POSTMORTEM DIAGNOSIS OF DIABETIC METABOLIC DERANGEMENT - ELEVATED ALPHA(1)-ANTITRYPSIN AND HAPTOGLOBIN GLYCOSYLATION LEVELS AS AN INDEX OF ANTEMORTEM HYPERGLYCEMIA

Fatal diabetic metabolic derangement is difficult to diagnose postmort em because of the paucity of characteristic morphologic findings. Hype rglycemia is an indicator of diabetic derangement. Conventional bioche mical parameters for postmortem diagnosis of antemortem hyperglycemic states are not sufficiently resistant to antemortem and postmortem non -diabetic influences or are suited only for long and medium-term asses sment of diabetes control. In the search for other, more reliable, ind ices of immediately antemortem blood glucose levels, we investigated t he value of glycosylation levels of serum proteins with very brief bio logic half-lives: a) In vitro studies were performed on the glycosylat ion course of the short-lived serum proteins alpha(1)-antitrypsin (alp ha 1-AT) and haptoglobin (HP). b) Glycosylation levels were measured a fter purification of alpha(1)-AT and HP from sera of living and deceas ed non-diabetics and diabetics. c) The resistance of alpha(1)-AT and H P glycosylation levels to autolysis was investigated. Our studies reve aled the following: 1) alpha(1)-AT and HP glycosylate considerably mor e rapidly than either albumin or hemoglobin. This rapid glycosylation, combined with the rapid turnover of both proteins, facilitates detect ion of short-term changes in glycemia. 2) alpha(1)-AT and HP glycosyla tion levels are autolysis-stable and can be assessed even after advanc ed hemolysis. 3) alpha(1)-AT and HP glycosylation levels appear to all ow reliable ante- and postmortem discrimination between normoglycemic and hyperglycemic metabolic states. As a tool in the postmortem diagno sis of antemortem hyperglycemic states, alpha(1)-AT and HP glycosylati on levels combine the advantages of a short-term parameter with resist ance to non-diabetic influences.