Phosphatidylethanol in blood (B‐PEth): A marker for alcohol use and abuse

Abstract

Phosphatidylethanol (PEth) represents a group of glycerophospholipid homologues where ethanol by phospholipase D has been bound at the position that normally contains an amino-alcohol. Since the formation of PEth is specifically dependent on ethanol, the diagnostic specificity of PEth as an alcohol biomarker is theoretically 100%. The half-life of PEth in blood is approximately 4 days. The amount of alcohol consumed correlates to blood concentration of PEth and PEth has been shown to be a more sensitive indicator of alcohol consumption than traditional alcohol markers, such as CDT (carbohydrate-deficient transferrin), GGT (γ-glutamyl transferase), and MCV (mean corpuscular volume) or a combination of these. Almost all clinical data so far available are based on a high performance liquid chromatography (HPLC) method with limited analytical sensitivity. With the advent of methods with considerably higher analytical sensitivity (e.g. mass spectrometric methods), clinical sensitivity will increase correspondingly. The possibility of determining very low concentrations of PEth by new sensitive analytical techniques may, however, have both ethical and legal consequences that have to be considered.

Application of phosphatidylethanol (PEth) in whole blood in comparison to ethyl glucuronide in hair (hEtG) in driving aptitude assessment (DAA)

“…These homologues have two fatty acid chains bound to the glycerol backbone in sn-1 and sn-2 position and phosphoethanol in sn-3 position. The fatty acid chains typically contain 14 -22 carbon atoms with 0 -6 double bonds [15,16]. PEth homologues are present in cell membranes [17] and are biosynthesized from phosphatidylcholine (PC) catalyzed by the enzyme phospholipase D (PLD) [18], as long as ethanol is present in the organism.…”

“…Due to an elimination half-life of about four days [17], accumulation of PEth is observed after repeated drinking. Therefore, PEth has been discussed as marker for detection of prolonged excessive alcohol consumption in several studies [16,[19][20][21][22][23].…”

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

“…As a direct biomarker, PEth differs from serum ethanol level in two ways. First, PEth requires a longer duration of alcohol use in order to become elevated (at least 20-50 g or two to four standard drinks daily for several weeks) and remains elevated for 2-3 weeks after cessation of drinking (Isaksson et al 2011;Stewart et al 2014). It is believed to have nearly 100% sensitivity for alcohol consumption, making it more sensitive to a range of consumption than many other biomarkers (Isaksson et al 2011;Walther et al 2015;Wurst et al 2015), but it cannot discriminate between low to moderate and heavy consumption.…”

Alcohol Consumption in Obese Patients Before and After Gastric Bypass as Assessed with the Alcohol Marker Phosphatidylethanol (PEth)

“…Since selfreported alcohol consumption can be biased, an alternative approach would be to assess alcohol consumption with a specific alcohol marker, e.g., phosphatidylethanol (PEth). PEth is a collective term for a group of abnormal phospholipid homologs, the most prevalent being PEth 16:0/18:1, formed in the membranes of erythrocytes only in the presence of ethanol [12]. Being an alcohol metabolite, the theoretical specificity of PEth as an alcohol marker is 100% [12].…”

“…PEth is a collective term for a group of abnormal phospholipid homologs, the most prevalent being PEth 16:0/18:1, formed in the membranes of erythrocytes only in the presence of ethanol [12]. Being an alcohol metabolite, the theoretical specificity of PEth as an alcohol marker is 100% [12]. There is a correlation between alcohol consumed and PEth value [13,14].…”