Brief history of the alcohol biomarkers CDT, EtG, EtS, 5‐HTOL, and PEth

Abstract

This article traces the historical development of various biomarkers of acute and/or chronic alcohol consumption. Much of the research in this domain of clinical and laboratory medicine arose from clinics and laboratories in Sweden, as exemplified by carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth). Extensive studies of other alcohol biomarkers, such as ethyl glucuronide (EtG), ethyl sulfate (EtS), and 5‐hydroxytryptophol (5‐HTOL), also derive from Sweden. The most obvious test of recent drinking is identification of ethanol in a sample of the person's blood, breath, or urine. However, because of continuous metabolism in the liver, ethanol is eliminated from the blood at a rate of 0.15 g/L/h (range 0.1–0.3 g/L/h), so obtaining positive results is not always possible. The widow of detection is increased by analysis of ethanol's non‐oxidative metabolites (EtG and EtS), which are more slowly eliminated from the bloodstream. Likewise, an elevated ratio of serotonin metabolites in urine (5‐HTOL/5‐HIAA) can help to disclose recent drinking after ethanol is no longer measurable in body fluids. A highly specific biomarker of hazardous drinking is CDT, a serum glycoprotein (transferrin), with a deficiency in its N‐linked glycosylation. Another widely acclaimed biomarker is PEth, an abnormal phospholipid synthesized in cell membranes when people drink excessively, having a long elimination half‐life (median ~6 days) during abstinence. Research on the subject of alcohol biomarkers has increased appreciably and is now an important area of drug testing and analysis.

Identification of Alcohol Use Prior to Major Cancer Surgery: Timeline Follow Back Interview Compared to Four Other Markers

“…P–CDT in plasma has a specificity of 70–100% but a wider range of 46–90% in sensitivity [ 17 ]. Cut off levels for long-time excessive drinking are indicated by levels >2% (P–CDT compared to total transferrin) [ 16 ].…”

“…Additionally, one-time consumption can be indicated as levels rise within 1–2 h [ 17 ]. Levels that exceed 0.30 µmol/L indicate excessive consumption of alcohol, whereas levels between 0.05 and 0.30 µmol/L correlate with moderate consumption and levels <0.05 µmol/L imply a non-existent or very low sporadic intake [ 16 ].…”

“…A negative test, showing no recent alcohol consumption, is defined as ≤0.5 mg/L. Positive tests are confirmed with a mass spectrometric method [ 16 ].…”