The Case of the Murdered Midwife

Part I: The Investigation

It’s your first day shadowing a detective, and already it’s been interesting…if you can
call the murder of a young woman interesting. You’ve been trying to detach yourself
by reading the file, but you have interviews later this morning and you’re nervous.
Going back to the file, you jot down some notes on what you know so far.

Meleea was a 35-year-old nurse midwife with over ten years’ experience delivering
babies both in hospitals, as well as in homes when risk for complications were low.
She was healthy; her only medical condition was an allergy to bee stings. The body
was discovered by her boyfriend when he came over for a planned dinner. The
dinner – spaghetti – was laid out, but no cooking had begun. There was also a plate
of cupcakes, with a bite out of only one of them. The boyfriend said Meleea had not
mentioned feeling unwell when they spoke earlier in the day. She was, however,
tired, and understandably upset about a long birth she had assisted with where a
mother had died in childbirth.

The medical examiner did not have results yet, so you sketch out some questions
you have for the interviewees.

1. Who would you interview, and what would you ask?

I would begin by interviewing the boyfriend and checking for motives. After
this, I feel that neighbors would be the first go-to. I would ask the neighbors if
they had seen or spoken with Meleea that day, or if they were familiar with
her at all and what their relationship with her was like.

2. Do you have any hypotheses about what happened to Meleea? Write at least
one or two possibilities.

Yes. Based on the given information, I would suspect that the cupcakes had
something to do with her death. While it may be a stretch, cupcakes are a
relatively fast treat to make, so it seems unusual that they would be baked
before dinner was even started. Furthermore, that they would have been
baked, plated, and eaten before dinner, when one could assume they were
made for Meleea and her boyfriend to share. Rather, this could point to either
her boyfriend or a neighbor or other aquaintence having gifted her the
cupcakes. This leads me to two separate conclusions:
a. This was an act of fowl play, and the cupcakes were poisoned in some
way with the intention of killing Meleea
b. The cupcakes contained something that Meleea had an allergic
reaction to, causing her untimely death. While it is noted that Meleea
only had an allergy to bee stings, it is not unheard of for people to
develop new allergies, or to discover ones they had not been tested
for or were unaware of.
Part II: The Medical Examiner’s Report
You now have the medical examiner’s (ME) report. The ME believes she died of
asphyxiation. You read that there were no marks on the body, including bee stings.
She was healthy, but tissue analysis showed some bizarre results. There was tissue
death, but not only that, microscopic analysis showed mitochondrial damage. In
addition, there were high levels of oxygen in all tissues examined.

1. Based on the above, what cellular process might have been interrupted?
Support your answer with the information above and knowledge gained in
this module. Cite sources using APA Style.

It would seem that the electron transport chain was interrupted. Complex IV,
the final complex of the electron transport chain, is responsible for taking
oxygen and turning them into H2O (Clark et al., 2018), so without this final
step, a surplus of oxygen would be found. The mitochondria also helps to
remove produced oxygen, so seeing high levels of oxygen is consistent with
mitochondrial damage.

2. Are there any conflicting pieces of information in the above? If so, what are
they?

It may initially seem to be contradictory that she was able to die of

asphyxiation, but showed no visible marks on her body. This can be
attributed to the cell death, however, as if the mitochondria were damaged
and the electron transport chain interrupted, the body could not properly
utilize oxygen, which would thus lead to asphyxiation.

Part III: Analysis of Metabolites

The ME’s report also has a note at the end. She suspects poisoning based on the
below results.

Metabolite Level Compared to Normal

(High, Normal, or Low)
Oxygen High
NADH High
NAD+ Low
Pyruvate Normal
Glucose Normal
Acetyl CoA Normal
ATP Low
ADP High

1. What is the role of each of the above metabolites in cellular respiration?

 Oxygen – A reactant that helps to create water, carbon dioxide, and most
importantly ATP. Used in the final portion of the electron transport chain to
help create ATP.
NADH – Helps to transport the electrons made during glycolysis and the
Krebs cycle to the electron transport chain.
NAD+ - Picks up the electrons made during glycolysis, NAD+ then produces
the aforementioned NADH which will transport said electrons.
Pyruvate – May provide energy to the cells by being transported to the
mitochondria where it is used in the citric acid cycle.
Glucose – Broken down during cellular respiration to produce ATP and
energy for the cell.
Acetyl CoA – Carries carbon atoms so that they can be oxidized for energy
production.
ATP – The energy produced during cellular respiration, this allows the cell to
function and complete all of its needed tasks.
ADP – What ATP becomes after using its energy. ADP can then be
“regenerated” into ATP to be used again.

2. Which of the above are abnormal? Which are normal?

The amount of oxygen, ADP and NADH was abnormal for being too high,
while ATP and NAD+ were abnormal for being too low.

3. Based on your answers to the first two questions, what part of cellular
respiration do you believe was interrupted?

The electron transport chain was interrupted. This would explain the high
degree of oxygen found, as it wasn't able to be utilized properly. Additionally,
the ATP was low because the cells were unable to produce more, leading to
the ATP being expended, which would thus lead to a high amount of ADP to
be present.

Part IV: Test Results

The ME received results for three poisons, and one came back positive: cyanide, a
potent inhibitor of cellular respiration.

1. What is the mechanism of action of cyanide? Focus on the enzyme it inhibits,

the type of inhibition, and the normal role of the enzyme in cellular
respiration.

Cyanide directly attacks the enzyme Cytochrome C oxidase, also known as

“Complex IV” (Leavesley et al., 2008). Complex IV is used in the electron
transport chain, and is responsible for helping to synthesize ATP. Cyanide
will bind to Complex IV to inhibit cellular oxygen utilization and ATP
production, and cause cellular dysfunction (Leavesley et al., 2008). Because
of this, the cells are no longer able to properly obtain energy from oxygen
 that is being processed, and this can lead to myocardial dysfunction and
death as the body's cells are no longer able to properly use oxygen.

2. Explain how Meleea died of asphyxiation when her oxygen levels are high.

Though the cells had a surplus of oxygen, it was unable to be utilized

properly. Oxygen was being produced by the cell, but with Complex IV being
attacked by cyanide, and the electron transport chain unable to function
properly, this oxygen could not be used, leading to an abundance of oxygen,
but none of which would be properly used by the cell.

Part V: Interviews
After the detective saw the test results, you interviewed the boyfriend, the grieving
husband, and the neighbors. No one confessed to the crime, but you did notice a
spatula in the neighbor’s sink with the same color icing on it as the cupcake Meleea
had begun eating. The detective bagged the spatula, and after confirming a match,
the neighbor was arrested. After further interviews it appeared he had an
unrequited love interest that turned to murder.
 References

Biologydictionary.net Editors. (2016, November 17). Cellular Respiration.

https://biologydictionary.net/cellular-respiration/

Britannica, T. Editors of Encyclopaedia (2020, March 13). Cellular respiration.

Encyclopedia Britannica. https://www.britannica.com/science/cellular-
respiration

Clark, M. A., Jung, C., & Douglas, M. (2018). Biology 2e. Houston: OpenStax.

Leavesley, H. B., Li, L., Prabhakaran, K., Borowitz, J.L., Isom, G. E., Interaction of
Cyanide and Nitric Oxide with Cytochrome c Oxidase: Implications for Acute Cyanide
Toxicity, Toxicological Sciences, Volume 101, Issue 1, January 2008, Pages 101–111,
https://doi.org/10.1093/toxsci/kfm254