A study of the endogenous opioid system in the sudden infant death syndrome.

To investigate the possible role of the endogenous opioid system in the pathogenesis of the sudden infant death syndrome (SIDS), we measured met-enkephalin immunoreactivity by radioimmunoassay in brain, lung, and adrenal glands of SIDS victims and of infants (controls) dying of nonneurologic causes. Met-enkephalin was stable in brain tissue up to 24 hours after death. On inspection, met-enkephalin levels in the cerebral cortex of SIDS victims were similar to those in controls. Levels in the caudate nucleus were lower in infants than in adults. In the medulla, the levels in SIDS cases and controls were not found to differ significantly. The linear relationship between the levels in the medulla and age was not detectably different in SIDS and controls. However, as a subset, levels in the control group significantly decreased with increasing age (P = 0.005), whereas levels in the SIDS group showed no correlation with age (P = 0.33). Levels of met-enkephalin in the adrenal gland of SIDS victims were similar to those in controls and were considerably lower than adult values. Lung tissue was assayed for beta-endorphin immunoreactivity and met-enkephalin: for both peptides the values in SIDS cases were low (femtomolar range) and similar to those in controls. These data suggest that met-enkephalin is not markedly overproduced in brains of SIDS victims. Future postmortem studies should focus on more subtle evidence of endogenous opioid overactivity such as differences in age related changes, receptor number, and levels of other endogenous opioid peptides.