title: Evaluation of the membrane attack complex of complement for the detection of a recent myocardial infarction in man.
abstract: The diagnosis of an acute myocardial infarction (MI) can be cumbersome for pathologists. Even with a positive nitroblue tetrazolium (NBT) reaction, haematoxylin and eosin (H&E) evaluation of the myocardial tissue can remain inconclusive. Early signs presumed diagnostic for myocardial infarction, such as hypereosinophilia, waviness, and contraction band necrosis, have to be considered non-specific and are probably reversible signs of ischaemia. Several studies implicate the complement system, and especially complement factor C9, as part of the membrane attack factor (MAC), in cardiomyocyte damage during MI. In a post-mortem study on well-documented cardiological autopsies, we evaluated the use of complement factor C9 immunostaining as a marker for the detection of very recent MI. Forty-three tissue samples from 40 patients were obtained from the left ventricular free wall only, a region that can be specifically attributed to one corresponding coronary artery. As some patients presented with MIs of various stages in that perfusion area, in total 57 observations were possible. C9 immunostaining specifically detected irreversibly damaged (=infarcted) cardiomyocytes, as is implied by the lytic activity of C9/MAC binding to cell membranes. Most interesting was the group of clinically suspected, NBT-positive MIs resulting from very recent myocardial ischaemia. In this population, where H&E evaluation by (cardio-) experienced pathologists was not conclusive, C9 immunostaining clearly pointed towards myocardial infarction in 47% of the cases. In conclusion, C9 immunostaining, routinely practicable in the pathology laboratory, has an additional value in discriminating between reversible ischaemia and infarcted cardiomyocytes in very early MIs.
authors.affiliation: Department of Pathology, Academic Hospital Maastricht, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: S R
authors.initials: SR
authors.lastname: Robert-Offerman
authors.forename: M P
authors.initials: MP
authors.lastname: Leers
authors.forename: R J
authors.initials: RJ
authors.lastname: van Suylen
authors.forename: M
authors.initials: M
authors.lastname: Nap
authors.forename: M J
authors.initials: MJ
authors.lastname: Daemen
authors.forename: P H
authors.initials: PH
authors.lastname: Theunissen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D015415:Biomarkers / Q000032:analysis; D003186:Complement C9 / Q000032:analysis*; D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007202:Indicators and Reagents; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D017202:Myocardial Ischemia / Q000175:diagnosis; D009580:Nitroblue Tetrazolium
chemical_list: D015415:Biomarkers; D003186:Complement C9; D007202:Indicators and Reagents; D009580:Nitroblue Tetrazolium