Symposium 2, Sunday Sept. 23rd 2 pm–3.30 pm; Room: Lecture Hall 2
New biomarkers of ethanol intake—how to use, when to use: Chairpersons: Wurst F (Austria), Allen JP (USA)
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Abstract |
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Presentation S2-1
The role of direct ethanol metabolites in optimizing diagnosis and therapy of alcohol related disorders
Wurst FM, Wiesbeck GA, Duersteler K, McFarland, Alling C, Aradottir S, Pragst F, Johnson BA, Favors M, Roache JD, Ait-Daoud N, Skipper GE, Spies C, Lesch O, Ramskogler K, Hartmann S, Wolfersdorf M, Haber PS, Conigrave KM, Whitfield JB, Weinmann W (Austria)
Direct ethanol metabolites are formed only when alcohol was/is present. Each of these remains positive for a characteristic time spectrum after the cessation of ethanol intake—EtG and EtS in serum for hours and in urine up to 5 days, PEth in whole blood more than to 2 weeks. Additionally, EtG and FAEE can be detected in hair for months.
Patients and Methods. Patients were a) 50 alcoholics during detoxification, b) 200 detoxified alcoholics that were monitored for alcohol consumption during a rehabilitation program, c) 453 individuals from the WHO/ISBRA study, d) alcoholics seeking pharmacological treatment to reduce ethanol intake e) 60 patients from an emergency room, f) patients in a methadone maintenance treatment, suffering from Hepatitis C, among others. Methods used include gas chromatography-mass spectrometry (FAEEs), liquid chromatography/tandem mass spectrometry (EtG, EtS, EtP) and high pressure liquid chromatography (PEth). Direct ethanol metabolites are compared to traditional markers and self reports.
Results. Results include new basic aspects and recent clinical findings in various populations.
Conclusions. Data suggest a) the combined use of EtG and EtS, b) good potential of identifying hazardous alcohol use by the use of EtG and FAEEs in hair and PEth in blood, c) the potential of direct ethanol metabolites in the identification of previous alcohol use in patients in an emergency unit when blood alcohol is zero. A synopsis for the differential use of the various biomarkers will be given. The findings suggest, that direct ethanol metabolites have potential in detection of previous ethanol intake in a variety of situations and settings. Their combined use and the conjoint use with traditional markers and self reports might be promising.
Presentation S2-2
Monitoring alcohol intake during pregnancy: How useful are direct ethanol metabolites?
Sundstrom-Poromaa I (Sweden)
Objectives. To investigate if biomarkers of alcohol consumption would provide additional information to the use of a validated alcohol questionnaire in pregnant women.
Study Design. 103 pregnant women were included in this population-based study. The women completed the Alcohol Use Disorders Identification Test (AUDIT) questionnaire and a urine and hair sample was collected. The urine samples were used for determination of ethyl glucuronide (EtG) and ethyl sulfate (EtS) and the hair samples for EtG and fatty acid ethyl esters (FAEE). Medical records provided information on pregnancy outcome.
Results. Twenty-six (25.2%) women were identified as possible alcohol consumers by the combined use of AUDIT and direct ethanol metabolites. Six subjects were positive on AUDIT only, 14 subjects were positive for hair EtG only, three subjects were positive for hair FAEEs only and three subjects were positive for both AUDIT and any of the biomarkers. Seven subjects had EtG or FAEE levels in hair highly suspicious of heavy drinking but only two of these were positive according to the AUDIT questionnaire
Conclusion. The combined use of the AUDIT questionnaire and direct ethanol metabolites appear to be more sensitive for detecting pregnant women who consume alcohol.
Presentation S2-3
What hair tell us about ethanol intake
Yegles M (Luxemburg)
Alcoholism is one of the most frequent addictions and is therefore of particular interest in forensic and clinical medicine. Hair analysis proved to be suitable for the detection of excessive alcohol consumption.
Alcohol itself cannot be used as the analyte for this purpose because of its high volatility. However, there are several suitable minor metabolites of ethanol from which fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) were thoroughly investigated. Both markers cannot prove absolute abstinence, However, both FAEE and EtG in hair can discriminate between moderate social drinking and chronic alcohol abuse. A value of the sum of FAEE below the cut-off of 0.4 ng/mg and/or EtG concentration below the cut-off of 8 pg/mg may indicate weak social drinkers or teetotalers. A value of the sum of FAEE above the cut-off of 1 ng/mg hair and/or EtG concentration in hair above the cut-off of 25 pg/mg may be taken as strong evidence for excessive drinking behaviour.
The combined use of FAEE and EtG is recommended since both markers complete each other and increase the accuracy of the result.
Presentation S2-4
Selecting the most appropriate alcohol biomarker
Allen JP (USA)
Aims. 1. To assist participants in recognizing the relative strengths and limitations of alternative alcohol biomarkers. 2. To assist participants to select the most appropriate alcohol biomarkers in various applied situations. 3. To identify the needs for future research on various alcohol biomarkers.
Methods. Review of published research on alcohol biomarkers with reflection on how the biomarker can be best employed in varying applied contexts and identification of the questions that remain unanswered by research to date.
Results. A rich array of alcohol biomarkers is now available to the research, clinical and public policy communities. Each offers particular advantages, but each is also subject to limitations. Optimal application of alcohol biomarkers in the range of their possible applications requires that the user be keenly aware of these.
Conclusions. Informed use of biomarkers can assist in screening for alcohol use disorders; monitoring progress of patients receiving alcohol treatment; enhancing traffic safety; dissuading alcohol use by those prohibited from drinking; evaluating efficacy of alcohol interventions; evaluating alcohol treatment prevention and treatment programs; etc. To maximize the utility of alcohol biomarkers, users must be knowledgeable about their characteristics, benefits, and limitations.