Proteomics in Deaths by Drowning: Diagnostic Efficacy of Apolipoprotein A1 and α-1 Antitrypsin, Pilot Study

Abstract

Drowning is one of the leading causes of death worldwide. The pathophysiology of drowning is complex and, sometimes, interpretation of the circumstances of death in the autopsy becomes the main source of information in its diagnosis. New advances in medical research, such as proteomics, especially in forensic pathology, are still in the development. We proposed to investigate the application of Mass Spectrometry-based technologies, to identify differentially expressed proteins that may act as potential biomarkers in the postmortem diagnosis of drowning. We performed a pilot proteomic experiment with the inclusion of two drowned and two control forensic cases. After applying restrictive parameters, we identified apolipoprotein A1 (ApoA1) and α-1 antitrypsin as differentially expressed between the two diagnostic groups. A validation experiment, with the determination of both proteins in 25 forensic cases (16 drowned and 9 controls) was performed, and we corroborated ApoA1 higher values in the drowning group, whereas α-1 antitrypsin showed lower levels. After adjusting by confounder factors, both remained as predictive independent factors for diagnosis of drowning (p = 0.010 and p = 0.022, respectively). We constructed ROC curves for biomarkers’ levels attending at the origin of death and established an ApoA1 cut-off point of 100 mg/dL. Correct classification based on the diagnosis criteria was reached for 73.9% of the cases in a discriminant analysis. We propose apolipoprotein A1 (with our cutoff value for correct classification) and α-1 antitrypsin as valuable biomarkers of drowning. Our study, based on forensic cases, reveals our proteomic approach as a new complementary tool in the forensic diagnosis of drowning and, perhaps, in clinical future implications in drowned patients. However, this is a pilot approach, and future studies are necessary to consolidate our promising preliminary data.

From flesh to bones: Multi‐omics approaches in forensic science

“…Through this analysis, ApoA1 and $$-1$$ antitrypsin were identified as biomarkers of particular interest. To validate these findings, immunonephelometry was performed using a BN ProSpec equipment from Siemens Healthcare Diagnostics (Marburg, Germany) on a larger cohort of drowning cases ( n = 16) and compared to cases with other causes of death ( n = 9, including four cardiovascular deaths, one hanging, two cases of polytrauma, one stabbing and one death from drug overdose) [175]. The use of advanced analytical techniques like LC‐MS/MS, in combination with biomarker validation, offers promising insights into the distinctive biochemical profiles associated with drowning cases.…”

Proteomic Approaches vis-a-vis Forensic Evidence Analysis: Forensic Proteomics a Valuable Tool

“…Peptide biomarkers in seminal fluid corresponding to known seminal protein biomarkers have also been identified, including prostate-specific antigen, semenogelin I and II, and prostate acid phosphatase. 19…”

Proteomics in Forensic Analysis: Applications for Human Samples

“…A recent study performed proteomic analysis of blood samples to identify potential protein biomarkers in the postmortem diagnosis of drowning [50]. When comparing the drowning group (16 samples) and control group (9 samples), apolipoprotein A1 (ApoA1) showed higher levels in the drowning group, whereas alpha-1 antitrypsin exhibited the opposite pattern (Figure 6b).…”