Basic Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13288-13293
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13288
Mast cell tryptase and carboxypeptidase A expression in body fluid and gastrointestinal tract associated with drug-related fatal anaphylaxis
Xiang-Jie Guo, Ying-Yuan Wang, Hao-Yue Zhang, Qian-Qian Jin, Cai-Rong Gao
Xiang-Jie Guo, Ying-Yuan Wang, Hao-Yue Zhang, Qian-Qian Jin, Cai-Rong Gao, Department of Forensic Medicine, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Gao CR designed the research; Guo XJ, Wang YY, Zhang HY and Jin QQ performed the research; Guo XJ and Gao CR wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81172905; and Shanxi Province Science Foundation for Youths, No. 2012021032-2.
Institutional review board statement: All experiments were approved by the ethics committee of Shanxi Medical University.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at 258187101@qq.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Cai-Rong Gao, Department of Forensic Medicine, Shanxi Medical University, No. 56 South Xinjian Road, Taiyuan 030001, Shanxi Province, China. 258187101@qq.com
Telephone: +86-351-4135175 Fax: +86-351-4135175
Received: May 24, 2015
Peer-review started: May 25, 2015
First decision: June 25, 2015
Revised: July 9, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: December 21, 2015
Processing time: 204 Days and 14.5 Hours
Abstract

AIM: To investigate the expression of mast cell tryptase and carboxypeptidase A in drug-related fatal anaphylaxis.

METHODS: The expression of mast cell tryptase and carboxypeptidase A in 15 autopsy cases of drug-related fatal anaphylaxis and 20 normal autopsy cases were detected. First, the expression of mast cell tryptase was determined in stomach, jejunum, lung, heart, and larynx by immunofluorescence. Different tissues were removed and fixed in paraformaldehyde solution, then paraffin sections were prepared for immunofluorescence. Using specific mast cell tryptase and carboxypeptidase A antibodies, the expression of tryptase and carboxypeptidase A in gastroenterology tract and other tissues were observed using fluorescent microscopy. The postmortem serum and pericardial fluid were collected from drug-related fatal anaphylaxis and normal autopsy cases. The level of mast cell tryptase and carboxypeptidase A in postmortem serum and pericardial fluid were measured using fluor enzyme linked immunosorbent assay (FEIA) and enzyme linked immunosorbent assay (ELISA) assay. The expression of mast cell tryptase and carboxypeptidase A was analyzed in drug-related fatal anaphylaxis cases and compared to normal autopsy cases.

RESULTS: The expression of carboxypeptidase A was less in the gastroenterology tract and other tissues from anaphylaxis-related death cadavers than normal controls. Immunofluorescence revealed that tryptase expression was significantly increased in multiple organs, especially the gastrointestinal tract, from anaphylaxis-related death cadavers compared to normal autopsy cases (46.67 ± 11.11 vs 4.88 ± 1.56 in stomach, 48.89 ± 11.02 vs 5.21 ± 1.34 in jejunum, 33.72 ± 5.76 vs 1.30 ± 1.02 in lung, 40.08 ± 7.56 vs 1.67 ± 1.03 in larynx, 7.11 ± 5.67 vs 1.10 ± 0.77 in heart, P < 0.05). Tryptase levels, as measured with FEIA, were significantly increased in both sera (43.50 ± 0.48 μg/L vs 5.40 ± 0.36 μg/L, P < 0.05) and pericardial fluid (28.64 ± 0.32 μg/L vs 4.60 ± 0.48 μg/L, P < 0.05) from the anaphylaxis group in comparison with the control group. As measured by ELISA, the concentration of carboxypeptidase A was also increased more than 2-fold in the anaphylaxis group compared to control (8.99 ± 3.91 ng/mL vs 3.25 ± 2.30 ng/mL in serum, 4.34 ± 2.41 ng/mL vs 1.43 ± 0.58 ng/mL in pericardial fluid, P < 0.05).

CONCLUSION: Detection of both mast cell tryptase and carboxypeptidase A could improve the forensic identification of drug-related fatal anaphylaxis.

Keywords: Gastrointestinal tract; Drug-related fatal anaphylaxis; Forensic Pathology; Mast cell carboxypeptidase A; Mast cell tryptase

Core tip: Drug-related fatal anaphylaxis is occasionally encountered in forensic pathology routine. However, markers in the identification of drug-related fatal anaphylaxis still need further exploration. This study identified two important markers in drug-related fatal anaphylaxis, tryptase and carboxypeptidase A, which may improve postmortem diagnosis of anaphylaxis in medicolegal expertise.