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Tamama K, Kruckenberg KM, DiMartini AF. Gut and bladder fermentation syndromes: a narrative review. BMC Med 2024; 22:26. [PMID: 38246992 PMCID: PMC10801939 DOI: 10.1186/s12916-023-03241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
We recently reported the first clinical case of bladder fermentation syndrome (BFS) or urinary auto-brewery syndrome, which caused the patient to fail abstinence monitoring. In BFS, ethanol is generated by Crabtree-positive fermenting yeast Candida glabrata in a patient with poorly controlled diabetes. One crucial characteristic of BFS is the absence of alcoholic intoxication, as the bladder lumen contains transitional epithelium with low ethanol permeability. In contrast, patients with gut fermentation syndrome (GFS) or auto-brewery syndrome can spontaneously develop symptoms of ethanol intoxication even without any alcohol ingestion because of alcoholic fermentation in the gut lumen. In abstinence monitoring, a constellation of laboratory findings with positive urinary glucose and ethanol, negative ethanol metabolites, and the presence of yeast in urinalysis should raise suspicion for BFS, whereas endogenous ethanol production needs to be shown by a carbohydrate challenge test for GFS diagnosis. GFS patients will also likely fail abstinence monitoring because of the positive ethanol blood testing. BFS and GFS are treated by yeast eradication of fermenting microorganisms with antifungals (or antibiotics for bacterial GFS cases) and modification of underlying conditions (diabetes for BFS and gut dysbiosis for GFS). The under-recognition of these rare medical conditions has led to not only harm but also adverse legal consequences for patients, such as driving under the influence (DUI). GFS patients may be at risk of various alcohol-related diseases.
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Affiliation(s)
- Kenichi Tamama
- Clinical Laboratories, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 3477 Euler Way, UPMC Presbyterian Clinical Laboratory Building, Pittsburgh, PA, 15213, USA.
| | - Katherine M Kruckenberg
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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2
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Herzog J, Skopp G, Musshoff F, Hartung B. Formation of phosphatidylethanol and ethylglucuronide after low to moderate alcohol consumption in volunteers with a previous three-week alcohol abstinence. Alcohol Alcohol 2023; 58:599-605. [PMID: 37097639 DOI: 10.1093/alcalc/agad025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
AIMS Phosphatidylethanol (PEth) is only formed when ethanol is present in blood. This direct alcohol marker has been widely discussed, including the minimum amount of ethanol being necessary to form as much PEth as to exceed the threshold of 20 ng/mL in previously PEth negative subjects. In order to corroborate hitherto existing results, a drinking study including 18 participants after a 3-week alcohol abstinence was performed. METHODS They consumed a pre-calculated amount of ethanol to reach a blood alcohol concentration (BAC) of at least 0.6 g/kg. Blood was drawn before and periodically seven times after alcohol administration on day 1. Blood and urine were also collected the next morning. Dried blood spots (DBS) were prepared immediately from collected venous blood. BAC was determined by head space gas chromatography and the concentrations of both PEth (16:0/18:1, 16:0/18:2 and five additional homologues) and ethyl glucuronide (EtG) were analysed using liquid chromatography-tandem mass spectrometry. RESULTS Out of 18, 5 participants had concentrations of PEth 16:0/18:1 above the threshold of 20 ng/mL, and 11 out of the 18 subjects had concentrations between 10 and 20 ng/mL. In addition, four persons had PEth 16:0/18:2 concentrations above 20 ng/mL the following morning. All test subjects tested positive for EtG in DBS (≥ 3 ng/mL) and urine (≥100 ng/mL) upon 20-21 h after alcohol administration. CONCLUSION By combining both a lower cutoff of 10 ng/mL and the homologue PEth 16:0/18:2, the sensitivity to detect a single alcohol intake after a 3-week abstinence increases to 72.2%.
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Affiliation(s)
- Josefine Herzog
- Forensic Toxicological Center (FTC) Munich, Munich 80992, Germany
| | - Gisela Skopp
- Forensic Toxicological Center (FTC) Munich, Munich 80992, Germany
| | - Frank Musshoff
- Forensic Toxicological Center (FTC) Munich, Munich 80992, Germany
| | - Benno Hartung
- Institute of Legal Medicine, Ludwig Maximilian University Munich, Munich 80539, Germany
- Institute of Legal Medicine, University Hospital Essen, Essen 45147, Germany
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3
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Fraser ER, Hill-Kapturczak N, Jett J, Beck R, Oluwoye O, Kriegel LS, Alcover KC, McPherson S, Cabassa LJ, Javors M, McDonell MG. Mixed-methods trial of a phosphatidylethanol-based contingency management intervention to initiate and maintain alcohol abstinence in formerly homeless adults with alcohol use disorders. Contemp Clin Trials Commun 2021; 22:100757. [PMID: 33763620 PMCID: PMC7973861 DOI: 10.1016/j.conctc.2021.100757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Contingency management (CM) is an intervention where incentives are provided in exchange for biochemically confirmed alcohol abstinence. CM is effective at initiating alcohol abstinence, but it is less effective at maintaining long-term abstinence. Phosphatidylethanol (PEth), collected via a finger-stick, can detect alcohol use for 14–28 days. PEth allows for the development of a CM model that includes increasingly less frequent monitoring of abstinence to assist high risk groups, such as formerly homeless individuals, maintain long-term abstinence. Aims Investigate whether PEth-based CM intervention targeting alcohol abstinence in formerly homeless, currently housed individuals with alcohol use disorders is: (1) acceptable and feasible for housing program tenants and personnel; and is associated with increased (2) alcohol abstinence and (3) housing tenure. Methods Acceptability and feasibility will be assessed using a QUAL+quant mixed-methods design using qualitative interviews and quantitative measures of satisfaction and attrition. Effectiveness will be evaluated through a randomized pilot trial of 50 study participants who will receive 6 months of either treatment as usual (TAU) including incentives (e.g., gift cards) for providing blood samples (Control Condition) or TAU and incentives for negative PEth results (PEth-CM Condition). Outcomes will be assessed during the intervention and at a three-month follow-up visit. The trial will be conducted via telehealth as a result of COVID-19. Discussion This protocol seeks to utilize a novel alcohol biomarker to evaluate the acceptability, feasibility, and initial effectiveness of a CM model that encourages long-term abstinence in a high-risk group.
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Affiliation(s)
- Elizabeth R Fraser
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA
| | - Nathalie Hill-Kapturczak
- Biological Psychiatry Analytical Lab, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Julianne Jett
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachael Beck
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA
| | - Oladunni Oluwoye
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Liat S Kriegel
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Karl C Alcover
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Martin Javors
- Biological Psychiatry Analytical Lab, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Michael G McDonell
- Behavioral Health Innovations, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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4
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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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Girard M, Labrunie A, Malauzat D, Nubukpo P. Evolution of BDNF serum levels during the first six months after alcohol withdrawal. World J Biol Psychiatry 2020; 21:739-747. [PMID: 32081048 DOI: 10.1080/15622975.2020.1733079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Brain-Derived Neurotrophic Factor (BDNF) has been associated with alcohol dependence and appear to vary after withdrawal, although the link with the withdrawal outcome on the long term is unknown. We aimed to assess the evolution of BDNF levels during the six months following withdrawal and determine the association with the status of alcohol consumption. METHODS Serum BDNF levels of alcohol-dependent patients (n = 248) and biological and clinical parameters were determined at the time of alcohol cessation (D0), 14 days (D14), 28 days (D28), and 2, 4, and 6 months after (M2, M4, M6). RESULTS Abstinence decreased during follow-up and was 31.9% after six months. BDNF levels increased by 14 days after withdrawal and remained elevated throughout the six-month period, independently of alcohol consumption. Serum BDNF levels evolved over time (p < 0.0001), with a correlation between BDNF and GGT levels. The prescription of baclofen at the time of withdrawal was associated with higher serum BDNF levels throughout the follow-up and that of anti-inflammatory drugs with lower BDNF levels. CONCLUSIONS A link between BDNF levels, liver function, and the inflammatory state in the context of alcohol abuse and not only with alcohol dependence itself is proposed.
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Affiliation(s)
- Murielle Girard
- Unité de Recherche et de Neurostimulation, Centre Hospitalier Esquirol, Limoges, France
| | | | - Dominique Malauzat
- Unité de Recherche et de Neurostimulation, Centre Hospitalier Esquirol, Limoges, France
| | - Philippe Nubukpo
- Unité de Recherche et de Neurostimulation, Centre Hospitalier Esquirol, Limoges, France.,Centre Hospitalier Esquirol, Pôle Universitaire d'Addictologie, Limoges, France
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Winder GS, Shenoy A, Dew MA, DiMartini AF. Alcohol and other substance use after liver transplant. Best Pract Res Clin Gastroenterol 2020; 46-47:101685. [PMID: 33158473 DOI: 10.1016/j.bpg.2020.101685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
In this article we tackle the controversial subject of alcohol and other substance use following liver transplantation (LT). Most of the literature on and importance of this topic pertains not to recreational use of alcohol or substances but to patients who have alcohol or substance use disorders (AUDs/SUDs). To understand these behaviors after such a lifesaving and resource-intensive procedure as LT necessitates an understanding of these disorders as chronic medical diseases. It also requires an awareness that management of these disorders begins before transplant, so we will briefly touch on considerations to prepare patients for the transplantation. Additionally, we review not only the rates of alcohol and substance use post-LT but strategies clinicians could adopt to identify and manage these events post-LT. Thus, we will summarize approaches for monitoring use and a range of therapeutic treatment options, including pharmacotherapy, to employ once use is discovered. While clinical gastroenterologists may be the primary clinicians responsible for the care of LT recipients, we emphasize a multidisciplinary team approach which, especially for the behavioral health components of the treatment, is likely to be the most successful. This article concludes with a summary of recommendations for clinicians working with these patients and possible future directions for both clinical care and research. While the bulk of the literature is on LT in the context of AUD, we review the smaller body of literature available on non-alcohol substance use.
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Affiliation(s)
- Gerald Scott Winder
- Departments of Psychiatry and Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, 622 West 168th Street, PH14-105, New York, NY, 10032, USA.
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Nursing, Biostatistics and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Andrea F DiMartini
- Departments of Psychiatry, Surgery and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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7
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Daglioglu N, Atasoy A, Asadi A, Guzel EY, Dengiz H. Estimating alcohol consumption by using wastewater-based epidemiology in Adana Province, Turkey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:31884-31891. [PMID: 32506405 DOI: 10.1007/s11356-020-09056-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/27/2020] [Indexed: 05/28/2023]
Abstract
Increased alcohol consumption, especially among young people, is a major concern in Turkey as it is around the world due to negative effects on public health and safety. Regarding this, it is pivotal to monitor and therefore control alcohol use in public. In this case, wastewater-based epidemiology (WBE), which is the in-depth analysis of wastewater and a relatively new method, can deliver complementary information concerning the abuse of different substances. The proven potential of the WBE approach offers new promises in the process of monitoring alcohol use, namely the monitoring of the levels of ethyl sulfate (EtS) as a urinary biomarker of alcohol consumption, and it is a powerful mean to estimate alcohol use at the community level. In this study, raw 24-h composite wastewater samples were collected from Seyhan and Yüregir wastewater treatment plants (WWTPs) in Adana Province for one week per season (October 2016-August 2017). The fast and validated analytical method was performed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) and therefore applied to the analysis of ethyl sulfate (EtS). Obtained concentration values were back-calculated, and regional and temporal social usage rates were determined. Higher values were calculated for both WWTPs on Sunday. Alcohol consumption in the region served by Seyhan WWTP was higher than Yüregir WWTP. The results showed that the levels of alcohol consumption during given periods in Adana ranged from 659.8 to 8998.7 mL/day/1000 per person with an average value of 4983.9 and 3924.2 mL/day/1000 inhabitant in Seyhan WWTP and Yüregir WWTP, respectively. This study shows that weekly and annual trends in alcohol consumption can be detected quickly from wastewater analysis.
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Affiliation(s)
- Nebile Daglioglu
- Department of Forensic Medicine, Faculty of Medicine, University of Cukurova, Adana, Turkey.
| | - Asli Atasoy
- Institute of Addiction and Forensic Sciences, University of Cukurova, Adana, Turkey
| | - Anvar Asadi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Department of Environmental Health Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Evsen Yavuz Guzel
- Faculty of Fisheries, Department of Basic Sciences, University of Cukurova, 01330, Adana, Turkey
| | - Huseyin Dengiz
- Institute of Addiction and Forensic Sciences, University of Cukurova, Adana, Turkey
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8
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Kane JC, Murray SM, Vinikoor MJ, Greene MC, Fine SL, Paul R, Murray LK. Concordance of Self- and Partner-Reported Alcohol Consumption Among Couples Experiencing Intimate Partner Violence in Zambia. Alcohol Clin Exp Res 2019; 43:2568-2577. [PMID: 31557344 PMCID: PMC6904506 DOI: 10.1111/acer.14205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hazardous alcohol use is a predictor of intimate partner violence (IPV), and both are increasingly prevalent in sub-Saharan Africa. The accurate measurement of alcohol consumption is therefore critical in IPV intervention studies that target hazardous drinking. Collecting a collateral report in addition to self-report is one convergent validity approach to improve alcohol measurement. We investigated concordance between self- and partner-reported alcohol use among women who reported recent IPV and their male partners in Zambia. METHODS Data were from the baseline of a randomized IPV intervention trial of 247 heterosexual couples in which a woman has reported recent IPV and her male partner has recent hazardous alcohol use. Both partners completed the Alcohol Use Disorders Identification Test (AUDIT) in reference to their own drinking and in reference to their partner's drinking. We calculated percent agreement across a range of outcomes: any use, quantity, frequency, and hazardous use. We also compared self- and partner-reported AUDIT scores using t-tests. RESULTS Concordance was poor across most outcomes. Percent agreement with respect to the women's drinking ranged from 60% to 65% across outcomes and with respect to the men's drinking from 51% to 89%. Women's average partner-reported AUDIT score (20.7) was statistically significantly (p < 0.0001) higher than men's average self-reported score (15.8). CONCLUSIONS In contrast to collateral report studies conducted in the United States, concordance between self- and partner-reported alcohol consumption was poor among families experiencing IPV in Zambia. Given the possible biases associated with self-reported alcohol use, findings suggest that a convergent validity approach is useful in this research context.
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Affiliation(s)
- Jeremy C. Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Michael J. Vinikoor
- University of Alabama at Birmingham School of Medicine, 1720 2nd Ave., S., Birmingham, AL 35294
| | - M. Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Shoshanna L. Fine
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
| | - Ravi Paul
- Department of Psychiatry, University of Zambia School of Medicine, Nationalist Road, University Teaching Hospital, PO. Box 50110, Lusaka, Zambia
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North, Broadway, Baltimore, MD, 21205
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High Agreement Between Benchtop and Point-of-Care Dipcard Tests for Ethyl Glucuronide. Ther Drug Monit 2018; 39:461-462. [PMID: 28520580 DOI: 10.1097/ftd.0000000000000412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Designing a Non-invasive Surface Acoustic Resonator for Ultra-high Sensitive Ethanol Detection for an On-the-spot Health Monitoring System. BIOTECHNOL BIOPROC E 2018. [DOI: 10.1007/s12257-017-0432-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ulwelling W, Smith K. The PEth Blood Test in the Security Environment: What it is; Why it is Important; and Interpretative Guidelines. J Forensic Sci 2018; 63:1634-1640. [DOI: 10.1111/1556-4029.13874] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/06/2018] [Accepted: 06/26/2018] [Indexed: 12/29/2022]
Affiliation(s)
- William Ulwelling
- National Security Psychological Services; 2155 Louisiana Blvd, Suite 6500 Albuquerque NM 87110
| | - Kim Smith
- National Security Psychological Services; 2155 Louisiana Blvd, Suite 6500 Albuquerque NM 87110
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Pérez-Mañá C, Farré M, Pastor A, Fonseca F, Torrens M, Menoyo E, Pujadas M, Frias S, Langohr K, de la Torre R. Non-Linear Formation of EtG and FAEEs after Controlled Administration of Low to Moderate Doses of Ethanol. Alcohol Alcohol 2018; 52:587-594. [PMID: 28591763 DOI: 10.1093/alcalc/agx033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/09/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) are non-oxidative metabolites of alcohol that can be detected in conventional and non-conventional biological matrices for longer periods than alcohol. The aim was to describe the time courses of both biomarkers after ingestion of acute low-moderate doses of ethanol. Methods The study design was double-blind, randomized, crossover and controlled with placebo. Participants were distributed in three different cohorts: (a) Cohort-1: two doses of 18 and 30 g of ethanol and placebo were administered to 12 subjects; (b) Cohort-2: two doses of 6 and 12 g of ethanol and placebo were administered to six subjects and (c) Cohort-3: two doses of 24 and 42 g of ethanol and placebo were administered to six subjects. Each participant received two doses of ethanol and placebo. Plasma concentrations (0-6 h) of ethanol and specific FAEEs (palmitic, stearic, linoleic and oleic acid ethyl esters) and urinary concentrations of EtG (0-24 h) were measured. Results A dose-dependent increase in blood ethanol concentrations was observed. EtG excretion and FAEEs plasmatic concentrations showed a disproportionate increase with the ethanol dose suggesting non-linearity. Area under the curve (AUC0-6h) of ethanol concentrations showed a linear trend with non-oxidative metabolites' concentrations. Conclusion The formation rate of ethanol non-oxidative biomarkers does not follow a linear trend, explained mainly by a disproportionate increase in AUC0-6h of ethanol concentrations in relation to dose. This observation should be taken into account when interpreting results in biological matrices in clinical and forensic settings. Short summary A double-blind, randomized, crossover and controlled study was conducted administering ethanol (6-42 g). Ethyl glucuronide (EtG) excretion and fatty acid ethyl esters (FAEEs) plasmatic concentrations showed a disproportionate increase with the ethanol dose suggesting non-linearity. This observation should be taken into account when interpreting biomarker concentrations in clinical settings.
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Affiliation(s)
- Clara Pérez-Mañá
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain.,Autonomous University of Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Magí Farré
- Autonomous University of Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain.,Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Carretera de Canyet, s/n, 08916 Badalona, Spain
| | - Antoni Pastor
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain.,Autonomous University of Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain.,CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Francina Fonseca
- Autonomous University of Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain.,Drug Addiction Unit, Institute of Neuropsychiatry and Addictions (INAD), IMIM, Parc de Salut Mar, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Marta Torrens
- Autonomous University of Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain.,Drug Addiction Unit, Institute of Neuropsychiatry and Addictions (INAD), IMIM, Parc de Salut Mar, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Esther Menoyo
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Mitona Pujadas
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain.,CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Silvia Frias
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Klaus Langohr
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain.,Department of Statistics and Operations Research, Universitat Politècnica de Cataluña (UPC)/BarcelonaTech, Jordi Girona 1-3, 08034 Barcelona, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain.,CIBER de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Monforte de Lemos 3-5, 28029 Madrid, Spain.,Pompeu Fabra University (CEXS-UPF), Plaça de la Mercè 10-12, 08002 Barcelona, Spain
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Fucci N, Gili A, Aroni K, Bacci M, Carletti P, Pascali VL, Gambelunghe C. Monitoring people at risk of drinking by a rapid urinary ethyl glucuronide test. Interdiscip Toxicol 2018; 10:155-162. [PMID: 30147423 PMCID: PMC6102674 DOI: 10.1515/intox-2017-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/08/2017] [Indexed: 12/29/2022] Open
Abstract
Alcohol and illicit drug abuse are major public health problems worldwide. Since alcohol is the predominant substance of choice in polydrug abusers, monitoring its use, along with urinary drug screening in patients in rehabilitation programs, appeared to be crucial in identifying patients at risk of alcohol disorders leading to impaired quality of life. Ethyl β-D-6-glucuronide, a non-oxidative, non-volatile, stable and minor direct ethanol metabolite, has a 6h to 4 day window of detection in urine after the last alcohol intake. Each of the 119 subjects (85 males, 34 females) registered with the Public Health Service for Drug Dependence Treatment provided a urine sample for ethylglucoronide (EtG) determination in an immunochemical test with a 500 ng/ml cutoff. All results were evaluated with confirmation criteria of a fully validated gas chromatography/mass spectrometry assay. The diagnostic performance of the EtG immunochemical test was assessed using Receiver Operating Characteristic Curve analysis. The immunochemical test specificity was 100% for EtG urinary values above 500 ng/ml. No false positive results were found. With levels below 500 ng/ml, 12% of the samples were classified as negative. The average consumption of the incorrectly classified subjects was 171 ng/ml, with a misclassification error of 6.5% to 18.5%. High agreement between EtG as determined in an immunochemical test and gas chromatography/mass spectrometry, suggests that the rapid EtG test is a reliable, cost-effective alcohol monitoring assay for patient management in many non-forensic settings, such as drug rehabilitation programs.
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Affiliation(s)
- Nadia Fucci
- Forensic Medicine Section, Public Health Institute, Sacred Heart Catholic University, Largo Francesco Vito, 1-00168 Rome, Italy
| | - Alessio Gili
- Hygiene and Public Health Section, Department of Experimental Medicine, University of Perugia, Piazza Lucio Severi-06132 Perugia, Italy
| | - Kyriaki Aroni
- Forensic Medicine, Forensic Science and Sports Medicine Section, Department of Surgical and Biomedical Science, University of Perugia, Piazza Lucio Severi, 06132 Perugia, Italy
| | - Mauro Bacci
- Forensic Medicine, Forensic Science and Sports Medicine Section, Department of Surgical and Biomedical Science, University of Perugia, Piazza Lucio Severi, 06132 Perugia, Italy
| | - Paola Carletti
- Local Health Unit, USL Umbria 2, Ser.T Perugia, Ospedale S. Maria della Misericordia, 06132 Perugia, Italy
| | - Vincenzo Lorenzo Pascali
- Forensic Medicine Section, Public Health Institute, Sacred Heart Catholic University, Largo Francesco Vito, 1-00168 Rome, Italy
| | - Cristiana Gambelunghe
- Forensic Medicine, Forensic Science and Sports Medicine Section, Department of Surgical and Biomedical Science, University of Perugia, Piazza Lucio Severi, 06132 Perugia, Italy
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Prisciandaro JJ, Tolliver BK, Prescot AP, Brenner HM, Renshaw PF, Brown TR, Anton RF. Unique prefrontal GABA and glutamate disturbances in co-occurring bipolar disorder and alcohol dependence. Transl Psychiatry 2017; 7:e1163. [PMID: 28675386 PMCID: PMC5538121 DOI: 10.1038/tp.2017.141] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/25/2022] Open
Abstract
Bipolar disorder (BD) and alcohol dependence (AD) frequently co-occur, and co-occurring BD and AD are associated with devastating public health costs. Minimal neurobiological research exists to guide the development of effective treatments for this treatment-resistant population. We believe the present study represents the first investigation of prefrontal gamma-aminobutyric acid (GABA) and glutamate levels in co-occurring BD and current AD. The participants were 78 individuals who met DSM-IV criteria for BD I/II and current AD (n=20), BD I/II alone (n=19), current AD alone (n=20) or no diagnosis (n=19). The participants completed a baseline diagnostic visit, then returned approximately 4 days later for a two-dimensional J-resolved proton magnetic resonance spectroscopy (1H-MRS) acquisition in dorsal anterior cingulate cortex (dACC). All participants were required to demonstrate ⩾1 week of abstinence from alcohol/drugs via serial biomarker testing before 1H-MRS. A 2 × 2 factorial analysis of variance of cerebrospinal fluid (CSF)-corrected GABA/water concentrations demonstrated a significant BD × AD interaction (F=2.91, P<0.05), signifying uniquely low levels of GABA in BD+AD; this effect doubled when the sample was restricted to individuals who consumed alcohol within 2 weeks of 1H-MRS. There were no overall effects of BD/AD on CSF-corrected glutamate/water levels. However, the BD × AD interaction, signifying uniquely low levels of glutamate in BD+AD, approached statistical significance (F=3.83, P=0.06) in individuals who consumed alcohol within 2 weeks of 1H-MRS. The dACC GABA levels were significantly, negatively associated with Barratt Impulsiveness Scale (r=-0.28, P=0.02) and Obsessive Compulsive Drinking Scale (r=-0.35, P<0.01) scores. If replicated, these results may suggest that future treatment studies should preferentially evaluate therapeutics in BD+AD known to increase prefrontal GABA and glutamate levels.
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Affiliation(s)
- J J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425, USA. E-mail:
| | - B K Tolliver
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - A P Prescot
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - H M Brenner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - P F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - T R Brown
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - R F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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15
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16
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MacLean RR, Valentine GW, Jatlow PI, Sofuoglu M. Inhalation of Alcohol Vapor: Measurement and Implications. Alcohol Clin Exp Res 2017; 41:238-250. [PMID: 28054395 DOI: 10.1111/acer.13291] [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: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 02/06/2023]
Abstract
Decades of alcohol research have established the health risks and pharmacodynamic profile of oral alcohol consumption. Despite isolated periods of public health concern, comparatively less research has evaluated exposure to alcohol vapor. Inhaled alcohol initially bypasses first-pass metabolism and rapidly reaches the arterial circulation and the brain, suggesting that this route of administration may be associated with pharmacological effects that increase the risk of addiction. However, detailed reviews assessing the possible effects of inhaled alcohol in humans are lacking. A comprehensive, systematic literature review was conducted using Google Scholar and PubMed to examine manuscripts studying exposure to inhaled alcohol and measurement of biomarkers (biochemical or functional) associated with alcohol consumption in human participants. Twenty-one publications reported on alcohol inhalation. Fourteen studies examined inhalation of alcohol vapor associated with occupational exposure (e.g., hand sanitizer) in a variety of settings (e.g., naturalistic, laboratory). Six publications measured inhalation of alcohol in a controlled laboratory chamber, and 1 evaluated direct inhalation of an e-cigarette with ethanol-containing "e-liquid." Some studies have reported that inhalation of alcohol vapor results in measurable biomarkers of acute alcohol exposure, most notably ethyl glucuronide. Despite the lack of significantly elevated blood alcohol concentrations, the behavioral consequences and subjective effects associated with repeated use of devices capable of delivering alcohol vapor are yet to be determined. No studies have focused on vulnerable populations, such as adolescents or individuals with alcohol use disorder, who may be most at risk of problems associated with alcohol inhalation.
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Affiliation(s)
- Robert Ross MacLean
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Gerald W Valentine
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Peter I Jatlow
- Laboratory Medicine, Yale University, West Haven, Connecticut
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
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17
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A wearable biochemical sensor for monitoring alcohol consumption lifestyle through Ethyl glucuronide (EtG) detection in human sweat. Sci Rep 2016; 6:23111. [PMID: 26996103 PMCID: PMC4800395 DOI: 10.1038/srep23111] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Abstract
We demonstrate for the first time a wearable biochemical sensor for monitoring alcohol consumption through the detection and quantification of a metabolite of ethanol, ethyl glucuronide (EtG). We designed and fabricated two co-planar sensors with gold and zinc oxide as sensing electrodes. We also designed a LED based reporting for the presence of EtG in the human sweat samples. The sensor functions on affinity based immunoassay principles whereby monoclonal antibodies for EtG were immobilized on the electrodes using thiol based chemistry. Detection of EtG from human sweat was achieved through chemiresistive sensing mechanism. In this method, an AC voltage was applied across the two coplanar electrodes and the impedance across the sensor electrodes was measured and calibrated for physiologically relevant doses of EtG in human sweat. EtG detection over a dose concentration of 0.001–100 μg/L was demonstrated on both glass and polyimide substrates. Detection sensitivity was lower at 1 μg/L with gold electrodes as compared to ZnO, which had detection sensitivity of 0.001 μg/L. Based on the detection range the wearable sensor has the ability to detect alcohol consumption of up to 11 standard drinks in the US over a period of 4 to 9 hours.
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18
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Valentine GW, Jatlow PI, Coffman M, Nadim H, Gueorguieva R, Sofuoglu M. The effects of alcohol-containing e-cigarettes on young adult smokers. Drug Alcohol Depend 2016; 159:272-6. [PMID: 26778759 PMCID: PMC5171208 DOI: 10.1016/j.drugalcdep.2015.12.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The liquids (e-liquids) used in an electronic cigarette (e-cigarette) contain myriad chemicals without adequate human inhalation safety data. Furthermore, the absence of e-liquid labeling requirements poses a formidable challenge to understanding how e-liquid constituents may promote nicotine addiction and/or have independent or synergistic biological effects when combined with nicotine. Ethyl alcohol is such a constituent, but has received little scientific interest in this context. METHODS Using a randomized, double blind, crossover design, acute changes in subjective drug effects, motor performance and biochemical measures of alcohol and nicotine intake were evaluated after directed and ad lib puffing from two commercially available e-liquids containing nicotine (8 mg/ml), vanilla flavor and either 23.5% (high) or 0.4% (trace) alcohol. RESULTS While no differences in subjective drug effects were observed between alcohol conditions, performance on the Purdue Pegboard Dexterity Test (PPDT) improved under the trace, but not under the 23.5% alcohol condition. Although plasma alcohol levels remained undetectable during testing, urine ethyl glucuronide (EtG), an alcohol metabolite, became measurable in three participants after puffing from the 23.5% alcohol e-cigarette. CONCLUSIONS Brief use of a widely available type of e-cigarette containing an e-liquid purchased from an internet vendor can negatively impact psychomotor performance and in some instances, produce detectable levels of a urine alcohol metabolite. Given the widespread and unregulated use of e-cigarettes, especially by youth and other vulnerable populations, further studies are needed to evaluate both the acute safety and long-term health risks of using alcohol-containing e-cigarettes.
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Affiliation(s)
- Gerald W Valentine
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States.
| | - Peter I Jatlow
- Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, United States
| | - Marcedes Coffman
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States
| | - Haleh Nadim
- Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, United States
| | - Ralitza Gueorguieva
- Yale University School of Public Health, Department of Biostatistics, New Haven, CT, United States
| | - Mehmet Sofuoglu
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States
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19
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McDonell MG, Skalisky J, Leickly E, McPherson S, Battalio S, Nepom JR, Srebnik D, Roll J, Ries RK. Using ethyl glucuronide in urine to detect light and heavy drinking in alcohol dependent outpatients. Drug Alcohol Depend 2015; 157:184-7. [PMID: 26475403 PMCID: PMC4663163 DOI: 10.1016/j.drugalcdep.2015.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/02/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
AIMS This study investigated which ethyl glucuronide immunoassay (EtG-I) cutoff best detects heavy versus light drinking over five days in alcohol dependent outpatients. METHODS A total of 121 adults with alcohol use disorders and co-occurring psychiatric disorders took part in an alcohol treatment study. Participants provided self-reported drinking data and urine samples three times per week for 16-weeks (total samples=2761). Agreement between low (100 ng/mL, 200 ng/mL), and moderate (500 ng/mL) EtG-I cutoffs and light (women ≤3 standard drinks, men ≤4 standard drinks) and heavy drinking (women >3, men >4 standard drinks) were calculated over one to five days. RESULTS The 100 ng/mL cutoff detected >76% of light drinking for two days, and 66% at five days. The 100 ng/mL cutoff detected 84% (1 day) to 79% (5 days) of heavy drinking. The 200 ng/mL cutoff detected >55% of light drinking across five days and >66% of heavy drinking across five days. A 500 ng/mL cutoff identified 68% of light drinking and 78% of heavy drinking for one day, with detection of light (2-5 days <58%) and heavy drinking (2-5 days <71%) decreasing thereafter. Relative to 100 ng/mL, the 200 ng/mL and 500 ng/mL cutoffs were less likely to result in false positives. CONCLUSIONS An EtG-I cutoff of 100 ng/mL is most likely to detect heavy drinking for up to five days and any drinking during the previous two days. Cutoffs of ≥500 ng/mL are likely to only detect heavy drinking during the previous day.
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Affiliation(s)
- Michael G. McDonell
- Initiative for Research and Education to Advance Community Health (I-REACH), Washington State University, Box 1495, Spokane, WA 99210, United States
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health (I-REACH), Washington State University, Box 1495, Spokane, WA 99210, United States
| | - Emily Leickly
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325 9 Avenue, Seattle, WA 98195
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, PO Box 1495, Spokane, WA 99210,Providence Medical Research Center, Providence Health Care, Spokane, WA 99210, United States
| | - Samuel Battalio
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325 9 Avenue, Seattle, WA 98195
| | - Jenny R. Nepom
- Initiative for Research and Education to Advance Community Health (I-REACH), Washington State University, Box 1495, Spokane, WA 99210, United States
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325 9 Avenue, Seattle, WA 98195
| | - John Roll
- Program of Excellence in Addictions Research, Washington State University, PO Box 1495, Spokane, WA 99210
| | - Richard K. Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325 9 Avenue, Seattle, WA 98195
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20
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Lowe JM, McDonell MG, Leickly E, Angelo FA, Vilardaga R, McPherson S, Srebnik D, Roll J, Ries RK. Determining ethyl glucuronide cutoffs when detecting self-reported alcohol use in addiction treatment patients. Alcohol Clin Exp Res 2015; 39:905-10. [PMID: 25866234 DOI: 10.1111/acer.12699] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/04/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ethyl glucuronide (EtG) is an alcohol biomarker with potential utility as a clinical research and alcohol treatment outcome. Debate exists regarding the appropriate cutoff level for determining alcohol use, particularly with the EtG immunoassay. This study determined the EtG immunoassay cutoff levels that most closely correspond to self-reported drinking in alcohol-dependent outpatients. METHODS Eighty adults with alcohol dependence and mental illness, taking part in an alcohol treatment study, provided urine samples 3 times per week for up to 16 weeks (1,589 samples). Self-reported drinking during 120 hours prior to each sample collection was assessed. Receiver operating characteristic analyses were conducted to assess the ability of the EtG immunoassay to detect self-reported alcohol use across 24- to 120-hour time periods. Sensitivity and specificity of EtG immunoassay cutoff levels was compared in 100 ng/ml increments (100 to 500 ng/ml) across 24 to 120 hours. RESULTS Over half (57%) of the 1,589 samples indicated recent alcohol consumption. The EtG immunoassay closely corresponded to self-reported drinking from 24 (area under the curve [AUC] = 0.90, 95% confidence interval [CI]: 0.88, 0.92) to 120 hours (AUC = 0.88, 95% CI: 0.87, 0.90). When cutoff levels were compared across 24 to 120 hours, 100 ng/ml had the highest sensitivity (0.93 to 0.78) and lowest specificity (0.67 to 0.85). Relative to 100 ng/ml, the 200 ng/ml cutoff demonstrated a reduction in sensitivity (0.89 to 0.67), but improved specificity (0.78 to 0.94). The 300, 400, and 500 ng/ml cutoffs demonstrated the lowest sensitivity (0.86 to 0.33) and highest specificity (0.86 to 0.97) over 24 to 120 hours. CONCLUSIONS For detecting alcohol use for >24 hours, the 200 ng/ml cutoff level is recommended for use as a research and clinical outcome.
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Affiliation(s)
- Jessica M Lowe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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21
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O'Malley SS, Gueorguieva R, Wu R, Jatlow PI. Acute alcohol consumption elevates serum bilirubin: an endogenous antioxidant. Drug Alcohol Depend 2015; 149:87-92. [PMID: 25707709 PMCID: PMC4540054 DOI: 10.1016/j.drugalcdep.2015.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Moderate alcohol consumption has been associated with both negative and favorable effects on health. The mechanisms responsible for reported favorable effects remain unclear. Higher (not necessarily elevated) concentrations of serum bilirubin, an antioxidant, have also been associated with reduced risk of cardiovascular disease and all-cause mortality. This study tests the hypothesis that single dose alcohol consumption elevates bilirubin providing a potential link between these observations. METHODS 18 healthy individuals (eight cigarette smokers) were administered alcohol, calibrated to achieve blood concentrations of 20, 80 and 120 mg/dL, in random order in three laboratory sessions separated by a week. Each session was preceded by and followed by 5-7 days of alcohol abstinence. Serum bilirubin was measured at 7:45 a.m. prior to drinking, at 2p.m., and at 7:45 the next morning. Mixed effects regression models compared baseline and 24h post-drinking bilirubin concentrations. RESULTS Total serum bilirubin (sum of indirect and direct) concentration increased significantly after drinking from baseline to 24h in non-smokers (from M = 0.38, SD = 0.24 to M = 0.51, SD = 0.30, F(1,32.2) = 24.24, p<.0001) but not in smokers (from M = 0.25, SD = 0.12 to M = 0.26, SD = 0.15, F(1,31.1) = 0.04, p = 0.84). In nonsmokers the indirect bilirubin concentration and the ratio of indirect (unconjugated) to direct (conjugated) bilirubin also increased significantly. CONCLUSIONS Alcohol consumption leads to increases in serum bilirubin in nonsmokers. Considering the antioxidant properties of bilirubin, our findings suggest one possible mechanism for the reported association between alcohol consumption and reduced risk of some disorders that could be tested in future longitudinal studies.
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Affiliation(s)
- Stephanie S O'Malley
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States.
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale Schools of Public Health and Medicine, New Haven, CT, United States.
| | - Ran Wu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
| | - Peter I Jatlow
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States; Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States.
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Leickly E, McDonell MG, Vilardaga R, Angelo FA, Lowe JM, McPherson S, Srebnik D, Roll JM, Ries RK. High levels of agreement between clinic-based ethyl glucuronide (EtG) immunoassays and laboratory-based mass spectrometry. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:246-50. [PMID: 25695340 DOI: 10.3109/00952990.2015.1011743] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Immunoassay urine drug screening cups that detect use for two or more days are commonly used in addiction treatment settings. Until recently, there has been no comparable immunoassay test for alcohol use in these settings. OBJECTIVES The aim of this study was to assess the agreement of a commercially available ethyl glucuronide immunoassay (EtG-I) test conducted at an outpatient addiction clinic and lab-based EtG mass spectrometry (EtG-MS) conducted at a drug testing laboratory at three cut-off levels. High agreement between these two measures would support the usefulness of EtG-I as a clinical tool for monitoring alcohol use. METHODS Forty adults with co-occurring alcohol dependence and serious mental illnesses submitted 1068 urine samples over a 16-week alcohol treatment study. All samples were tested using EtG-I on a benchtop analyzer and 149 were randomly selected for EtG-MS analysis at a local laboratory. Agreement was defined as the number of samples where EtG-I and EtG-MS were both above or below a specific cut-off level. Agreement was calculated at low cut-off levels (100 and 250 ng/ml), as well as at a higher cut-off level (500 ng/ml) recommended by most by commercial drug testing laboratories. RESULTS Agreement between EtG-I and EtG-MS was high across all cut-off levels (90.6% at 100 ng/ml, and 96.6% at 250 and 500 ng/ml). CONCLUSIONS EtG immunoassays conducted at low cut-off levels in point-of-care testing settings have high agreement with lab-based EtG-MS. EtG-I can be considered a useful clinical monitoring tool for alcohol use in community-based addiction treatment settings.
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Affiliation(s)
- Emily Leickly
- Psychiatry & Behavioral Sciences, University of Washington , Seattle, WA , USA and
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23
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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: 62] [Impact Index Per Article: 6.2] [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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Berger L, Fendrich M, Jones J, Fuhrmann D, Plate C, Lewis D. Ethyl glucuronide in hair and fingernails as a long-term alcohol biomarker. Addiction 2014; 109:425-31. [PMID: 24524319 PMCID: PMC3927158 DOI: 10.1111/add.12402] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/22/2013] [Accepted: 10/23/2013] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to evaluate the performance of ethyl glucuronide (EtG) in hair and fingernails as a long-term alcohol biomarker. DESIGN Cross-sectional survey with probability sampling. SETTING Midwestern United States. PARTICIPANTS Participants were 606 undergraduate college students between the ages of 18 and 25 years at the time of selection for potential study participation. MEASUREMENTS EtG concentrations in hair and fingernails were measured by liquid chromatography-tandem mass spectrometry at three thresholds [30 picograms (pg) per milligram (mg); 20 pg/mg; and 8 pg/mg]. Any weekly alcohol use, increasing-risk drinking and high-risk drinking on average during the past 12 weeks was assessed by participant interview using the time-line follow-back method. FINDINGS In both hair and fingernails at all three EtG thresholds, sensitivity was greatest for the high-risk drinking group [hair: 0.43, confidence interval (CI)=0.17, 0.69 at 30 pg/mg, 0.71, CI=0.47, 0.95 at 20 pg/mg; 0.93, CI=0.79, 1.00 at 8 pg/mg; fingernails: 1.00, CI=1.00-1.00 at 30, 20 and 8 pg/mg] and specificity was greatest for any alcohol use (hair: 1.00, CI=1.00, 1.00 at 30 and 20 pg/mg; 0.97, CI=0.92-0.99 at 8 pg/mg; fingernails: 1.00, CI=1.00-1.00 at 30, 20 and 8 pg/mg). Areas under the receiver operating characteristic curves were significantly higher for EtG concentration in fingernails than hair for any weekly alcohol use (P = 0.02, DeLong test, two-tailed) and increasing-risk drinking (P = 0.02, DeLong test, two-tailed). CONCLUSIONS Ethyl glucuronide, especially in fingernails, may have potential as a quantitative indicator of alcohol use.
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Affiliation(s)
- Lisa Berger
- Center for Applied Behavioral Health Research, University of Wisconsin-MilwaukeeMilwaukee, WI, USA
| | - Michael Fendrich
- Center for Applied Behavioral Health Research, University of Wisconsin-MilwaukeeMilwaukee, WI, USA
| | - Joseph Jones
- United States Drug Testing Laboratories, Inc.Des Plaines, IL, USA
| | - Daniel Fuhrmann
- Center for Applied Behavioral Health Research, University of Wisconsin-MilwaukeeMilwaukee, WI, USA
| | - Charles Plate
- United States Drug Testing Laboratories, Inc.Des Plaines, IL, USA
| | - Douglas Lewis
- United States Drug Testing Laboratories, Inc.Des Plaines, IL, USA
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Lande RG, Marin B. A Comparison of Two Alcohol Biomarkers in Clinical Practice: Ethyl Glucuronide Versus Ethyl Sulfate. J Addict Dis 2013; 32:288-92. [DOI: 10.1080/10550887.2013.824332] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- R. Gregory Lande
- a Walter Reed National Military Medical Center , Bethesda , Maryland , USA
| | - Barbara Marin
- a Walter Reed National Military Medical Center , Bethesda , Maryland , USA
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Arndt T, Schröfel S, Stemmerich K. Ethyl glucuronide identified in commercial hair tonics. Forensic Sci Int 2013; 231:195-8. [PMID: 23890636 DOI: 10.1016/j.forsciint.2013.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 04/29/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ethyl glucuronide (EtG) in hair is considered as a specific marker of ethanol consumption. Prompted by a report of positive EtG hair testings due to hair treatment with an EtG containing hair lotion, commercially available herbal hair tonics from supermarkets, drug-stores, and health food stores were analyzed for the presence of EtG and ethyl sulfate (EtS). METHODS LC-MS/MS (QTRAP 5500 mass spectrometer) was done in multiple reaction monitoring (MRM), enhanced product ion (EPI) and MS(3) mode. The lower limit of quantitation was 0.05 mg/L for EtG and the cut-off for the detection of EtS 0.01 mg/L. RESULTS Altogether 11 hair tonics from 8 manufacturers were tested, with 1 product in 3 different lots. EtG ranged between 0.07 and 1.06 mg/L (7 products from 4 manufacturers) and was almost identical in the 3 lots of 1 product (1.01-1.06 mg/L). EtS was found in 3 out of the 11 hair tonics. CONCLUSIONS EtG is quite frequently present in commercially available herbal hair tonics. Using EtG in hair as a marker of alcohol (ab)use, one has to consider external sources of EtG and has to assess the use of hair care products, esp. if the patient denies any ethanol intake. Whether EtS is a more reliable alcohol (ab)use marker, as sometimes discussed, should be critically assessed against the background of its broad use in large amounts in industrial chemistry.
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Affiliation(s)
- Torsten Arndt
- Bioscientia Institut für Medizinische Diagnostik GmbH, Konrad-Adenauer-Strasse 17, D-55218 Ingelheim, Germany.
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Flynn A, Tremblay PF, Rehm J, Wells S. A modified random walk door-to-door recruitment strategy for collecting social and biological data relating to mental health, substance use, addiction, and violence problems in a Canadian community. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2013; 2:7-16. [PMID: 27279929 PMCID: PMC4894817 DOI: 10.7895/ijadr.v2i2.143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIMS To describe a modified "random walk" door-to-door recruitment strategy used to obtain a random community sample for participation in a study relating to mental health, substance use, addiction, and violence (MSAV) problems and involving the collection of both self-report and biological (hair and saliva) data. This paper describes study protocols, response rates for the study and for the provision of biological data, and possible further applications for this data collection method. DESIGN A two-stage cluster sample was derived from the 2006 Canadian census sampling frame for a small Ontario community, based on the random selection of city blocks as the primary sampling units and households as the secondary sampling units. SETTING A small city in Ontario, Canada. PARTICIPANTS A general population sample of 92 participants selected randomly from households using Kish tables. MEASURES A computerized questionnaire was administered to obtain self-report data on MSAV problems. Saliva was collected to study genetic vulnerabilities to MSAV problems, and hair was collected to examine stress levels (via the hormone cortisol) as they relate to MSAV problems. FINDINGS The study showed a response rate of 50% and a high rate of provision of biological samples (over 95%). CONCLUSIONS Modified random walk methodologies involving face-to-face recruitment may represent a useful approach for obtaining general population samples for studies of MSAV problems, particularly those involving the collection of biological samples. Further studies are needed to assess whether this approach leads to better response rates and improved estimates compared to other survey methods used in research on substance use.
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Affiliation(s)
- Andrea Flynn
- Centre for Addiction and Mental Health (CAMH), London, Canada
| | | | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Epidemiological Research Unit, Institute for Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Samantha Wells
- Centre for Addiction and Mental Health (CAMH), London, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Canada
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Petersen IN, Tortzen C, Kristensen JL, Pedersen DS, Breindahl T. Identification of a new metabolite of GHB: gamma-hydroxybutyric acid glucuronide. J Anal Toxicol 2013; 37:291-7. [PMID: 23612681 DOI: 10.1093/jat/bkt027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gamma-hydroxybutyric acid (GHB) is an important analyte in clinical and forensic toxicology with a narrow detection window of 3-6 h. In the search of improved detection methods, the existence in vivo of a glucuronated GHB metabolite (GHB-GLUC) was hypothesized. Chemically pure standards of GHB-GLUC and a deuterated analogue for chromatography were synthesized. Liquid chromatography and tandem mass spectrometry were used for targeted analysis in anonymous clinical urine samples (n = 50). GHB-GLUC was found in concentrations ranging from 0.11 to 5.0 µg/mL (mean: 1.3 ± 1.2 µg/mL). Thus far, this is the first report of a GHB glucuronide detected in biological samples. Given that glucuronides generally have longer half-life values than their corresponding free drugs, GHB-GLUC should theoretically be a biomarker of GHB intoxication. It is also proposed that the hitherto unexplained reports of elevated GHB concentrations in some biological samples, which has caused the setting of a relatively high cutoff value (10 µg/mL), represent total GHB measurements (sum of free GHB and actively chemically hydrolyzed GHB-GLUC). To address these challenges, the present study must be followed by comprehensive pharmacokinetic and stability studies after the controlled administration of GHB.
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Affiliation(s)
- Ida Nymann Petersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nymann Petersen I, Langgaard Kristensen J, Tortzen C, Breindahl T, Sejer Pedersen D. Synthesis and stability study of a new major metabolite of γ-hydroxybutyric acid. Beilstein J Org Chem 2013; 9:641-6. [PMID: 23616808 PMCID: PMC3628683 DOI: 10.3762/bjoc.9.72] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/11/2013] [Indexed: 01/10/2023] Open
Abstract
γ-Hydroxybutanoic acid (GHB) is used as a date-rape drug, which renders the victims unconscious and defenceless. Intoxications are very difficult to detect for forensic scientists due to rapid metabolism to endogenous levels of GHB. We recently discovered a new major metabolite, 2, of GHB (1) that could potentially extend the analytical detection window for GHB intoxications. Herein we disclose synthetic procedures based on a Koenigs-Knorr glucuronidation approach that provides GHB glucuronide 2 and a deuterium-labelled analogue d 4-2 of high purity suitable for analytical chemistry. In addition, we have assessed the stability of GHB glucuronide 2 by mimicking the natural pH range for urine, which is of importance in the development of new analytical methods. Using NMR we show that GHB glucuronide 2 is highly stable towards aqueous hydrolysis within the pH range normally observed for urine even at elevated temperature.
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Affiliation(s)
- Ida Nymann Petersen
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark
| | - Jesper Langgaard Kristensen
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark
| | - Christian Tortzen
- Department of Chemistry, University of Copenhagen, Universitetsparken 5, DK-2100 Copenhagen, Denmark
| | - Torben Breindahl
- Department of Clinical Biochemistry, Vendsyssel Hospital, Bispensgade 37, DK-9800 Hjørring, Denmark
| | - Daniel Sejer Pedersen
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark
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Seneviratne C, Johnson BA. Serotonin transporter genomic biomarker for quantitative assessment of ondansetron treatment response in alcoholics. Front Psychiatry 2012; 3:23. [PMID: 22470354 PMCID: PMC3314249 DOI: 10.3389/fpsyt.2012.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 03/04/2012] [Indexed: 01/22/2023] Open
Abstract
Paucity of sensitive biomarkers to quantify transient changes in alcohol consumption level remains a critical barrier for the development of efficacious therapeutic agents to treat alcoholism. Recently, in an 11-week, randomized, placebo-controlled, double-blind trial of 283 alcohol-dependent individuals, we demonstrated that ondansetron was efficacious at reducing the severity of drinking (measured as drinks per drinking day; DDD) in alcoholics carrying the LL compared with the LS/SS genotype of the serotonin transporter gene, 5'-HTTLPR. Using peripheral blood samples from a cohort of 41 of these subjects, we determined whether there was a relationship between mRNA expression level of the 5'-HTTLPR genotypes (measured at weeks 0, 4, and 11) and self-reported alcohol consumption following treatment with either ondansetron (4 μg/kg twice daily; N = 19) or placebo (N = 22). Using a mixed-effects linear regression model, we analyzed the effects of DDD and 5'-HTTLPR genotypes on mRNA expression levels within and between the ondansetron and placebo groups. We found a significant three-way interaction effect of DDD, 5'-HTTLPR genotypes, and treatment on mRNA expression levels (p = 0.0396). Among ondansetron but not placebo recipients, there was a significant interaction between DDD and 5'-HTTLPR genotype (p = 0.0385 and p = 0.7938, respectively). In the ondansetron group, DDD was associated positively with mRNA levels at a greater rate of expression alteration per standard drink in those with the LL genotype (slope = +1.1698 in ln scale). We suggest that the combination of the LL genotype and 5'-HTTLPR mRNA expression levels might be a promising and novel biomarker to quantify drinking severity in alcoholics treated with ondansetron.
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Affiliation(s)
- Chamindi Seneviratne
- Department of Psychiatry and Neurobehavioral Sciences, University of VirginiaCharlottesville, VA, USA
| | - Bankole A. Johnson
- Department of Psychiatry and Neurobehavioral Sciences, University of VirginiaCharlottesville, VA, USA
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Current Awareness in Drug Testing and Analysis. Drug Test Anal 2010. [DOI: 10.1002/dta.66] [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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Abstract
Biomarkers to detect past alcohol use and identify alcohol-related diseases have long been pursued as important tools for research into alcohol use disorders as well as for clinical and treatment applications and other settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) sponsored a workshop titled "Workshop on Biomarkers for Alcohol-Induced Disorders" in June 2008. The intent of this workshop was to review and discuss recent progress in the development and implementation of biomarkers for alcohol use and alcohol-related disorders with a goal to formulate a set of recommendations to use to stimulate and advance research progress in this critical area of alcoholism research. Presentations at this workshop reviewed the current status of alcohol biomarkers, providing a summary of the history of biomarkers and the major goals of alcohol biomarker research. Moreover, presentations provided a comprehensive overview of the current status of several well-recognized biomarkers of alcohol use, a summary of recent studies to characterize novel biomarkers and their validation, along with perspectives and experiences from other NIH institutes and from other federal agencies and industry, related to regulatory issues. Following these presentations, a panel discussion focused on a set of issues presented by the organizers of this workshop. These discussion points addressed: (i) issues related to strategies to be adopted to stimulate biomarker discovery and application, (ii) the relevance of animal studies in biomarker development and the status of biomarkers in basic science studies, and (iii) issues related to the opportunities for clinical and commercial applications. This article summarizes these perspectives and highlights topics that constituted the basis for recommendations to enhance alcohol biomarker research.
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Affiliation(s)
- Cynthia F Bearer
- Division of Neonatology, Department of Pediatrics, University of Maryland Hospital for Children, Baltimore, Maryland, USA
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