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J Forensic Sci. 2012 Nov;57(6):1519-23. doi: 10.1111/j.1556-4029.2012.02212.x. Epub 2012 Jul 16.

Increased heat shock protein 70 gene expression in the brains of cocaine-related fatalities may be reflective of postdrug survival and intervention rather than excited delirium.

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Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI 48201, USA.


Cocaine-related fatalities can pose forensic challenges, particularly when accompanied by excited delirium (ED) syndrome and interventions by law enforcement and medical personnel. A recent report concluded that elevated heat shock protein 70 (HSP70) expression in autopsy brain samples constitutes a reliable forensic biomarker for the identification of ED as a cause of death. The present study quantified the abundance of both HSPA1A and HSPA1B gene (HSP70-encoding) transcripts in midbrain specimens from a series of cocaine-related fatalities and matched drug-free control subjects. HSP70 expression was increased significantly in cocaine abusers as a group compared to control subjects, irrespective of the presence or absence of ED. Furthermore, elevated HSP70 expression was predictive of a period of survival between cocaine use and death that included medical and/or police intervention. The present data do not support the assertion that HSP70 expression is a reliable brain biomarker for identifying ED as a cause of death.

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