Abstract:
A chromatographic method used to detect chronic alcohol usage and alcoholism and to monitor alcohol rehabilitation treatment; the method provides improved resolution of the Hb A 1-AcH  peak from the contiguous Hb A 1c  peak by means of a polyaspartic acid chromatographic column and a nonlinear buffer gradient; the resulting Hb A 1-AcH  peak is then evaluated to determine chronic alcohol usage which is indicative of alcoholism and which can be used to monitor alcohol rehabilitation treatment.

Description:
FIELD OF THE INVENTION 
     The invention relates to a procedure whereby one acetaldehyde adduct of hemoglobin, commonly designated as Hb A 1-Ach , can be separated from contiguous hemoglobin peaks (Hb Pre-A 1c  and Hb A 1c ) during the process of liquid chromatography and used to diagnose chronic alcohol use, alcoholism or to monitor alchoholism treatment. 
     BACKGROUND OF THE INVENTION 
     Alcohol abuse has become a problem of epidemic proportions in industrialized countries. The accepted medical treatment includes counselling and behavior modification. However, other than asking for a direct admission from a patient, few tests exist to determine whether that patient is an alcoholic or a chronic alcohol user. 
     Many of the tests which have been developed rely upon biochemical markers which reflect changes in particular liver enzymes which indicate hepatic damage or abnormal hematological tests which are impaired by prolonged elevation in blood alcohol levels. The value of these tests is measured by their sensitivity (i.e., the percent of alcoholics showing a positive test) and specificity (i.e., the percent of non-alcoholics showing a negative test). The sensitivity and specificity of these tests is not high because other forms of liver injury or abnormalities other than alcoholism, influence the biological markers. Because of the influence of these other factors, tests based upon a marker directly derived from a metabolite of ethanol, such as acetaldehyde, which is not influenced by conditions unrelated to alcohol abuse would have advantages. 
     Acetaldehyde (AcH), the primary metabolite of ethanol, has been known to bind covalently to form stable adducts with many proteins including hemoglobin (Stevens, V. J. et al., J. Clin. Invest. 67:361-69, 1981) and it has been proposed to use these adducts as a biological marker for alcoholism and chronic alcohol use. Acetaldehyde adducts can be detected in blood from volunteers who have consumed alcohol (Niemela, O, et al., Alcoholism: Clin. Exp. Res. 14:838-41, 1990) and in the serum of alcoholic patients (Lin, RC, et al., Alcoholism: Clin. Exp. Res. 14:438-43, 1990) using various antibodies developed against protein-AcH adducts in enzyme-linked immunosorbent assays (ELISA). Unfortunately, these assays lack specificity owing to difficulties in the selection of specific Ach-protein adducts for development of antibody formation. 
     In 1984, Homaidan reported that acetaldehyde-hemoglobin adducts were an unreliable marker of alcohol abuse (Homaidan, F. et al., Clin. Chem. 30:480-82, 1984). Homaidan was unable to detect differences between alcoholics and social drinkers in the amounts of so-called &#34;fast hemoglobins&#34; (variants of HbA 0 ) produced by acetylation by acetaldehyde or glycosylation by sugars when measured by cation-exchange chromatography or by agar gel electrophoresis. 
     The separation of hemoglobin fractions by high pressure liquid chromatography (HPLC), offers markedly improved resolution of hemoglobin A variants when compared to previous methods of iso-electric focusing and ion-exchange chromatography. Huisman, T. H. J. et al., J. Lab. Clin. Med. 102:163-173, 1983, may represent the earliest detection by HPLC of the Hb A 1-AcH  complex as an unidentified minor Hb which cochromatographed with Hb A 1c  in the blood of alcoholics. 
     Sillanaukee and Koivula (Alcoholism: Clin. Exp. Res. 4:842-46, 1990) found that AcH induces an increase in Hb A 1-AcH  which is one of the faster eluting hemoglobin A variants when separated by HPLC. They proposed its use as a diagnostic marker in alcoholism (as a ratio of HB A 1-AcH  /HB A 1c ) and as an indicator of heavy drinking (Sillanaukee, P. et al., Alcohol &amp; Alcoholism 26:519-25, 1991 and Sillanaukee et al., J. Lab. Clin. Med. 120:42-47, 1992). However, difficulties have been encountered in using the Hb A 1-AcH  adduct as a biological indicator of alcohol abuse. The method used by Sillanaukee, inadequately resolves the Hb A 1-AcH  peak from the contiguous Hb A 1c  complex. This seriously compromises the ability of the analysis to diagnose chronic alcohol usage. The Hb A 1c  complex is associated with a number of nonalcoholic conditions including diabetes and, hence, is elevated in many non-heavy drinking subjects such that if the Hb A 1-AcH  peak does not adequately resolve from the Hb A 1-Ach  complex, the Hb A 1-AcH  peak is dwarfed by the much larger the contiguous Hb A 1c  peak and integration of the Hb A 1-AcH  peak is prevented. 
     SUMMARY OF THE INVENTION 
     The present invention provides a method for achieving improved resolution of hemoglobin peaks and particularly the Hb A 1-AcH  peak and thereby provides improved quantitation of AcH adducts of Hb and a more reliable test useful in the diagnosis of alcohol abuse and monitoring alcoholism treatment for resumed drinking. This invention solves the problems in the Sillanaukee assay by offering an improved resolution of the Hb A 1-AcH  peak from the contiguous Hb A 1c  peak. In accordance with the invention, by using a polyaspartic acid chromatographic column and a non-linear buffer gradient elution of the Hb A 1c  complex can be controlled such that this complex is a reliable marker for alcohol abuse. This invention solves the Homaidian problem by providing a method by which clinicians can use acetaldehyde-hemoglobin adducts as an indicator of alcohol consumption. This invention is more reliable than previous methods because the Hb A 1-AcH  peak is measured independently of the Hb A 1c  peak and the Hb A 1-AcH  peak is directly tied to alcohol consumption. Finally, this method can detect changes in hemoglobin peaks using AcH concentrations in the micromolar range which corresponds to AcH blood levels during heavy alcohol consumption. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a graph of absorbance versus time at 415 nm and the Buffer A gradient versus time for a chromatogram of a hemosylate prepared from the blood sample of one alcoholic subject admitted with a blood alcohol level (BAL) greater than 200 mg/dL. 
     FIG. 2 is a graph of absorbance versus time at 415 nm and the buffer gradient for a chromatogram of a hemosylate prepared from a control blood sample. 
     FIG. 3 is a graph of absorbance versus time at 415 nm for a chromatogram of a hemosylate prepared from a control blood sample of FIG. 2 after incubation of the sample with 300 μM of acetaldehyde (AcH) for 15 min. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     FIG. 1 is a liquid chromatograph of a blood sample for a patient, diagnosed as an alcoholic, in which hemoglobin peaks have been identified showing the resolution of the Hb A 1-AcH  from the Hb A 1c  complex. All references to hemoglobin peaks, e.g. Hb A 1-AcH  and Hb A 1c , herein, are made with reference to the labelled peaks in FIG. 1. 
     FIGS. 2 and 3 show a comparison of chromatogram from a non-drinking control subject (FIG. 2) and the same hemosylate after incubation at 37° C. for 15 min. with 300 μM AcH (FIG. 3). As can be seen, the addition of AcH causes a marked increase in the peak designated as Hb A 1-AcH . Increases in the relative percentage of hemoglobins can be detected at 2 peaks within the Hb A 1a+b  cluster as well as the Hb pre-A 1c  peak and the Hb A 1d3  peak. Corresponding decreases are seen in the Hb A 1c  and Hb A 0  peaks after incubation with Ach. 
     In accordance with the invention, blood is collected from the subject to be tested and washed twice with a sodium chloride solution. The blood is then centrifuged to separate the red blood cells from the plasma. In order to eliminate the effects of short-term drinking on the test and thereby reduce the incidence of false positives, it is necessary to remove labile Schiff bases from the sample. These bases are unstable Hb AcH complexes which are formed in the blood and associated with the metabolism of alcohol. These bases can be found in the blood of any subject which has consumed alcohol and are not associated with chronic alcohol usage. While not desiring to be bound, these complexes are believed to be held together by weak intermolecular forces. With chronic excessive use of alcohol, the bonds forming these complexes are believed to convert to stronger, less labile, possibly covalent bonds. The labile bases can be removed by incubating the red blood cells in a sodium acetate buffer and then centrifuging to sediment the red blood cells. Incubation of AcH-incubated hemosylates with sodium acetate buffer for 30 min. at 37° C. completely removes the Hb pre-A 1c  as expected for unstable Schiff bases as shown in Table 1. This same treatment reduces the Hb A 1cH  and Hb A 1d3  peaks by approximately 50%, indicating that, at least under these conditions, some of the acetylated products represent reversibly bound Schiff bases. 
     
                       TABLE 1______________________________________Effect of sodium acetate buffer removal of unstable Schiff baseAcH-hemoglobin adducts after incubation with 1000 μM AcHfor 30 min. (% of Total peak area - avg. of 3 detm&#39;ns.)       With Na Acetate                    Without NaHb Peak     Buffer       Acetate Buffer______________________________________Hb A.sub.1a+b (1)       0.900        0.889Hb A.sub.1a+b (2)       0            1.050Hb A.sub.1-AcH       0.560        1.623Pre-HbA.sub.1c       0            1.078Hb A.sub.1c 3.363        3.140Hb A.sub.1d3       4.859        8.750Hb A.sub.0  85.344       79.303______________________________________ 
    
     After removing the labile complex, the red blood cells are hemolyzed with an equal volume of water and 0.4 volumes of carbon tetrachloride, vortexing, and shaking. The sample is then centrifuged to separate the cellular debris from the hemoglobin in the supernatant. The concentration of the hemoglobin is determined by absorbency of the supernatant at 540 nanometers. The samples are then diluted with a buffer solution, frozen, and stored until ready for analysis. 
     Before injection onto the column, the samples are preferably filtered through a 0.2 micron filter. The HPLC column is washed with a mixture of buffer solutions. During the HPLC, a nonlinear buffer gradient is employed as described below. The effluent absorbency is typically monitored at 415 nanometers. Upon completion of the HPLC, the column is washed with Buffer A and recycled to the initial buffer ratio. 
     To diagnose alcohol abuse, chronic usage or alcoholism, the amount of Hb A 1-Ach  complex as a percentage of the total hemoglobin A complex is measured. Studies have shown that totally abstaining non-alcoholic drinkers typically have Hb A 1-Ach  mean levels of about 0.058%±0.056% S.D. Adding two standard deviations to the mean, a level of 0.176% or more of Hb A 1-Ach  complex is considered a reliable threshold indication of chronic alcohol use. Typically alcoholics will exhibit levels of Hb A 1-AcH  complex of about 0.2% or greater. 
     The invention is illustrated in more detail by the following non-limiting examples. 
     Examples 
     Sample Preparation: 
     Human blood is collected in an EDTA Vacutainer. The sample is then washed twice with 0.9% sodium chloride solution. To separate the red blood cells from the plasma, the sample is centrifuged for ten minutes at 1000×G. Schiff bases are removed by first incubating the red blood cells for thirty minutes at 37° C. with a sodium acetate buffer having a pH =5.5 and then centrifuging the samples at 2,000×G for ten minutes to sediment the red blood cells. The sodium acetate buffer consisted of 0.05M sodium acetate trihydrate and 0.11M sodium chloride adjusted to pH =5.5 with 2M acetate acid. The red blood cells are then hemolyzed by adding an equal volume of water and 0.4 volumes of carbon tetrachloride, vortexing the solution for five seconds, and shaking for 15 minutes. To separate cellular debris from hemoglobin in the supernatant, the samples are centrifuged at 2,000×G for 15 minutes. The concentration of hemoglobin in the samples can be determined by the absorbency of the supernatant, diluted 1:100, at a wavelength of 540 nanometers. 
     The samples are diluted to 2 mg/ml with a third buffer (Buffer B). This buffer consisted of 3 mM Bis Tris, 3 mM ammonium acetate, and 1.5 mM potassium cyanide, adjusted to pH =6.6 with 20% acetic acid. The diluted samples were frozen at -30° C. , and stored until ready for chromatography. Before injection onto the column, all samples are filtered through a two micron filter. 
     HPLC of samples: 
     Separation of the hemoglobins was accomplished using a polyCAT A column (a cation exchange column packed with polyaspartic acid covalently bonded to silica) 200 mm ×6 mm in diameter. The packing consisted of 5 μm particles with a 1,000 angstrom pore size. The column is protected by a guard cartridge having the same packing. The column and the guard cartridge were purchased from PolyLC Inc. of Columbia, Md. 
     The flow rate of the column is 2 ml/minute at a pressure of 100 atmospheres. The effluent absorbency is monitored at 415 nanometers using a Varian Star 9010 HPLC with a Varian variable wavelength detector connected to a Hewlett Packard HP 339A integrator. The integrations are preformed at an attenuation of 2↑=0 with a chart speed of 0.3 cm/min. and a peak width =0.64 min. 
     Before each run the column is conditioned with a 28:72 mixture of Buffer A:Buffer B. Buffer A consisted of 35 mM bis[2-hydroxyethyl]amino-tris-[hydroxymethyl] methane (Bis Tris), 16.85 mM ammonium acetate, 90 mM sodium acetate, and 1.5 mM potassium cyanide, adjusted to pH =6.8 with 20% acetic acid. From time (T) T=0 to T=15 minutes, the A:B buffer ratio is maintained at 28:72. From T=15 to T=43 minutes, the buffer ratio is increased to 100:0 using a nonlinear gradient as shown in FIG. 1 and in the following table: 
     
         ______________________________________Time            % Buffer A                     % Buffer B______________________________________T = 0 to T = 15 28        72T = 15 to T = 26           43        57T = 26 to T = 36           50        50T = 36 to T = 42           80        20T = 42 to T = 43           100        0______________________________________ 
    
     After the chromatogram is completed, the column is washed with 100% Buffer A for five minutes and then recycled to 28:72 before the next run. 
     Having described the invention in detail and by reference to preferred embodiments thereof, it will be apparent that modifications and variations are possible without departing from the scope of the invention defined in the appended claims.