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Groff E, Lucchiari M, Stocchero G, Donini F, Marchio GM, Ingenito F, Bertoldi L, Pecoraro L, Bertol E, Favretto D, Anesi A. Comparison of two methods for the extraction of ethylglucuronide from hair. Drug Test Anal 2024; 16:65-70. [PMID: 37162012 DOI: 10.1002/dta.3516] [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: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/05/2023] [Indexed: 05/11/2023]
Abstract
The aim was the comparison between the Society of Hair Testing (SoHT) consensus for the use of alcohol markers which powdering hair for the extraction of ethylglucuronide (EtG) in water and extraction using the patented M3 Reagent Test kit on cut hair. Hair samples were cut into small segments and washed twice with methanol and diethyl ether. The SoHT-Consensus entails the extraction of pulverised hair in water. This is obtained by incubation of 25 mg of hair at room temperature overnight and 2 h sonication, even if the overnight incubation is not mandatory. The M3 method entails incubation of 25 mg of cut hair with the M3-Reagent at 100°C for 60 min. After centrifugation, the supernatant is injected into a liquid chromatography-tandem mass spectrometry (LC-MS/MS). Samples (191) were collected in the APSS laboratory in Trento, Italy, between 2021 and 2022. The limit of quantification (LOQ) was set at 5 pg/mg for the pulverised and M3-Reagent methods. Assays showed good linearity above the range of LOQ-300 pg/mg. Precision (within 20%) values were also obtained using both methods. In the Passing-Bablock linear regression, the final regression curve between M3 (y) and the pulverising method (x) showed good agreement; the Bland-Altman analysis did not show any significant bias between the two methods. The M3-Reagent method, due to cut hair use, is easy to perform, saves time and allows for a smaller sample quantity loss with use of nondisposable grinding jars for the ball mill to obtain the extraction of EtG.
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Affiliation(s)
- Eleonora Groff
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
- Forensic Toxicology Division, Department of Health Science, University of Firenze, Florence, Italy
| | - Manuela Lucchiari
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | - Giulia Stocchero
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | - Flora Donini
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | - Giovanni Michele Marchio
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | - Francesco Ingenito
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | - Lucia Bertoldi
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | - Lucia Pecoraro
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
| | | | - Donata Favretto
- Legal Medicine and Toxicology, University Hospital of Padova, Padova, Italy
| | - Adriano Anesi
- Toxicology Laboratory Unit, Multi-zone Operating Unit Clinical Pathology Laboratory, Department of Laboratories, APSS of Trento, Trento, Italy
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Cerioni A, Buratti E, Mietti G, Cippitelli M, Cingolani M, Froldi R, Scendoni R. Validation of a new method for the detection of Ethyl glucuronide in larvae of Lucilia sericata as a marker of ante-mortem alcohol consumption. Heliyon 2023; 9:e20802. [PMID: 37860567 PMCID: PMC10582484 DOI: 10.1016/j.heliyon.2023.e20802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
Larvae and insects are an important and alternative biological matrix in the development anpost-mortem forensic toxicology. They are very useful when conventional matrices are not available, in particular when the loss of biological fluids, due to the decomposition of corpses or to a traumatic death, occurs. The purpose of this study is to develop and validate an analytical method in Ultra High-Performance Liquid Chromatography at High Resolution Mass Spectrometry (HPLC/HR-MS) for the research and quantification of Ethyl glucuronide (EtG) on larvae. The criteria taken into consideration for the validation are linearity, quantitation limits (LOD and LLOQ), accuracy, precision, carryover, interferences and ionization suppression/enhancement. The method was shown to be linear within the tested range, with a coefficient of determination higher than 0.99. LOD was 2 pg mg-1, while LLOQ was 5 pg mg-1. Accuracy, precision and ionization/suppression enhancement fulfilled the criteria indicated in the guidelines used for the validation. The establishment and validation of this method allowed the identification of Ethyl glucuronide on the larvae of Lucilia sericata (Calliphoridae) of a subject found death in an advanced state of decomposition.
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Affiliation(s)
- Alice Cerioni
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
| | - Erika Buratti
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
| | - Gianmario Mietti
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
| | - Marta Cippitelli
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
| | - Mariano Cingolani
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
| | - Rino Froldi
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
| | - Roberto Scendoni
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, 62100 Macerata, Italy
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Ethyl glucuronide and ethyl sulfate: a review of their roles in forensic toxicology analysis of alcohol postmortem. Forensic Toxicol 2021; 40:19-48. [DOI: 10.1007/s11419-021-00588-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
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Dip A, Mozayani A. Evaluation of the Compatibility of Ethyl Glucuronide and Ethyl Sulphate Levels to Assess Alcohol Consumption in Decomposed and Diabetic Postmortem Cases. J Anal Toxicol 2021; 45:878-884. [PMID: 34086901 DOI: 10.1093/jat/bkab061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022] Open
Abstract
The aim of the study is to evaluate the contribution of ethanol metabolite detection in postmortem cases by showing the connection between the presence of ethanol metabolites, which are indicators of alcohol consumption, and the detection of potential postmortem ethanol formation in decomposed and diabetic cases. Determination of ethanol consumption before death is often one of the most important questions in death investigations. Postmortem ethanol formation or degradation products in the blood make it difficult to distinguish antemortem consumption or postmortem formation of ethanol and eventually may lead to misinterpretation. Decomposed bodies and diabetic cases are vulnerable to postmortem ethanol formation due to putrefaction, fermentation or other degradations. Ethyl glucuronide (EtG) and ethyl sulphate (EtS) are two metabolites of ethanol produced only in the antemortem time interval. In this study, EtG and EtS levels in urine and vitreous humor samples of 27 postmortem cases, including diabetic and degraded bodies were compared to ethanol results of their blood, urine, and vitreous humor samples. EtG and EtS in urine and vitreous humor were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS-MS) and ethanol was assayed by routine headspace gas chromatography-flame ionization detector (GC-FID). These cases were devoid of other influences from forensically relevant drugs, so ethanol and/or glucose were among the only positive findings in these cases. The results of this pilot study indicate the postmortem ethanol concentrations do not correlate with the measured EtG and EtS values but are beneficial in rulings of accidental or natural deaths. This preliminary study gives additional data to help distinguish between antemortem ethanol intake and postmortem formation. EtG and EtS were well correlated positively with antemortem ethanol use instead of forming spontaneously in samples from decedents who are decomposing or have a history of diabetic hyperglycemia.
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Affiliation(s)
- Aybike Dip
- Council of Forensic Medicine, Chemistry Department, Turkey Ministry of Justice, 01120 Adana, Turkey
| | - Ashraf Mozayani
- Department of Administration of Justice, Texas Southern University, 3100 Cleburne Street, Houston, Texas 77004, USA
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Snozek CLH, Souers R, Dizon A, Magnani B, Krasowski MD. Ethanol Biomarker Testing and Challenges: Lessons Learned From a College of American Pathologists Proficiency Testing Survey. Arch Pathol Lab Med 2021; 145:1492-1498. [PMID: 33635953 DOI: 10.5858/arpa.2020-0699-cp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Clinical and forensic testing for ethanol biomarkers including ethyl glucuronide (EtG) and ethyl sulfate (EtS) is used to discern alcohol use from abstinence. These markers can be key in major decisions including transplant eligibility or retaining licensure after alcohol misuse. Accuracy, precision, and recognition of the implications of reporting cutoffs are all essential for correct interpretation. OBJECTIVE.— To evaluate trends in testing for EtG and EtS, including how laboratories perform testing and how comparable participant results are. DESIGN.— The study examined the College of American Pathologists' ethanol biomarker proficiency testing survey from 2013 to 2019. Trends in methodology, reporting cutoffs, and participant performance were evaluated for qualitative and quantitative EtG testing and for quantitative EtS testing. RESULTS.— There was little consensus in reporting cutoffs, which ranged from 10 to 1000 ng/mL for EtG and 10 to 1500 ng/mL for EtS. Although median EtG and EtS compared well with target concentrations, individual participants' results varied widely. For quantitative enzyme immunoassay, accuracy and precision were best in EtG challenges less than 1500 ng/mL. For EtG or EtS by mass spectrometry, overall accuracy was good over a wide concentration range, but variability between participants was high. Approximately 10% (409 of 4059) of results were unacceptable, which for mass spectrometry corresponded to more than 35% above or below the group mean. CONCLUSIONS.— Although many participants performed well, there was insufficient consensus in reporting cutoffs and a consistent fraction of laboratories failed to achieve survey standards. Guidelines for assay performance and reporting could greatly benefit laboratories and end users.
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Affiliation(s)
- Christine L H Snozek
- Supplemental digital content is available for this article. See text for hyperlink. From the Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale (Snozek)
| | - Rhona Souers
- The Biostatistics Division (Souers), College of American Pathologists, Northfield Illinois
| | - Annabel Dizon
- Proficiency Testing Division (Dizon), College of American Pathologists, Northfield Illinois
| | - Barbarajean Magnani
- The Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts (Magnani)
| | - Matthew D Krasowski
- The Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City (Krasowski)
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Arnts J, Vanlerberghe BTK, Roozen S, Crunelle CL, Masclee AAM, Olde‐Damink SWM, Heeren RMA, van Nuijs A, Neels H, Nevens F, Verbeek J. Diagnostic Accuracy of Biomarkers of Alcohol Use in Patients With Liver Disease: A Systematic Review. Alcohol Clin Exp Res 2021; 45:25-37. [PMID: 33190239 PMCID: PMC7898850 DOI: 10.1111/acer.14512] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/09/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Alcohol-related liver disease is the most frequent cause of cirrhosis and a major indication for liver transplantation. Several alcohol use biomarkers have been developed in recent years and are already in use in several centers. However, in patients with liver disease their diagnostic performance might be influenced by altered biomarker formation by hepatic damage, altered excretion by kidney dysfunction and diuretics use, and altered deposition in hair and nails. We systematically reviewed studies on the diagnostic accuracy of biomarkers of alcohol use in patients with liver disease and performed a detailed study quality assessment. METHODS A structured search in PubMed/Medline/Embase databases was performed for relevant studies, published until April 28, 2019. The risk of bias and applicability concerns was assessed according to the adapted quality assessment of diagnostic accuracy studies-2 (QUADAS-2) checklist. RESULTS Twelve out of 6,449 studies met inclusion criteria. Urinary ethyl glucuronide and urinary ethyl sulfate showed high sensitivity (70 to 89 and 73 to 82%, respectively) and specificity (93 to 99 and 86 to 89%, respectively) for assessing any amount of alcohol use in the past days. Serum carbohydrate-deficient transferrin showed low sensitivity but higher specificity (40 to 79 and 57 to 99%, respectively) to detect excessive alcohol use in the past weeks. Whole blood phosphatidylethanol showed high sensitivity and specificity (73 to 100 and 90 to 96%, respectively) to detect any amount of alcohol use in the previous weeks. Scalp hair ethyl glucuronide showed high sensitivity (85 to 100%) and specificity (97 to 100%) for detecting chronic excessive alcohol use in the past 3 to 6 months. Main limitations of the current evidence are the lack of an absolute gold standard to assess alcohol use, heterogeneous study populations, and the paucity of studies. CONCLUSIONS Urinary and scalp hair ethyl glucuronide are currently the most validated alcohol use biomarkers in patients with liver disease with good diagnostic accuracies. Phosphatidylethanol is a highly promising alcohol use biomarker, but so far less validated in liver patients. Alcohol use biomarkers can complement each other regarding diagnostic time window. More validation studies on alcohol use biomarkers in patients with liver disease are needed.
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Affiliation(s)
- Janique Arnts
- From theDivision of Gastroenterology and Hepatology(JA, BTKV, AAMM)Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Benedict T. K. Vanlerberghe
- From theDivision of Gastroenterology and Hepatology(JA, BTKV, AAMM)Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Sylvia Roozen
- Governor Kremers Centre‐Maastricht University Medical Centre(SR)MaastrichtThe Netherlands
| | - Cleo L. Crunelle
- Department of Psychiatry(CLC)Vrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
- Toxicological Center(CLC, AN, HN)University of AntwerpAntwerpBelgium
| | - Ad A. M. Masclee
- From theDivision of Gastroenterology and Hepatology(JA, BTKV, AAMM)Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism(AAMM, SWMO‐D)Maastricht UniversityMaastrichtThe Netherlands
| | - Steven W. M. Olde‐Damink
- NUTRIM School of Nutrition and Translational Research in Metabolism(AAMM, SWMO‐D)Maastricht UniversityMaastrichtThe Netherlands
- Department of Surgery(Maastricht University Medical CenterMaastrichtThe Netherlands
- Department of General, Visceral and Transplantation Surgery(RWTH University Hospital AachenAachenGermany
| | - Ron M. A. Heeren
- Division of Imaging Mass Spectrometry(RMAH)Maastricht MultiModal Molecular Imaging (M4I) InstituteMaastricht UniversityMaastrichtThe Netherlands
| | | | - Hugo Neels
- Toxicological Center(CLC, AN, HN)University of AntwerpAntwerpBelgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology(FN, JV)University Hospitals KU LeuvenLeuvenBelgium
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology(FN, JV)University Hospitals KU LeuvenLeuvenBelgium
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Elshaghabee FMF, Ghadimi D, Habermann D, de Vrese M, Bockelmann W, Kaatsch HJ, Heller KJ, Schrezenmeir J. Effect of Oral Administration of Weissella confusa on Fecal and Plasma Ethanol Concentrations, Lipids and Glucose Metabolism in Wistar Rats Fed High Fructose and Fat Diet. Hepat Med 2020; 12:93-106. [PMID: 32617026 PMCID: PMC7326399 DOI: 10.2147/hmer.s254195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose In previous investigations, Weissella confusa was shown to lack the metabolic pathway from fructose to mannitol and to produce ethanol when cultivated in the presence of fructose. Hence, we assessed the effect of oral administration of W. confusa (strain NRRL-B-14171) on blood and fecal ethanol concentrations, glucose and lipid metabolism and traits of the metabolic syndrome in Wistar rats (n=27) fed diets with two different fat and fructose levels and with or without the addition of W. confusa during a total intervention time of 15 weeks (105 days). Materials and Methods From week 1 to 6, rats were given a medium fructose and fat (MFru-MF) diet containing 28% fructose and 10% fat without the addition of W. confusa (control group, n=13) or mixed with 30 g per kg diet of lyophilized W. confusa (10.56 ± 0.20 log CFU/g; W. confusa group, n=14). From week 7 to 15, the percentage of dietary fructose and fat in the control and W. confusa group was increased to 56% and 16%, respectively (high fructose-high fat (HFru-HF) diet). Results In HFru-HF-fed rats, W. confusa was detected in feces, regardless of whether W. confusa was added to the diet or not, but not in rats receiving the MFru-MF diet without added W. confusa or in an additional control group (n=10) fed standard rat food without fructose, increased fat content and W. confusa. This indicates that fecal W. confusa may be derived from orally administered W. confusa as well as - in the case of high fructose and fat intake and obesity of rats - from the intestinal microbiota. As shown by multifactorial ANOVA, blood ethanol, the relative liver weight, serum triglycerides, and serum cholesterol as well as fecal ethanol, ADH, acetate, propionate and butyrate, but not lactate, were significantly higher in the W. confusa - compared to the control group. Discussion This is the first in vivo trial demonstrating that heterofermentative lactic acid bacteria lacking the mannitol pathway (like W. confusa) can increase fecal and blood ethanol concentrations in mammals on a high fructose-high fat diet. This may explain why W. confusa resulted in hyperlipidemia and may promote development of NAFLD in the host.
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Affiliation(s)
- Fouad M F Elshaghabee
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology, Kiel, Germany
| | - Darab Ghadimi
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology, Kiel, Germany
| | - Diana Habermann
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology, Kiel, Germany
| | - Michael de Vrese
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology, Kiel, Germany
| | - Wilhelm Bockelmann
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology, Kiel, Germany
| | - Hans-Jürgen Kaatsch
- Institute of Legal Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Knut J Heller
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Microbiology and Biotechnology, Kiel, Germany
| | - Jürgen Schrezenmeir
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Physiology and Biochemistry of Nutrition, Karlsruhe, Germany.,Clinical Research Center, Kiel Innovation and Technology Center, Kiel, Germany
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Neumann J, Beck O, Helander A, Dahmen N, Böttcher M. Sensitive determination of ethyl glucuronide in serum and whole blood: detection time after alcohol exposure compared with urine. J LAB MED 2020. [DOI: 10.1515/labmed-2019-0203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Ethyl glucuronide (EtG) is a conjugated, minor ethanol metabolite used as a biomarker for recent alcohol intake. EtG is commonly measured in urine as part of a drug testing service but has also attracted attention for measurement in blood. However, due to lower EtG concentrations in blood, the detection time is expected to be shorter. The present work aimed to improve the analytical sensitivity of EtG in blood, to prolong the detection time.
Methods
A liquid chromatography-tandem mass spectrometry method was developed for EtG in whole blood and serum, using protein precipitation with methanol, a deuterated internal standard, and selected reaction monitoring mode with negative electrospray ionization. No significant matrix effect was observed. The method generated linear results in the measuring range 1.0–50 μg/L, the accuracy was within ±10% and the imprecision <15%.
Results
In 46 patients followed with daily blood and urine sampling during alcohol detoxification, the mean (median) time to first negative serum EtG sample was 112 (111) h. This was slightly longer than for EtG in urine, using 100 μg/L as cutoff. The detection rate was 76% for serum EtG and 68% for urine EtG. In cases where serum EtG was positive but urine EtG negative, the urine samples tended to be more dilute as indicated by lower creatinine concentrations. On admission to hospital, the whole-blood and serum EtG concentrations correlated with the breath ethanol concentration (p = 0.012 and p = 0.027, respectively). In 100 patients sampled at admission to hospital for other reasons than substance abuse and with no ethanol detected in breath, 40% tested positive for EtG in serum and 43% in urine. In 79 paired urine and serum EtG measurements, the median urine/serum concentration ratio was 155.
Conclusions
A sensitive method was developed for EtG measurement in whole-blood and serum specimens, offering similar detection time for recent alcohol exposure compared with routine EtG measurement in urine.
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Affiliation(s)
- Jasna Neumann
- Department of Toxicology, MVZ Labor Dessau GmbH , Dessau-Rosslau , Germany
| | - Olof Beck
- Department of Toxicology, MVZ Labor Dessau GmbH , Dessau-Rosslau , Germany
- Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden
- Division of Clinical Pharmacology , Karolinska University Hospital , Stockholm , Sweden
| | - Norbert Dahmen
- Universitätsklinikum Mainz, Klinik für Psychiatrie und Psychotherapie , Mainz , Germany
| | - Michael Böttcher
- Department of Toxicology, MVZ Labor Dessau GmbH , Dessau-Rosslau , Germany
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Dengiz H, Daglioglu N, Goren IE. Assessment of recent alcohol consumption by detecting ethyl glucuronide and ethyl sulphate level among traffic accident patients. TRAFFIC INJURY PREVENTION 2020; 21:371-374. [PMID: 32496812 DOI: 10.1080/15389588.2020.1767777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
Objective: This study aims to explain whether EtG and EtS, which are two non-oxidative ethanol metabolites secreted by the liver and used as markers of alcohol intake related to an incident, were also present in whole blood samples of patients with traffic accident injuries.Methods: EtG and EtS concentrations in all of the whole blood samples were sent to the Forensic Medicine Department of Cukurova University for testing Blood Alcohol Concentrations (BAC) via validated liquid chromatography-tandem mass spectrometer method.Results: The scope of the study covers 200 patients that were admitted to medical services within 12 h following the incident. Of all patients 16.5% were found to be BAC positive, while 35.5 and 23.5 were positive for EtG and EtS, respectively. All samples with a positive BAC result were also positive for EtG and EtS.Conclusion: Detection of EtG and EtS, minor metabolites along with ethanol in the blood can serve as an objective tool to provide further analysis regarding alcohol-related traffic accidents at emergency services.
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Affiliation(s)
- Huseyin Dengiz
- Department of Forensic Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nebile Daglioglu
- Department of Forensic Medicine, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Ismail Ethem Goren
- Department of Forensic Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
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Kwon M, Choi HJ, Jo YH, Son MH, Min JS, Kim NY, Jung JE. Analysis of ethyl glucuronide and ethyl sulfate in blood to determine the absorption or elimination phase of alcohol for Korean. Forensic Sci Int 2019; 302:109857. [DOI: 10.1016/j.forsciint.2019.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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Jones AW. Alcohol, its absorption, distribution, metabolism, and excretion in the body and pharmacokinetic calculations. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/wfs2.1340] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alan W. Jones
- Department of Clinical Pharmacology University of Linköping Linköping Sweden
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Polettini AE, Bleicher S, Kutzler J, Mauerer R, Schultis W. Higher Creatinine Concentrations in Ethyl Glucuronide-Positive Urine Specimens Collected from Subjects in a Controlled Alcohol Abstinence Program: Is Serum Creatinine a Good Marker of Renal Function in Drinkers? Alcohol Alcohol 2018; 54:19-22. [DOI: 10.1093/alcalc/agy084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/27/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aldo Eliano Polettini
- Department of Toxicology & Forensic Toxicology, SYNLAB MVZ Weiden GmbH, Zur Kesselschmiede 4, Weiden, Germany
- Department of Diagnostics & Public Health, University of Verona, Piazzale L.A. Scuro, 10, Verona, Italy
| | - Sergej Bleicher
- Department of Toxicology & Forensic Toxicology, SYNLAB MVZ Weiden GmbH, Zur Kesselschmiede 4, Weiden, Germany
| | - Johannes Kutzler
- Department of Toxicology & Forensic Toxicology, SYNLAB MVZ Weiden GmbH, Zur Kesselschmiede 4, Weiden, Germany
| | - Richard Mauerer
- Department of Toxicology & Forensic Toxicology, SYNLAB MVZ Weiden GmbH, Zur Kesselschmiede 4, Weiden, Germany
| | - Wolfgang Schultis
- Department of Toxicology & Forensic Toxicology, SYNLAB MVZ Weiden GmbH, Zur Kesselschmiede 4, Weiden, Germany
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Busardò FP, Jones AW. Interpreting γ-hydroxybutyrate concentrations for clinical and forensic purposes. Clin Toxicol (Phila) 2018; 57:149-163. [PMID: 30307336 DOI: 10.1080/15563650.2018.1519194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION γ-Hydroxybutyric acid is an endogenous substance, a therapeutic agent, and a recreational drug of abuse. This psychoactive substance acts as a depressant of the central nervous system and is commonly encountered in clinical and forensic practice, including impaired drivers, poisoned patients, and drug-related intoxication deaths. OBJECTIVE The aim of this review is to assist clinical and forensic practitioners with the interpretation of γ-hydroxybutyric acid concentrations in blood, urine, and alternative biological specimens from living and deceased persons. METHODS The information sources used to prepare this review were PubMed, Scopus, and Web-of-Science. These databases were searched using keywords γ-hydroxybutyrate (GHB), blood, urine, alternative specimens, non-conventional biological matrices, saliva, oral fluid, sweat, hair, vitreous humor (VH), brain, cerebrospinal fluid (CSF), dried blood spots (DBS), breast milk, and various combinations thereof. The resulting 4228 references were screened to exclude duplicates, which left 1980 articles for further consideration. These publications were carefully evaluated by taking into account the main aims of the review and 143 scientific papers were considered relevant. Analytical methods: The analytical methods used to determine γ-hydroxybutyric acid in blood and other biological specimens make use of gas- or liquid-chromatography coupled to mass spectrometry. These hyphenated techniques are accurate, precise, and specific for their intended purposes and the lower limit of quantitation in blood and other specimens is 0.5 mg/L or less. Human pharmacokinetics: GHB is rapidly absorbed from the gut and distributes into the total body water compartment. Only a small fraction of the dose (1-2%) is excreted unchanged in the urine. The plasma elimination half-life of γ-hydroxybutyric acid is short, being only about 0.5-0.9 h, which requires timely sampling of blood and other biological specimens for clinical and forensic analysis. Endogenous concentrations of GHB in blood: GHB is both an endogenous metabolite and a drug of abuse, which complicates interpretation of the laboratory results of analysis. Moreover, the concentrations of GHB in blood and other specimens tend to increase after sampling, especially in autopsy cases. This requires the use of practical "cut-off" concentrations to avoid reporting false positive results. These cut-offs are different for different biological specimen types. Concentrations of GHB in clinical and forensic practice: As a recreational drug GHB is predominantly used by young males (94%) with a mean age of 27.1 years. The mean (median) and range of concentrations in blood from apprehended drivers was 90 mg/L (82 mg/L) and 8-600 mg/L, respectively. The concentration distributions in blood taken from living and deceased persons overlapped, although the mean (median) and range of concentrations were higher in intoxication deaths; 640 mg/L (280 mg/L) and 30-9200 mg/L, respectively. Analysis of GHB in alternative specimens: All biological fluids and tissue containing water are suitable for the analysis of GHB. Examples of alternative specimens discussed in this review are CSF, saliva, hair strands, breast milk, DBS, VH, and brain tissue. CONCLUSIONS Body fluids for the analysis of GHB must be obtained as quickly as possible after a poisoned patient is admitted to hospital or after a person is arrested for a drug-related crime to enhance chances of detecting the drug. The sampling of urine lengthens the window of detection by 3-4 h compared with blood samples, but with longer delays between last intake of GHB and obtaining specimens, hair strands, and/or nails might be the only option. In postmortem toxicology, the concentrations of drugs tend to be more stable in bladder urine, VH, and CSF compared with blood, because these sampling sites are protected from the spread of bacteria from the gut. Accordingly, the relationship between blood and urine concentrations of GHB furnishes useful information when drug intoxication deaths are investigated.
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Affiliation(s)
- Francesco Paolo Busardò
- a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy
| | - Alan Wayne Jones
- b Department of Clinical Pharmacology , University of Linköping , Linköping , Sweden
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Becker R, Lô I, Sporkert F, Baumgartner M. The determination of ethyl glucuronide in hair: Experiences from nine consecutive interlaboratory comparison rounds. Forensic Sci Int 2018; 288:67-71. [DOI: 10.1016/j.forsciint.2018.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/28/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
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15
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Frey S, Eichler A, Stonawski V, Kriebel J, Wahl S, Gallati S, Goecke TW, Fasching PA, Beckmann MW, Kratz O, Moll GH, Heinrich H, Kornhuber J, Golub Y. Prenatal Alcohol Exposure Is Associated With Adverse Cognitive Effects and Distinct Whole-Genome DNA Methylation Patterns in Primary School Children. Front Behav Neurosci 2018; 12:125. [PMID: 29997484 PMCID: PMC6028559 DOI: 10.3389/fnbeh.2018.00125] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Prenatal alcohol exposure (PAE) is known to elicit a broad range of systemic effects, including neurophysiological alterations that result in adverse behavioral and cognitive outcomes. However, molecular pathways underlying these long-term intrauterine effects remain to be investigated. Here, we tested a hypothesis that PAE may lead to epigenetic alterations to the DNA resulting in attentional and cognitive alterations of the children. We report the results of the study that included 156 primary school children of the Franconian Cognition and Emotion Studies (FRANCES) cohort which were tested for an objective marker of PAE, ethyl glucuronide (EtG) in meconium at birth. Thirty-two newborns were found to be exposed to alcohol with EtG values above 30 ng/g (EtG+). Previously we described PAE being associated with lower IQ and smaller amplitude of the event-related potential component P3 in go trials (Go-P3), which indicates a reduced capacity of attentional resources. Whole-genome methylation analysis of the buccal cell DNA revealed 193 differentially methylated genes in children with positive meconium EtG, that were clustered into groups involved in epigenetic modifications, neurodegeneration, neurodevelopment, axon guidance and neuronal excitability. Furthermore, we detected mediation effects of the methylation changes in DPP10 and SLC16A9 genes on the EtG related cognitive and attention-related deficits. Our results suggest that system-wide epigenetic changes are involved in long-term effects of PAE. In particular, we show an epigenetic mediation of PAE effects on cognition and attention-related processes.
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Affiliation(s)
- Stefan Frey
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Valeska Stonawski
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jennifer Kriebel
- Research Unit of Molecular Epidemiology, German Research Center for Environmental Health - Institute of Epidemiology II, Helmholtz Zentrum München, Munich, Germany
| | - Simone Wahl
- Research Unit of Molecular Epidemiology, German Research Center for Environmental Health - Institute of Epidemiology II, Helmholtz Zentrum München, Munich, Germany
| | - Sabina Gallati
- Division of Human Genetics, Department of Paediatrics, Inselspital University of Bern, Bern, Switzerland
| | - Tamme W Goecke
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Obstetrics and Gynecology, RWTH Aachen University, Aachen, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynecology, RWTH Aachen University, Aachen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, RWTH Aachen University, Aachen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,kbo-Heckscher-Klinikum, Munich, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Yulia Golub
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Dresden, Germany
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16
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Pellock SJ, Redinbo MR. Glucuronides in the gut: Sugar-driven symbioses between microbe and host. J Biol Chem 2017; 292:8569-8576. [PMID: 28389557 DOI: 10.1074/jbc.r116.767434] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The intestinal milieu is astonishingly complex and home to a constantly changing mixture of small and large molecules, along with an abundance of bacteria, viral particles, and eukaryotic cells. Such complexity makes it difficult to develop testable molecular hypotheses regarding host-microbe interactions. Fortunately, mammals and their associated gastrointestinal (GI) microbes contain complementary systems that are ideally suited for mechanistic studies. Mammalian systems inactivate endobiotic and xenobiotic compounds by linking them to a glucuronic acid sugar for GI excretion. In the GI tract, the microbiota express β-glucuronidase enzymes that remove the glucuronic acid as a carbon source, effectively reversing the actions of mammalian inactivation. Thus, by probing the actions of microbial β-glucuronidases, and by understanding which substrate glucuronides they process, molecular insights into mammalian-microbial symbioses may be revealed amid the complexity of the intestinal tract. Here, we focus on glucuronides in the gut and the microbial proteins that process them.
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Affiliation(s)
- Samuel J Pellock
- From the Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3290
| | - Matthew R Redinbo
- From the Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3290
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17
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Castillo-Peinado LS, Luque de Castro MD. An overview on forensic analysis devoted to analytical chemists. Talanta 2017; 167:181-192. [PMID: 28340709 DOI: 10.1016/j.talanta.2017.01.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/28/2017] [Accepted: 01/29/2017] [Indexed: 12/01/2022]
Abstract
The present article has as main aim to show analytical chemists interested in forensic analysis the world they will face if decision in favor of being a forensic analytical chemist is adopted. With this purpose, the most outstanding aspects of forensic analysis in dealing with sampling (involving both bodily and no bodily samples), sample preparation, and analytical equipment used in detection, identification and quantitation of key sample components are critically discussed. The role of the great omics in forensic analysis, and the growing role of the youngest of the great omics -metabolomics- are also discussed. The foreseeable role of integrative omics is also outlined.
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Affiliation(s)
- L S Castillo-Peinado
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Córdoba, Córdoba, Spain; University of Córdoba, Agrifood Excellence Campus, ceiA3, Spain; Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía University Hospital, University of Córdoba, E-14071 Córdoba, Spain
| | - M D Luque de Castro
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Córdoba, Córdoba, Spain; University of Córdoba, Agrifood Excellence Campus, ceiA3, Spain; Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía University Hospital, University of Córdoba, E-14071 Córdoba, Spain.
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18
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Ondersma SJ, Beatty JR, Rosano TG, Strickler RC, Graham AE, Sokol RJ. Commercial Ethyl Glucuronide (EtG) and Ethyl Sulfate (EtS) Testing is Not Vulnerable to Incidental Alcohol Exposure in Pregnant Women. Subst Use Misuse 2016; 51:126-30. [PMID: 26771303 PMCID: PMC4832416 DOI: 10.3109/10826084.2015.1073324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ethyl Glucoronide (EtG) and Ethyl Sulfate (EtS) have shown promise as biomarkers for alcohol and may be sensitive enough for use with pregnant women in whom even low-level alcohol use is important. However, there have been reports of over-sensitivity of EtG and EtS to incidental exposure to sources such as alcohol-based hand sanitizer. Further, few studies have evaluated these biomarkers among pregnant women, in whom the dynamics of these metabolites may differ. OBJECTIVES This study evaluated whether commercial EtG-EtS testing was vulnerable to high levels of environmental exposure to alcohol in pregnant women. METHODS Two separate samples of five nurses-one pregnant and the other postpartum, all of whom reported high levels of alcohol-based hand sanitizer use-provided urine samples before and 4-8 hours after rinsing with alcohol-based mouthwash and using hand sanitizer. The five pregnant nurses provided urine samples before, during, and after an 8-hour nursing shift, during which they repeatedly cleansed with alcohol-based hand sanitizer (mean 33.8 uses). The five postpartum nurses used hand sanitizer repeatedly between baseline and follow-up urine samples. RESULTS No urine samples were positive for EtG-EtS at baseline or follow-up, despite use of mouthwash and-in the pregnant sample-heavy use of hand sanitizer (mean of 33.8 uses) throughout the 8-hour shift. CONCLUSIONS/IMPORTANCE Current, commercially available EtG-EtS testing does not appear vulnerable to even heavy exposure to incidental sources of alcohol among pregnant and postpartum women.
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Affiliation(s)
- Steven J Ondersma
- a Department of Psychiatry , Wayne State University , Detroit , Michigan , USA
| | - Jessica R Beatty
- b Merrill-Palmer Skillman Institute , Wayne State University , Detroit , Michigan , USA
| | - Thomas G Rosano
- c Pathology & Laboratory Medicine , Albany Medical College , Albany , New York , USA
| | - Ronald C Strickler
- d Division of Reproductive Medicine, Gynecology , Obstetrics, and Women's Health, Henry Ford Health System , Detroit , Michigan , USA
| | - Amy E Graham
- b Merrill-Palmer Skillman Institute , Wayne State University , Detroit , Michigan , USA
| | - Robert J Sokol
- e Obstetrics & Gynecology , Wayne State University , Detroit , Michigan , USA
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19
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Ethyl glucuronide in nails: method validation, influence of decontamination and pulverization, and particle size evaluation. Forensic Toxicol 2015. [DOI: 10.1007/s11419-015-0302-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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L Crunelle C, Cappelle D, Yegles M, De Doncker M, Michielsen P, Dom G, van Nuijs ALN, Maudens KE, Covaci A, Neels H. Ethyl glucuronide concentrations in hair: a controlled alcohol-dosing study in healthy volunteers. Anal Bioanal Chem 2015; 408:2019-25. [PMID: 26549114 DOI: 10.1007/s00216-015-9117-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/20/2015] [Accepted: 10/13/2015] [Indexed: 01/28/2023]
Abstract
Ethyl glucuronide (EtG) is a minor phase II metabolite of alcohol that accumulates in hair. It has been established as a sensitive marker to assess the retrospective consumption of alcohol over recent months using a cut-off of ≥7 pg/mg hair to assess repeated alcohol consumption. The primary aim was to assess whether amounts of alcohol consumed correlated with EtG concentrations in hair. Additionally, we investigated whether the current applied cut-off value of 7 pg/mg hair was adequate to assess the regular consumption of low-to-moderate amounts of alcohol. A prospective controlled alcohol-dosing study in 30 healthy individuals matched on age and gender. Individuals were instructed to drink no alcohol (N = 10), 100 g alcohol per week (N = 10) or 150 g alcohol per week (N = 10) for 12 consecutive weeks, before and after which hair was collected. Throughout the study, compliance to daily alcohol consumption was assessed by analyzing urine EtG three times weekly. Participants in the non-drinking group had median EtG concentrations of 0.5 pg/mg hair (interquartile range (IQR) 1.7 pg/mg; range < 0.21-4.5 pg/mg). Participants consuming 100 and 150 g alcohol per week showed median EtG concentrations of 5.6 pg/mg hair (IQR 4.7 pg/mg; range 2.0-9.8 pg/mg) and 11.3 pg/mg hair (IQR 5.0 pg/mg; range 7.7-38.9 pg/mg), respectively. Hair EtG concentrations between the three study groups differed significantly from one another (p < 0.001). Hair EtG concentrations can be used to differentiate between repeated (low-to-moderate) amounts of alcohol consumed over a long time period. For the assessment of repeated alcohol use, we propose that the current cut-off of 7 pg/mg could be re-evaluated.
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Affiliation(s)
- Cleo L Crunelle
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium
| | - Delphine Cappelle
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.
| | - Michel Yegles
- Laboratoire National de Santé, Service de Toxicologie, Dudelange, Luxembourg
| | | | - Peter Michielsen
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Alexander L N van Nuijs
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium
| | - Kristof E Maudens
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium
| | - Adrian Covaci
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium
| | - Hugo Neels
- Toxicological Center, Department of Pharmaceutical Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium
- Toxicology and TDM Laboratory, ZNA Stuivenberg, Antwerp, Belgium
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De Giovanni N, Cittadini F, Martello S. The usefulness of biomarkers of alcohol abuse in hair and serum carbohydrate-deficient transferrin: a case report. Drug Test Anal 2015; 7:703-7. [PMID: 25557913 DOI: 10.1002/dta.1763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/11/2014] [Accepted: 11/14/2014] [Indexed: 11/11/2022]
Abstract
The detection of carbohydrate-deficient transferrin (CDT) in serum is widely accepted to identify chronic alcohol consumption over the previous two weeks, but minor ethanol metabolites detected in hair often complete the information obtained. In particular, ethylglucuronide and cocaethylene (a marker of simultaneous intake of cocaine and alcohol) allow correct interpretation of data obtained in forensic cases. We refer to a negative CDT value obtained from a serum sample collected during hospitalization of a man admitted for cardiac arrest who died about 14 h later. Clinical analysis performed on admission showed a high ethanol level and a positive urinary screening for cocaine. The toxicological analyses of post-mortem samples found cocaine metabolites in his urine and blood. The negative CDT level suggested the ethanol concentration at admission to be an acute episode. Cocaine and cocaethylene well above the cut-off suggested by the literature were found in hair analyzed for the entire length (about 1 cm). Ethylglucuronide detected on the same hair sample confirmed chronic abuse of ethanol in the previous month, at least. The present report suggests caution in the interpretation of biomarkers of alcohol abuse, encouraging the detection of more than one marker to avoid misinterpretation.
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Affiliation(s)
- Nadia De Giovanni
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Francesca Cittadini
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Simona Martello
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
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Utility of urinary ethyl glucuronide analysis in post-mortem toxicology when investigating alcohol-related deaths. Forensic Sci Int 2014; 241:178-82. [DOI: 10.1016/j.forsciint.2014.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/15/2014] [Accepted: 05/23/2014] [Indexed: 01/09/2023]
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Salomone A, Pirro V, Lombardo T, Di Corcia D, Pellegrino S, Vincenti M. Interpretation of group-level factors from a large population dataset in the determination of ethyl glucuronide in hair. Drug Test Anal 2014; 7:407-13. [DOI: 10.1002/dta.1697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/27/2014] [Accepted: 06/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Alberto Salomone
- Centro Regionale Antidoping e di Tossicologia ‘A. Bertinaria’; Regione Gonzole 10/1 10043 Orbassano, Torino Italy
| | - Valentina Pirro
- Centro Regionale Antidoping e di Tossicologia ‘A. Bertinaria’; Regione Gonzole 10/1 10043 Orbassano, Torino Italy
- Dipartimento di Chimica; Università degli Studi di Torino; Via Pietro Giuria 7 10125 Torino Italy
| | - Tonia Lombardo
- Centro Regionale Antidoping e di Tossicologia ‘A. Bertinaria’; Regione Gonzole 10/1 10043 Orbassano, Torino Italy
| | - Daniele Di Corcia
- Centro Regionale Antidoping e di Tossicologia ‘A. Bertinaria’; Regione Gonzole 10/1 10043 Orbassano, Torino Italy
| | - Sergio Pellegrino
- Centro Regionale Antidoping e di Tossicologia ‘A. Bertinaria’; Regione Gonzole 10/1 10043 Orbassano, Torino Italy
| | - Marco Vincenti
- Centro Regionale Antidoping e di Tossicologia ‘A. Bertinaria’; Regione Gonzole 10/1 10043 Orbassano, Torino Italy
- Dipartimento di Chimica; Università degli Studi di Torino; Via Pietro Giuria 7 10125 Torino Italy
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Fu J, Liu H, Xing H, Sun H, Ma Z, Wu B. Comparative analysis of glucuronidation of ethanol in treeshrews, rats and humans. Xenobiotica 2014; 44:1067-73. [DOI: 10.3109/00498254.2014.926573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jatlow PI, Agro A, Wu R, Nadim H, Toll BA, Ralevski E, Nogueira C, Shi J, Dziura JD, Petrakis IL, O'Malley SS. Ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. Alcohol Clin Exp Res 2014; 38:2056-65. [PMID: 24773137 DOI: 10.1111/acer.12407] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/13/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), are biomarkers of recent alcohol consumption that provide objective measures of abstinence. Our goals are to better understand the impact of cutoff concentration on test interpretation, the need for measuring both metabolites, and how best to integrate test results with self-reports in clinical trials. METHODS Subjects (n = 18) were administered, 1 week apart, 3 alcohol doses calibrated to achieve blood concentrations of 20, 80, and 120 mg/dl, respectively. Urinary EtG/EtS was measured at timed intervals during a 24-hour hospitalization and twice daily thereafter. In addition, participants from 2 clinical trials provided samples for EtG/EtS and drinking histories. Cutoffs for EtG/EtS of 100/50, 200/100, and 500/250 ng/ml were evaluated. RESULTS Twelve hours following each challenge, EtG was always positive at the 100 and 200 cutoffs, but at 24 hours sensitivity was poor at all cutoffs following the low dose, and poor after 48 hours regardless of dose or cutoff. Similarly, in the clinical trials EtG sensitivity was good for detecting any drinking during the last 24 hours at the 2 lowest cutoffs, but under 40% during the last 24 to 48 hours. Sensitivity was reduced at the 500 ng/ml cutoff. Discrepancies between EtG and EtS were few. Comparison of self-reports of abstinence and EtG-confirmed abstinence indicated underreporting of drinking. CONCLUSIONS Any drinking the night before should be detectable the following morning with EtG cutoffs of 100 or 200 ng/ml. Twenty-four hours after drinking, sensitivity is poor for light drinking, but good for heavier consumption. At 48 hours, sensitivity is low following 6 drinks or less. Increasing the cutoff to 500 ng/ml leads to substantially reduced sensitivity. Monitoring both EtG and EtS should usually be unnecessary. We recommend EtG-confirmed self-reports of abstinence for evaluation of outcomes in clinical trials.
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Kratz EM, Waszkiewicz N, Kałuża A, Szajda SD, Zalewska-Szajda B, Szulc A, Zwierz K, Ferens-Sieczkowska M. Glycosylation Changes in the Salivary Glycoproteins of Alcohol-Dependent Patients: A Pilot Study. Alcohol Alcohol 2013; 49:23-30. [DOI: 10.1093/alcalc/agt152] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Urine ethyl glucuronide (EtG) was screened in 75 patients during a hospital-based treatment for an alcohol use disorder. During follow-up, EtG was detected in 35 (14.6%) of the 239 urine samples. Positive screens were found in 22 patients (29%), of whom nine were outpatients (39.1% of all outpatients) and 13 inpatients (25.0% of all inpatients). Of the 22 patients with positive EtG, five (22%) also gave a positive breath alcohol test and 10 (45.5%) reported recent alcohol consumption; 12 (54.5%) gave a negative breath alcohol test and declared no alcohol lapse. Ethyl glucuronide has been found useful in detecting covered lapses.
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Preliminary investigations on ethyl glucuronide and ethyl sulfate cutoffs for detecting alcohol consumption on the basis of an ingestion experiment and on data from withdrawal treatment. Int J Legal Med 2012; 126:757-64. [DOI: 10.1007/s00414-012-0725-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/12/2012] [Indexed: 01/03/2023]
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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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Albermann ME, Musshoff F, Madea B. A high-performance liquid chromatographic-tandem mass spectrometric method for the determination of ethyl glucuronide and ethyl sulfate in urine validated according to forensic guidelines. J Chromatogr Sci 2012; 50:51-6. [PMID: 22291056 DOI: 10.1093/chromsci/bmr012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are powerful markers for alcohol intake and abuse. Several analytical procedures for the quantification of EtG and EtG in serum and urine have been developed so far. Many of the published methods show limits of detections (LODs) or limits of quantifications (LOQs) for EtG in urine within the range of 0.1 mg/L or higher. Since this is the actual cutoff value for proving abstinence in Germany, problems may occur if urine samples are highly diluted. In this paper, the validation of a highly sensitive, fast and simple LC-MS-MS for the determination of EtG and EtS in urine is described. The calibration curves for EtG and EtS is linear over the whole range (0.025-2.0 mg/L). Very low detection limits can be achieved (LOD: EtG 0.005 mg/L, EtS 0.005 mg/L; and LOQ: EtG 0.019 mg/L, EtS 0.015 mg/L). All data for selectivity, precision and accuracy, recovery, as well as for the processed sample and the freeze/thaw stability, comply with the guidelines of the German Society of Toxicological and Forensic Chemistry. Strong matrix-related effects can be compensated for by using an internal standard. Finally, the applicability of the procedure is proven by analysis of 87 human urine samples and by successful participation in interlaboratory comparison tests.
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Affiliation(s)
- M E Albermann
- Institute of Forensic Medicine, University Hospital Bonn, Stiftsplatz 12, 53111 Bonn, Germany.
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Albermann ME, Musshoff F, Aengenheister L, Madea B. Investigations on the influence of different grinding procedures on measured ethyl glucuronide concentrations in hair determined with an optimized and validated LC-MS/MS method. Anal Bioanal Chem 2012; 403:769-76. [DOI: 10.1007/s00216-012-5926-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
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Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol 2012; 4:81-90. [PMID: 22489260 PMCID: PMC3321494 DOI: 10.4254/wjh.v4.i3.81] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/07/2011] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
Alcohol use disorders affect millions of individuals worldwide. Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs. Alcoholic liver disease (ALD) may take the form of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis). The severity and prognosis of alcohol-induced liver disease depends on the amount, pattern and duration of alcohol consumption, as well as on the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. While steatosis is an almost completely benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. The median survival of patients with advanced cirrhosis is 1-2 years. Severe acute alcoholic hepatitis (AH) is associated with mortality as high as 50%. It has been managed with corticoids, pentoxifylline and enteral nutrition, although evidence based data are still conflicting. Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH. Absolute abstinence is a basic condition for any treatment of acute or chronic ALD, the other therapeutical procedure being of a supportive nature and questionable significance. Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alcohol dependent patients. Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation, which leads to a markedly prolonged life expectancy. The crucial step in ALD prevention is in the prevention of alcohol abuse, whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.
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Affiliation(s)
- Radan Bruha
- Radan Bruha, 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University, 12808 Prague, Czech Republic
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Wright TH, Ferslew KE. Biotransformation of ethanol to ethyl glucuronide in a rat model after a single high oral dosage. Alcohol 2012; 46:159-64. [PMID: 22019193 DOI: 10.1016/j.alcohol.2011.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 12/01/2022]
Abstract
Ethyl glucuronide (EtG) is a minor ethanol metabolite that confirms the absorption and metabolism of ethanol after oral or dermal exposure. Human data suggest that maximum blood EtG (BEtG) concentrations are reached between 3.5 and 5.5h after ethanol administration. This study was undertaken to determine if the Sprague-Dawley (SD) rat biotransforms ethanol to EtG after a single high oral dose of ethanol. SD rats (male, n=6) were gavaged with a single ethanol dose (4 g/kg), and urine was collected for 3 h in metabolic cages, followed by euthanization and collection of heart blood. Blood and urine were analyzed for ethanol and EtG by gas chromatography and enzyme immunoassay. Blood and urine ethanol concentrations were 195±23 and 218±19 mg/dL, whereas BEtG and urine EtG (UEtG) concentrations were 1,363±98 ng equivalents/mL and 210±0.29 mg equivalents/dL (X ± standard error of the mean [S.E.M.]). Sixty-six male SD rats were gavaged ethanol (4 g/kg) and placed in metabolic cages to determine the extent and duration of ethanol to EtG biotransformation and urinary excretion. Blood and urine were collected up to 24 h after administration for ethanol and EtG analysis. Maximum blood ethanol, urine ethanol, and UEtG were reached within 4 h, whereas maximum BEtG was reached 6 h after administration. Maximum concentrations were blood ethanol, 213±20 mg/dL; urine ethanol, 308±34 mg/dL; BEtG, 2,683±145 ng equivalents/mL; UEtG, 1.2±0.06 mg equivalents/mL (X±S.E.M.). Areas under the concentration-time curve were blood ethanol, 1,578 h*mg/dL; urine ethanol, 3,096 h*mg/dL; BEtG, 18,284 h*ng equivalents/mL; and UEtG, 850 h*mg equivalents/dL. Blood ethanol and BEtG levels were reduced to below limits of detection (LODs) within 12 and 18 h after ethanol administration. Urine ethanols were below LOD at 18 h, but UEtG was still detectable at 24h after administration. Our data prove that the SD rat biotransforms ethanol to EtG and excretes both in the urine and suggest that it is similar to that of the human.
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Affiliation(s)
- Trista H Wright
- Section of Toxicology, East Tennessee State University, Johnson City, TN 37614, USA.
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Høiseth G, Nordal K, Pettersen E, Mørland J. Prolonged Urinary Detection Times of EtG and EtS in Patients with Decreased Renal Function. Alcohol Clin Exp Res 2012; 36:1148-51. [DOI: 10.1111/j.1530-0277.2011.01713.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 11/02/2011] [Indexed: 11/27/2022]
Affiliation(s)
| | - Kristin Nordal
- Division of Forensic Toxicology and Drug Abuse; Norwegian Institute of Public Health; Oslo; Norway
| | - Eirik Pettersen
- Division of Internal Medicine; Department of Nephrology; Akershus University Hospital; Lørenskog; Norway
| | - Jørg Mørland
- Division of Forensic Toxicology and Drug Abuse; Norwegian Institute of Public Health; Oslo; Norway
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Thieme D, Große J, Keller L, Graw M. Urinary concentrations of ethyl glucuronide and ethyl sulfate as thresholds to determine potential ethanol-induced alteration of steroid profiles. Drug Test Anal 2011; 3:851-6. [DOI: 10.1002/dta.396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D. Thieme
- Institute of Doping Analysis; Dresden; Germany
| | - J. Große
- Institute of Doping Analysis; Dresden; Germany
| | - L. Keller
- Institute of Legal Medicine; University of Munich; Germany
| | - M. Graw
- Institute of Legal Medicine; University of Munich; Germany
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AlSaabi A, Tournel G, Hennart B, Notebaert D, Allorge D. Development and validation of a GC-MS/MS method for the determination of ethylglucuronide in human urine and serum. ACTA ACUST UNITED AC 2011. [DOI: 10.1051/ata/2011129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chemometric evaluation of nine alcohol biomarkers in a large population of clinically-classified subjects: pre-eminence of ethyl glucuronide concentration in hair for confirmatory classification. Anal Bioanal Chem 2011; 401:2153-64. [DOI: 10.1007/s00216-011-5314-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 08/03/2011] [Accepted: 08/03/2011] [Indexed: 11/27/2022]
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A study of distribution of ethyl glucuronide in different keratin matrices. Forensic Sci Int 2011; 210:271-7. [DOI: 10.1016/j.forsciint.2011.03.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 11/19/2022]
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Dahl H, Hammarberg A, Franck J, Helander A. Urinary Ethyl Glucuronide and Ethyl Sulfate Testing for Recent Drinking in Alcohol-Dependent Outpatients Treated with Acamprosate or Placebo. Alcohol Alcohol 2011; 46:553-7. [DOI: 10.1093/alcalc/agr055] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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41
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Albermann ME, Musshoff F, Madea B. Comparison of ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) concentrations in hair for testing abstinence. Anal Bioanal Chem 2010; 400:175-81. [DOI: 10.1007/s00216-010-4443-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 11/30/2022]
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42
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Paul R, Tsanaclis L, Kingston R, Berry A, Guwy A. Simultaneous determination of GHB and EtG in hair using GCMS/MS. Drug Test Anal 2010; 3:201-5. [DOI: 10.1002/dta.172] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 11/09/2022]
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Ethyl glucuronide and ethyl sulfate in urine after consumption of various beverages and foods—misleading results? Int J Legal Med 2010; 124:623-30. [DOI: 10.1007/s00414-010-0511-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 08/24/2010] [Indexed: 11/25/2022]
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44
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Helander A, Kenan N, Beck O. Comparison of analytical approaches for liquid chromatography/mass spectrometry determination of the alcohol biomarker ethyl glucuronide in urine. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2010; 24:1737-1743. [PMID: 20499317 DOI: 10.1002/rcm.4573] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Official guidelines originating from a European Union directive regulate requirements for analytical methods used to identify chemical compounds in biological matrices. This study compared different liquid chromatography/electrospray ionization mass spectrometry (LC/ESI-MS) and tandem mass spectrometry (LC/ESI-MS/MS) procedures for accurate determination of the conjugated ethanol metabolite and alcohol biomarker ethyl glucuronide (EtG) in urine, and the value of combined EtG and ethyl sulfate (EtS) measurement. Analysis was carried out on 482 urines following solid-phase extraction (SPE) sample cleanup or using direct injection of a diluted sample. SPE combined with LC/MS/MS was demonstrated to be the most selective and sensitive method and was chosen as reference method. The EtG results by different methods showed good correlation (r = 0.96-0.98). When comparing five reporting limits for EtG in the range 0.10-1.00 mg/L, the overall agreement with the reference method (frequency of true positives plus true negatives) was 82-97% for direct-injection LC/MS/MS, 90-97% for SPE-LC/MS, 86-98% for direct-injection LC/MS, and 86-98% for direct-injection LC/MS analysis of EtG and EtS. Most deviations were attributable to uncertainty in quantitation, when the value was close to a cutoff but the respective results were slightly above and below, or vice versa, the critical limit. However, for direct-injection LC/MS/MS, despite earning 4 identification points, equally many negative results were due to a product ion ratio outside the +/-20% deviation accepted by the guidelines. These results indicate that the likelihood of different analytical methods to provide reliable analytical results depends on the reporting limit applied.
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Affiliation(s)
- Anders Helander
- Karolinska Institutet, Department of Laboratory Medicine, Stockholm, Sweden.
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Gjerde H, Christophersen AS, Moan IS, Yttredal B, Walsh JM, Normann PT, Mørland J. Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid. J Occup Med Toxicol 2010; 5:13. [PMID: 20550667 PMCID: PMC2907386 DOI: 10.1186/1745-6673-5-13] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/15/2010] [Indexed: 11/26/2022] Open
Abstract
Background The use of alcohol and drugs may affect workplace safety and productivity. Little is known about the magnitude of this problem in Norway. Methods Employee recruitment methods with or without individual follow-up were compared. The employees filled in a questionnaire and provided a sample of oral fluid. Samples were analysed for alcohol, ethyl glucuronide (EtG; a biological marker of recent large alcohol intake), psychoactive medicinal drugs and illegal drugs. Results Participation rates with and without individual follow-up were 96% and 68%, respectively. Alcohol was negative (≤0.1 mg/ml) in all samples, but 21.0% reported the intake of alcohol during the last 24 h. EtG was positive (>2.2 ng/ml) in 2.1% of the samples. In-efficiency or hangover at work during the past year was reported by 24.3%, while 6.2% had been absent from work due to the use of alcohol. The combination of self-report and analytical testing indicated that medicinal or illegal drugs had been used during the last 48 h by 5.1% and 1.7% of the participants, respectively; while only 4.2% and 0.4% admitted the use in the questionnaire. Conclusions Self-reported data suggest that hangover after drinking alcohol appears to be the largest substance abuse problem at Norwegian workplaces, resulting in absence and inefficiency at work. Analysis of oral fluid revealed that the use of illegal drugs was more common than drinking alcohol before working or at the workplace. The analysis of oral fluid may be a valuable tool in obtaining additional information on alcohol and drug use compared to using questionnaires alone.
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Affiliation(s)
- Hallvard Gjerde
- Norwegian Institute of Public Health, PB 4404 Nydalen, NO-0403 Oslo, Norway.
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Abstract
Forensic toxicology has developed as a forensic science in recent years and is now widely used to assist in death investigations, in civil and criminal matters involving drug use, in drugs of abuse testing in correctional settings and custodial medicine, in road and workplace safety, in matters involving environmental pollution, as well as in sports doping. Drugs most commonly targeted include amphetamines, benzodiazepines, cannabis, cocaine and the opiates, but can be any other illicit substance or almost any over-the-counter or prescribed drug, as well as poisons available to the community. The discipline requires high level skills in analytical techniques with a solid knowledge of pharmacology and pharmacokinetics. Modern techniques rely heavily on immunoassay screening analyses and mass spectrometry (MS) for confirmatory analyses using either high-performance liquid chromatography or gas chromatography as the separation technique. Tandem MS has become more and more popular compared to single-stage MS. It is essential that analytical systems are fully validated and fit for the purpose and the assay batches are monitored with quality controls. External proficiency programs monitor both the assay and the personnel performing the work. For a laboratory to perform optimally, it is vital that the circumstances and context of the case are known and the laboratory understands the limitations of the analytical systems used, including drug stability. Drugs and poisons can change concentration postmortem due to poor or unequal quality of blood and other specimens, anaerobic metabolism and redistribution. The latter provides the largest handicap in the interpretation of postmortem results.
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Jatlow P, O'Malley SS. Clinical (nonforensic) application of ethyl glucuronide measurement: are we ready? Alcohol Clin Exp Res 2010; 34:968-75. [PMID: 20374218 DOI: 10.1111/j.1530-0277.2010.01171.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are minor metabolites of ethanol. Multiple studies have documented that, depending upon the amount of alcohol consumed, they can be measured in biological fluids for hours to days after the parent compound can no longer be detected. Testing for the presence of EtG, in a manner analogous to urinary drug abuse screening, has largely been restricted to forensic and law enforcement situations. Despite a real need for an objective and possibly quantitative marker of ethanol exposure for use in conjunction with outpatient clinical trials and treatment programs, measurement of these metabolites has seen only limited clinical application. The barriers to more extensive clinical use of EtG/EtS testing, particularly misleading assay results that can occur as a consequence of inadvertent exposure to nonbeverage ethanol-containing substances, are reviewed and put into perspective. Additional information needed to develop guidelines for optimal clinical utilization of EtG/EtS measurements is discussed.
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Affiliation(s)
- Peter Jatlow
- Yale University School of Medicine, New Haven, Connecticut, USA.
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48
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Ethyl glucuronide determination in meconium and hair by hydrophilic interaction liquid chromatography–tandem mass spectrometry. Forensic Sci Int 2010; 196:121-7. [DOI: 10.1016/j.forsciint.2009.12.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 09/12/2009] [Indexed: 11/18/2022]
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49
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Current Awareness in Drug Testing and Analysis. Drug Test Anal 2009. [DOI: 10.1002/dta.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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50
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Stewart SH, Reuben A, Brzezinski WA, Koch DG, Basile J, Randall PK, Miller PM. Preliminary evaluation of phosphatidylethanol and alcohol consumption in patients with liver disease and hypertension. Alcohol Alcohol 2009; 44:464-7. [PMID: 19535495 DOI: 10.1093/alcalc/agp039] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS The goal of this preliminary study was to evaluate the relationship between blood phosphatidylethanol (PEth) and recent drinking in patients with liver disease and hypertension. METHODS Twenty-one patients with liver disease and 21 patients with essential hypertension were recruited at an academic medical center. Alcohol consumption was estimated using validated self-report methods, and blood PEth was measured by HPLC-MS/MS at a contracted laboratory. Nonparametric comparisons were made between abstainers/light drinkers, moderate drinkers consuming between 1 and 3 drinks per day, and those drinking above this level. Regression methods were used to estimate the effects of liver disease, gender, and age on the relationship between PEth and alcohol use, and to estimate the strength of the linear relationship between PEth and drinking. RESULTS PEth differed significantly between the three drinking groups (P < 0.001). The relationship between PEth and alcohol did not differ between hypertension and liver disease patients (P = 0.696), nor by gender and age. While there was substantial variability between subjects in the PEth concentration given a similar level of reported drinking, the amount of ethanol consumed was strongly associated with the PEth concentration (P < 0.001). CONCLUSION Results support PEth measurement by HPLC-MS/MS as a promising marker of past 1- to 2-week moderate to heavy alcohol consumption in patients with and without liver disease. PEth appears useful for differentiating abstinence or light drinking from moderate to heavy consumption, but may have limited utility for differentiating moderate from heavy alcohol use.
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Affiliation(s)
- Scott H Stewart
- Medical University of South Carolina, Charleston, 29425, USA.
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