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Jones AW. Brief history of the alcohol biomarkers CDT, EtG, EtS, 5-HTOL, and PEth. Drug Test Anal 2024; 16:570-587. [PMID: 37806783 DOI: 10.1002/dta.3584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
This article traces the historical development of various biomarkers of acute and/or chronic alcohol consumption. Much of the research in this domain of clinical and laboratory medicine arose from clinics and laboratories in Sweden, as exemplified by carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth). Extensive studies of other alcohol biomarkers, such as ethyl glucuronide (EtG), ethyl sulfate (EtS), and 5-hydroxytryptophol (5-HTOL), also derive from Sweden. The most obvious test of recent drinking is identification of ethanol in a sample of the person's blood, breath, or urine. However, because of continuous metabolism in the liver, ethanol is eliminated from the blood at a rate of 0.15 g/L/h (range 0.1-0.3 g/L/h), so obtaining positive results is not always possible. The widow of detection is increased by analysis of ethanol's non-oxidative metabolites (EtG and EtS), which are more slowly eliminated from the bloodstream. Likewise, an elevated ratio of serotonin metabolites in urine (5-HTOL/5-HIAA) can help to disclose recent drinking after ethanol is no longer measurable in body fluids. A highly specific biomarker of hazardous drinking is CDT, a serum glycoprotein (transferrin), with a deficiency in its N-linked glycosylation. Another widely acclaimed biomarker is PEth, an abnormal phospholipid synthesized in cell membranes when people drink excessively, having a long elimination half-life (median ~6 days) during abstinence. Research on the subject of alcohol biomarkers has increased appreciably and is now an important area of drug testing and analysis.
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Affiliation(s)
- Alan Wayne Jones
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
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Fakhari S, Waszkiewicz N. Old and New Biomarkers of Alcohol Abuse: Narrative Review. J Clin Med 2023; 12:jcm12062124. [PMID: 36983134 PMCID: PMC10054673 DOI: 10.3390/jcm12062124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
The harmful use of alcohol is responsible for 5.1% of the global burden of disease, and the early detection of alcohol problems may prevent its development and progression. Therefore, the aim of the study is to review traditional and new biomarkers associated with alcohol use. The nature and practical application and limitations of alcohol biomarkers in the diagnosis and monitoring of drinking are reviewed. Despite the limited specificity and sensitivity in alcohol drinking detection, traditional biomarkers are useful in clinical practice, and new generations of biomarkers, e.g., proteomic markers, are in need of further investigation. Traditional biomarkers are broadly available and cost-efficient, providing valuable data on the complications of drinking and prognosis, as well as on concurrent conditions affected by drinking. The most important challenge in the future will be to translate methodically advanced methods of detecting alcohol markers into simpler and cheaper methods. Larger population studies are also needed to test the usefulness of these potential markers of alcohol use.
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Affiliation(s)
- Sara Fakhari
- Department of Psychiatry, Mazowieckie Specjalistyczne Centrum Zdrowia w Pruszkowie, 05-800 Pruszków, Poland
- Correspondence: ; Tel.: +48-69-6963901
| | - Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Bialystok, 15-089 Bialystok, Poland
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3
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Lappas NT, Lappas CM. Ethanol. Forensic Toxicol 2022. [DOI: 10.1016/b978-0-12-819286-3.00021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mackus M, van de Loo AJAE, van den Bogaard WJM, Korte-Bouws GAH, Garssen J, Verster JC. The 5HTOL/5HIAA Ratio as a Biomarker of Alcohol Hangover. J Clin Med 2021; 10:jcm10184241. [PMID: 34575350 PMCID: PMC8467792 DOI: 10.3390/jcm10184241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/20/2022] Open
Abstract
Assessment of the presence and severity of alcohol hangovers relies on the subjective method of self-report. Therefore, there is a need of adequate biomarkers that (1) correlate significantly with hangover severity, and (2) correspond to the level of hangover-related performance impairment objectively. In this naturalistic study, n = 35 social drinkers participated. Urine samples were obtained the morning after alcohol consumption and after an alcohol-free control day. Concentrations of 5-hydroxytryptophol (5-HTOL), 5-hydroxyindoleacetic acid (5-HIAA) and the 5-HTOL/5-HIAA ratio were determined. The results confirm previous findings that 5-HTOL and the 5HTOL/5-HIAA ratio are useful biomarkers of recent alcohol consumption. Significant correlations were found with the amount of alcohol consumed, total drink time, and estimated BAC. However, urine concentrations of 5-HTOL and 5-HIAA (and their ratio 5HTOL/5-HIAA) did not significantly correlate with hangover severity. In conclusion, urine 5-HTOL, 5-HIAA, and the 5HTOL/5-HIAA ratio cannot be considered to be suitable biomarkers of alcohol hangover.
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Affiliation(s)
- Marlou Mackus
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.M.); (A.J.A.E.v.d.L.); (W.J.M.v.d.B.); (G.A.H.K.-B.); (J.G.)
| | - Aurora J. A. E. van de Loo
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.M.); (A.J.A.E.v.d.L.); (W.J.M.v.d.B.); (G.A.H.K.-B.); (J.G.)
| | - Willie J. M. van den Bogaard
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.M.); (A.J.A.E.v.d.L.); (W.J.M.v.d.B.); (G.A.H.K.-B.); (J.G.)
| | - Gerdien A. H. Korte-Bouws
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.M.); (A.J.A.E.v.d.L.); (W.J.M.v.d.B.); (G.A.H.K.-B.); (J.G.)
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.M.); (A.J.A.E.v.d.L.); (W.J.M.v.d.B.); (G.A.H.K.-B.); (J.G.)
- Global Centre of Excellence Immunology, Nutricia Danone Research, 3584 CT Utrecht, The Netherlands
| | - Joris C. Verster
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.M.); (A.J.A.E.v.d.L.); (W.J.M.v.d.B.); (G.A.H.K.-B.); (J.G.)
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia
- Correspondence: ; Tel.: +31-30-253-6909
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Lin Z, Wang H, Jones AW, Wang F, Zhang Y, Rao Y. Evaluation and review of ways to differentiate sources of ethanol in postmortem blood. Int J Legal Med 2020; 134:2081-2093. [PMID: 32940841 DOI: 10.1007/s00414-020-02415-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022]
Abstract
Accurate determination of a person's blood alcohol concentration (BAC) is an important task in forensic toxicology laboratories because of the existence of statutory limits for driving a motor vehicle and workplace alcohol testing regulations. However, making a correct interpretation of the BAC determined in postmortem (PM) specimens is complicated, owing to the possibility that ethanol was produced in the body after death by the action of various micro-organisms (e.g., Candida species) and fermentation processes. This article reviews various ways to establish the source of ethanol in PM blood, including collection and analysis of alternative specimens (e.g., bile, vitreous humor (VH), and bladder urine), the identification of non-oxidative metabolites of ethanol, ethyl glucuronide (EtG) and ethyl sulfate (EtS), the urinary metabolites of serotonin (5-HTOL/5-HIAA), and identification of n-propanol and n-butanol in blood, which are known putrefaction products. Practical utility of the various biomarkers including specificity and stability is discussed.
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Affiliation(s)
- Zijie Lin
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hao Wang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China
| | - Alan Wayne Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fanglin Wang
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, People's Republic of China
| | - Yunfeng Zhang
- Institute of Forensic Science, Ministry of Public Security, Beijing, 100038, People's Republic of China
| | - Yulan Rao
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China.
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Tang Y, Hu C, Sang S. Characterization of Reaction Products and Mechanisms between Serotonin and Methylglyoxal in Model Reactions and Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:2437-2444. [PMID: 32011875 DOI: 10.1021/acs.jafc.0c00071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Serotonin is an important endogenous regulatory neurotransmitter and has also been found in fruits, vegetables, and nuts. Methylglyoxal (MGO) is a reactive dicarbonyl metabolite and also a food toxin that modifies protein and DNA to cause the development of many chronic diseases. The objective of this study is to understand the reaction mechanisms between serotonin and MGO and determine whether serotonin could trap MGO in vivo. Five products were detected in phosphate buffer (pH 7.4) at 37 °C. Four products (compounds 2 and 4-6) were purified from the reaction mixture, and their structures were characterized by the analysis of their high-resolution mass and one- and two-dimensional nuclear magnetic resonance spectra. One product (compound 3), as a result of its instability, could not be properly purified and was tentatively characterized on the basis of its high-resolution mass spectrum and corresponding mass fragments. On the basis of the structures of these five products, two reaction pathways were proposed. Compounds 2, 3, 5, and 6 were produced through the Pictet-Spengler condensation pathway between the primary amine of serotonin and the ketone of MGO, and compound 3 was identified as the intermediate product to form products 2, 5, and 6, whereas compound 4 was formed through nucleophilic substitution by the benzene ring of serotonin, which is a new reaction pathway between biogenic amines and reactive carbonyl species. More importantly, the detection of adducts 2 and 4-6 in mice supports our hypothesis that the reaction between serotonin and MGO also happens in vivo through the same pathways as those in model reactions, suggesting that dietary or endogenous serotonin has the capacity to trap MGO in vivo.
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Affiliation(s)
- Yao Tang
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies , North Carolina Agricultural and Technical State University , North Carolina Research Campus, 500 Laureate Way , Kannapolis , North Carolina 28081 , United States
| | - Changling Hu
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies , North Carolina Agricultural and Technical State University , North Carolina Research Campus, 500 Laureate Way , Kannapolis , North Carolina 28081 , United States
| | - Shengmin Sang
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies , North Carolina Agricultural and Technical State University , North Carolina Research Campus, 500 Laureate Way , Kannapolis , North Carolina 28081 , United States
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Palmieri A, Petrini M. Tryptophol and derivatives: natural occurrence and applications to the synthesis of bioactive compounds. Nat Prod Rep 2019; 36:490-530. [DOI: 10.1039/c8np00032h] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This report presents some fundamental aspects related to the natural occurrence and bioactivity of tryptophol as well as the synthesis of tryptophols and their utilization for the preparation of naturally occurring alkaloid metabolites embedding the indole system.
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Affiliation(s)
- Alessandro Palmieri
- School of Science and Technology
- Chemistry Division
- University of Camerino
- Italy
| | - Marino Petrini
- School of Science and Technology
- Chemistry Division
- University of Camerino
- Italy
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Biomarkers of alcohol misuse: recent advances and future prospects. GASTROENTEROLOGY REVIEW 2016; 11:78-89. [PMID: 27350834 PMCID: PMC4916243 DOI: 10.5114/pg.2016.60252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 12/24/2015] [Indexed: 12/21/2022]
Abstract
Alcohol abuse and dependence are highly prevalent in many cultures and contribute considerably to the global burden of health and social issues. The current inability to accurately characterise long-term drinking behaviours is a major obstacle to alcoholism diagnosis and treatment. Therefore, it is of great importance to develop objective diagnostic tools to discern subjects with excessive alcohol use and alcoholism or to confirm abstinence. Research over past years has revealed several biochemical compounds with considerable potential for accurate reflection of alcohol intake. This review will address the issue of alcohol biomarker definition, the types of molecules used as so-called traditional biomarkers, and the compounds that can serve as novel biomarker candidates or components of biomarker panels.
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Types of Interpretations. Forensic Toxicol 2016. [DOI: 10.1016/b978-0-12-799967-8.00012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Bianchi V, Premaschi S, Raspagni A, Secco S, Vidali M. A comparison between serum carbohydrate-deficient transferrin and hair ethyl glucuronide in detecting chronic alcohol consumption in routine. Alcohol Alcohol 2015; 50:266-70. [PMID: 25698630 DOI: 10.1093/alcalc/agv005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 01/27/2015] [Indexed: 12/20/2022] Open
Abstract
AIMS In heavy alcohol consumption laboratory tests represent an objective evidence. In this study we compared older and newer biomarkers in blood and in hair. METHODS Carbohydrate-deficient transferrin (CDT), ethyl glucuronide (EtG), AST, ALT, GGT, MCV were measured in a large sample (n = 562). All people declared no alcohol consumption within the last 3 months. Serum CDT was measured by the candidate HPLC reference method and expressed as relative amount of disialotransferrin (%DST: cutoff 1.7%). EtG was measured in hair by a validated in-house method by LC-MS/MS (cutoff 30 pg/mg). RESULTS Respectively, 42 (7.5%) and 76 (13.5%) subjects were positive to CDT and EtG. In particular, 30 (5.3%) subjects were positive to both tests, 12 (2.1%) only to CDT, while 46 (8.2%) only to EtG. The agreement (positive and negative pairs) between CDT and EtG was 89.7%. Interestingly, 6 out of 12 (50%) CDT-positive subjects had EtG < 15 pg/mg, whereas 27 out of 46 (59%) EtG-positive subjects had CDT < 1.1%. Forty-one out of 76 (54%) EtG-positive subjects display EtG values within 30-50 pg/mg. CONCLUSION Large variability exists between CDT and EtG in detecting chronic alcohol consumption. We suggest to use CDT, or a combination of different biomarkers, to identify alcohol abuse in a forensic context. EtG results close to the cutoff (30-50 pg/mg) should be cautiously considered before any sanction is assigned.
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Affiliation(s)
- Vincenza Bianchi
- Toxicology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Simone Premaschi
- Toxicology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | | | - Serena Secco
- Toxicology Laboratory, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | - Matteo Vidali
- Department of Medical Sciences, University 'Amedeo Avogadro' of Eastern Piedmont, Novara, Italy Clinical Chemistry Unit, Maggiore della Carità Hospital, Novara, Italy
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Abstract
Alcohol abuse can lead to a number of health and social issues. Our current inability to accurately assess long-term drinking behaviors is an important obstacle to its diagnosis and treatment. Biomarkers for chronic alcohol consumption have made a number of important advances but have yet to become highly accurate and as accepted as objective tests for other diseases. Thus, there is a crucial need for the development of more sensitive and specific markers of alcohol abuse. Recent advancements in proteomic technologies have greatly increased the potential for alcohol abuse biomarker discovery. Here, the authors review established and novel protein biomarkers for long-term alcohol consumption and the proteomic technologies that have been used in their study.
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Affiliation(s)
- Mariana P Torrente
- Department of Pharmacology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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Affiliation(s)
- Jitka Caslavska
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
| | - Wolfgang Thormann
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
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Joya X, Friguls B, Ortigosa S, Papaseit E, Martínez S, Manich A, Garcia-Algar O, Pacifici R, Vall O, Pichini S. Determination of maternal-fetal biomarkers of prenatal exposure to ethanol: A review. J Pharm Biomed Anal 2012; 69:209-22. [DOI: 10.1016/j.jpba.2012.01.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/05/2012] [Accepted: 01/07/2012] [Indexed: 12/19/2022]
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Helander A, Péter O, Zheng Y. Monitoring of the alcohol biomarkers PEth, CDT and EtG/EtS in an outpatient treatment setting. Alcohol Alcohol 2012; 47:552-7. [PMID: 22691387 DOI: 10.1093/alcalc/ags065] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS To compare the sensitivity of whole blood phosphatidylethanol (PEth) with serum carbohydrate-deficient transferrin (CDT) as biomarkers of current regular alcohol consumption, during outpatient treatment for alcohol-related problems. Urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS), and clinical assessment, were used as complementary estimates of relapse to drinking. METHODS Biomarker results for 29 men and 11 women (aged 20-73 years) undergoing voluntary outpatient treatment for harmful alcohol use or dependence were utilized for this evaluation. In connection with visits to the unit, blood and/or urine were sampled for measurement of PEth, EtG and EtS (by liquid chromatography-mass spectrometry), and CDT (%disialotransferrin, by high-pressure liquid chromatography). RESULTS The comparison included 326 whole blood, 319 serum (1-82 samples/patient) and 654 urine samples (1-178 samples/patient) collected over ~2 years. At the initial assessment, the total PEth value ranged between 0 and 16.5 µmol/l (mean 2.6) with 70% being above the quantification limit (0.1 µmol/l) and 55% above the reference interval (0.7 µmol/l). Initial CDT values were 0.87-6.9% (mean 2.1) with 35% above the applied reference interval (1.7%). At the final sampling (treatment period up to 21 months), the total PEth value had decreased to 0-5.9 µmol/l (mean 0.6; P = 0.0004) and CDT to 0.87-3.3% (mean 1.3; P = 0.0030). Relapses were detected by PEth alone (43% of cases), by PEth and CDT (38%) and the remainder by EtG/EtS. CONCLUSION PEth was the most sensitive biomarker of current regular alcohol consumption. PEth-16:0/18:1, usually being the major subform, was as sensitive as total PEth. PEth, CDT and EtG/EtS are useful complementary tools for objective identification of current drinking and relapse detection.
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Affiliation(s)
- Anders Helander
- Alcohol Laboratory, Department of Laboratory Medicine, Karolinska Institutet, C1:74, Clinical Chemistry, Karolinska University Laboratory Huddinge, SE-141 86 Stockholm, Sweden.
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Dahl H, Voltaire Carlsson A, Hillgren K, Helander A. Urinary Ethyl Glucuronide and Ethyl Sulfate Testing for Detection of Recent Drinking in an Outpatient Treatment Program for Alcohol and Drug Dependence. Alcohol Alcohol 2011; 46:278-82. [DOI: 10.1093/alcalc/agr009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Litten RZ, Bradley AM, Moss HB. Alcohol biomarkers in applied settings: recent advances and future research opportunities. Alcohol Clin Exp Res 2010; 34:955-67. [PMID: 20374219 DOI: 10.1111/j.1530-0277.2010.01170.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
During the past decade, advances have been made in the identification, development, and application of alcohol biomarkers. This is important because of the unique functions that alcohol biomarkers can serve in various applied settings. To carry out these functions, biomarkers must display several features including validity, reliability, adequacy of temporal window of assessment, reasonable cost, and transportability. During the past two decades, several traditional alcohol biomarkers have been studied in multiple human studies. Meanwhile, several new, promising biomarkers, including various alcohol metabolites and alcohol biosensors, are being explored in human studies. In addition, researchers have explored using biomarkers in combination and using biomarkers in combination with self-reports, resulting in increased sensitivity with little sacrifice in specificity. Despite these advances, more research is needed to validate biomarkers, especially the new ones, in humans. Moreover, recent advances in high-throughput technologies for genomics, proteomics, and metabolomics offer unique opportunities to discover novel biomarkers, while additional research is needed to perfect newly developed alcohol sensors. Development of more accurate biomarkers will help practicing clinicians to more effectively screen and monitor individuals who suffer from alcohol use disorders.
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Affiliation(s)
- Raye Z Litten
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9304, USA.
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Stenbacka M, Beck O, Leifman A, Romelsjö A, Helander A. Problem drinking in relation to treatment outcome among opiate addicts in methadone maintenance treatment. Drug Alcohol Rev 2009; 26:55-63. [PMID: 17364837 DOI: 10.1080/09595230601036994] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study analyzed indicators of alcohol-related problems in opiate addicts before, during, and after leaving methadone maintenance treatment (MMT), in relation to illicit drug use and retention in treatment. The study was based on 204 patients, admitted to MMT for the first time between 1 January 1995 and 31 July 2000, and followed until 31 December 2000. Three measures were used to indicate alcohol use and alcohol-related problems; records of hospital care with an alcohol-related diagnosis, any treatment with alcohol-sensitizing drugs (disulfiram or calcium carbimide) during MMT, and results of the 5-hydroxytryptophol to 5-hydroxyindoleacetic acid ratio (5HTOL/5HIAA) in urine, a sensitive biomarker for recent drinking. Use of illicit drugs was determined by routine urine drug testing. About one third of the patients (n = 69) had a lifetime prevalence of hospital treatment for an alcohol-related diagnosis, 45 of whom had been hospitalized (mean 4.2 stays) prior to the start of MMT. There was a significant association (p<0.05) between the number of alcohol-related diagnoses prior to treatment and a positive 5HTOL/5HIAA test during MMT. The alcohol indicators first became positive on average 1.6 years after admission to treatment, compared with after about 4 months for illicit drugs. Use of cannabis or benzodiazepines was significantly associated with alcohol use. Female methadone patients with indications of alcohol-related problems relapsed more often into illicit drug use than did women without such indications (3.9 vs. 2.5 relapse periods/year; p<0.005), whereas no significant association was found for men. The results of the present study indicate that drinking problems among patients undergoing MMT is associated with an increased risk of relapse into illicit drug use and with discharge from treatment. Concurrent treatment of alcohol-related problems, including systematic monitoring of alcohol use, therefore should be recommended to reduce the risk for relapse into illicit drug use and improve overall treatment outcome in MMT.
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Affiliation(s)
- M Stenbacka
- Departments of Clinical Neuroscience, Public Health Sciences, Stockholm University, Stockholm, Sweden.
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Kalapatapu RK, Chambers R. Novel Objective Biomarkers of Alcohol Use: Potential Diagnostic and Treatment Management Tools in Dual Diagnosis Care. J Dual Diagn 2009; 5:57-82. [PMID: 20582236 PMCID: PMC2891542 DOI: 10.1080/15504260802628684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Alcohol use disorders are highly prevalent conditions that generate a large fraction of the total public health burden. These disorders are concentrated in mentally ill populations, in which reliability of self-reporting of alcohol consumption may be especially compromised. The application of objective biomarkers for alcohol use may therefore play an important role in these patients. This article provides a description and comparative overview of traditional versus novel biomarkers of alcohol consumption. Greater professional familiarity with and use of novel biomarkers as diagnostic and treatment management tools may enhance clinical standards and research on alcohol use in patients with a dual diagnosis.
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Affiliation(s)
- Raj K Kalapatapu
- Geriatric Psychiatry Fellowship, Mount Sinai School of Medicine, New York, New York, USA
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Helander A, Beck O. Chapter 17 Analytical markers of acute and chronic alcohol consumption. HANDBOOK OF ANALYTICAL SEPARATIONS 2008. [DOI: 10.1016/s1567-7192(06)06017-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Stephanson N, Helander A, Beck O. Alcohol biomarker analysis: simultaneous determination of 5-hydroxytryptophol glucuronide and 5-hydroxyindoleacetic acid by direct injection of urine using ultra-performance liquid chromatography-tandem mass spectrometry. JOURNAL OF MASS SPECTROMETRY : JMS 2007; 42:940-9. [PMID: 17565712 DOI: 10.1002/jms.1231] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A direct ultra-performance liquid chromatography-tandem mass spectrometry method (UPLC-MS/MS) for simultaneous measurement of urinary 5-hydroxytryptophol glucuronide (GTOL) and 5-hydroxyindoleacetic acid (5-HIAA) was developed. The GTOL/5-HIAA ratio is used as an alcohol biomarker with clinical and forensic applications. The method involved dilution of the urine sample with deuterated analogues (internal standards), reversed-phase chromatography with gradient elution, electrospray ionisation and monitoring of two product ions per analyte in selected reaction monitoring mode. The measuring ranges were 6.7-10 000 nmol/l for GTOL and 0.07-100 micromol/l for 5-HIAA. The intra- and inter-assay imprecision, expressed as the coefficient of variation, was below 7%. Influence from ion suppression was noted for both compounds but was compensated for by the use of co-eluting internal standards. The accuracy in analytical recovery of added substance to urine samples was 96 and 98%, respectively, for GTOL and 5-HIAA. Method comparison with GC-MS for GTOL in 25 authentic patient samples confirmed the accuracy of the method with a median ratio between methods (GC-MS to UPLC-MS/MS) of 1.14 (r(2) = 0.975). The difference is explained by the fact that the GC-MS method also measures unconjugated 5-hydroxytryptophol naturally present in urine. The comparison with data for 5-HIAA obtained by an HPLC method demonstrated a median ratio of 1.05 between the methods. The UPLC-MS/MS method was capable of measuring endogenous GTOL and 5-HIAA levels in urine, which agreed with the literature data. In conclusion, a fully validated and robust direct method for the routine measurement of urinary GTOL and 5-HIAA was developed.
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Affiliation(s)
- Nikolai Stephanson
- Department of Medicine, Division of Clinical Pharmacology, Karolinska Institute and University Hospital, SE-171 76 Stockholm, Sweden
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Erim Y, Beckmann M, Tagay S, Beckebaum S, Gerken G, Broelsch CE, Senf W. [Stabilisation of abstinence by means of psychoeducation for patients with alcoholic liver disease awaiting liver transplantation]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2007; 52:341-57. [PMID: 17156604 DOI: 10.13109/zptm.2006.52.4.341] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A manualised six-month psychoeducational intervention was conducted in patients with alcoholic liver disease and abstinence problems who were waiting for a transplantation. OBJECTIVES In a naturalistic design it was investigated whether the intervention could improve patients' alcohol abstinence. METHODS Between January 2002 and November 2003, 72 patients were enrolled in the therapeutic intervention, 48 of whom participated in group therapy. Health-related quality of life (SF-12), anxiety and depression (HADS-D), symptom strain (BSI) and social support (F-SOZU) were measured. Alcohol abstinence was examined in each group session by measuring the alcohol concentration in breath. RESULTS At the beginning and end of the group therapy patients showed subsyndromal measures of anxiety and depression and minor symptoms of psychopathology. Physical quality of life was reduced (t = -8.694; df = 44; p < .001). Mental quality of life was in the range of the normative sample and was correlated with depression (r = -0.400; p = .009). Patients perceived high social support (t = 8.213; df = 45; p < .001). During the course of therapy four patients had relapses but the remaining patients stayed abstinent. Physical quality of life improved (t = -2.275; df = 27; p = .031), mental quality of life and symptom strain remained stable. CONCLUSIONS The therapy presented here facilitated a stabilisation of mental well-being in patients with alcoholic liver disease who were waiting for organ transplantation. The relapse rate measured by alcohol concentration in breath remained low.
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Affiliation(s)
- Yesim Erim
- Klinik für Psychosomatische Medizin und Psychotherapie der Universität Duisburg-Essen.
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23
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Hannuksela ML, Liisanantti MK, Nissinen AET, Savolainen MJ. Biochemical markers of alcoholism. ACTA ACUST UNITED AC 2007; 45:953-61. [PMID: 17579567 DOI: 10.1515/cclm.2007.190] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alcohol and alcohol-related diseases have become a major cause of death in Western countries. The most sensitive and specific of the commonly used biomarkers of alcohol intake are carbohydrate-deficient transferrin (CDT), and the combination of gamma-glutamyltransferase (GGT) and CDT. Other widely used laboratory markers are GGT, mean corpuscular volume of erythrocytes and the ratio of aspartate aminotransferase to alanine aminotransferase. Blood ethanol levels reveal recent alcohol use. However, more specific and sensitive biomarkers to improve the detection of excessive alcohol use at an early stage are needed. New biomarkers, not yet used in routine clinical work, include phosphatidylethanol, fatty acid ethyl esters, ethyl glucuronide, sialic acid, and acetaldehyde adducts.
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Affiliation(s)
- Minna L Hannuksela
- Department of Internal Medicine, Clinical Research Center, University of Oulu, Oulu, Finland.
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24
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Littner Y, Bearer CF. Detection of alcohol consumption during pregnancy—Current and future biomarkers. Neurosci Biobehav Rev 2007; 31:261-9. [PMID: 16919733 DOI: 10.1016/j.neubiorev.2006.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 06/12/2006] [Indexed: 02/05/2023]
Abstract
Alcohol, one of the most frequently reported addictions, is a significant public health problem in the USA. Early identification is important and would aid in intervention for the pregnant woman who continues to drink and for the affected infant. To date, there isn't a definitive test which identifies either alcohol abuse during pregnancy or newborns exposed to alcohol prenatally. The existing biomarkers can detect varying degrees of alcohol exposure but further research is needed to improve sensitivity/specificity and to validate these markers.
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Affiliation(s)
- Yoav Littner
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, 11100 Euclid Avenue Cleveland, OH 44106, USA.
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25
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Dierkes J, Wolfersdorf M, Borucki K, Weinmann W, Wiesbeck G, Beck O, Borg S, Wurst FM. Determination of glucuronidated 5-hydroxytryptophol (GTOL), a marker of recent alcohol intake, by ELISA technique. Clin Biochem 2007; 40:128-31. [PMID: 17112495 DOI: 10.1016/j.clinbiochem.2006.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 09/21/2006] [Accepted: 10/02/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare markers of alcohol consumption. DESIGN AND METHODS Measurement of urinary ethyl glucuronide, 5-hydroxytryptophol, 5-hydroxytryptophol glucuronide, 5-hydroxyindole acetic acid in 10 patients during alcohol withdrawal. RESULTS 5-Hydroxytryptophol glucuronide was measured by ELISA with good analytical precision, its diagnostic specificity and sensitivity was better than that of 5-hydroxytryptophol and its correlation was closer to ethyl glucuronide than to 5-hydroxytryptophol. CONCLUSION Determination of 5-hydroxytryptophol glucuronide by ELISA offers promising results in detection of previous alcohol consumption.
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Affiliation(s)
- Jutta Dierkes
- Institute of Clinical Chemistry, Otto von Guericke University, Magdeburg, Germany
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26
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Niemelä O. Biomarkers in alcoholism. Clin Chim Acta 2006; 377:39-49. [PMID: 17045579 DOI: 10.1016/j.cca.2006.08.035] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 08/28/2006] [Accepted: 08/30/2006] [Indexed: 12/18/2022]
Abstract
Alcoholism ranks as one of the main current threats to the health and safety of people in most Western countries. Therefore, a high priority should be given to aims at reducing its prevalence through more effective diagnosis and early intervention. The need for objective methods for revealing alcohol abuse in its early phase has also been widely acknowledged. It is postulated here that the diagnosis of alcohol use disorders could be markedly improved by a more systematic use of specific questionnaires and laboratory tests, including blood ethanol, serum gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), and mean corpuscular volume of erythrocytes (MCV). Recent research has provided new insights into the relationships between ethanol intake, biomarkers, and factors affecting their diagnostic validation, including gender, age, and the effects of moderate drinking and obesity. It appears that the concept of reference intervals for several ethanol-sensitive parameters in laboratory medicine needs to be revisited. CDT is currently the most specific marker of alcohol abuse, and when combined with GGT using a mathematically formulated equation a high sensitivity is reached without loss of assay specificity. Possible new biomarkers include minor ethanol metabolites (protein-acetaldehyde condensates and associated autoimmune responses, ethylglucuronide, and phosphatidylethanolamine), 5-hydroxytryptophol, and genetic markers although so far their routine applications have been limited.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, FIN-60220 Seinäjoki, Finland.
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27
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Pragst F, Yegles M. Alcohol Markers in Hair. ANALYTICAL AND PRACTICAL ASPECTS OF DRUG TESTING IN HAIR 2006. [DOI: 10.1201/9781420006193.ch14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Alling C, Chick JD, Anton R, Mayfield RD, Salaspuro M, Helander A, Harris RA. Revealing Alcohol Abuse: To Ask or to Test? Alcohol Clin Exp Res 2005; 29:1257-63. [PMID: 16088981 DOI: 10.1097/01.alc.0000171489.55856.a5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Alling
- Department of Laboratory Medicine, Lund University Hospital, Lund, Sweden
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29
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30
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Stephanson N, Dahl H, Helander A, Beck O. Determination of urinary 5-hydroxytryptophol glucuronide by liquid chromatography–mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2005; 816:107-12. [PMID: 15664340 DOI: 10.1016/j.jchromb.2004.11.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 11/08/2004] [Indexed: 11/25/2022]
Abstract
5-Hydroxytryptophol glucuronide (GTOL) is the major excretion form of 5-hydroxytryptophol (5-HTOL), a minor serotonin metabolite under normal conditions. Because the concentration of 5-HTOL is markedly increased following consumption of alcohol, measurement of 5-HTOL is used as a sensitive biomarker for detection of recent alcohol intake. This study describes the development and evaluation of a liquid chromatography-electrospray ionization mass spectrometry (LC-MS) procedure for direct quantification of GTOL in human urine. Deuterium labelled GTOL (GTOL-(2)H(4)) was used as internal standard. GTOL was isolated from urine by solid-phase extraction on a C(18) cartridge prior to injection onto a gradient eluted Hypurity C(18) reversed-phase HPLC column. The detection limit of the method was 2.0 nmol/L and the measuring range 6-8500 nmol/L. The intra- and inter-assay coefficients of variation were <3.5% (n=10) and <6.0% (n=9), respectively. The new LC-MS method was highly correlated with an established GC-MS method for urinary 5-HTOL (r(2)=0.99, n=70; mean 5-HTOL/GTOL ratio=1.10). This is the first direct assay for quantification of GTOL in urine. The method is suitable for routine application.
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Affiliation(s)
- Nikolai Stephanson
- Department of Medicine, Division of Clinical Pharmacology, Karolinska Institute and University Hospital, SE-17176 Stockholm, Sweden
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Helander A, Beck O. Mass spectrometric identification of ethyl sulfate as an ethanol metabolite in humans. Clin Chem 2004; 50:936-7. [PMID: 15105353 DOI: 10.1373/clinchem.2004.031252] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Anders Helander
- Karolinska Institutet and University Hospital, Department of Clinical Neuroscience, Stockholm, Sweden.
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32
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Affiliation(s)
- Raye Z Litten
- Division of Treatment and Recovery Research, National Institute of Alcohol Abuse and Alcoholism, Bethedsa, MD, USA.
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