Liver and Adipose Tissue Fatty Acid Ethyl Esters Obtained at Autopsy Are Postmortem Markers for Premortem Ethanol Intake

Abstract

Background: Fatty acid ethyl esters (FAEEs) are nonoxidative ethanol metabolites that have been implicated as mediators of alcohol-induced organ damage. FAEEs are detectable in the blood after ethanol ingestion, and on that basis have been proposed as markers of ethanol intake. Because blood is not always available at autopsy, in this study we quantified FAEEs in human liver and adipose tissue as potential postmortem markers of premortem ethanol intake. Methods: Twenty-four sets of samples were collected at the Massachusetts State Medical Examiner’s Office, and 7 sets of samples were obtained from the Pathology Department of Massachusetts General Hospital. Samples of liver and adipose tissue were collected at autopsy, and FAEEs were isolated and quantified from these organs as mass per gram of wet weight. Postmortem analysis of blood involved assessment for ethanol and other drugs. Results: The study shows a substantial difference in FAEE concentrations in liver and adipose tissue of patients with detectable blood ethanol at the time of autopsy vs those with no detectable blood ethanol, who were either chronic alcoholics or social drinkers. In addition, a specific FAEE, ethyl arachidonate, was found at concentrations >200 pmol/g almost exclusively in the liver and adipose tissue of individuals with detectable blood ethanol at the time of death, providing an additional FAEE-related marker for prior ethanol intake. Conclusions: The mass of FAEEs in liver and adipose tissue and the presence of ethyl arachidonate can serve as postmortem markers of premortem ethanol intake when no blood sample can be obtained.

In Heavy Drinkers, Fatty Acid Ethyl Esters Remain Elevated for Up to 99 Hours

“…One explanation for this observation may be that this is a result of ongoing elimination and an influx of FAEEs out of one or more storage compartments. The observation that FAEEs are stored in certain organs had been made earlier: FAEEs were detected in the pancreas (Werner et al, 2002), liver (Refaai et al, 2002, Szczepiorkowski et al, 1995, brain (Laposata and Lange, 1986), meconium (Bearer et al, 1999(Bearer et al, , 2005Moore et al, 2003), hair (Auwarter et al, 2001;Yegles et al, 2004), red blood cells (Best et al, 2003), and fat tissue (Laposata et al, 1989). To test whether fat would be a relevant storage organ, in this study, we compared the initial FAEE concentrations and their decrease between individuals with normal and high BMI.…”

Fatty Acid Ethyl Esters in Meconium: Are They Biomarkers of Fetal Alcohol Exposure and Effect?

“…The amount of FAEE is also proportional to the amount of alcohol intake (Laposata, 1997). Different types or species of FAEEs have been identified based on the tissue examined and the acuteness of alcohol intake, i.e., binge consumption versus chronic alcoholism (Laposata et al, 2000;Refaai et al, 2002). Fatty acid ethyl esters are toxic in the brain, liver, and heart of alcoholics through their disruption of mitochondrial and other cell functions (Bora and Lange, 1993;Beckemeier and Bora, 1998).…”

Ethanol metabolism and its effects on the intestinal epithelial barrier

“…[84][85][86][87][88][89][90] In the GI tract, FAEEs have been found to accumulate in the pancreas and the liver. 91,92 Since fatty acids and ethanol are absorbed by intestinal mucosa, the intestine is considered to be another site where FAEE synthesis can occur. 83 FAEE synthase activity with subsequent FAEE synthesis has been demonstrated in duodenal mucosa.…”