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Arbouche N, Farrugia A, Gheddar L, Ameline A, Blanchot A, Raul JS, Kintz P. Is it really possible to kill with insulin without leaving traces? From lifesaver to killer, the issues surrounding the analytical characterization of postmortem insulin illustrated by an exemplary case. J Forensic Sci 2024; 69:1106-1113. [PMID: 38481368 DOI: 10.1111/1556-4029.15501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/26/2024]
Abstract
Evidence of an insulin overdose is very complicated in the medico-legal field. The analysis and subsequent interpretation of results is complex, especially when treating postmortem blood samples. The instability of insulin, the special pre-analytical conditions and the absence of specific analytical methods has led most laboratories not to analyze insulin in their routine with a consequent underestimation of cases. This paper aims to assess the difficulties associated with the analytical characterization of insulin by describing a case that typically represents most of the inconveniences encountered following a suspected insulin overdose. The case concerns a man found dead at home by his brother. After an external examination, which did not reveal a specific cause of death, toxicological analysis was requested which did not reveal any substance of toxicological interest. Only 9 months later, it was reported to the toxicologist that the subject was diabetic, on insulin lispro treatment and that three empty syringes were found next to his body. Following analysis by LC-high-resolution mass spectrometry, the presence of insulin lispro at a concentration of 1.1 ng/mL, a therapeutic concentration, was evidenced. Despite the low concentration found, overdose cannot be excluded and this paper will describe the criteria evaluated to reach this conclusion. This case highlights that the interpretation of a postmortem insulin concentration is very complex and requires the evaluation of various elements including the circumstances of death, the subject's medical history, the interval between death and sampling and the sample storage.
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Affiliation(s)
| | | | | | | | | | | | - Pascal Kintz
- Institut de Médecine Légale, Strasbourg, France
- X-Pertise Consulting, Mittelhausbergen, France
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2
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Becam J, Pelissier-Alicot AL, Doudka N, Richez M, Solas C, Fabresse N. Validation of a non-targeted method devoted to identification and quantitation of toxicologically relevant compounds in plasma with HRMS. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1224:123739. [PMID: 37172558 DOI: 10.1016/j.jchromb.2023.123739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
The objective of this study was to develop and validate a simple method using liquid chromatography hyphenated to high resolution mass spectrometry (HRMS) allowing both the performance of a non-targeted screening and the simultaneous quantification of 29 compounds of interest in clinical and forensic toxicology. Extraction was done with QuEChERS salts and acetonitrile, after addition of internal standard to 200 μL of human plasma samples. The mass spectrometer was an Orbitrap, with a heated electrospray ionization (HESI) probe. The analyses were carried out in full scan experiment with a nominal resolving power of 60,000 FWHM within the 125-650 m/z mass range, followed by four cycles of data dependent analysis (DDA) with a mass resolution of 16,000 FWHM. The untargeted screening was evaluated using 132 compounds, mean limit of identification (LOI) was 8.8 ng/mL (min = 0.05 ng/mL, max = 500 ng/mL) and mean limit of detection (LOD) was 0.25 ng/mL (min = 0.05 ng/mL, max = 5 ng/mL). The method was linear in the 5 to 500 ng/mL range (0.5 to 50 ng/mL for cannabinoids, 6-acetylmorphine and buprenorphine) with correlation coefficients > 0.99, intra- and inter-day accuracy and precision were < 15% for all compounds. The method was successfully applied to 31 routine samples.
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Affiliation(s)
- Jenny Becam
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264, rue Saint Pierre, 13385 Marseille Cedex 5, France
| | | | - Natalia Doudka
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264, rue Saint Pierre, 13385 Marseille Cedex 5, France
| | - Magali Richez
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264, rue Saint Pierre, 13385 Marseille Cedex 5, France
| | - Caroline Solas
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264, rue Saint Pierre, 13385 Marseille Cedex 5, France
| | - Nicolas Fabresse
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264, rue Saint Pierre, 13385 Marseille Cedex 5, France; Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Sciences of Health and Medical Information Processing, 27 Bd Jean Moulin, 13385 Marseille, France.
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3
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Van den Bergh S, Croonenborghs B, Gillet A, Schlecht J, DeMent A, Haghedooren E, Cabooter D. Sterilisation of biopharmaceuticals: Effect of gamma irradiation, e-beam irradiation and nitrogen dioxide on human insulin. Int J Pharm 2023; 636:122867. [PMID: 36934881 DOI: 10.1016/j.ijpharm.2023.122867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Biopharmaceuticals are administered parenterally and therefore sterility is required. Sterility can be obtained via different processes including exposure to steam or dry heat. Sterilisation studies on biopharmaceuticals, which are highly sensitive medicinal products, are scarce. This study investigates the effect of different sterilisation processes on recombinant human insulin in solid state (gamma and e-beam irradiation (w/wo dry ice), nitrogen dioxide (NO2)) and in aqueous solution (gamma irradiation (w/wo dry ice, w/wo glycerin)) using ultra-high performance liquid chromatography-diode array detection-mass spectrometry. It is observed that NO2 substantially degrades the solid samples, while gamma and e-beam irradiation result in lower levels of degradation (mean normalized peak areas of 95.2-96.2 % with respect to the non-sterilised samples). Gamma irradiation of insulin solutions with and without dry ice at 2.5 kGy results in mean normalised peak areas of 85 % and <40 % with respect to the non-sterilised samples, respectively. It is concluded that sterilisation using ionising radiation of liquid biopharmaceuticals with insulin and sterilisation of insulin dry powder using NO2 is less suitable with the set-ups used here because of substantial degradation. In contrast, evidence is presented in favour of sterilisation of insulin dry powder using ionising radiation.
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Affiliation(s)
- Sarah Van den Bergh
- KU Leuven - University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, 3000 Leuven, Belgium
| | - Bart Croonenborghs
- Sterigenics NV, a Sotera Health Division, 2015 Spring Road 650, Oak Brook, IL 60523, United States
| | - Annick Gillet
- Sterigenics NV, a Sotera Health Division, 2015 Spring Road 650, Oak Brook, IL 60523, United States
| | - John Schlecht
- Sterigenics NV, a Sotera Health Division, 2015 Spring Road 650, Oak Brook, IL 60523, United States
| | - Aaron DeMent
- Sterigenics NV, a Sotera Health Division, 2015 Spring Road 650, Oak Brook, IL 60523, United States
| | - Erik Haghedooren
- Sterigenics NV, a Sotera Health Division, 2015 Spring Road 650, Oak Brook, IL 60523, United States
| | - Deirdre Cabooter
- KU Leuven - University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, 3000 Leuven, Belgium.
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4
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Nagasawa S, Yamaguchi R, Chiba F, Torimitsu S, Iwase H. Identification, measurement, and evaluation of blood concentrations of insulin glargine and insulin lispro by UPLC-MS-MS in a dead body suspected of insulin overdose. J Forensic Sci 2023; 68:704-710. [PMID: 36762764 DOI: 10.1111/1556-4029.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
Insulin preparations, which are drug treatments for diabetes, cause fatal hypoglycemia when an overdose is administered. Cases of homicide and suicide using these preparations have been reported and are of great forensic interest. However, there are few reports assessing the postmortem concentration of insulin preparations, and it is often difficult to determine the cause of death. In the present study, we report a case of a suspected insulin glargine and insulin lispro overdose for suicide. A woman in her 30s had a history of mental illness and diabetes. The day before her death, she reported to her boyfriend that she had taken large doses of insulin preparations and prescription drugs. An autopsy revealed no fatal injuries or lesions. Drug screening tests revealed several prescription drugs, none of which showed toxic concentrations. Analysis using LC-MS/MS detected insulin glargine in the peripheral and cardiac blood at 429 μU/mL and 1362 μU/mL, respectively, whereas insulin lispro was detected in both the peripheral and cardiac blood at levels below the lower limit of quantification (LLOQ; <50 μU/mL). The cause of death was considered likely to be hypoglycemia caused by an overdose of insulin glargine. Insulin glargine is rapidly metabolized after subcutaneous administration and is rarely detected in the blood when used at therapeutic doses. There are no other reports on the quantification of insulin glargine parent compounds in postmortem samples, and this case provides important data on postmortem blood concentrations of insulin glargine intoxication.
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Affiliation(s)
- Sayaka Nagasawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Laboratoly of Forensic Toxicology, Graduate School of Pharmaceutical, Chiba University, Chiba, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Laboratoly of Forensic Toxicology, Graduate School of Pharmaceutical, Chiba University, Chiba, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Japan
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Lotierzo M, Galvez T, Conquet G, Verani Q, Aguilhon C, Rangeard I, Cristol JP, Renard E. Accurate selection of insulin immunoassay to discern factitious hypoglycemia: a case report. Acta Diabetol 2023; 60:315-317. [PMID: 36255518 DOI: 10.1007/s00592-022-01995-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/09/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Manuela Lotierzo
- Laboratory of Biochemistry and Hormonology, Montpellier University Hospital, Montpellier, France.
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
| | - Thierry Galvez
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Guilhem Conquet
- Laboratory of Biochemistry and Hormonology, Montpellier University Hospital, Montpellier, France
| | - Quentin Verani
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Caroline Aguilhon
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Isabelle Rangeard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Jean Paul Cristol
- Laboratory of Biochemistry and Hormonology, Montpellier University Hospital, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- INSERM 1411 Clinical Investigation Centre, Montpellier, France
- CNRS, INSERM, Institute of Functional Genomics, University of Montpellier, Montpellier, France
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6
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Insulin murder and the case of Colin Norris. J Forensic Leg Med 2023; 94:102483. [PMID: 36680946 DOI: 10.1016/j.jflm.2023.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Although insulin is an essential medicine and a life-saving drug, it has also been incriminated in many poisoning deaths; accidental, suicidal and some with malicious intent. Overdosing with insulin precipitates a life-threatening state of hypoglycemia and if untreated leads to coma, irreversible brain damage and death. Normally, the pancreatic β-cells secrete equimolar amounts of insulin and C-peptide into the portal venous blood, although under physiological conditions the plasma concentration ratio (insulin/C-peptide) is less than unity, because insulin is more susceptible to hepatic first-pass metabolism. A high ratio of insulin/C-peptide in plasma from a poisoned patient is compelling evidence that pharmaceutical insulin was administered, which does not contain C-peptide. The analysis of insulin and C-peptide was traditionally done by immunoassay methods (RIA and/or ELISA), although high resolution LC-MS/MS is more suitable for forensic purposes and permits the identification of insulin analogues. Use of insulin as a murder weapon is exemplified by the case of Colin Norris, a male nurse found guilty of murdering four elderly patients and the attempted murder of a fifth by injecting them with insulin. However, the prosecution evidence against Norris was mainly circumstantial and hearsay. Toxicological evidence against Norris consisted of a high insulin/C-peptide concentration ratio in plasma from one of the victims. This analysis was done by an immunoassay method at a clinical laboratory and not a forensic laboratory. Analytical procedures, including chain-of-custody routines, are more stringent at forensic laboratories. Since his conviction, some of the medical evidence against Norris has been called into question, especially the prevalence of spontaneous attacks of hypoglycemia in elderly and frail patients with co-morbidities.
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Arbouche N, Macoin E, Raul JS, Kintz P. Influence of Preservatives on Insulin in Postmortem Blood: Application to a Case of Insulin Aspart Suicide. J Anal Toxicol 2023; 46:e300-e306. [PMID: 36472350 DOI: 10.1093/jat/bkac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Insulin aspart (NovoRapid®, NovoMix®, Novolog® and Fiasp®) is a fast-acting analog of human insulin, indicated in the treatment of type I and II diabetes. It is administered before meals to mimic the physiological insulin secretion that follows a rise in blood glucose. Its misuse for the purposes of suicide and murder and in the context of factitious order has often been described. In forensic medicine, the identification of insulin in biological samples has always been complex. In this paper, we present a case of suicide of a 64-year-old man who died after the injection of insulin aspart. He was suffering from terminal lung cancer and left a letter explaining the reasons for his suicide. Four empty NovoRapid® pens were found near the body. Body examination was unremarkable, and the femoral blood was collected in two dry Vacutainer™ tubes (red cap) and two sodium fluoride (NaF) tubes (gray cap). A liquid chromatography coupled to high-resolution mass spectrometry method was used to identify and discriminate insulin aspart from human insulin after immunopurification in the blood samples and in the pens. Blood specimens tested positive for insulin aspart with the concentrations of 36 and 37 ng/mL in dry tubes and 58 and 71 ng/mL in tubes containing NaF when tested ∼3 weeks after the collection of the specimens. The contents of the pens also matched with insulin aspart. The stability of insulin in blood is a critical point in the interpretation of the concentrations due to their rapid decrease caused by the activity of proteases in blood. During a degradation study implemented to compare three preservatives and dry tubes, suitable insulin aspart stability was observed with disodium salt of ethylenediaminetetracetic acid and NaF. Given that NaF is standard in forensic toxicology for measuring blood alcohol concentrations, the authors suggest its use for blood collection when insulin intoxication is suspected.
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Affiliation(s)
- Nadia Arbouche
- Institut de Médecine Légale, 11 Rue Humann, Strasbourg, France
| | - Elisa Macoin
- Institut de Médecine Légale, 11 Rue Humann, Strasbourg, France
| | | | - Pascal Kintz
- Institut de Médecine Légale, 11 Rue Humann, Strasbourg, France.,X-Pertise Consulting, 42 Rue Principale, Mittelhausbergen 67206, France
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8
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Augustine MF, King K, Zhang YV. Explaining Unexplained Hypoglycemia Due To Insulin Analogs. Mayo Clin Proc 2022; 97:1966-1968. [PMID: 36333011 DOI: 10.1016/j.mayocp.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 03/21/2023]
Affiliation(s)
- Marilyn F Augustine
- Department of Medicine, Division of Endocrinology and Metabolism, University of Rochester Medical Center, Rochester, NY
| | - Katie King
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Y Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY.
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9
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Interest of HRMS systems in analytical toxicology: Focus on doping products. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bottinelli C, Fanton L, Cartiser N, Guitton J, Bévalot F. Identification et dosage des insulines en post-mortem : l’importance de multiplier les prélèvements. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdelwaly EA, Mohamed AA, El-Kosasy AM, Ayad MF. A comprehensive stability assessment of insulin degludec using New customized validated RP-HPLC and SEC-HPLC methods in an orthogonal testing protocol. J Pharm Biomed Anal 2021; 203:114175. [PMID: 34098506 DOI: 10.1016/j.jpba.2021.114175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022]
Abstract
Stress testing of biopharmaceuticals plays an important role in preparation of their stability profiles through investigation of possible degradation pathways and identification of degradation products, so in this study Insulin Degludec which is a new generation ultra-long-acting basal insulin is subjected to stress conditions as different temperatures, different pH, oxidation, mechanical agitation, and repeated freeze and thaw cycles to generate possible degradation products and aggregation that are investigated by two new validated RP-HPLC and SEC-HPLC methods in addition to dynamic light scattering (DLS) and native polyacrylamide gel electrophoresis (Nu-PAGE). SEC-HPLC was used to investigate formation of aggregates whose results were correlated with those obtained from DLS and Nu-PAGE, while RP-HPLC was used to investigate any possible chemical modifications. The Proposed RP-method had limit of detection (LOD) and limit of quantitation (LOQ) of 0.012 mg/mL and 0.045 mg/mL respectively and accuracy of 99.22 ± 1.07 %, while the SEC methods had limit of detection (LOD) and limit of quantitation (LOQ) of 0.012 mg/mL and 0.031 mg/mL, respectively. The degradation pattern due to high temperature effect and oxidation is investigated by LC- tandem mass spectrometry. Results showed that Insulin degludec is highly stable under low temperature, mechanical agitation and repeated freeze and thaw stress conditions but elevated temperature and high acidic condition lead to formation of aggregates and also chemical modifications including deamidation, isomerization and oxidation. Such different chemical degradation pathways are due to presence of variable reactive moieties in Insulin degludec structure. Insulin degludec is highly vulnerable to oxidation at the sulfur containing cysteine residue in B chain in position B7 forming trioxidation derivative when exposed to hydrogen peroxide. Formation of A21-Asp and A18-Asp deamidated variants as well as B3-Asp and B3-isoAsp deamidated variants are prominent degradation pathways at neutral pH but at elevated temperature.
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Affiliation(s)
- Eman A Abdelwaly
- Egyptian Drug Authority, Central Administration of Biological and Innovative Products and Clinical Studies, Egypt.
| | - Abeer A Mohamed
- Egyptian Drug Authority, Central Administration of Biological and Innovative Products and Clinical Studies, Egypt; Pharmaceutical Chemistry Department, Faculty of Pharmacy, Heliopolis University, Egypt
| | - Amira M El-Kosasy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Miriam F Ayad
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Bottinelli C, Bévalot F, Cartiser N, Fanton L, Guitton J. Detection of insulins in postmortem tissues: an optimized workflow based on immunopurification and LC-MS/HRMS detection. Int J Legal Med 2021; 135:1813-1822. [PMID: 33932171 DOI: 10.1007/s00414-021-02598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
Diabetes is a worldwide disease in perpetual expansion. Type 1 and sometimes type 2 diabetic patients require daily human insulin (HI) or analog administration. Easy access to insulins for insulin-treated diabetics, their relatives, and medical professionals can enable abuse for suicidal or homicidal purpose. However, demonstrating insulin overdose in postmortem blood is challenging. Tissue analyses are contributive, as insulins can accumulate before death or undergo only limited degradation. The present study describes an assay for HI and synthetic analogs (lispro, aspart, glulisine, detemir and degludec, glargine and its main metabolite (M1)) in liver, kidney, muscle, and injection site samples. It is based on a 5-step sample preparation (reduction of tissue sample size, homogenization, extraction, concentration, and immunopurification) associated with liquid chromatography coupled to high-resolution mass spectrometry (LC-MS/HRMS). Selectivity and limit of detection (LOD) for all target analogs were assessed in the above matrices. LOD was determined at 25 ng/g for HI and for analogs except detemir and degludec, where LOD was 50 ng/g in kidney and injection site samples and 80 ng/g in the liver and muscle. The method was applied to13 forensic cases in which insulin use was suspected.
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Affiliation(s)
- Charline Bottinelli
- LAT LUMTOX Laboratory, 32 Rue du 35ème Régiment d'Aviation 69500, Bron, France.
| | - Fabien Bévalot
- LAT LUMTOX Laboratory, 32 Rue du 35ème Régiment d'Aviation 69500, Bron, France
| | - Nathalie Cartiser
- Department of Forensic Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Fanton
- Department of Forensic Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,Faculty of Medicine Lyon-Est, University of Lyon, UCBL1, Lyon, France
| | - Jérôme Guitton
- Toxicology Laboratory, ISPB Faculty of Pharmacy, University of Lyon, UCBL1, Lyon, France.,Pharmacology-Toxicology Laboratory, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
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