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Primed neutrophil infiltrations into multiple organs in child physical abuse cases: A preliminary study
Takahito Hayashi1, Takuma Nakamae1, Eri Higo1
1Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
Insights
Physical abuse in children causes significant neutrophil infiltration in multiple organs, driven by interleukin-8 (IL-8). This neutrophil elastase (NE) and oxidized alpha1-antitrypsin (AAT) response may serve as a diagnostic indicator for child abuse.
Area of Science:
- Forensic Pathology
- Immunology
- Pediatrics
Background:
- Physical abuse in the elderly triggers neutrophil infiltration via IL-8.
- Similar inflammatory responses are observed in traumatic or hemorrhagic shock.
Purpose of the Study:
- To investigate neutrophil infiltration in physically abused children.
- To examine the expression of neutrophil elastase (NE) and alpha1-antitrypsin (AAT) in these cases.
Main Methods:
- Immunohistochemical analyses were performed on autopsy samples.
- Quantified neutrophil, IL-8, and NE-positive cells in multiple organs.
- Assessed oxidized AAT levels in liver tissues.
Main Results:
- Significantly increased neutrophils, IL-8, and NE-positive cells in the heart, lung, liver, and kidney of abuse cases compared to controls.
- Elevated levels of oxidized AAT, a dysfunctional NE inhibitor, were found in the liver of abused children.
- Neutrophil infiltration correlated positively with the severity of non-fatal injuries.
Conclusions:
- Massive neutrophil infiltration induced by IL-8 is a potential new diagnostic indicator for physical child abuse.
- Presence of NE-positive cells and oxidized AAT provides evidence of associated tissue damage.
Abstract:
Physical abuse of the elderly induces a massive primed neutrophil infiltration into the lung and liver through chemotaxis by interleukin (IL)-8, similar to cases of traumatic or hemorrhagic shock. Here, we used immunohistochemical analyses to investigate this infiltration in cases of physically abused children. In addition, we examined the expression of neutrophil elastase (NE) as the inflammatory mediator and α1-antitrypsin (AAT) as the elastase inhibitor. The number of neutrophils in the abuse cases was increased significantly in the heart, lung, liver, and kidney, compared with that of control cases. IL-8-positive cells and NE-positive cells in all organs of abuse cases were significantly greater than those in control cases. Large quantities of oxidized AAT, which fails to inactivate NE and results in tissue damage, was detected in the liver of abuse cases. Neutrophil infiltration showed positive correlation with the degree of systemic accumulation of non-fatal injuries caused by repetitive abusive behavior. Although further investigation using more autopsy samples is necessary, results of our preliminary study indicate that massive neutrophil infiltration induced by IL-8 in multiple organs is a new complementary diagnostic indicator of physical abuse in children. Moreover, the demonstration of NE-positive cells and oxidized AAT provides firm evidence of tissue damage.
