CDT Auto assay: Focus on the Highly Accurate Disialotransferrin Isomer

CDT: The socio-biomarker for safety and public health

An accurate, reproducible test

The World Health Organisation (WHO) published a global status report on alcohol and health in 2014 (www.who.int)1 which indicates that approximately 5.9% of deaths worldwide are due to the harmful misuse of alcohol, with a further 5.1% of the global disease burden being related to alcohol consumption. Further to this, the WHO is pushing the global strategy to reduce the harmful use of alcohol (www.who.int)2, which was published in 2010. This aims to see a 10% reduction in the harmful use of alcohol by 2025.
 
Planning for reductions in harmful alcohol use is a social scheme relying on alcohol abusers admitting the problem they face prior to the development of a serious alcohol related disease. There are a small number of biological tests that can be adopted to diagnose alcohol misuse; however the majority are of low sensitivity. The single biomarker with the highest sensitivity used for monitoring and diagnosing alcohol misuse is CDT (carbohydrate deficient transferrin), which was first described in the 1980s as a marker of chronic alcohol consumption.

Carbohydrate Deficient Transferrin (CDT): an accurate, reproducible test

CDT is an effective marker of long term alcohol abuse because of the half life of the protein in circulation. Much like HbA1c gives an indication of a person’s blood glucose over the lifespan of a red blood cell (~120 days), CDT demonstrates alcohol consumption over the life of the CDT protein (14-28 days). CDT will not substantially increase with occasional drinking or even binge drinking, but increases with continual high levels of drinking over a period of time.
 
CDT is recommended internationally for the diagnosis and monitoring of alcohol misuse. The test has been utilised for monitoring drink drivers through driving licence agencies, airlines, transport and distribution agencies. It has also been used to monitor patients requiring organ donation and members of the armed and emergency service providers. To this end, CDT has a wide scope in helping reduce the risk of alcohol related accidents and to allow people that are dependent on alcohol to get the treatment that is needed.

Transferrin is a blood plasma glycoprotein that is synthesised in the liver and undergoes post translational glycosylation. It is normally seen in the Beta 1 region of a normal serum protein electrophoretic trace.

When high quantities of alcohol are consumed (>50g per day), the post translational glycosylation of transferrin is altered by reducing the presence of sialic acid. This leads to more of the lower sialated isomers (a-, mono- and disialotransferrin) being synthesised. These three lower sialated isomers are collectively known as CDT.

  • Disialotransferrin is the most reproducible isomer of CDT
  • Monosialotransferrin is very rarely seen, even in chronic alcohol intake
  • Asialotransferrin is affected by biological variation and not reproducible across individuals for detecting alcohol abuse

CDT by V8 E-Class

The Helena Biosciences' CDT test has proven high performance and offers an automated, robust, high throughput assay for specialised clinical testing, with easy to interpret sensitive and accurate CDT measurements. This is demonstrated through independent peer reviewed comparison studies with both HPLC and capillary methods (HPLC Comparison3 and Capillary Comparison4 respectively).
 
The Helena Biosciences' CDT method follows the IFCC’s recommendations of using only the diasalotransferrin isomer of CDT. Disialotransferrin is a much more sensitive and comparable method for measuring CDT concentrations5, and the most effective way of diagnosing chronic alcohol abuse. Furthermore, with the imminent release of an IFCC harmonised methodology, the Helena Biosciences assay will offer fully comparable results to all other harmonised methods. With IFCC established universal cut points and reference range, it is as easy to switch methods to Helena as it is to start using Helena for the first time.
 
The Helena Biosciences' method is an important clinical tool in helping the WHO strategy to reduce the harmful use of alcohol, due to the wide range of benefits that the test has to offer.

A dedicated, specific test

The Helena Biosciences' CDT Auto assay focuses on the highly accurate Disialotransferrin isomer. Transferrin isomers are detected by focusing on and zooming into the Beta-1 region of a serum protein trace for clear interpretation

CDT is reported as a percentage of the total transferrin present in a serum sample

  • %CDT over 1.6% indicates harmful alcohol intake
  • %CDT over 2.0% suggests alcohol dependency

High performance V8 CDT Auto assay

  • Walk-away, fully automated Clinical Capillary Electrophoresis (CCE) assay
  • Continuous sample loading of up to 112 on-board samples
  • 16 samples analysed per hour
  • Independently evaluated assay
  • Easy to interpret software
  • Excellent correlation with other methods and technologies

Further Information

  1. Global status report on alcohol and health 2014 
  2. Global strategy to reduce the harmful use of alcohol 
  3. First evaluation of a multi-capillary electrophoresis CDT assay on Helena Biosciences' V8 analyser
  4. Sebia Capillarys 2 versus the Helena Biosciences V8 capillary electrophoresis analyser
  5. Harmonization of measurement results of the alcohol biomarker carbohydrate-deficient transferrin

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