The challenge of breath analysis for clinical diagnosis and therapeutic monitoring

Breath analysis by optical fiber sensor for the determination of exhaled organic compounds with a view to diagnostics

Breath analysis constitutes a promising tool in clinical and analytical fields due to its high potential for non-invasive diagnostics of metabolic disorders and monitoring of disease status. An optical fiber (OF) sensor has been developed for determination of volatile organic compounds (ethane, pentane, heptane, octane, decane, benzene, toluene and styrene) in human breath for clinical diagnosis. The analytical system developed showed a high performance for breath analysis, inferred for the analytical signal intensity and stability, linear range, and detection limits ranging from 0.8 pmol L(-1), for heptane, and to 9.5 pmol L(-1), for decane. The OF sensor also showed advantageous features of near real-time response and low instrumentation costs, besides showing an analytical performance equivalent to the breath analysis by gas chromatography-mass spectrometry (GC-MS), used as the reference method.

Novel sensing materials for breath analysis devices

The development of new transition metal complexes (TMCs) sensing materials, based on di-rhodium (II,II) complexes with a lantern structure, is investigated. Specifically, in this work is reported a study carried out with the Rh2(form)4 complex having the formamidinate (form = N.N-p-tolylformamidinate anion) bridging ligand in the equatorial positions. Thick films of the complex have been deposited on interdigitated alumina substrate and their electrical characteristics have been evaluated. Rh2(form)4 behaves as a p-type semiconductor, showing a large decrease in forward and reverse current in presence of ammonia vapors in air. The preliminary results reported promise a practical application of the developed devices in the breath analysis for clinical diagnostics.

Breath analysis using laser spectroscopic techniques: breath biomarkers, spectral fingerprints, and detection limits

Breath analysis, a promising new field of medicine and medical instrumentation, potentially offers noninvasive, real-time, and point-of-care (POC) disease diagnostics and metabolic status monitoring. Numerous breath biomarkers have been detected and quantified so far by using the GC-MS technique. Recent advances in laser spectroscopic techniques and laser sources have driven breath analysis to new heights, moving from laboratory research to commercial reality. Laser spectroscopic detection techniques not only have high-sensitivity and high-selectivity, as equivalently offered by the MS-based techniques, but also have the advantageous features of near real-time response, low instrument costs, and POC function. Of the approximately 35 established breath biomarkers, such as acetone, ammonia, carbon dioxide, ethane, methane, and nitric oxide, 14 species in exhaled human breath have been analyzed by high-sensitivity laser spectroscopic techniques, namely, tunable diode laser absorption spectroscopy (TDLAS), cavity ringdown spectroscopy (CRDS), integrated cavity output spectroscopy (ICOS), cavity enhanced absorption spectroscopy (CEAS), cavity leak-out spectroscopy (CALOS), photoacoustic spectroscopy (PAS), quartz-enhanced photoacoustic spectroscopy (QEPAS), and optical frequency comb cavity-enhanced absorption spectroscopy (OFC-CEAS). Spectral fingerprints of the measured biomarkers span from the UV to the mid-IR spectral regions and the detection limits achieved by the laser techniques range from parts per million to parts per billion levels. Sensors using the laser spectroscopic techniques for a few breath biomarkers, e.g., carbon dioxide, nitric oxide, etc. are commercially available. This review presents an update on the latest developments in laser-based breath analysis.

Evaluation of selected-ion flow-tube mass spectrometry for the measurement of ethanol, methanol and isopropanol in physiological fluids: effect of osmolality and sample volume

Selected-ion flow-tube mass spectrometry (SIFT-MS) is particularly suited for the analysis of volatile low molecular weight compounds. We have evaluated this technique for the assay of different alcohols in aqueous solutions, including blood plasma, and in particular whether the osmolality or sample volume affected vapourisation. Solutions of three different alcohols (methanol, ethanol and isopropanol) ranging from 0.005 to 50 mmol/L were prepared in deionised water (0 milliosmol), phosphate-buffered saline (690 mOsm), isotonic saline (294 mOsm) and plasma (296 mOsm). The vapour above the sample (50 to 1000 microL) contained in air-tight tubes at 37 degrees C was aspirated into the instrument. The outputs for ethanol, methanol and isopropanol were linear over the concentration range and independent of the sample volume and relatively independent of the osmolar concentration. SIFT-MS can reliably and accurately measure common alcohols in the headspace above aqueous solutions, including serum/plasma. This novel application of SIFT-MS is easy to follow, requires no sample preparation and the wide dynamic range will facilitate measurement of alcohols present from normal metabolism as well as when taken in excess or in accidental poisoning.

Development of extractive electrospray ionization ion trap mass spectrometry for in vivo breath analysis

In metabolomics studies and clinical diagnosis, interest is increasing in the rapid analysis of exhaled breath. In vivo breath analysis offers a unique, unobtrusive, non-invasive method of investigating human metabolism. To analyze breath in vivo, we constructed a novel platform of extractive electrospray ionization (EESI) ion trap mass spectrometry (ITMS) using a home-made EESI source coupled to a linear trap quadrupole mass spectrometer. A reference compound (authentic n-octyl amine) was used to evaluate effects of systematically varying selected characteristics of the EESI source on signal intensity. Under the optimized working conditions, metabolic changes of human bodies were in vivo followed by performing rapid breath analysis using the multi-stage EESI-ITMS tandem mass spectrometry platform. For nicotine, a limit of determination was found to be 0.05 fg mL(-1) (S/N = 3, RSD = 5.0 %, n = 10) for nicotine in aerosol standard samples; the dynamic response range was from 0.0155 pg mL(-1) to 155 pg mL(-1). The concentration of nicotine in the exhaled breath of a regular smoker was in vivo determined to be 5.8 pg mL(-1), without any sample pre-treatment. Our results show that EESI-ITMS is a powerful analytical platform to provide high sensitivity, high specificity and high throughput for semi-quantitative analysis of complex samples in life science, particularly for in vivo metabolomics studies.

Acetone, butanone, pentanone, hexanone and heptanone in the headspace of aqueous solution and urine studied by selected ion flow tube mass spectrometry

Urine is commonly analysed in clinical practice by a variety of liquid-phase techniques to check for excessive ketone bodies, proteins and salts to name just a few compounds. However, little work has been carried out to measure the volatile compounds emitted by urine since these do not yet have an established role in clinical diagnosis. There is, however, a growing body of evidence that these volatile compounds can be indicators of adverse physiological conditions and disease and with the advent of sensitive gas-phase analytical methods they can be quickly quantified in urine headspace and potentially provide valuable support for clinical diagnosis. Thus, we are developing selected ion flow tube mass spectrometry, SIFT-MS, for the real-time analysis of urine headspace, ultimately to support rapid diagnosis in the clinical environment. In this paper we focus on volatile ketones in the headspace of aqueous solutions and urine donated by three healthy volunteers. Using SIFT-MS, we have unambiguously quantified in urine headspace acetone, by far the most abundant ketone, butanone, pentanone, hexanone and heptanone using NO(+) precursor ions. Further to this, we have determined the Henry's Law coefficients, HLC, for these ketones in aqueous solution to allow the liquid-phase concentrations in urine to be estimated from headspace levels of their vapours. In addition, the influence of the addition of physiological amounts of dissolved urea, sodium chloride and hydrochloric acid on the partitioning of these ketones between the aqueous phase and gas phase has been investigated and found to be small, which gives greater credence to the use of the HLC obtained using aqueous solutions for the estimation of ketone concentrations in urine. Finally, parallel measurements of the levels of acetone in exhaled breath and urine headspace have been obtained and shown to be very similar, which gives support to the previous deduction from breath analysis that acetone is a truly systemic compound.

Analysis of breath, exhaled via the mouth and nose, and the air in the oral cavity

Analyses have been performed, using on-line selected ion flow tube mass spectrometry (SIFT-MS), of the breath of three healthy volunteers, as exhaled via the mouth and the nose and also of the air in the oral cavity during breath hold, each morning over a period of one month. Nine trace compounds have been quantified and concentration distributions have been constructed. Of these compounds, the levels of acetone, methanol and isoprene are the same in the mouth-exhaled and the nose-exhaled breath; hence, we deduce that these compounds are totally systemic. The levels of ammonia, ethanol and hydrogen cyanide are much lower in the nose-exhaled breath than in the mouth-exhaled breath and highest in the oral cavity, indicating that these compounds are largely generated in the mouth with little being released at the alveolar interface. Using the same ideas, both the low levels of propanol and acetaldehyde in mouth-exhaled breath appear to have both oral and systemic components. Formaldehyde is at levels in mouth- and nose-exhaled breath and the oral cavity that are lower than that of the ambient air and so its origin is difficult to ascertain, but it appears to be partially systemic. These results indicate that serious contamination of alveolar breath exhaled via the mouth can occur and if breath analysis is to be used to diagnose metabolic disease then analyses should be carried out of both mouth- and nose-exhaled breath to identify the major sources of particular trace compounds.

Sub-parts per billion detection of trace volatile chemicals in human breath using selected ion flow tube mass spectrometry

Background

Selected ion flow tube mass spectrometry (SIFT-MS) allows the real time quantification of trace gases in air. Due to its tolerance of high humidity levels the technique is particularly suited to the chemical analysis of breath. The detection limit of SIFT-MS has previously reported to be approximately 5 – 10 PPBV which is insufficient for the measurement of some low abundance constituents of breath. Recent developments in the design of SIFT-MS instruments have increased the ion precursor count rates. It is, however, unclear as to how these advances will affect instrument sensitivity for breath analysis.

Findings

Standard gases were prepared by adding known quantities of compounds present at zero or very low levels in breath (xylene and toluene) to either humidified bottled air or actual human breath. These were then analysed by SIFT-MS to calculate the limits of detection for each compound under conditions which mimic a single breath exhalation. For xylene and toluene the limits of detection was approximately 0.5 PPBV per 10 seconds of analysis time. Results gained using this level of sensitivity suggested the presence of low levels of the compounds indole and methylindole in human alveolar and static oral air, although further studies are necessary to confirm these findings.

Conclusion

Recent advances in SIFT-MS have increased the techniques sensitivity for breath analysis into the sub PPBV range enabling the real time quantification of low level trace gases in human breath.