Baby's first stool may provide clues to fetal alcohol exposure, WSU School of Medicine study finds

Fetal alcohol exposure is usually determined through self-reported maternal consumption, an often unreliable measure that can lead to detrimental delays in identifying and treating children who are affected by fetal-alcohol syndrome. But Wayne State University School of Medicine researchers have found that the presence of certain fatty acid ethyl esters (FAEEs) in a baby's first stool may provide a dependable biomarker of fetal alcohol exposure.

Results are published in the July 2006 issue of Alcoholism: Clinical & Experimental Research .

“There are only a few biomarkers that indicate if an infant has been exposed to alcohol during pregnancy, and most of them are not strictly associated with alcohol use,” said Enrique M. Ostrea, Jr., professor of pediatrics at Wayne State University . “In this study, we have found a direct association between the presence of certain FAEEs and alcohol use.” Dr. Ostrea is also the corresponding author for the study.

When people drink alcohol, it combines with certain fats in the body known as fatty acids, and FAEEs are formed. These “markers” are either deposited in tissues or, in the case of a growing fetus, in fetal urine or meconium, a baby's first stool.

“People characteristically underreport the amount of alcohol they drink,” said Michael Laposata, director of clinical laboratories at the Massachusetts General Hospital and professor of pathology at Harvard Medical School . “One can measure blood alcohol but it disappears from the blood relatively quickly after drinking stops, so only very recent intake can be documented. FAEEs are ‘long-term markers' of alcohol intake because they stay much longer in blood than alcohol itself and, in this case, accumulate in meconium.”

For this study, researchers examined 124 mother/infant pairs. Based on self reports, 93 of the mothers had consumed alcohol during pregnancy, and 31 had not. FAEEs were analyzed in the infants' meconium by a highly sensitive and specific method called positive chemical ionization gas chromatography/mass spectrometry. Results were correlated to maternal alcohol use during pregnancy.

The presence of FAEE ethyl linoleate in meconium is highly indicative of fetal exposure to alcohol during pregnancy, Dr. Ostrea said. The incidence of ethyl linoleate in meconium was found to be significantly higher in the alcohol-exposed group when compared to the control group. There was also a significant association between alcohol exposure and group concentrations of ethyl linoleate. Furthermore, the highest ethyl-linoleate concentration was only found in the alcohol-exposed infants.

Dr. Ostrea said the results also suggest that FAEEs ethyl arachidonate and docosahexanoate may have potential as biomarkers of alcohol effects on the developing fetal brain. Because these FAEEs are key to the formation of certain compounds required in retinal and brain development, alcohol exposure may interfere in the synthesis of these compounds, potentially resulting in mental retardation.

“This is an important report,” said Laposata. “The measurements of the FAEEs are exceedingly well done. However, the test is only able to identify about one quarter of the mothers who ingest alcohol during pregnancy.”

He suggested that testing expectant mothers for alcohol intake prior to delivery would have more merit than testing meconium after birth because an objective identification of alcohol intake during pregnancy could lead to intervention, possible cessation of drinking and a better outcome for the fetus. “We have an obvious need to check mothers during pregnancy before damage to the fetus is done,” he said.

Until that transpires, Dr. Ostrea said, “Our manuscript is supportive of the validity of using FAEEs as biomarkers of prenatal alcohol exposure. This would allow early identification and treatment for children born with fetal alcohol effects who might otherwise not be recognized, particularly if the mother does not admit to drinking.”

Alcoholism: Clinical & Experimental Research is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the paper, “Fatty acid ethyl esters in meconium: Are they biomarkers of fetal alcohol exposure and effect?,” were: Joel D. Hernandez, Dawn M. Bielawski, Jack M. Kan, Gregorio M. Leonardo, Michelle Buda Abela, Michael W. Church, John H. Hannigan, Robert J. Sokol, James J. Janisse and Joel W. Ager. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

 

The Kresge Foundation recently awarded the Wayne State University School of Medicine $3 million to support construction of the Richard J. Mazurek, M.D., Medical Education Commons. But it comes with a challenge: The school must raise the balance of the project by July 1, 2007.

To date, $13 million has been raised toward the total project goal of $30 million as the university gears up for the second phase of its "Wayne First" capital fundraising campaign. Many generous donors have already dedicated their support; to help make a difference in this important effort, please contact Patty Paquin at ppaquin@med.wayne.edu.

"This challenge by The Kresge Foundation shows a great deal of confidence in the School of Medicine's fundraising capabilities.” said Robert M. Mentzer, Jr., M.D., dean of Wayne State University's School of Medicine. "The Richard J. Mazurek, M.D., Medical Education Commons will provide a much-needed academic center for students, faculty, alumni and the community. It will house world-class programs and technologies that will educate and inspire the next generation of physicians."

The 34,000-square-foot, two-story complex will be the nucleus of all programs for undergraduate, graduate and continuing education in the School of Medicine. Students will have “one-stop shopping” for all administrative, support and learning services.

Community residents will benefit from other resources available through the Commons such as educational programs, health information services and the commitment of Wayne State medical students to services for those in need.

The Kresge Foundation is a national foundation with $3 billion in assets. Through its grant making programs, The Kresge Foundation seeks to strengthen nonprofit organizations by catalyzing their growth, connecting them to their stakeholders, and challenging greater support through grants.

The foundation's core grant making activity is its Capital Challenge Grants program. In this program, the foundation focuses on opportunities to strengthen leadership and giving through challenge grants for capital projects. Projects supported include the construction and renovation of facilities, acquisition of property and purchase of equipment. Grant recipients have raised initial funds toward their respective projects before requesting foundation support. Kresge grants are then made on a challenge basis -- requesting the raising of the remaining balance -- by a deadline.

 

Uzoma Azuh, a 22-year-old Wayne State University School of Medicine student, is looking for someone to help save his life. Diagnosed with acute myeloid leukemia, Mr. Azuh is undergoing chemotherapy to stave off the disease until a matching bone-marrow donor can be found for a transplant.

Two drives to register with the National Marrow Donor Program will be held this Saturday:

• 9 a.m. to 3 p.m., Smith Chapel A.M.E. Church, 3505 Walnut, Inkster, Mich.; and
• Noon to 6 p.m., Charles H. Wright Museum of African-American History, 315 E. Warren Ave., Detroit.

Many members of the WSU School of Medicine community have joined the National Marrow Donor Program Registry since Mr. Azuh was diagnosed; however, to improve Mr. Azuh's chances of finding a matching donor, more people are needed to participate in upcoming drives. In addition, financial donations to defray costs associated with tissue testing in Nigeria are being accepted.“

Joining the registry requires a non-invasive cheek swab.

In addition, Mr. Azuh's family is sending kits to test for tissue matches to Nigeria. The cost of each kit is $210. To make a donation toward the cost of this effort, please visit http://www.donorcorner.com/ and click on the link for "Uzo's Donation" on the lower right-hand side of the page. Checks also may be mailed to: Uzoma Azuh Fund, c/o Issele Association of North America, Detroit Chapter, 1614 Old Salem, Plymouth MI 48170.

The characteristics that determine whether a patient and donor match are inherited, so the most likely match is with a sibling. However, 70 percent of patients will not find a suitable matching donor in their family.

These patients can turn to the volunteer marrow and blood cell adult donors and cord blood units listed on the NMDP Registry – the largest source for all types of blood and marrow cells available for unrelated transplants. Although it is possible for a patient to match a donor from any racial or ethnic group, the most likely match is someone from a similar background. Mr. Azuh is African American.

“More people from diverse backgrounds are needed on the NMDP Registry, so all patients in need can have a second chance at life,” Ms. Rozier said.

Each year, thousands of patients are diagnosed with life-threatening blood diseases such as leukemia. For a chance to survive, these patients need healthy marrow and blood cells to help their bodies make new, healthy marrow.

The first step to becoming a donor is to join the NMDP Registry. Anyone age between the ages of 18 and 60 who meets the health guidelines can join. Volunteers should be committed to helping any patient in need. To join, volunteers complete a short health questionnaire and sign a form stating that they understand what it means to be listed on the NMDP Registry. Then, a small swab of cheek cells is taken to determine the tissue type to be matched against patients who need a donor. This information is added to the NMDP Registry.

The NMDP facilitates unrelated marrow and blood cell transplants as the hub for a long-standing collaborative network of national and international leading medical facilities in blood and marrow transplantation. The NMDP connects patients, doctors, donors and researchers to the resources they need to help more people live longer and healthier lives.

For more information about marrow and blood cell donation, contact the Great Lakes Region donor center in Detroit at (313) 833-2647, (313) 833-2624 or the NMDP at 1-800-MARROW-2. Online information is available at www.marrow.org/thanks .

Wayne State University School of Medicine sent 249 new physicians into the world Tuesday, June 6. Held this year at Detroit's Fox Theatre, the ceremonies marked the first commencement for Dean Robert M. Mentzer, Jr. The keynote speaker was Richard S. Stack, M.D., a leading expert on cardiovascular disease and president of Synecor, a business incubator designed to bring new medical devices to the market. In addition, Executive Vice Dean Robert R. Frank, M.D., was honored with a Distinguished Service Award for his three decades of continuous service to the WSU School of Medicine.

Dean Robert M. Mentzer, Jr., recently announced the appointment of Darius R. Mehregan, M.D., as chair of the Wayne State University Department of Dermatology. Dr. Mehregan, who has served as a clinical assistant professor in the department for 12 years, is a dermatopathologist for the well-respected Pinkus Laboratory, in Monroe , Mich.

“I am confident that Dr. Mehregan is the right person to lead the department to a new level of excellence,” Dean Mentzer said. “Dr. Mehregan will work to diversify the department through aggressive faculty recruitment. He also plans to reach out to voluntary faculty in the community to rebuild and fortify relationships that have long been integral to the department's ability to provide quality education to medical students and residents.”

David A. Mehregan, M.D., to lead educational, residency programs

In addition, David A. Mehregan, M.D., another longtime clinical assistant professor in the department, has been named associate chair and residency program director. David Mehregan, Darius's brother, will work to streamline and strengthen educational programming, particularly for the 12 residents enrolled in the department's three-year program.

The Mehregans have each authored more than 50 papers, chapters and books within the field of dermatology. They also serve as associate editors for the International Journal of Dermatology .

Darius Mehregan, a graduate of the University of Michigan 's Medical School , completed an internship in internal medicine at UM Hospitals before serving out his residency in the Mayo Clinic's Department of Dermatology. In 1993, he completed a fellowship in dermatopathology at New York University .

David Mehregan graduated from the WSU School of Medicine before completing an internship at William Beaumont Hospital , in Royal Oak . He served his residency and dermatopathology fellowship at the Mayo Clinic.

The Mehregans have served as co-directors of the American Society of Dermatopathology Quality Assurance Program and are members of numerous professional societies, including the American and International societies of dermatopathology, the Society of Investigative Dermatology, the International Society of Dermatology and the American Academy of Dermatology.

 

Robert R. Frank, M.D., executive vice dean, will be honored at Tuesday's commencement ceremonies with a Distinguished Service Award for his three decades of continuous service to the WSU School of Medicine.

The ceremonies, at which 249 students will become medical doctors, will be at 2 p.m., Tuesday, June 6, in the Detroit's Fox Theatre. The keynote speaker will be Richard S. Stack, M.D., a leading expert on cardiovascular disease and president of Synecor, a business incubator designed to bring new medical devices to the market.

Dr. Frank has dedicated his entire career to the school, and his experiences over the years has run the gamut: as a student, resident, faculty physician and even as interim dean.

During his tenure as interim dean, Dr. Frank's steady guidance was essential to maintaining and enhancing the institution's role as a leader in medical education, research and patient care. With the implementation of his “Make a Difference” campaign, Dr. Frank brought stability, positive energy and a heightened sense of morale to students, faculty and administration.

Dr. Frank's message has not strayed from the beliefs he carried early in his medical career: to stay true to the well-being of patients; to deal with the pressure of economic survival, but never at the expense of good care; and to be socially responsible.