Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers

Kharbouche, Hicham; Faouzi, Mohamed; Sanchez, Nathalie; Daeppen, Jean‐Bernard; Augsburger, Marc; Mangin, Patrice; Staub, Christian; Sporkert, Frank

doi:10.1007/s00414-011-0619-9

Cited by 76 publications

(71 citation statements)

References 47 publications

(52 reference statements)

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“…In the absence of observational data or positive self-report, the most widely used methods through which chronic alcohol consumption can be inferred consist of algorithms that incorporate levels of liver proteins (e.g., alanine aminotransferase, γ-glutamyl transferase, aspartate aminotransferase or carbohydrate-deficient transferrin) or metabolites such as ethyl glucuronide (EtG) 8 , 9 . Serious deficiencies in the sensitivity and specificity of these assays, as well as their high cost, have limited their clinical impact.…”

Section: Introductionmentioning

confidence: 99%

A pilot examination of the genome-wide DNA methylation signatures of subjects entering and exiting short-term alcohol dependence treatment programs

et al. 2014

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Alcoholism has a profound impact on millions of people throughout the world. However, the ability to determine if a patient needs treatment is hindered by reliance on self-reporting and the clinician’s capability to monitor the patient’s response to treatment is challenged by the lack of reliable biomarkers. Using a genome-wide approach, we have previously shown that chronic alcohol use is associated with methylation changes in DNA from human cell lines. In this pilot study, we now examine DNA methylation in peripheral mononuclear cell DNA gathered from subjects as they enter and leave short-term alcohol treatment. When compared with abstinent controls, subjects with heavy alcohol use show widespread changes in DNA methylation that have a tendency to reverse with abstinence. Pathway analysis demonstrates that these changes map to gene networks involved in apoptosis. There is no significant overlap of the alcohol signature with the methylation signature previously derived for smoking. We conclude that DNA methylation may have future clinical utility in assessing acute alcohol use status and monitoring treatment response.

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Section: Introductionmentioning

confidence: 99%

A pilot examination of the genome-wide DNA methylation signatures of subjects entering and exiting short-term alcohol dependence treatment programs

et al. 2014

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“…EtG in hair offers a much greater window of detection and has emerged as a superior biomarker in some studies (Kharbouche et al, 2012; Pirro et al, 2011). However, Kronstrand et al (Kronstrand, Brinkhagen, & Nystrom, 2012) could definitively detect EtG in the hair of only 1 of 14 women who ingested approximately one standard drink per day for 3 months.…”

Section: Discussionmentioning

confidence: 99%

Commercial Ethyl Glucuronide (EtG) and Ethyl Sulfate (EtS) Testing is Not Vulnerable to Incidental Alcohol Exposure in Pregnant Women

Ondersma

Beatty

Rosano

et al. 2016

Substance Use & Misuse

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Background Ethyl Glucoronide (EtG) and Ethyl Sulfate (EtS) have shown promise as biomarkers for alcohol and may be sensitive enough for use with pregnant women in whom even low-level alcohol use is important. However, there have been reports of over-sensitivity of EtG and EtS to incidental exposure to sources such as alcohol-based hand sanitizer. Further, few studies have evaluated these biomarkers among pregnant women, in whom the dynamics of these metabolites may differ. Objectives This study evaluated whether commercial EtG-EtS testing was vulnerable to high levels of environmental exposure to alcohol in pregnant women. Methods Two separate samples of five nurses—one pregnant and the other postpartum, all of whom reported high levels of alcohol-based hand sanitizer use—provided urine samples before and 4–8 hours after rinsing with alcohol-based mouthwash and using hand sanitizer. The five pregnant nurses provided urine samples before, during, and after an 8-hour nursing shift, during which they repeatedly cleansed with alcohol-based hand sanitizer (mean 33.8 uses). The five postpartum nurses used hand sanitizer repeatedly between baseline and follow-up urine samples. Results No urine samples were positive for EtG-EtS at baseline or follow-up, despite use of mouthwash and—in the pregnant sample—heavy use of hand sanitizer (mean of 33.8 uses) throughout the 8-hour shift. Conclusions/Importance Current, commercially available EtG-EtS testing does not appear vulnerable to even heavy exposure to incidental sources of alcohol among pregnant and postpartum women.

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“…An analysis of an array of biomarkers with varying detection windows may increase the likelihood of detecting drinking throughout pregnancy. While some previous studies have simultaneously assessed other biomarkers, such as CDT, MCV, GGT, FAEE, and EtS, along with hEtG, they did not specifically report the importance of using a combination of these biomarkers to ascertain alcohol exposure during pregnancy (Kharbouche et al, 2012; Pirro, Valente, et al, 2011). In our study, hEtG/PEth and hEtG/GGT combinations resulted in increased estimated sensitivity (27.5% and 32.5%, respectively) without a substantial drop in estimated specificity (86.0% and 83.3%, respectively) compared to an hEtG stand-alone test (sensitivity: 19.1%; specificity: 86.1%).…”

Section: Discussionmentioning

confidence: 99%

Ethylglucuronide in maternal hair as a biomarker of prenatal alcohol exposure

Gutierrez

Hund

Shrestha

et al. 2015

Alcohol

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While direct ethanol metabolites, including ethylglucuronide (EtG), play an important role for the confirmation of prenatal alcohol exposure (PAE), their utility is often limited by their short half-lives in blood and urine. Maternal hair might allow for a retrospective measure of PAE for up to several months. This study examined the validity of hair EtG (hEtG) relative to self-reporting and five other biomarkers (gamma glutamyltranspeptidase [GGT], carbohydrate-deficient transferrin [%dCDT], urine ethyl glucuronide [uEtG], urine ethyl sulfate [uEtS], and phosphatidylethanol [PEth]) in 85 pregnant women. Patients were recruited from a University of New Mexico prenatal clinic, which provides care to women with substance abuse and addiction disorders, and followed until early postpartum. The composite index, which was based on self-reported measures of alcohol use and allowed us to classify subjects into PAE (n = 42) and control (n = 43) groups, was the criterion measure used to estimate the sensitivity and specificity of hEtG and other biomarkers. Proximal segments of hair were collected at enrollment (average 22.0 gestational weeks) and analyzed by liquid chromatography–tandem mass spectrometry (LC-MS/MS). At the same visit, maternal blood and urine specimens were collected for analysis of GGT, %dCDT, PEth, uEtG, and uEtS. The study population included mostly opioiddependent (80%) patients, a large proportion of ethnic minorities (75.3% Hispanic/Latina, 8.2% American Indian, 4.7% African-American), and patients with low education (48.2% < high school). The mean maternal age at enrollment was 26.7 ± 4.8 years. Hair EtG demonstrated 19% sensitivity and 86% specificity. The sensitivities of other biomarkers were comparable (5–20%) to hEtG in this cohort, but specificities were higher (98–100%). Hair EtG sensitivity improved when combined with other biomarkers, especially with GGT (32.5%) and PEth (27.5%). In addition, validity of hEtG improved in patients with less frequent shampooing and those who did not use hair dyes/chemical treatments. Mothers of two children with Fetal Alcohol Syndrome had hEtG levels of 158 and 58 pg/mg. These data suggest that hEtG alone, as measured in maternal hair, is not a sufficiently sensitive or specific biomarker to be used separately for the identification of PAE, but might be useful in a battery along with other maternal biomarkers.

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Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers

Abstract: Hair EtG definitively provides an accurate and reliable diagnostic test for detecting chronic and excessive alcohol consumption. The proposed cutoff values can serve as reference for future cutoff recommendations for clinical and forensic use.

Cited by 76 publications

References 47 publications

A pilot examination of the genome-wide DNA methylation signatures of subjects entering and exiting short-term alcohol dependence treatment programs

A pilot examination of the genome-wide DNA methylation signatures of subjects entering and exiting short-term alcohol dependence treatment programs

Commercial Ethyl Glucuronide (EtG) and Ethyl Sulfate (EtS) Testing is Not Vulnerable to Incidental Alcohol Exposure in Pregnant Women

Ethylglucuronide in maternal hair as a biomarker of prenatal alcohol exposure

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