POSTMORTEM DIAGNOSIS OF DIABETIC METABOLIC DERANGEMENT - ELEVATED ALPHA(1)-ANTITRYPSIN AND HAPTOGLOBIN GLYCOSYLATION LEVELS AS AN INDEX OF ANTEMORTEM HYPERGLYCEMIA
S. Ritz et al., POSTMORTEM DIAGNOSIS OF DIABETIC METABOLIC DERANGEMENT - ELEVATED ALPHA(1)-ANTITRYPSIN AND HAPTOGLOBIN GLYCOSYLATION LEVELS AS AN INDEX OF ANTEMORTEM HYPERGLYCEMIA, Journal of forensic sciences, 41(1), 1996, pp. 94-100
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.