Non-separative mass spectrometry methods for non-invasive medical diagnostics based on volatile organic compounds: A review

Metabolic trajectories of diabetic ketoacidosis onset described by breath analysis

Purpose

This feasibility study aimed to investigate the use of exhaled breath analysis to capture and quantify relative changes of metabolites during resolution of acute diabetic ketoacidosis under insulin and rehydration therapy.

Methods

Breath analysis was conducted on 30 patients of which 5 with DKA. They inflated Nalophan bags, and their metabolic content was subsequently interrogated by secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS).

Results

SESI-HRMS analysis showed that acetone, pyruvate, and acetoacetate, which are well known to be altered in DKA, were readily detectable in breath of participants with DKA. In addition, a total of 665 mass spectral features were found to significantly correlate with base excess and prompt metabolic trajectories toward an in-control state as they progress toward homeostasis.

Conclusion

This study provides proof-of-principle for using exhaled breath analysis in a real ICU setting for DKA monitoring. This non-invasive new technology provides new insights and a more comprehensive overview of the effect of insulin and rehydration during DKA treatment.

Increasing the Robustness of SIFT-MS Volatilome Fingerprinting by Introducing Notional Analyte Concentrations

Selected ion flow tube-mass spectrometry (SIFT-MS) is an analytical technique for volatile detection and quantification. SIFT-MS can be applied in a "white box" approach, measuring concentrations of target compounds, or as a "black box" fingerprinting technique, scanning all product ions during a full scan. Combining SIFT-MS full scan data acquired from multibatches or large-scale experiments remains problematic due to signal fluctuation over time. The standard approach of normalizing full scan data to the total signal intensity was insufficient. This study proposes a new approach to correct SIFT-MS fingerprinting data. In this concept, all of the product ions from a full scan are considered individual compounds for which notional concentrations can be calculated. Converting ion count rates into notional analyte concentrations accounts for any changes in the instrument parameters. The benefits of the proposed approach are demonstrated on three years of data from both multibatches and long-term experiments showing a significant reduction of system-induced fluctuations providing a better focus on the changes of interest.

Online mass spectrometry of exhaled breath with a modified ambient ion source

Exhaled breath (EB) may contain metabolites that are closely related to human health conditions. Real time analysis of EB is important to study its true composition, however, it has been difficult. A robust ambient ionization mass spectrometry method using a modified direct analysis in real time (DART) ion source was developed for the online analysis of breath volatiles. The modified DART ion source can provide a confined region for direct sampling, rapid transmission and efficient ionization of exhaled breath. With different sampling methods, offline analysis and near real-time evaluation of exhaled breath were also achieved, and their unique molecular features were characterized. High resolution MS data aided the putative metabolite identification in breath samples, resulting in hundreds of volatile organic compounds being identified in the exhalome. The method was sensitive enough to be used for monitoring the breath feature changes after taking different food and over-the-counter medicine. Quantification was performed for pyridine and valeric acid with fasting and after ingesting different food. The developed method is fast, simple, versatile, and potentially useful for evaluating the true state of human exhaled breath.

Non-invasive Exhaled Breath and Skin Analysis to Diagnose Lung Cancer: Study of Age Effect on Diagnostic Accuracy

Development of simple, fast, and non-invasive tests for lung cancer diagnostics is essential for clinical practice. In this paper, exhaled breath and skin were studied as potential objects to diagnose lung cancer. The influence of age on the performance of diagnostic models was studied. Gas chromatography in combination with mass spectrometry (MS) was used to analyze the exhaled breath of 110 lung cancer patients and 212 healthy individuals of various ages. Peak area ratios of volatile organic compounds (VOCs) were used for data analysis instead of VOC peak areas. Various machine learning algorithms were applied to create diagnostic models, and their performance was compared. The best results on the test data set were achieved using artificial neural networks (ANNs): classification of patients with lung cancer and young healthy volunteers: 88 ± 4% sensitivity and 83 ± 3% specificity; classification of patients with lung cancer and old healthy individuals: 81 ± 3% sensitivity and 85 ± 1% specificity. The difference between performance of models based on young and old healthy groups was minor. The results obtained have shown that metabolic dysregulation driven by the disease biology is too high, which significantly overlaps the age effect. The influence of tumor localization and histological type on exhaled breath samples of lung cancer patients was studied. Statistically significant differences between some parameters in these samples were observed. A possibility of assessing the disease status by skin analysis in the Zakharyin-Ged zones using an electronic nose based on the quartz crystal microbalance sensor system was evaluated. Diagnostic models created using ANNs allow us to classify the skin composition of patients with lung cancer and healthy subjects of different ages with a sensitivity of 69 ± 2% and a specificity of 68 ± 8% for the young healthy group and a sensitivity of 74 ± 7% and a specificity of 66 ± 6% for the old healthy group. Primary results of skin analysis in the Zakharyin-Ged zones for the lung cancer diagnosis have shown its utility, but further investigation is required to confirm the results obtained.

Protonation induced redshift in the fluorescence of a pyridine derivative as a potential anti-counterfeiting agent

A simple pyridine-based compound, i.e. (2,4,6-tris(4-(hexyloxy)phenyl)pyridine), was synthesized and exhibited excellent solubility in various organic solvents owing to the presence of three 4-n-hexyloxy chains in its molecular structure. Further, we studied the effect of various solvents on its absorption and emission properties. We observed a greater extent of redshift in the chloroform solvent compared to the rest of the solvents. In fact, the observed redshift was attributed to protonation of the pyridine moiety by HCl (present due to the oxidative photo-decomposition of chloroform) in the solvent. Therefore, we also studied the acidochromic properties of the compound using acetic acid (AA), trifluoroacetic acid (TFA), and hydrochloric acid (HCl). We found that the compound sensed the HCl vapor much more efficiently than the TFA and AA vapours. Additionally, DFT analysis suggested a narrow theoretical bandgap for the protonated molecule when compared to the neutral molecule, explaining the redshift in the absorption and emission spectra of the protonated molecule. Furthermore, the compound exhibited a good level of aggregation induced enhanced emission (AIEE) in the THF-water system. In fact, compounds showing both AIEE and acidochromism are rarely reported in the literature. Finally, we employed it as an anti-counterfeiting agent based on its acid-base vapour sensing capability.

Quantitative Analysis of Exhaled Breath Collected on Filter Substrates via Low-Temperature Plasma Desorption/Ionization Mass Spectrometry

Breath analysis has attracted increasing attention in recent years due to its great potential for disease diagnostics at early stages and for clinical drug monitoring. There are several recent examples of successful development of real-time, in vivo quantitative analysis of exhaled breath metabolites via mass spectrometry. On the other hand, current mass spectrometer accessibility limitations restrict point-of-care applications. Here now, an offline method is developed for quantitative analysis of exhaled breath collected on inexpensive filter substrates for direct desorption and ionization by using low-temperature plasma-mass spectrometry (LTP-MS). In particular, different operating conditions of the ionization source were systematically studied to optimize desorption/ionization by using glycerol, a low volatility compound. Applications with respect to propofol, γ-valprolactone, and nicotine analysis in exhaled breath are demonstrated in this study. The effects of several filter substrate properties, including filter material and pore size, on the analyte signal were characterized. Cellulose filter papers performed best with the present analytes. In addition, filters with smaller pores enabled a more efficient sample collection. Furthermore, sample-collection flow rate was determined to have a very significant effect, with slower flow rates yielding the best results. It was also found that filters loaded with sample can be successfully stored in glass vials with no observable sample loss even after 3 days. Limits of detection under optimized conditions are shown to be competitive or significantly better compared with relevant techniques and with additional benefits of cost-efficiency and sample storage capabilities.

Profiling of Urine Carbonyl Metabolic Fingerprints in Bladder Cancer Based on Ambient Ionization Mass Spectrometry

The diagnosis of bladder cancer (BC) is currently based on cystoscopy, which is invasive and expensive. Here, we describe a noninvasive profiling method for carbonyl metabolic fingerprints in BC, which is based on a desorption, separation, and ionization mass spectrometry (DSI-MS) platform with N,N-dimethylethylenediamine (DMED) as a differential labeling reagent. The DSI-MS platform avoids the interferences from intra- and/or intersamples. Additionally, the DMED derivatization increases detection sensitivity and distinguishes carboxyl, aldehyde, and ketone groups in untreated urine samples. Carbonyl metabolic fingerprints of urine from 41 BC patients and 41 controls were portrayed and 9 potential biomarkers were identified. The mechanisms of the regulations of these biomarkers have been tentatively discussed. A logistic regression (LR) machine learning algorithm was applied to discriminate BC from controls, and an accuracy of 85% was achieved. We believe that the method proposed here may pave the way toward the point-of-care diagnosis of BC in a patient-friendly manner.

Qualitative and quantitative determination of butanol in latex paint by fast gas chromatography proton transfer reaction mass spectrometry

Butanol is a common organic solvent used in latex paint, and one of its isomers, tert-butanol, is toxic and can cause potential harm to the human body. Therefore, it is of great significance to develop a qualitative and quantitative detection method for butanol isomers. In this study, we combined the advantages of rapid detection of proton transfer reaction mass spectrometry (PTR-MS) with the separation and qualitative capabilities of gas chromatography-mass spectrometry (GC-MS) to achieve the detection of isomers, building a fast gas chromatography proton transfer reaction mass spectrometry (FastGC-PTR-MS) equipment. Firstly, the developed technology was optimized using standard samples of several common volatile organic compounds. The retention times of acetonitrile, acetone, and alcohols were less than 50 s, and the retention times of the benzene series were less than 110 s, on the premise that these isomers could be basically separated (resolution R > 1.0). Compared with a commercial GC-MS equipment, the detection times were shortened by 5-6 times and 2-4 times, respectively. Then the FastGC-PTR-MS was applied to detect the isomers of butanol in latex paint. The results showed that the headspace of brand D latex paint mainly contained five substances: tert-butanol, n-butanol, acetaldehyde, methanol, and acetone. Tert-butanol and n-butanol could be completely separated (R > 1.5). The concentration of tert-butanol was 4.41 ppmv, far below the 100 ppmv maximum allowable workplace concentration. The developed FastGC-PTR-MS can be used for rapid qualitative and quantitative detection of butanol isomers in latex paint. The new equipment has the potential to play an important role in indoor environmental safety applications.

Changes in the urine volatile metabolome throughout growth of transplanted hepatocarcinoma

Trained detection dogs distinguish between urine samples from healthy organisms and organisms with malignant tumors, suggesting that the volatile urine metabolome contains information about tumor progression. The aim of this study was to determine whether the stage of tumor growth affects the chemical differences in the urine of mice and to what extent the "olfactory image of disease" perceived by dogs coincides with the "image of disease" recorded by the mass spectrometer. We used a novel laser ionization mass spectrometry method and propose a mass spectrometric analysis without detailed interpretation of the spectrum of volatile metabolomes in urine. The mass spectrometer we use works without sample preparation and registers volatile organic compounds in air at room temperature without changing the pH of the sample, i.e. under conditions similar to those in which dogs solve the same problem. The experimental cancer models were male BDF-f1 hybrid mice transplanted with hepatocarcinoma tissue, and similar mice transplanted with healthy liver tissue were used as controls. Our data show that both dogs and our proposed laser mass spectrometry method are able to detect both the entire spectrum of volatile organic compounds associated with the disease and minor changes in this spectrum during its course.

Evaluation of a New DC-Ion Funnel Drift Tube for Use in Proton Transfer Reaction Mass Spectrometry

We have developed and characterized a novel drift tube called the direct current-ion funnel (DC-ion funnel) drift tube, consisting of 20 traditional ring electrodes and 5 new DC-focusing electrodes (DC-FEs) for use in proton transfer reaction mass spectrometry (PTR-MS). Ion trajectory simulations demonstrate the ion focusing effect of the DC-FE and DC-ion funnel drift tube. Further comparative experiments show that the PTR-MS with the novel DC-ion funnel drift tube has a higher sensitivity (3.8-7.3 times for the volatile organic compounds considered in this work) than the PTR-MS with a traditional drift tube. Different from conventional radiofrequency (rf) focusing methods, the DC-ion funnel drift tube can realize ion focusing with only a DC electric field and no additional rf power supply, which makes it especially suitable for instruments requiring miniaturization and low power consumption to improve detection sensitivity. In addition, the DC-ion funnel drift tube can easily be coupled to other types of mass spectrometers to increase their detection sensitivity.

Metabonomics Analysis of Stem Extracts from Dalbergia sissoo

Dalbergia sissoo is a woody plant with economic and medicinal value. As the pharmacological qualities and properties of the wood from this plant primarily depend on its extractives, in this study, the metabolomic analysis of extractives from its stems was carried out using UPLC-MS/MS. A total of 735 metabolites were detected from two groups of samples, heartwood and sapwood, with the largest number of terpenoids in type and the largest number of flavonoids in quantity. The PCA and cluster analysis showed significant differences in the metabolite composition between the two groups. The differential metabolites were mainly organic oxygen compounds, flavonoids, and isoflavones. Among the 105 differential metabolites, 26 metabolites were significantly higher in relative content in sapwood than in heartwood, while the other 79 metabolites were significantly higher in relative content in heartwood than in sapwood. KEGG metabolic pathway enrichment analysis showed that these differential metabolites were mainly enriched in three metabolic pathways: Flavonoid biosynthesis, isoflavonoid biosynthesis, and flavonoid and flavonol biosynthesis. This study provides a reference for metabolomics studies in Dalbergia and other woody plants.

Implementing reactive secondary electrospray ionization based on gas–droplet reactions for VOC analysis

A reactive secondary electrospray ionization method is proposed based on accelerated gas–liquid reactions in microdroplets. It enables online derivatization of volatile organic compounds and can facilitate rapid analysis of these samples.

Method for Accurate Quantitation of Volatile Organic Compounds in Urine Using Point of Collection Internal Standard Addition

A method to achieve accurate measurement of unmetabolized volatile organic compounds (VOCs) in urine was developed and characterized. The method incorporates a novel preanalytical approach of adding isotopically labeled internal standard (ISTD) analogues directly to the collection container at the point of collection to compensate for analyte loss to the headspace and the collection container surfaces. Using this approach, 45 toxic VOCs ranging in water solubility and boiling point were evaluated and analyzed by headspace solid-phase microextraction/gas chromatography-mass spectrometry. Results show that urine VOCs could be equally lost to the container headspace as to the container surface suggesting similarity of these two regions as partition phases. Surface adsorption loss was found to trend with compound water solubility. In particular, with no headspace, more nonpolar VOCs experienced substantial losses (e.g., 48% for hexane) in a standard 120 mL urine cup at concentrations in the low- and sub-ppb range. The most polar VOCs evaluated (e.g., tetrahydrofuran) showed no significant loss. Other commonly practiced methods for urine sample collection and analysis such as aliquoting, specimen freezing, and use of surrogate ISTD were found to significantly bias results. With this method, we achieved errors ranging from -8.0 to 4.8% of spiked urine specimens. Paired urine and blood specimens from cigarette smokers were compared to assess this method.

Real-time versus thermal desorption selected ion flow tube mass spectrometry for quantification of breath volatiles

RATIONALE

Selected ion flow tube mass spectrometry (SIFT-MS) is versatile, rapidly provides result output and determines a wide range of volatiles, making it suitable for biomedical applications. When direct sampling into the SIFT-MS instrument is impractical, combining thermal desorption (TD) and SIFT-MS might offer a solution as it allows sample storage on sorbent tubes for later analysis. This work compares off-line TD SIFT-MS and real-time SIFT-MS for the quantification of selected breath volatiles.

METHODS

Ten healthy non-smoking individuals provided 60 breath samples per method. For off-line analysis, breath was collected onto sorbent tubes via a breath sampler provided with filtered inspiratory air. After TD, samples were re-collected in Tedlar bags which were then connected to the SIFT-MS instrument. For real-time analysis, breath was sampled directly into the instrument. In both cases the analytical method included a total of 155 product ions, and 14 selected volatiles were quantified. The agreement between the methods was assessed using Pearson correlation coefficients and Bland-Altman plots.

RESULTS

Overall, correlations between real-time and off-line analysis were moderate to very strong (r = 0.43-0.92) depending on the volatile of interest, except for 2,3-butanedione and styrene. The difference between real-time and off-line measured breath concentrations (average bias) ranged between -14.57 and 20.48 ppbv. For acetone and isoprene, it was 251.53 and 31.9 ppbv, respectively.

CONCLUSIONS

Real-time SIFT-MS and off-line TD SIFT-MS for quantification of selected breath volatiles did not show optimal agreement. Analyzing a multitude of analytes in breath via direct exhalation into a SIFT-MS instrument for real-time analysis is challenging. On the other hand, off-line analysis using a breath collection device also has its issues such as possible sample losses due to selective absorption depending on the sorbent used or during desorption and transfer to the instrument. Despite these drawbacks, both methods were moderately well correlated.

Analysis of urinary VOCs using mass spectrometric methods to diagnose cancer: A review

The development of non-invasive screening techniques for early cancer detection is one of the greatest scientific challenges of the 21st century. One promising emerging method is the analysis of volatile organic compounds (VOCs). VOCs are low molecular weight substances generated as final products of cellular metabolism and emitted through a variety of biological matrices, such as breath, blood, saliva and urine. Urine stands out for its non-invasive nature, availability in large volumes, and the high concentration of VOCs in the kidneys. This review provides an overview of the available data on urinary VOCs that have been investigated in cancer-focused clinical studies using mass spectrometric (MS) techniques. A literature search was conducted in ScienceDirect, Pubmed and Web of Science, using the keywords "Urinary VOCs", "VOCs biomarkers" and "Volatile cancer biomarkers" in combination with the term "Mass spectrometry". Only studies in English published between January 2011 and May 2020 were selected. The three most evaluated types of cancers in the reviewed studies were lung, breast and prostate, and the most frequently identified urinary VOC biomarkers were hexanal, dimethyl disulfide and phenol; with the latter seeming to be closely related to breast cancer. Additionally, the challenges of analyzing urinary VOCs using MS-based techniques and translation to clinical utility are discussed. The outcome of this review may provide valuable information to future studies regarding cancer urinary VOCs.

Understanding Gas Phase Ion Chemistry Is the Key to Reliable Selected Ion Flow Tube-Mass Spectrometry Analyses

Ion-molecule reactions (IMR) are at the very core of trace gas analyses in modern chemical ionization (CI) mass spectrometer instruments, which are increasingly being used in diverse areas of research and industry. The focus of this Perspective is on the ion chemistry that underpins gas-phase analytical CI methods. Special attention is given to the soft chemical ionization method known as selected ion flow tube-mass spectrometry (SIFT-MS). The processes involved in the ion chemistry of the reagent cations, H₃O⁺, NO⁺, and O₂^+•, and the anions, O^-•, O₂^-•, OH^-, and NO₂^-, are discussed in some detail. Stressed throughout is that an understanding of these processes is mandatory to obtain reliable analyses of humid gaseous media such as ambient air and exhaled breath. It is indicated that further research is needed to understand the consequences of replacing helium in some situations by the more readily available nitrogen as the carrier gas in SIFT-MS.

THE USE OF MASS SPECTROMETRY TO STUDY ZN-METALLOPROTEASE-SUBSTRATE INTERACTIONS

Zinc metalloproteases (ZnMPs) participate in diverse biological reactions, encompassing the synthesis and degradation of all the major metabolites in living organisms. In particular, ZnMPs have been recognized to play a very important role in controlling the concentration level of several peptides and/or proteins whose homeostasis has to be finely regulated for the correct physiology of cells. Dyshomeostasis of aggregation-prone proteins causes pathological conditions and the development of several different diseases. For this reason, in recent years, many analytical approaches have been applied for studying the interaction between ZnMPs and their substrates and how environmental factors can affect enzyme activities. In this scenario, mass spectrometric methods occupy a very important role in elucidating different aspects of ZnMPs-substrates interaction. These range from identification of cleavage sites to quantitation of kinetic parameters. In this work, an overview of all the main achievements regarding the application of mass spectrometric methods to investigating ZnMPs-substrates interactions is presented. A general experimental protocol is also described which may prove useful to the study of similar interactions. © 2020 John Wiley & Sons Ltd. Mass Spec Rev.

Highly selective and sensitive online measurement of trace exhaled HCN by acetone-assisted negative photoionization time-of-flight mass spectrometry with in-source CID

Exhaled hydrogen cyanide (HCN) has been extensively investigated as a promising biomarker of the presence of Pseudomonas aeruginosa in the airways of patients with cystic fibrosis (CF) disease. Its concentration profile for exhalation can provide useful information for medical disease diagnosis and therapeutic procedures. However, the complexity of breath gas, like high humidity, carbon dioxide (CO₂) and trace organic compounds, usually leads to quantitative error, poor selectivity and sensitivity for HCN with some of existing analytical techniques. In this work, acetone-assisted negative photoionization (AANP) based on a vacuum ultraviolet (VUV) lamp with a time-of- flight mass spectrometer (AANP-TOFMS) was firstly proposed for online measurement of trace HCN in human breath. In-source collision-induced dissociation (CID) was adopted for sensitivity improvement and the signal response of the characteristic ion CN^- (m/z 26) was improved by about 24-fold. For accurate and reliable analysis of the exhaled HCN, matrix influences in the human breath including humidity and CO₂ were investigated, respectively. A Nafion tube was used for online dehumidification of breath samples. Matrix-adapted calibration in the concentration range of 0.5-50 ppbv with satisfactory dynamic linearity and repeatability was obtained. The limit of quantitation (LOQ) for HCN at 0.5 ppbv was achieved in the presence of 100% relative humidity and 4% CO₂. Finally, the method was successfully applied for online determination of human mouth- and nose-exhaled HCN, and the nose-exhaled HCN were proved to be reliable for assessing systemic HCN levels for individuals. The results are encouraging and highlight the potential of AANP-TOFMS with in-source CID as a selective, accurate, sensitive and noninvasive technique for determination of the exhaled HCN for CF clinical diagnosis and HCN poisoning assessment.

Real-Time Volatilomics: A Novel Approach for Analyzing Biological Samples

The use of the 'omics techniques in environmental research has become common-place. The most widely implemented of these include metabolomics, proteomics, genomics, and transcriptomics. In recent years, a similar approach has also been taken with the analysis of volatiles from biological samples, giving rise to the so-called 'volatilomics' in plant analysis. Developments in direct infusion mass spectrometry (DI-MS) techniques have made it possible to monitor the changes in the composition of volatile flux from parts of plants, single specimens, and entire ecosystems in real-time. The application of these techniques enables a unique insight into the dynamic metabolic processes that occur in plants. Here, we provide an overview of the use of DI-MS in real-time volatilomics research involving plants.

Profiles of volatile indole emitted by Escherichia coli based on CDI-MS

Escherichia coli is an important pathogen of nosocomial infection in clinical research, Thus, exploring new methods for the rapid detection of this pathogen is urgent. We reported the early release of molecular volatile indole vapour of E. coli cultures and blood cultures analyzed by direct atmospheric corona discharge ionization mass spectrometry (CDI-MS). The concentration of indole in E. coli cultures remarkably increases during the early log and lag phases of bacterial growth, thereby enabling early detection. Technical replicates were cultivated for 3 days for reference diagnosis using current conventional bacteraemia detection. A reference MS screen of common microbes from other genera confirmed that the peaks at m/z 116 signal corresponded to indole were specifically present in E. coli. Our results indicated that volatile indole based on CDI-MS without the need for any sample pretreatment is highly suitable for the reliable and cost-efficient differentiation of E. coli, especially for bacteraemia in humans.

Simultaneous Proton Transfer Reaction-Mass Spectrometry and electronic nose study of the volatile compounds released by Plasmodium falciparum infected red blood cells in vitro

The discovery that Volatile Organic Compounds (VOCs) can be biomarkers for several diseases has led to the conception of their possible application as diagnostic tools. In this study, we aimed at defining of diagnostic signatures for the presence of malaria transmissible stages in infected individuals. To do this, we compared VOCs released by asexual and sexual stage cultures of Plasmodium falciparum, the deadliest species of malaria, with those emitted by uninfected red blood cells (RBCs). VOC analysis was carried out with an innovative set-up, where each sample was simultaneously analysed by proton transfer reaction time of flight mass spectrometry (PTR-ToF-MS) and an electronic nose. PTR-Tof-MS results show that sexual stages are characterized by a larger emission of hexanal, compared with uninfected or asexual stage-infected RBCs, which makes them clearly identifiable. PTR-Tof-MS analysis also detected differences in VOC composition between asexual stages and uninfected RBCs. These results have been substantially replicated by the electronic nose analysis and may open the possibility to develop sensitive and easy-to-use devices able to detect sexual parasite stages in infected individuals. This study also demonstrates that the combination of mass spectrometry with electronic noses is a useful tool to identify markers of diseases and to support the development of optimized sensors.

On-Line Analysis of Exhaled Breath Focus Review

On-line analysis of exhaled breath offers insight into a person's metabolism without the need for sample preparation or sample collection. Due to its noninvasive nature and the possibility to sample continuously, the analysis of breath has great clinical potential. The unique features of this technology make it an attractive candidate for applications in medicine, beyond the task of diagnosis. We review the current methodologies for on-line breath analysis, discuss current and future applications, and critically evaluate challenges and pitfalls such as the need for standardization. Special emphasis is given to the use of the technology in diagnosing respiratory diseases, potential niche applications, and the promise of breath analysis for personalized medicine. The analytical methodologies used range from very small and low-cost chemical sensors, which are ideal for continuous monitoring of disease status, to optical spectroscopy and state-of-the-art, high-resolution mass spectrometry. The latter can be utilized for untargeted analysis of exhaled breath, with the capability to identify hitherto unknown molecules. The interpretation of the resulting big data sets is complex and often constrained due to a limited number of participants. Even larger data sets will be needed for assessing reproducibility and for validation of biomarker candidates. In addition, molecular structures and quantification of compounds are generally not easily available from on-line measurements and require complementary measurements, for example, a separation method coupled to mass spectrometry. Furthermore, a lack of standardization still hampers the application of the technique to screen larger cohorts of patients. This review summarizes the present status and continuous improvements of the principal on-line breath analysis methods and evaluates obstacles for their wider application.

Direct Analysis of Carbonyl Compounds by Mass Spectrometry with Double-Region Atmospheric Pressure Chemical Ionization

Direct analysis of highly reactive volatile species such as the aliphatic aldehydes as vital biomarkers remains a great challenge due to difficulties in the sample pretreatment. To address such a challenge, we herein report the development of a novel double-region atmospheric pressure chemical ionization mass spectrometry (DRAPCI-MS) method. The DRAPCI source implements a separated structural design that uses a focus electrode to divide the discharge and ionization region to reduce sample fragmentation in the ionization process. Counterflow introduction (CFI) configuration was adopted in the DRAPCI source to reduce background noise, while ion transmission efficiency was optimized through simulating the voltage of the focus electrode and the ion trajectory of the ion source. The limits of detection (LODs) of four carbonyl compounds cyclohexanone, hexanal, heptanal, and octanal by DRAPCI-MS were between 0.1 and 3 μg·m^-3, approximately two to eight times lower than those by atmospheric pressure chemical ionization mass spectrometry. Additionally, the DRAPCI-MS method carried out effective in situ analyses of the volatile components in expired milk and the exhaled breath of smokers, demonstrating the DRAPCI-MS as a practical tool to analyze complex mixtures. The DRAPCI-MS method provides a rapid, sensitive, and high-throughput technique in the real-time analysis of gaseous small-molecule compounds.