title: Development of CT-guided biopsy sampling for time-dependent postmortem redistribution investigations in blood and alternative matrices--proof of concept and application on two cases.
abstract: The postmortem redistribution (PMR) phenomenon complicates interpretation in forensic toxicology. Human data on time-dependent PMR are rare and only exist for blood so far. A new method for investigation of time-dependent PMR in blood as well as in alternative body fluids and tissues was developed and evaluated using automated biopsy sampling. At admission of the bodies, introducer needles were placed in liver, lung, kidney, muscle, spleen, adipose tissue, heart, femoral vein, and lumbar spine using a robotic arm guided by a computed tomography scanner (CT). Needle placement accuracy was analyzed and found to be acceptable for the study purpose. Tissue biopsies and small volume body fluid samples were collected in triplicate through the introducer needles. At autopsy (around 24 h after admission), samples from the same body regions were collected. After mastering of the technical challenges, two authentic cases were analyzed as a proof of concept. Drug concentrations of venlafaxine, O-desmethylvenlafaxine, bromazepam, flupentixol, paroxetine, and lorazepam were determined by LC-MS/MS, and the percentage concentration changes between the two time points were calculated. Concentration changes were observed with both increases and decreases depending on analyte and matrix. While venlafaxine, flupentixol, paroxetine, and lorazepam generally showed changes above 30% and more, O-desmethylvenlafaxine and bromazepam did not undergo extensive PMR. The presented study shows that CT-controlled biopsy collection provides a valuable tool for systematic time-dependent PMR investigation, demanding only minimal sample amount and causing minimal damage to the body.
authors.affiliation: Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Sandra N
authors.initials: SN
authors.lastname: Staeheli
authors.affiliation: Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Dominic
authors.initials: D
authors.lastname: Gascho
authors.affiliation: Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Juergen
authors.initials: J
authors.lastname: Fornaro
authors.affiliation: Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Laberke
authors.affiliation: Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Lars C
authors.initials: LC
authors.lastname: Ebert
authors.affiliation: Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Martinez
authors.affiliation: Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.affiliation: Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kraemer
authors.affiliation: Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zürich, Switzerland. andrea.steuer@irm.uzh.ch.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Steuer
mesh_terms: D001344:Autopsy; D002853:Chromatography, Liquid; D000069468:Desvenlafaxine Succinate / Q000032:analysis; D004867:Equipment Design; D005260:Female; D005475:Flupenthixol / Q000032:analysis; D053593:Forensic Toxicology / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation / Q000379:methods*; D008140:Lorazepam / Q000032:analysis; D008875:Middle Aged; D017374:Paroxetine / Q000032:analysis; D011180:Postmortem Changes; D012371:Robotics / Q000295:instrumentation; D053719:Tandem Mass Spectrometry; D013997:Time Factors; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed; D000069470:Venlafaxine Hydrochloride / Q000032:analysis
chemical_list: D017374:Paroxetine; D000069470:Venlafaxine Hydrochloride; D005475:Flupenthixol; D008140:Lorazepam; D000069468:Desvenlafaxine Succinate
keywords: Alternative matrices; Biopsies; Computed tomography; LC-MS/MS; Time-dependent postmortem redistribution