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.
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.
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.
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
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