This study, besides to delineate the cytoarchitecture and the localization in the brainstem of the human raphé nuclei, aims to evaluate the correlation between neuropathological raphé defects and serotonin transporter gene (5-HTT) promoter region polymorphisms in a cohort of 28 SIDS victims, 12 sudden intrauterine unexplained deaths (SIUD), and 17 controls. Hypoplasia of one or more nuclei of both the rostral and caudal raphé groups was found in 57% of SIDS, in 67% of SIUD, and only in 12% of controls. Furthermore, a significant correlation among 5-HTT Long (L) allele, hypoplasia of the raphé nuclei, and maternal smoking in pregnancy was observed in sudden fetal and infant deaths. The presence of the L allele represents a predisposing factor for sudden fetal and infant death in association with morphologic developmental defects of the raphé nuclei and prenatal smoke exposure. A further consideration of the authors is that SIUD should not be regarded as a separate entity from SIDS, given the potentially shared neuropathological and genetic bases. additionally described an increase in number and density of serotonin cell bodies in the raphé, particularly in the raphé obscurus nucleus, in SIDS victims.The above-described neuropathological studies served as the impetus for investigation of genes regulating the synthesis, storage, membrane uptake, and metabolism of 5-HT, as well as related receptors in SIDS cohorts (4 -15). Key positive findings include the promoter region and intron 2 of the serotonin transporter gene (5-HTT) Long (L) allele, the L/L genotype, and the haplotype including the L alleles of both polymorphisms, and low frequency but apparent genetic variants in the FEV gene (11) and the PHOX2B gene (12). These results likely have a role in serotonin network dysfunction, resulting in a failure of autonomic and respiratory responses to hypoxia and/or hypercapnia, potentially resulting in risk for sudden death.Although the association of the promoter polymorphism L allele of the 5-HTT with SIDS has been widely documented, correlation with brainstem neuropathology and identification of all nuclei of the raphé complex in histopathologic studies in SIDS is limited. Further, the medullary serotonergic network in fetal life has not yet been described. Therefore, we aim to 1) clearly delineate the histology of the human raphé system in a cohort of SIDS victims and sudden intrauterine unexplained death (SIUD) cases; 2) determine the 5-HTT promoter region polymorphism in the same cohort of SIDS and SIUD; and 3) clarify the relationship of the 5-HTT L allele to cytoarchitectural alterations of the raphé complex in both the SIDS and SIUDs. Because maternal smoking is consistently identified as a risk factor for SIDS (16,17), the possible influence of maternal smoking in the serotonergic development will also be examined.
MATERIALS AND METHODSStudy Subjects. The study included three groups of Caucasian infants: a SIDS cohort, a SIUD cohort, and a control group.SIDS and SIUD victims. The SIDS cases included ...