title: β-Amyloid Precursor Protein and Ubiquitin Immunohistochemistry Aid in the Evaluation of Infant Autopsy Eyes With Abusive Head Trauma.
abstract: OBJECTIVE
  To investigate β-amyloid precursor protein (β-APP), ubiquitin, and glial fibrillary acid protein (GFAP) immunostaining as a diagnostic tool to aid in the discrimination between abusive head trauma and nonabusive head trauma in postmortem ocular histopathologic investigation.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  Seventy-four eyes of 37 infants were studied for hemorrhage and immunohistochemical expression of β-APP, ubiquitin, and GFAP in the retina and optic nerve. Infants were assigned to abusive head trauma or control groups, according to published criteria.
  
  
  RESULTS
  In the abusive head trauma group, positive β-APP and ubiquitin immunostaining of the retina was significantly more likely to be found than in the control group, odds ratio (OR) 11.4, confidence interval (CI) 2.9-44.3; P < .001 and OR 8.8, CI 2.2-34.5; P = .002, respectively. Positive correlations were found between retinal expression of β-APP and ubiquitin immunostaining and retinal hemorrhage. Vitreal hemorrhages, orbital fat hemorrhages, and macular folds could only be identified in abusive head trauma cases. Retinal hemorrhages were significantly more severe, occupied a larger proportion of the retina, and involved more retinal layers in abusive head trauma compared to controls (OR 2.7, CI 1.7-4.4; P < .001).
  
  
  CONCLUSIONS
  This study shows correlations between positive retinal β-APP and ubiquitin immunostaining as a sign of axonal injury in abusive head trauma. Axonal injury is a useful pathologic feature that can be demonstrated in postmortem ocular investigation of deceased children using immunohistochemical staining for β-APP and ubiquitin with a high OR for abusive head trauma when compared to controls.
authors.affiliation: Department of Pathology, Section Ophthalmic Pathology, ErasmusMC University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Forensic Medicine of the Netherlands Forensic Institute, The Hague, Netherlands.
authors.forename: Babette
authors.initials: B
authors.lastname: Bais
authors.affiliation: Department of Forensic Medicine of the Netherlands Forensic Institute, The Hague, Netherlands; Department of Pathology, Maastricht University Medical Center, Maastricht, Netherlands.
authors.forename: Bela
authors.initials: B
authors.lastname: Kubat
authors.affiliation: Department of Biostatistics, ErasmusMC University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Motazedi
authors.affiliation: Department of Pathology, Section Ophthalmic Pathology, ErasmusMC University Medical Center Rotterdam, Rotterdam, Netherlands. Electronic address: r.verdijk@erasmusmc.nl.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Verdijk
mesh_terms: D016564:Amyloid beta-Protein Precursor / Q000032:analysis*; D001344:Autopsy; D002649:Child Abuse; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D012189:Retrospective Studies; D025801:Ubiquitin / Q000032:analysis*
chemical_list: D016564:Amyloid beta-Protein Precursor; D025801:Ubiquitin