Analysis of the human locus coeruleus in perinatal and infant sudden unexplained deaths. Possible role of the cigarette smoking in the development of this nucleus.

We investigated the immunohistochemical expression of the tyrosine hydroxylase (TH) enzyme and the morphometric parameters of the human locus coeruleus (LC) in the brainstems of 32 subjects aged from 17 gestational weeks to 12 postnatal month, died of unknown (sudden unexplained perinatal and infant deaths) and known causes. The goals of this study were: (1) to obtain basic information about the structure and physiology of the LC during the first phases of human nervous system development; (2) to evaluate whether there is altered expression of TH and/or structural alterations of the LC in cases of sudden perinatal and infant death; and (3) to verify if morphological and/or physiological abnormalities of the LC could be related to maternal cigarette smoking. Morphometric analysis showed homogeneous data in cases of sudden perinatal and infant death and in age-matched controls who had died of known aetiology. However, immunohistochemistry demonstrated in a wide subset of sudden and unexplained deaths a negativity or low positivity of TH. High distribution of TH protein were instead detectable in the LC neurons of foetuses aged 17-18 gestational weeks who had died of known causes. Therefore, we postulate the functional importance of the LC in the early phases of central nervous system development. Besides, the observation of a significant correlation between sudden unexplained death, negativity of TH staining and maternal smoking, prompted us to suppose a close relation between smoking in utero and a decrease of the noradrenergic activity of the LC, leading to sudden death in the last part of pregnancy and in the first year of life.