title: Mast cell tryptase and carboxypeptidase A expression in body fluid and gastrointestinal tract associated with drug-related fatal anaphylaxis.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Detection of both mast cell tryptase and carboxypeptidase A could improve the forensic identification of drug-related fatal anaphylaxis.
authors.affiliation: 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.
authors.forename: Xiang-Jie
authors.initials: XJ
authors.lastname: Guo
authors.affiliation: 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.
authors.forename: Ying-Yuan
authors.initials: YY
authors.lastname: Wang
authors.affiliation: 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.
authors.forename: Hao-Yue
authors.initials: HY
authors.lastname: Zhang
authors.affiliation: 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.
authors.forename: Qian-Qian
authors.initials: QQ
authors.lastname: Jin
authors.affiliation: 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.
authors.forename: Cai-Rong
authors.initials: CR
authors.lastname: Gao
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced / Q000201:enzymology* / Q000401:mortality / Q000473:pathology; D001344:Autopsy; D015415:Biomarkers / Q000032:analysis; D043422:Carboxypeptidases A / Q000032:analysis* / Q000097:blood; D016022:Case-Control Studies; D004342:Drug Hypersensitivity / Q000201:enzymology* / Q000401:mortality / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005455:Fluorescent Antibody Technique; D006801:Humans; D008856:Microscopy, Fluorescence; D000069236:Pericardial Fluid / Q000201:enzymology*; D011237:Predictive Value of Tests; D053802:Tryptases / Q000032:analysis* / Q000097:blood
chemical_list: D015415:Biomarkers; D043422:Carboxypeptidases A; D053802:Tryptases
keywords: Drug-related fatal anaphylaxis; Forensic Pathology; Gastrointestinal tract; Mast cell carboxypeptidase A; Mast cell tryptase