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Wielders JPM, Porpiglia NM, Schellenberg F, Deenmamode J, Delanghe J, Anton RF, Bortolotti F, Siebelder C, Tagliaro F, Weykamp C, Helander A. Recommendations on the measurement and use of the alcohol consumption biomarker CDT. A position paper from the IFCC Working Group on CDT standardisation. Clin Chim Acta 2024; 555:117800. [PMID: 38309557 DOI: 10.1016/j.cca.2024.117800] [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: 09/29/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Carbohydrate deficient transferrin (CDT) is a biomarker for excessive alcohol consumption utilized in clinical and forensic medicine and workplace testing. Previously, many different analytical methods for CDT were used and the measurand varied considerably, making direct comparison of test results difficult. To end this confusion, the IFCC established a working group on CDT standardisation (WG-CDT) which completed its tasks in 2017. METHODS This IFCC position paper by the WG-CDT summarizes state of the art information about the measurand and the analytical methods and gives concise recommendations for its utilization. RESULTS The results achieved by the CDT standardisation process led to accuracy improvements in national external quality assessment schemes over the years. A brief review of ROC based comparison studies with the traditional biomarkers (GGT, MCV, ALT and AST) discusses the bias resulting from inadequate study populations. In large groups of the general population the superior diagnostic performance of CDT is confirmed. CONCLUSION The relationship between alcohol intake versus resulting CDT is discussed as well as the cutoff and measurement uncertainty. Concerning the application in practice, potential pitfalls are considered and recommendations handling both analytical and preanalytical caveats are given. Finally, some examples of serious misunderstandings in publications about CDT are addressed.
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Affiliation(s)
- J P M Wielders
- Joseph Peter Marie Wielders, Amersfoort, the Netherlands.
| | - N M Porpiglia
- Nadia Maria Porpiglia, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy.
| | | | | | - J Delanghe
- Joris Delanghe, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R F Anton
- Raymond Francis Anton, Medical University of South Carolina, Charleston, SC, USA
| | - F Bortolotti
- Federica Bortolotti, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Siebelder
- Carla Siebelder, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - F Tagliaro
- Franco Tagliaro, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Weykamp
- Cas Weykamp, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - A Helander
- Anders Helander, Karolinska Institutet, Karolinska University Laboratory, Stockholm, Sweden
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Porpiglia NM, Savchuk SA, Appolonova SA, Bortolotti F, Tagliaro F. Capillary Electrophoresis (CE) vs. HPLC in the determination of asialo-Tf, a crucial marker for the reliable interpretation of questioned CDT increases. Clin Chim Acta 2018; 486:49-53. [DOI: 10.1016/j.cca.2018.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
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Porpiglia NM, De Palo EF, Savchuk SA, Appolonova SA, Bortolotti F, Tagliaro F. A new sample treatment for asialo-Tf determination with capillary electrophoresis: an added value to the analysis of CDT. Clin Chim Acta 2018; 483:256-262. [DOI: 10.1016/j.cca.2018.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
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Caslavska J, Thormann W. Monitoring of transferrin isoforms in biological samples by capillary electrophoresis. J Sep Sci 2017; 41:303-322. [PMID: 28885776 DOI: 10.1002/jssc.201700914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022]
Abstract
Work dealing with the monitoring of transferrin isoforms in human serum and other body fluids by capillary electrophoresis is reviewed. It comprises capillary zone electrophoresis and capillary isoelectric focusing efforts that led to the exploration and use of assays for the determination of carbohydrate-deficient transferrin as a marker for excessive alcohol intake, genetic variants of transferrin, congenital disorders of glycosylation and β-2-transferrin, which is a marker for cerebrospinal fluid leakage. This paper provides insight into the development, specifications, strengths, weaknesses, and routine use of the currently known capillary electrophoresis based assays suitable to detect transferrin isoforms in body fluids. The achievements reached so far indicate that capillary zone electrophoresis is an attractive technology to monitor the molecular forms of transferrin in biological specimens as the assays do not require an elaborate sample pretreatment and thus can be fully automated for high-throughput analyses on multicapillary instruments. Assays based on capillary isoelectric focusing are less attractive. They require immunoextraction of transferrin from the biological matrix and mobilization after focusing if instrumentation with a whole-column imaging detector is not available. Interactions of the carrier ampholytes with the iron of transferrin may prevent iron saturation and thus provide more complicated isoform patterns.
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Affiliation(s)
- Jitka Caslavska
- Clinical Pharmacology Laboratory, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Wolfgang Thormann
- Clinical Pharmacology Laboratory, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Bortolotti F, Sorio D, Bertaso A, Tagliaro F. Analytical and diagnostic aspects of carbohydrate deficient transferrin (CDT): A critical review over years 2007-2017. J Pharm Biomed Anal 2017; 147:2-12. [PMID: 28912047 DOI: 10.1016/j.jpba.2017.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 02/07/2023]
Abstract
The need for investigating alcohol abuse by means of objective tools is worldwide accepted. Among the currently available biomarkers of chronic alcohol abuse, carbohydrate-deficient transferrin (CDT) is one of the most used indicator, mainly because of its high specificity. However, some CDT analytical and interpretation aspects are still under discussion, as witnessed by numerous research papers and reviews. The present article presents a critical review of the literature on CDT appeared in the period from 2007 to 2017 (included). The article is organized in the following sections: (1) introduction, (2) pre-analytical aspects (3) analytical aspects (4) diagnostic aspects (5) concluding remarks. As many as 139 papers appeared in the international literature and retrieved by the search engines PubMed, Web of Science and Scopus are quoted.
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Affiliation(s)
- F Bortolotti
- Dept of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Italy.
| | - D Sorio
- Dept of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Italy
| | - A Bertaso
- Dept of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Italy
| | - F Tagliaro
- Dept of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Italy; Institute of Pharmacy and Translational Medicine, Sechenov First Medical University, Moskow, Russia
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Bertaso A, Sorio D, Vandoros A, De Palo EF, Bortolotti F, Tagliaro F. Use of finger-prick dried blood spots (fpDBS) and capillary electrophoresis for carbohydrate deficient transferrin (CDT) screening in forensic toxicology. Electrophoresis 2016; 37:2867-2874. [DOI: 10.1002/elps.201500588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/17/2016] [Accepted: 04/18/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Anna Bertaso
- Department of Diagnostics and Public Health, Unit of Forensic Medicine; University of Verona; Verona Italy
| | - Daniela Sorio
- Department of Diagnostics and Public Health, Unit of Forensic Medicine; University of Verona; Verona Italy
| | - Anthula Vandoros
- Department of Diagnostics and Public Health, Unit of Forensic Medicine; University of Verona; Verona Italy
- Department of Forensic Science; University of New Haven; West Haven CT USA
| | - Elio F. De Palo
- Department of Diagnostics and Public Health, Unit of Forensic Medicine; University of Verona; Verona Italy
| | - Federica Bortolotti
- Department of Diagnostics and Public Health, Unit of Forensic Medicine; University of Verona; Verona Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health, Unit of Forensic Medicine; University of Verona; Verona Italy
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First evaluation of a multi-capillary electrophoresis CDT assay on Helena Biosciences' V8 analyser. Clin Biochem 2014; 47:228-32. [DOI: 10.1016/j.clinbiochem.2014.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/14/2014] [Accepted: 08/16/2014] [Indexed: 11/21/2022]
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Medina-Casanellas S, Benavente F, Giménez E, Barbosa J, Sanz-Nebot V. On-line immunoaffinity solid-phase extraction capillary electrophoresis mass spectrometry for the analysis of large biomolecules: A preliminary report. Electrophoresis 2014; 35:2130-6. [DOI: 10.1002/elps.201400119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/10/2014] [Accepted: 04/05/2014] [Indexed: 11/08/2022]
Affiliation(s)
| | - Fernando Benavente
- Department of Analytical Chemistry; University of Barcelona; Barcelona Spain
| | - Estela Giménez
- Department of Analytical Chemistry; University of Barcelona; Barcelona Spain
| | - José Barbosa
- Department of Analytical Chemistry; University of Barcelona; Barcelona Spain
| | - Victoria Sanz-Nebot
- Department of Analytical Chemistry; University of Barcelona; Barcelona Spain
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Caslavska J, Joneli J, Wanzenried U, Schiess J, Lanz C, Thormann W. Determination of genetic transferrin variants in human serum by high-resolution capillary zone electrophoresis†. J Sep Sci 2014; 37:1663-70. [DOI: 10.1002/jssc.201400243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Jitka Caslavska
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Jeannine Joneli
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Ursula Wanzenried
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Jeannette Schiess
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Christian Lanz
- Laboratory of Phytopharmacology, Bioanalytics and Pharmacokinetics; Department of Clinical Research; University of Bern; Bern Switzerland
| | - Wolfgang Thormann
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
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Joneli J, Wanzenried U, Schiess J, Lanz C, Caslavska J, Thormann W. Determination of carbohydrate-deficient transferrin in human serum by capillary zone electrophoresis: Evaluation of assay performance and quality assurance over a 10-year period in the routine arena. Electrophoresis 2013; 34:1563-71. [DOI: 10.1002/elps.201200653] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/21/2013] [Accepted: 03/05/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Jeannine Joneli
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
| | - Ursula Wanzenried
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
| | - Jeannette Schiess
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
| | - Christian Lanz
- Department of Clinical Research; Laboratory of Phytopharmacology; Bioanalytics and Pharmacokinetics; University of Bern; Bern; Switzerland
| | - Jitka Caslavska
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
| | - Wolfgang Thormann
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
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Affiliation(s)
- Jitka Caslavska
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
| | - Wolfgang Thormann
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern; Switzerland
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Caslavska J, Joneli J, Wanzenried U, Schiess J, Thormann W. Transferrin immunoextraction for determination of carbohydrate-deficient transferrin in human serum by capillary zone electrophoresis. J Sep Sci 2012; 35:3521-8. [DOI: 10.1002/jssc.201200712] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/21/2012] [Accepted: 08/22/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Jitka Caslavska
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Jeannine Joneli
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Ursula Wanzenried
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Jeannette Schiess
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
| | - Wolfgang Thormann
- Clinical Pharmacology Laboratory; Institute for Infectious Diseases; University of Bern; Bern Switzerland
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Pascali JP, Bortolotti F, Tagliaro F. Recent advances in the application of CE to forensic sciences, an update over years 2009-2011. Electrophoresis 2011; 33:117-26. [DOI: 10.1002/elps.201100463] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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