Abstract
The aim of this study was to investigate if the biomarkers myelin basic protein (MBP) and neurofilament-H (NF-H) yielded informative value in forensic diagnostics when examining cadaveric cerebrospinal fluid (CSF) biochemically via an enzyme-linked immunosorbent assay (ELISA) and comparing the corresponding brain tissue in fatal traumatic brain injury (TBI) autopsy cases by immunocytochemistry versus immunohistochemistry. In 21 trauma and 19 control cases, CSF was collected semi-sterile after suboccipital puncture and brain specimens after preparation. The CSF MBP (p = 0.006) and NF-H (p = 0.0002) levels after TBI were significantly higher than those in cardiovascular controls. Immunohistochemical staining against MBP and against NF-H was performed on cortical and subcortical samples from also biochemically investigated cases (5 TBI cases/5 controls). Compared to the controls, the TBI cases showed a visually reduced staining reaction against MBP or repeatedly ruptured neurofilaments against NF-H. Immunocytochemical tests showed MBP-positive phagocytizing macrophages in CSF with a survival time of > 24 h. In addition, numerous TMEM119-positive microglia could be detected with different degrees of staining intensity in the CSF of trauma cases. As a result, we were able to document that elevated levels of MBP and NF-H in the CSF should be considered as useful neuroinjury biomarkers of traumatic brain injury.
Highlights
Traumatic brain injury (TBI), isolated or combined with other injuries, is a relevant post-traumatic prognostic factor for morbidity and mortality
Biomarker concentrations in cerebrospinal fluid (CSF) of fatal TBI cases were compared with acute cardiac death cases as a control group
There are no significant differences between TBI cases with intracranial bleedings only compared to
Summary
Traumatic brain injury (TBI), isolated or combined with other injuries, is a relevant post-traumatic prognostic factor for morbidity and mortality. Investigations of fatal TBI cases have always been a classical domain of forensic medicine with regard to traumatological and biomechanical aspects as well as in the contextual assessment [11]. Autopsy and histological examination of the traumatized tissue [12] are the main investigations used in the forensic postmortem routine to evaluate lethality and survival time (wound age). International Journal of Legal Medicine (2021) 135:1525–1535 postmortem biochemical analyses of various cytokines, acute phase proteins, CNS biomarkers [7, 13,14,15,16,17], or Na+-glucose transporters [18] in CSF and brain tissue as well as investigations of the early tissue reaction of local microglia after trauma are increasingly performed [19]. The applicability of immunocytochemical staining in postmortem CSF could be demonstrated [20]
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