The aims of this study were to determine whether immunohistochemical staining for C9 can demonstrate myocardial necrosis in the fetus and neonate. Hearts from cases of stillbirth or neonatal death with confirmed myocardial necrosis (in neonates) or with ischemic lesions outside the heart (in neonates and stillborns) were stained immunohistochemically with antibodies to C9. All five cases with confirmed myocardial infarction showed positive immunohistochemical staining for C9, largely localized to the infarcted areas. The youngest subject was born at 24 weeks gestation and died at 4 days of age. One of two neonates without myocardial necrosis on H&E staining but with pathological evidence of ischemic lesions elsewhere showed staining of scattered fibers. Six out of ten hearts from macerated stillborn infants showed varying degrees of positive staining. Immunohistochemical staining for C9 detects myocardial necrosis in neonates of a gestational age of 24 weeks or more. C9 is also demonstrable immunohistochemically in macerated stillborns, and this is likely to represent myocardial necrosis. The method is of great potential value in the investigation of cardiac ischemia in the fetal and perinatal period.
SetzerE, ErmocillaR, TonkinI, JohnE, SansaM, CassadyG.Papillary muscle necrosis in a neonatal autopsy population: incidence and associated clinical manifestations. J Pediatr1980;96:289–294.
6.
DonnellyWH. Ischemic myocardial injury: the histopathologic spectrum in 167 cases. Lab Invest1982;46:5P.
7.
SchaferH, MatheyD, HugoF, BhakdiS.Deposition of the terminal C5b-9 complement complex in infarcted areas of human myocardium. J Immunol1986;137:1945–1949.
8.
EdstonE, KawaK.Immunohistochemical detection of early myocardial infarction. An evaluation of antibodies against the terminal complement complex (C5b-9). Int J Legal Med1995;108:27–30.
9.
DoranJP, HowieAJ, TownendJN, BonserRS. Detection of myocardial infarction by immunohistological staining for C9 on formalin fixed, paraffin wax embedded sections. J Clin Pathol1996;49:34–37.
10.
AdinolfiM.Human complement: onset and site of synthesis during fetal life. Am J Dis Child1977;131:1015–1023.
11.
AdinolfiM, BeckSE. Human complement C7 and C9 in fetal and newborn sera. Arch Dis Child1975;50:562–564.
12.
LassiterHA, WatsonSW, SeifringML, TannerJE. Complement factor 9 deficiency in serum of human neonates. J Infect Dis1992;166:53–57.
13.
AdamkinD, StitzelA, UrmsonJ, FarnettML, PostE, SpitzerR.Activity of the alternative pathway of complement in the newborn infant. J Pediatr1978;93:604–608.
14.
GenestDR, WilliamsMA, GreeneMF. Estimating the time of death in stillborn fetuses: I. Histologic evaluation of fetal organs; an autopsy study of 150 stillborns. Obstet Gynecol1992;80:575–584.
15.
HammondEH, YowellRL, NunodaS, Vascular (humoral) rejection in heart transplantation: pathologic observations and clinical implications. J Heart Transplant1989;8:430–443.
16.
FoersterA.Vascular rejection in cardiac transplantation. A morphological study of 25 human cardiac allografts. APMIS1992;100:367–376.
17.
BidaniAK, RobertsJL, SchwartzMM, LewisEJ. Immunopathology of cardiac lesions in fatal systemic lupus erythematosus. Am J Med1980;69:849–858.
18.
ZiporenL, GoldbergI, AradM, Libman-Sacks endocarditis in the antiphospholipid syndrome: immunopathologic findings in deformed heart valves. Lupus1996; 5:196–205.
19.
ButmanS, EspinozaLR, Del CarpioJ, OsterlandCK. Rheumatoid pericarditis. Rapid deterioration with evidence of local vasculitis. JAMA1977;238:2394–2396.
20.
HatleL, MelbyeOJ. Immunoglobulins and complement in chronic myocardial disease. A myocardial biopsy study. Acta Med Scand1976;200:385–389.
21.
MaischB, BuschelG, IzumiT, Four years of experience in endomyocardial biopsy—an immunohistologic approach. Heart Vessels (Suppl)1985;1:59–67.
22.
DawsonL, TalwarKK, ChopraP.Significance of pathological parameters of endomyocardial biopsy in clinical outcome of patients of dilated cardiomyopathy—II. Value of cardiac immune complexes and heart reactive antibodies. Indian Heart J1991;43:421–425.
23.
MaischB.Immunologic regulator and effector mechanisms in myocarditis and perimyocarditis. Heart Vessels (Suppl)1985;1:209–217.
24.
DragatakisLN, KlassenJ, HuttnerI, FraserDG, PoirierNL, KlassenGA. Autoimmune myocarditis: a clinical entity. Can Med Assoc J1979;120:317–321.
25.
MaischB, BauerE, CirsiM, KochsiekK.Cytolytic cross-reactive antibodies directed against the cardiac membrane and viral proteins in coxsackievirus B3 and B4 myocarditis. Characterization and pathogenetic relevance. Circulation1993;87 (Suppl IV):IV19–IV65.
26.
MolinaHA, MileiJ, StorinoR.Chronic Chagas' myocardiopathy. Demonstration of in vivo bound immunoglobulins in heart structures by the immunoperoxidase technique. Cardiology1984;71:297–306.
27.
GoldsteinI, ScebatL, RenaisJ, HadjinskyP, DutartreJ.Rheumatic-like carditis induced in rabbits by cross-reacting antigens: Streptococcus A polysaccharide and rabbit aortic glycoproteins. Isr J Med Sci1983;19:483–490.
28.
PolteraAA, HochmannA, LambertPH. A model for cardiopathy induced by Trypanosoma brucei brucei in mice. A histologic and immunopathologic study. Am J Pathol1980;99:325–351.
29.
RosenbergHS, DonnellyWH. The cardiovascular system. In: WigglesworthJS, SingerDB, eds. Textbook of Fetal and Perinatal Pathology, 2nd ed. Boston: Blackwell Scientific Publications, 1998;652–654.
30.
Lodge-PatchI.The ageing of cardiac infarcts and its influence on cardiac rupture. Br Heart J1951;6:115.
31.
RamkissoonRA. Macroscopic identification of early myocardial infarction by dehydrogenase alterations. J Clin Pathol1966;19:479.
32.
BouchardyB, MajnoG.Histopathology of early myocardial infarcts. A new approach. Am J Pathol1974;74:301–330.
33.
YoungNA, MondestinMA, BowmanRL. Ischemic changes in fetal myocardium. An autopsy series. Arch Path Lab Med1994;118:289–292.
34.
DeriasNW, AdamsCW. The non-specific nature of the myocardial wavy fibre. Histopatholy1979;3:241–245.
35.
HumphreySM, VanderweeMA. Factors affecting the development of contraction band necrosis during reperfusion of the isolated isovolumic rat heart. J Mol Cell Cardiol1986;18:319–329.
36.
VakevaA, MorganBP, TikkanenI, HelinK, LaurilaP, MeriS.Time course of complement activation and inhibitor expression after ischemic injury of rat myocardium. Am J Pathol1994;144:1357–1368.
37.
MatheyD, SchoferJ, SchaferHJ, Early accumulation of the terminal complement-complex in the ischaemic myocardium after reperfusion. Eur Heart J1994;15:418–423.
38.
DaviesMJ, MannJ, eds. The pathology of ischaemic heart disease. In: DaviesMJ, MannJ, eds. Systemic Pathology, Vol 10B, Acquired Diseases of the Heart. New York: Churchill Livingstone, 1995;43–47.
39.
BaroldiG.Diseases of the coronary arteries. In: SilverMD, ed. Cardiovascular Pathology, Vol. 1. New York: Churchill Livingstone, 1983;406–408.
