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Zha C, Li L, Zhu F, Zhao Y. The Classification of VOCs Based on Sensor Images Using a Lightweight Neural Network for Lung Cancer Diagnosis. SENSORS (BASEL, SWITZERLAND) 2024; 24:2818. [PMID: 38732924 PMCID: PMC11086312 DOI: 10.3390/s24092818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Abstract
The application of artificial intelligence to point-of-care testing (POCT) disease detection has become a hot research field, in which breath detection, which detects the patient's exhaled VOCs, combined with sensor arrays of convolutional neural network (CNN) algorithms as a new lung cancer detection is attracting more researchers' attention. However, the low accuracy, high-complexity computation and large number of parameters make the CNN algorithms difficult to transplant to the embedded system of POCT devices. A lightweight neural network (LTNet) in this work is proposed to deal with this problem, and meanwhile, achieve high-precision classification of acetone and ethanol gases, which are respiratory markers for lung cancer patients. Compared to currently popular lightweight CNN models, such as EfficientNet, LTNet has fewer parameters (32 K) and its training weight size is only 0.155 MB. LTNet achieved an overall classification accuracy of 99.06% and 99.14% in the own mixed gas dataset and the University of California (UCI) dataset, which are both higher than the scores of the six existing models, and it also offers the shortest training (844.38 s and 584.67 s) and inference times (23 s and 14 s) in the same validation sets. Compared to the existing CNN models, LTNet is more suitable for resource-limited POCT devices.
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Affiliation(s)
| | - Lei Li
- Department of Electronics and Electrical Engineering, Changchun University of Technology, Changchun 130012, China; (C.Z.); (F.Z.); (Y.Z.)
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2
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V A B, Mathew P, Thomas S, Mathew L. Detection of lung cancer and stages via breath analysis using a self-made electronic nose device. Expert Rev Mol Diagn 2024; 24:341-353. [PMID: 38369930 DOI: 10.1080/14737159.2024.2316755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Breathomics is an emerging area focusing on monitoring and diagnosing pulmonary diseases, especially lung cancer. This research aims to employ metabolomic methods to create a breathprint in human-expelled air to rapidly identify lung cancer and its stages. RESEARCH DESIGN AND METHODS An electronic nose (e-nose) system with five metal oxide semiconductor (MOS) gas sensors, a microcontroller, and machine learning algorithms was designed and developed for this application. The volunteers in this study include 114 patients with lung cancer and 147 healthy controls to understand the clinical potential of the e-nose system to detect lung cancer and its stages. RESULTS In the training phase, in discriminating lung cancer from controls, the XGBoost classifier model with 10-fold cross-validation gave an accuracy of 91.67%. In the validation phase, the XGBoost classifier model correctly identified 35 out of 42 patients with lung cancer samples and 44 out of 51 healthy control samples providing an overall sensitivity of 83.33% and specificity of 86.27%. CONCLUSIONS These results indicate that the exhaled breath VOC analysis method may be developed as a new diagnostic tool for lung cancer detection. The advantages of e-nose based diagnostics, such as an easy and painless method of sampling, and low-cost procedures, will make it an excellent diagnostic method in the future.
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Affiliation(s)
- Binson V A
- Saintgits College of Engineering, Kottayam, Kerala, India
| | - Philip Mathew
- Department of Critical Care Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Sania Thomas
- Saintgits College of Engineering, Kottayam, Kerala, India
| | - Luke Mathew
- Department of Pulmonology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
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3
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Martin JDM, Claudia F, Romain AC. How well does your e-nose detect cancer? Application of artificial breath analysis for performance assessment. J Breath Res 2024; 18:026002. [PMID: 38211310 DOI: 10.1088/1752-7163/ad1d64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Comparing electronic nose (e-nose) performance is a challenging task because of a lack of standardised method. This paper proposes a method for defining and quantifying an indicator of the effectiveness of multi-sensor systems in detecting cancers by artificial breath analysis. To build this method, an evaluation of the performances of an array of metal oxide sensors built for use as a lung cancer screening tool was conducted. Breath from 20 healthy volunteers has been sampled in fluorinated ethylene propylene sampling bags. These healthy samples were analysed with and without the addition of nine volatile organic compound (VOC) cancer biomarkers, chosen from literature. The concentration of the VOC added was done in increasing amounts. The more VOC were added, the better the discrimination between 'healthy' samples (breath without additives) and 'cancer' samples (breath with additives) was. By determining at which level of concentration the e-nose fails to reliably discriminate between the two groups, we estimate its ability to well predict the presence of the disease or not in a realistic situation. In this work, a home-made e-nose is put to the test. The results underline that the biomarkers need to be about 5.3 times higher in concentration than in real breath for the home-made nose to tell the difference between groups with a sufficient confidence.
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Affiliation(s)
- Justin D M Martin
- Department of Environmental Sciences, Sensing of Atmospheres and Monitoring (SAM), SPHERES Research Unit, University of Liège, 6700 Arlon, Belgium
| | - Falzone Claudia
- Department of Environmental Sciences, Sensing of Atmospheres and Monitoring (SAM), SPHERES Research Unit, University of Liège, 6700 Arlon, Belgium
| | - Anne-Claude Romain
- Department of Environmental Sciences, Sensing of Atmospheres and Monitoring (SAM), SPHERES Research Unit, University of Liège, 6700 Arlon, Belgium
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4
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Phung VBT, Tran TN, Tran QH, Luong TT, Dinh VA. Graphene as a Sensor for Lung Cancer: Insights into Adsorption of VOCs Using vdW DFT. ACS OMEGA 2024; 9:2302-2313. [PMID: 38250431 PMCID: PMC10795125 DOI: 10.1021/acsomega.3c06159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
The adsorption mechanism of individual volatile organic compounds (VOCs) on the surface of graphene is investigated using nonempirical van der Waals (vdW) density functional theory. The VOCs chosen as adsorbates are ethanol, benzene, and toluene, which are found in the exhaled breath of lung cancer patients. The most energetically favorable configurations of the adsorbed systems, adsorption energy profiles, charge transfer, and work function are calculated. The fundamental insight into the interactions between the considered VOC molecules and graphene through molecular doping, i.e., charge transfer, is estimated. It is found that the adsorption energy is highly sensitive to the vdW functionals. Adsorption energies calculated by revPBE-vdW are in good agreement with the available experimental data, and the revPBE-vdW functional can cover well the physical phenomena behind the adsorption of these VOCs on graphene. Bader charge analysis shows that 0.064, 0.042, and 0.061e of charge were transferred from the graphene surface to ethanol, benzene, and toluene, respectively. All of the considered VOCs act as electron acceptors from graphene. By analyzing the electronic structure of the adsorption systems, we found that the energy level of the highest occupied molecular orbitals of these considered VOCs is shifted backward toward the Fermi level. The interaction of the VOCs with the π and π* states of the C atoms in graphene breaks the symmetry of graphene, leading to the opening of a band gap at the Fermi level. The adsorption of these considered VOCs onto the pristine graphene produces a band gap of 5-12 meV.
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Affiliation(s)
- Viet Bac T. Phung
- Institute
of Sustainability Science, VNU Vietnam Japan
University, Luu Huu Phuoc
Str., My Dinh I, Nam Tu Liem, Hanoi 1000000, Vietnam
- Center
for Environmental Intelligence and College of Engineering & Computer
Science, VinUniversity, Hanoi 100000, Vietnam
| | - Thi Nhan Tran
- Faculty
of Fundamental Sciences, Hanoi University
of Industry, 298 Cau Dien Street, Bac Tu Liem District, Hanoi 100000, Vietnam
| | - Quang Huy Tran
- Faculty
of Physics, Hanoi Pedagogical University
2, Phuc Yen, Vinh Phuc 280000, Vietnam
| | - Thi Theu Luong
- Hoa
Binh University, Bui
Xuan Phai Str., My Dinh II, Nam Tu Liem, Hanoi 100000, Vietnam
| | - Van An Dinh
- Department
of Precision Engineering, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan
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5
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Jia Z, Thavasi V, Venkatesan T, Lee P. Breath Analysis for Lung Cancer Early Detection-A Clinical Study. Metabolites 2023; 13:1197. [PMID: 38132879 PMCID: PMC10745549 DOI: 10.3390/metabo13121197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
This clinical study presents a comprehensive investigation into the utility of breath analysis as a non-invasive method for the early detection of lung cancer. The study enrolled 14 lung cancer patients, 14 non-lung cancer controls with diverse medical conditions, and 3 tuberculosis (TB) patients for biomarker discovery. Matching criteria including age, gender, smoking history, and comorbidities were strictly followed to ensure reliable comparisons. A systematic breath sampling protocol utilizing a BIO-VOC sampler was employed, followed by VOC analysis using Thermal Desorption-Gas Chromatography-Mass Spectrometry (TD-GC/MS). The resulting VOC profiles were subjected to stringent statistical analysis, including Orthogonal Projections to Latent Structures-Discriminant Analysis (OPLS-DA), Kruskal-Wallis test, and Receiver Operating Characteristic (ROC) analysis. Notably, 13 VOCs exhibited statistically significant differences between lung cancer patients and controls. The combination of eight VOCs (hexanal, heptanal, octanal, benzaldehyde, undecane, phenylacetaldehyde, decanal, and benzoic acid) demonstrated substantial discriminatory power with an area under the curve (AUC) of 0.85, a sensitivity of 82%, and a specificity of 76% in the discovery set. Validation in an independent cohort yielded an AUC of 0.78, a sensitivity of 78%, and a specificity of 64%. Further analysis revealed that elevated aldehyde levels in lung cancer patients' breath could be attributed to overactivated Alcohol Dehydrogenase (ADH) pathways in cancerous tissues. Addressing methodological challenges, this study employed a matching of physiological and pathological confounders, controlled room air samples, and standardized breath sampling techniques. Despite the limitations, this study's findings emphasize the potential of breath analysis as a diagnostic tool for lung cancer and suggest its utility in differentiating tuberculosis from lung cancer. However, further research and validation are warranted for the translation of these findings into clinical practice.
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Affiliation(s)
- Zhunan Jia
- NUSNNI-Nanocore, National University of Singapore, Singapore 117411, Singapore;
| | - Velmurugan Thavasi
- Center for Quantum Research and Technology, Homer L. Dodge Department of Physics and Astronomy, University of Oklahoma, Norman, OK 73019, USA;
| | - Thirumalai Venkatesan
- NUSNNI-Nanocore, National University of Singapore, Singapore 117411, Singapore;
- Center for Quantum Research and Technology, Homer L. Dodge Department of Physics and Astronomy, University of Oklahoma, Norman, OK 73019, USA;
| | - Pyng Lee
- Respiratory and Critical Care Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
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6
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V. R. N, Mohapatra AK, Kartha VB, Chidangil S. Multiwavelength Photoacoustic Breath Analysis Sensor for the Diagnosis of Lung Diseases: COPD and Asthma. ACS Sens 2023; 8:4111-4120. [PMID: 37871260 PMCID: PMC10683506 DOI: 10.1021/acssensors.3c01316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Abstract
Breath analysis is emerging as a universal diagnostic method for clinical applications. The possibility of breath analysis is being explored vigorously using different analytical techniques. We have designed and assembled a multiwavelength UV photoacoustic spectroscopy (PAS) sensor for the said application. To optimize laser wavelength for sample excitation, photoacoustic signals from disease and normal conditions are recorded with different laser excitations (213, 266, 355, and 532 nm) on exhaled breath samples. Principal component analysis (PCA) of the PA signals has shown that 213, 266, and 355 nm laser excitations are suitable for breath analysis, with reliable descriptive statistics obtained for 266 nm laser. The study has, therefore, been extended for breath samples collected from asthma, chronic obstructive pulmonary disease (COPD), and normal subjects, using 266 nm laser excitation. PCA of the PA data shows good classification among asthma, COPD, and normal subjects. Match/No-match study performed with asthma, COPD, and normal calibration set has demonstrated the potential of using this method for diagnostic application. Sensitivity and specificity are observed as 88 and 89%, respectively. The area under the curve of the ROC curve is found to be 0.948, which justifies the diagnostic capability of the device for lung diseases. The same samples were studied using a commercial E-Nose, and the measurement outcome strongly supports the PAS results.
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Affiliation(s)
- Nidheesh V. R.
- Centre
of Excellence for Biophotonics, Department of Atomic and Molecular
Physics, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Aswini Kumar Mohapatra
- Department
of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Vasudevan Baskaran Kartha
- Centre
of Excellence for Biophotonics, Department of Atomic and Molecular
Physics, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Santhosh Chidangil
- Centre
of Excellence for Biophotonics, Department of Atomic and Molecular
Physics, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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7
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de Vries R, Farzan N, Fabius T, De Jongh FHC, Jak PMC, Haarman EG, Snoey E, In 't Veen JCCM, Dagelet YWF, Maitland-Van Der Zee AH, Lucas A, Van Den Heuvel MM, Wolf-Lansdorf M, Muller M, Baas P, Sterk PJ. Prospective Detection of Early Lung Cancer in Patients With COPD in Regular Care by Electronic Nose Analysis of Exhaled Breath. Chest 2023; 164:1315-1324. [PMID: 37209772 PMCID: PMC10635840 DOI: 10.1016/j.chest.2023.04.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Patients with COPD are at high risk of lung cancer developing, but no validated predictive biomarkers have been reported to identify these patients. Molecular profiling of exhaled breath by electronic nose (eNose) technology may qualify for early detection of lung cancer in patients with COPD. RESEARCH QUESTION Can eNose technology be used for prospective detection of early lung cancer in patients with COPD? STUDY DESIGN AND METHODS BreathCloud is a real-world multicenter prospective follow-up study using diagnostic and monitoring visits in day-to-day clinical care of patients with a standardized diagnosis of asthma, COPD, or lung cancer. Breath profiles were collected at inclusion in duplicate by a metal-oxide semiconductor eNose positioned at the rear end of a pneumotachograph (SpiroNose; Breathomix). All patients with COPD were managed according to standard clinical care, and the incidence of clinically diagnosed lung cancer was prospectively monitored for 2 years. Data analysis involved advanced signal processing, ambient air correction, and statistics based on principal component (PC) analysis, linear discriminant analysis, and receiver operating characteristic analysis. RESULTS Exhaled breath data from 682 patients with COPD and 211 patients with lung cancer were available. Thirty-seven patients with COPD (5.4%) demonstrated clinically manifest lung cancer within 2 years after inclusion. Principal components 1, 2, and 3 were significantly different between patients with COPD and those with lung cancer in both training and validation sets with areas under the receiver operating characteristic curve of 0.89 (95% CI, 0.83-0.95) and 0.86 (95% CI, 0.81-0.89). The same three PCs showed significant differences (P < .01) at baseline between patients with COPD who did and did not subsequently demonstrate lung cancer within 2 years, with a cross-validation value of 87% and an area under the receiver operating characteristic curve of 0.90 (95% CI, 0.84-0.95). INTERPRETATION Exhaled breath analysis by eNose identified patients with COPD in whom lung cancer became clinically manifest within 2 years after inclusion. These results show that eNose assessment may detect early stages of lung cancer in patients with COPD.
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Affiliation(s)
- Rianne de Vries
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Breathomix B.V, Leiden, The Netherlands.
| | | | - Timon Fabius
- Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Patrick M C Jak
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric G Haarman
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Snoey
- Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | | | - Anke-Hilse Maitland-Van Der Zee
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Mirte Muller
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul Baas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Peter J Sterk
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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8
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Li Y, Wei X, Zhou Y, Wang J, You R. Research progress of electronic nose technology in exhaled breath disease analysis. MICROSYSTEMS & NANOENGINEERING 2023; 9:129. [PMID: 37829158 PMCID: PMC10564766 DOI: 10.1038/s41378-023-00594-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
Exhaled breath analysis has attracted considerable attention as a noninvasive and portable health diagnosis method due to numerous advantages, such as convenience, safety, simplicity, and avoidance of discomfort. Based on many studies, exhaled breath analysis is a promising medical detection technology capable of diagnosing different diseases by analyzing the concentration, type and other characteristics of specific gases. In the existing gas analysis technology, the electronic nose (eNose) analysis method has great advantages of high sensitivity, rapid response, real-time monitoring, ease of use and portability. Herein, this review is intended to provide an overview of the application of human exhaled breath components in disease diagnosis, existing breath testing technologies and the development and research status of electronic nose technology. In the electronic nose technology section, the three aspects of sensors, algorithms and existing systems are summarized in detail. Moreover, the related challenges and limitations involved in the abovementioned technologies are also discussed. Finally, the conclusion and perspective of eNose technology are presented.
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Affiliation(s)
- Ying Li
- School of Instrument Science and Opto-Electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192 China
- Laboratory of Intelligent Microsystems, Beijing Information Science and Technology University, Beijing, 100192 China
| | - Xiangyang Wei
- School of Instrument Science and Opto-Electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192 China
- Laboratory of Intelligent Microsystems, Beijing Information Science and Technology University, Beijing, 100192 China
| | - Yumeng Zhou
- School of Instrument Science and Opto-Electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192 China
| | - Jing Wang
- School of Electronics and Information Engineering, Changchun University of Science and Technology, Changchun, 130022 China
| | - Rui You
- School of Instrument Science and Opto-Electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192 China
- Laboratory of Intelligent Microsystems, Beijing Information Science and Technology University, Beijing, 100192 China
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9
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Baudrexler T, Boeselt T, Li L, Bohlscheid S, Boas U, Schmid C, Rank A, Schmohl J, Koczulla R, Schmetzer HM. Volatile Phases Derived from Serum, DC, or MLC Culture Supernatants to Deduce a VOC-Based Diagnostic Profiling Strategy for Leukemic Diseases. Biomolecules 2023; 13:989. [PMID: 37371569 DOI: 10.3390/biom13060989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Volatile organic compounds (VOCs) reflect the metabolism in healthy and pathological conditions, and can be collected easily in a noninvasive manner. They are directly measured using electronical nose (eNose), and may qualify as a systemic tool to monitor biomarkers related to disease. Myeloid leukemic blasts can be transformed into leukemia-derived dendritic cells (DCleu) able to improve (anti-leukemic) immune responses. To profile immunological changes in healthy and acute myeloid leukemic (AML) patients' ex vivo cell cultures, we correlated the cell biological data with the profiles of cell culture supernatant-derived VOCs. DC/DCleu from leukemic or healthy whole blood (WB) were generated without (Control) or with immunomodulatory Kit M (Granulocyte macrophage-colony-stimulating-factor (GM-CSF) + prostaglandin E1 (PGE1)) in dendritic cell cultures (DC culture). Kit-pretreated/not pretreated WB was used to stimulate T cell-enriched immunoreactive cells in mixed lymphocyte cultures (MLC culture). Leukemia-specific adaptive and innate immune cells were detected with a degranulation assay (Deg) and an intracellular cytokine assay (InCyt). Anti-leukemic cytotoxicity was explored with a cytotoxicity fluorolysis assay (CTX). VOCs collected from serum or DC- and MLC culture supernatants (with vs. without Kit M pretreatment and before vs. after culture) were measured using eNose. Compared to the Control (without treatment), Kit M-pretreated leukemic and healthy WB gave rise to higher frequencies of mature (leukemia-derived) DC subtypes of activated and (memory) T cells after MLC. Moreover, antigen (leukemia)-specific cells of several lines (innate and adaptive immunity cells) were induced, giving rise to blast-lysing cells. The eNose could significantly distinguish between healthy and leukemic patients' serum, DC and MLC culture supernatant-derived volatile phases and could significantly separate several supernatant (with vs. without Kit M treatment, cultured vs. uncultured)-derived VOCs within subgroups (healthy DC or leukemic DC, or healthy MLC or leukemic MLC supernatants). Interestingly, the eNose could indicate a Kit M- and culture-associated effect. The eNose may be a prospective option for the deduction of a VOC-based profiling strategy using serum or cell culture supernatants and could be a useful diagnostic tool to recognize or qualify AML disease.
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Affiliation(s)
- Tobias Baudrexler
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Tobias Boeselt
- Department of Pulmonary Rehabilitation, German Center for Lung Research (DZL), Phillipps-University of Marburg, 35043 Marburg, Germany
| | - Lin Li
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Sophia Bohlscheid
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Ursel Boas
- Department of Pulmonary Rehabilitation, German Center for Lung Research (DZL), Phillipps-University of Marburg, 35043 Marburg, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | - Jörg Schmohl
- Department of Hematology and Oncology, Diaconia Hospital Stuttgart, 70176 Stuttgart, Germany
| | - Rembert Koczulla
- Department of Pulmonary Rehabilitation, German Center for Lung Research (DZL), Phillipps-University of Marburg, 35043 Marburg, Germany
| | - Helga Maria Schmetzer
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
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Sharma A, Kumar R, Varadwaj P. Smelling the Disease: Diagnostic Potential of Breath Analysis. Mol Diagn Ther 2023; 27:321-347. [PMID: 36729362 PMCID: PMC9893210 DOI: 10.1007/s40291-023-00640-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
Breath analysis is a relatively recent field of research with much promise in scientific and clinical studies. Breath contains endogenously produced volatile organic components (VOCs) resulting from metabolites of ingested precursors, gut and air-passage bacteria, environmental contacts, etc. Numerous recent studies have suggested changes in breath composition during the course of many diseases, and breath analysis may lead to the diagnosis of such diseases. Therefore, it is important to identify the disease-specific variations in the concentration of breath to diagnose the diseases. In this review, we explore methods that are used to detect VOCs in laboratory settings, VOC constituents in exhaled air and other body fluids (e.g., sweat, saliva, skin, urine, blood, fecal matter, vaginal secretions, etc.), VOC identification in various diseases, and recently developed electronic (E)-nose-based sensors to detect VOCs. Identifying such VOCs and applying them as disease-specific biomarkers to obtain accurate, reproducible, and fast disease diagnosis could serve as an alternative to traditional invasive diagnosis methods. However, the success of VOC-based identification of diseases is limited to laboratory settings. Large-scale clinical data are warranted for establishing the robustness of disease diagnosis. Also, to identify specific VOCs associated with illness states, extensive clinical trials must be performed using both analytical instruments and electronic noses equipped with stable and precise sensors.
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Affiliation(s)
- Anju Sharma
- Systems Biology Lab, Indian Institute of Information Technology, Allahabad, Uttar Pradesh, India
| | - Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Uttar Pradesh, Lucknow Campus, Lucknow, India
| | - Pritish Varadwaj
- Systems Biology Lab, Indian Institute of Information Technology, Allahabad, Uttar Pradesh, India.
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11
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Sas V, Cherecheș-Panța P, Borcau D, Schnell CN, Ichim EG, Iacob D, Coblișan AP, Drugan T, Man SC. Breath Prints for Diagnosing Asthma in Children. J Clin Med 2023; 12:jcm12082831. [PMID: 37109167 PMCID: PMC10146639 DOI: 10.3390/jcm12082831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Electronic nose (e-nose) is a new technology applied for the identification of volatile organic compounds (VOC) in breath air. Measuring VOC in exhaled breath can adequately identify airway inflammation, especially in asthma. Its noninvasive character makes e-nose an attractive technology applicable in pediatrics. We hypothesized that an electronic nose could discriminate the breath prints of patients with asthma from controls. A cross-sectional study was conducted and included 35 pediatric patients. Eleven cases and seven controls formed the two training models (models A and B). Another nine cases and eight controls formed the external validation group. Exhaled breath samples were analyzed using Cyranose 320, Smith Detections, Pasadena, CA, USA. The discriminative ability of breath prints was investigated by principal component analysis (PCA) and canonical discriminative analysis (CDA). Cross-validation accuracy (CVA) was calculated. For the external validation step, accuracy, sensitivity and specificity were calculated. Duplicate sampling of exhaled breath was obtained for ten patients. E-nose was able to discriminate between the controls and asthmatic patient group with a CVA of 63.63% and an M-distance of 3.13 for model A and a CVA of 90% and an M-distance of 5.55 for model B in the internal validation step. In the second step of external validation, accuracy, sensitivity and specificity were 64%, 77% and 50%, respectively, for model A, and 58%, 66% and 50%, respectively, for model B. Between paired breath sample fingerprints, there were no significant differences. An electronic nose can discriminate pediatric patients with asthma from controls, but the accuracy obtained in the external validation was lower than the CVA obtained in the internal validation step.
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Affiliation(s)
- Valentina Sas
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
| | - Paraschiva Cherecheș-Panța
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
| | - Diana Borcau
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
| | - Cristina-Nicoleta Schnell
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
| | - Edita-Gabriela Ichim
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
| | - Daniela Iacob
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
| | - Alina-Petronela Coblișan
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
- Department of Nursing, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
| | - Sorin-Claudiu Man
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, 400124 Cluj-Napoca, Romania
- Clinical Hospital for Pediatric Emergencies, 400124 Cluj-Napoca, Romania
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12
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Costantini M, Filianoti A, Anceschi U, Bove AM, Brassetti A, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Ciliberto G, Simone G, Torregiani G. Human Urinary Volatilome Analysis in Renal Cancer by Electronic Nose. BIOSENSORS 2023; 13:bios13040427. [PMID: 37185502 PMCID: PMC10136259 DOI: 10.3390/bios13040427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
Currently, in clinical practice there are still no useful markers available that are able to diagnose renal cancer in the early stages in the context of population screening. This translates into very high costs for healthcare systems around the world. Analysing urine using an electronic nose (EN) provides volatile organic compounds that can be easily used in the diagnosis of urological diseases. Although no convincing results have been published, some previous studies suggest that dogs trained to sniff urine can recognize different types of tumours (bladder, lung, breast cancer) with different success rates. We therefore hypothesized that urinary volatilome profiling may be able to distinguish patients with renal cancer from healthy controls. A total of 252 individuals, 110 renal patients and 142 healthy controls, were enrolled in this pilot monocentric study. For each participant, we collected, stabilized (at 37 °C) and analysed urine samples using a commercially available electronic nose (Cyranose 320®). Principal component (PCA) analyses, discriminant analysis (CDA) and ROC curves were performed to provide a complete statistical analysis of the sensor responses. The best discriminating principal component groups were identified with univariable ANOVA analysis. The study correctly identified 79/110 patients and 127/142 healthy controls, respectively (specificity 89.4%, sensitivity 71.8%, positive predictive value 84.04%, negative predictive value 80.37%). In order to test the study efficacy, the Cross Validated Accuracy was calculated (CVA 81.7%, p < 0.001). At ROC analysis, the area under the curve was 0.85. The results suggest that urine volatilome profiling by e-Nose seems a promising, accurate and non-invasive diagnostic tool in discriminating patients from controls. The low costs and ease of execution make this test useful in clinical practice.
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Affiliation(s)
- Manuela Costantini
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Alessio Filianoti
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
- Department of Urology, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology and Intensive Care Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
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13
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Wilson AD, Forse LB. Potential for Early Noninvasive COVID-19 Detection Using Electronic-Nose Technologies and Disease-Specific VOC Metabolic Biomarkers. SENSORS (BASEL, SWITZERLAND) 2023; 23:2887. [PMID: 36991597 PMCID: PMC10054641 DOI: 10.3390/s23062887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/19/2023] [Accepted: 03/03/2023] [Indexed: 06/12/2023]
Abstract
The established efficacy of electronic volatile organic compound (VOC) detection technologies as diagnostic tools for noninvasive early detection of COVID-19 and related coronaviruses has been demonstrated from multiple studies using a variety of experimental and commercial electronic devices capable of detecting precise mixtures of VOC emissions in human breath. The activities of numerous global research teams, developing novel electronic-nose (e-nose) devices and diagnostic methods, have generated empirical laboratory and clinical trial test results based on the detection of different types of host VOC-biomarker metabolites from specific chemical classes. COVID-19-specific volatile biomarkers are derived from disease-induced changes in host metabolic pathways by SARS-CoV-2 viral pathogenesis. The unique mechanisms proposed from recent researchers to explain how COVID-19 causes damage to multiple organ systems throughout the body are associated with unique symptom combinations, cytokine storms and physiological cascades that disrupt normal biochemical processes through gene dysregulation to generate disease-specific VOC metabolites targeted for e-nose detection. This paper reviewed recent methods and applications of e-nose and related VOC-detection devices for early, noninvasive diagnosis of SARS-CoV-2 infections. In addition, metabolomic (quantitative) COVID-19 disease-specific chemical biomarkers, consisting of host-derived VOCs identified from exhaled breath of patients, were summarized as possible sources of volatile metabolic biomarkers useful for confirming and supporting e-nose diagnoses.
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Affiliation(s)
- Alphus Dan Wilson
- Pathology Department, Center for Forest Health & Disturbance, Forest Genetics and Ecosystems Biology, Southern Research Station, USDA Forest Service, Stoneville, MS 38776, USA
| | - Lisa Beth Forse
- Southern Hardwoods Laboratory, Southern Research Station, USDA Forest Service, Stoneville, MS 38776, USA
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14
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Kort S, Brusse-Keizer M, Schouwink H, Citgez E, de Jongh FH, van Putten JWG, van den Borne B, Kastelijn EA, Stolz D, Schuurbiers M, van den Heuvel MM, van Geffen WH, van der Palen J. Diagnosing Non-Small Cell Lung Cancer by Exhaled Breath Profiling Using an Electronic Nose: A Multicenter Validation Study. Chest 2023; 163:697-706. [PMID: 36243060 DOI: 10.1016/j.chest.2022.09.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite the potential of exhaled breath analysis of volatile organic compounds to diagnose lung cancer, clinical implementation has not been realized, partly due to the lack of validation studies. RESEARCH QUESTION This study addressed two questions. First, can we simultaneously train and validate a prediction model to distinguish patients with non-small cell lung cancer from non-lung cancer subjects based on exhaled breath patterns? Second, does addition of clinical variables to exhaled breath data improve the diagnosis of lung cancer? STUDY DESIGN AND METHODS In this multicenter study, subjects with non-small cell lung cancer and control subjects performed 5 min of tidal breathing through the aeoNose, a handheld electronic nose device. A training cohort was used for developing a prediction model based on breath data, and a blinded cohort was used for validation. Multivariable logistic regression analysis was performed, including breath data and clinical variables, in which the formula and cutoff value for the probability of lung cancer were applied to the validation data. RESULTS A total of 376 subjects formed the training set, and 199 subjects formed the validation set. The full training model (including exhaled breath data and clinical parameters from the training set) were combined in a multivariable logistic regression analysis, maintaining a cut off of 16% probability of lung cancer, resulting in a sensitivity of 95%, a specificity of 51%, and a negative predictive value of 94%; the area under the receiver-operating characteristic curve was 0.87. Performance of the prediction model on the validation cohort showed corresponding results with a sensitivity of 95%, a specificity of 49%, a negative predictive value of 94%, and an area under the receiver-operating characteristic curve of 0.86. INTERPRETATION Combining exhaled breath data and clinical variables in a multicenter, multi-device validation study can adequately distinguish patients with lung cancer from subjects without lung cancer in a noninvasive manner. This study paves the way to implement exhaled breath analysis in the daily practice of diagnosing lung cancer. CLINICAL TRIAL REGISTRATION The Netherlands Trial Register; No.: NL7025; URL: https://trialregister.nl/trial/7025.
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Affiliation(s)
- Sharina Kort
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands.
| | - Marjolein Brusse-Keizer
- Medical School Twente, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
| | - Hugo Schouwink
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
| | - Emanuel Citgez
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
| | - Frans H de Jongh
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
| | - Jan W G van Putten
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Ben van den Borne
- Department of Respiratory Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Elisabeth A Kastelijn
- Department of Respiratory Medicine, Sint Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Daiana Stolz
- Clinic for Pulmonary Medicine and Respiratory Cell Research, Universitätspital Basel, Basel, Switzerland; Clinic for Respiratory Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Milou Schuurbiers
- Department of Respiratory Medicine, Radboud UMC, Nijmegen, The Netherlands
| | | | - Wouter H van Geffen
- Department of Respiratory Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Job van der Palen
- Medical School Twente, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
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15
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Safety and tolerability of stereotactic radiotherapy combined with durvalumab with or without tremelimumab in advanced non-small cell lung cancer, the phase I SICI trial. Lung Cancer 2023; 178:96-102. [PMID: 36806899 DOI: 10.1016/j.lungcan.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/23/2022] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION This phase I study primarily addresses the safety and tolerability of Stereotactic radiotherapy on the primary tumor combined with double Immune Checkpoint Inhibition (SICI) in patients with non-small cell lung cancer (NSCLC). Increasing the release of neoantigens by radiotherapy might enhance response to immunotherapy. Especially, by targeting trunk mutations in the primary tumor. MATERIALS AND METHODS In three sequential cohorts, immunotherapy regimes combined with stereotactic body radiotherapy (SBRT) on the primary tumor (1x20 Gy on 9 cc) were studied in stage IIIB/IV NSCLC patients progressing on chemotherapy. The first cohort (n = 3) received durvalumab. The second (n = 6) received a combination of tremelimumab and durvalumab followed by durvalumab monotherapy. The third cohort (n = 6) was similar except that the combination was reversed. Descriptive statistics were used to assess safety parameters and the exploratory outcomes of efficacy. Adverse events were reported using NCI CTCAE version 4.03. Exhaled breath was analyzed at baseline. RESULTS Fifteen patients were included. Median irradiated volume was 9.13 cc, on a median primary tumor volume of 79 cc. There were seven patients with grade 1-2, and two patients with grade 3 treatment related adverse events. There was 1 dose limiting toxicity (colitis) with double immunotherapy. CONCLUSION The combination of SBRT to the primary tumor and double immunotherapy in advanced NSCLC patients is safe and feasible.
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Gashimova EM, Temerdashev AZ, Porkhanov VA, Polyakov IS, Perunov DV. Comparative Analysis of Pre- and Post-Surgery Exhaled Breath Profiles of Volatile Organic Compounds of Patients with Lung Cancer and Benign Tumors. JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1134/s1061934822120036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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DeLouize AM, Eick G, Karam SD, Snodgrass JJ. Current and future applications of biomarkers in samples collected through minimally invasive methods for cancer medicine and population-based research. Am J Hum Biol 2022; 34:e23665. [PMID: 34374148 PMCID: PMC9894104 DOI: 10.1002/ajhb.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/04/2023] Open
Abstract
Despite advances in cancer medicine and research, invasive and potentially risky procedures such as biopsies, venous blood tests, imaging, colonoscopy, and pap smear tests are still primarily used for screening, staging, and assessing response to therapy. The development and interdisciplinary use of biomarkers from urine, feces, saliva, scent, and capillary blood collected with minimally invasive methods represents a potential opportunity for integration with biomarker analysis for cancers, both in clinical practice (e.g., in screening, treatment, and disease monitoring, and improved quality of life for patients) and population-based research (e.g., in epidemiology/public health, studies of social and environmental determinants, and evolutionary medicine). In this article, we review the scientific rationale, benefits, challenges, and potential opportunities for measuring cancer-related biomarkers in samples collected through minimally invasive methods.
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Affiliation(s)
| | - Geeta Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - J. Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
- Center for Global Health, University of Oregon, Eugene, Oregon, USA
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18
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Development of an Algorithm for Cervical High-Grade Squamous Intraepithelial Lesion Based on Breath Print Analysis. J Low Genit Tract Dis 2022; 27:7-11. [PMID: 36196881 DOI: 10.1097/lgt.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study was designed to develop an algorithm for the diagnosis of cervical high-grade squamous intraepithelial lesions (HSIL), based on patterns of volatile organic compounds, evaluated using an e-nose. METHODS For this pilot study, the study population consisted of a group of 25 patients with histologically confirmed HSIL and a group of 26 controls. Controls consisted of women visiting the outpatient department for gynecological complaints unrelated to cancer. Women had a negative high-risk human papillomavirus and/or normal cytology (negative for intraepithelial lesions of malignancy) of their most recent test performed in the context of participation in routine cervical cancer screening. Breath tests were performed and labeled with the correct diagnosis. Machine-learning techniques were used to develop a model for predicting HSIL. Based on the receiver operating characteristics curve, both sensitivity and specificity were calculated. RESULTS Individual classifications of all patients with HSIL and controls, as calculated by the model, showed a sensitivity of 0.88 (95% CI = 0.68-0.97) and specificity of 0.92 (95% CI = 0.73-0.99). The positive predictive value and the negative predictive value were 0.92 (95% CI = 0.72-0.99) and 0.89 (95% CI = 0.70-0.97), respectively. The Cohen κ coefficient was 0.80. CONCLUSIONS E-nose can detect distinctive patterns of volatile organic compounds between cervical HSIL patients and controls. Validation of the algorithm in further studies is necessary before possible implementation into daily practice.
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19
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Giró Benet J, Seo M, Khine M, Gumà Padró J, Pardo Martnez A, Kurdahi F. Breast cancer detection by analyzing the volatile organic compound (VOC) signature in human urine. Sci Rep 2022; 12:14873. [PMID: 36050339 PMCID: PMC9435419 DOI: 10.1038/s41598-022-17795-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/31/2022] [Indexed: 11/12/2022] Open
Abstract
A rising number of authors are drawing evidence on the diagnostic capacity of specific volatile organic compounds (VOCs) resulting from some body fluids. While cancer incidence in society is on the rise, it becomes clear that the analysis of these VOCs can yield new strategies to mitigate advanced cancer incidence rates. This paper presents the methodology implemented to test whether a device consisting of an electronic nose inspired by a dog’s olfactory system and olfactory neurons is significantly informative to detect breast cancer (BC). To test this device, 90 human urine samples were collected from control subjects and BC patients at a hospital. To test this system, an artificial intelligence-based classification algorithm was developed. The algorithm was firstly trained and tested with data resulting from gas chromatography-mass spectrometry (GC–MS) urine readings, leading to a classification rate of 92.31%, sensitivity of 100.00%, and specificity of 85.71% (N = 90). Secondly, the same algorithm was trained and tested with data obtained with our eNose prototype hardware, and class prediction was achieved with a classification rate of 75%, sensitivity of 100%, and specificity of 50%.
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Affiliation(s)
- Judit Giró Benet
- Center for Embedded Cyber-Physical Systems (CEPS), University of California Irvine (UCI), Irvine, 92697, USA.
| | - Minjun Seo
- Center for Embedded Cyber-Physical Systems (CEPS), University of California Irvine (UCI), Irvine, 92697, USA
| | - Michelle Khine
- Department of Biomedical Engineering, University of California Irvine (UCI), Irvine, 92697, USA
| | - Josep Gumà Padró
- South Catalonia Oncology Institute (IOCS), Sant Joan de Reus University Hospital, IISPV, Rovira i Virgili University, 43204, Reus, Spain
| | - Antonio Pardo Martnez
- Department of Electronic and Biomedical Engineering, Universitat de Barcelona (UB), 08028, Barcelona, Spain
| | - Fadi Kurdahi
- Center for Embedded Cyber-Physical Systems (CEPS), University of California Irvine (UCI), Irvine, 92697, USA
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Gashimova EM, Temerdashev AZ, Porkhanov VA, Polyakov IS, Perunov DV. Volatile Organic Compounds in Exhaled Breath as Biomarkers of Lung Cancer: Advances and Potential Problems. JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1134/s106193482207005x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Choueiry F, Barham A, Zhu J. Analyses of lung cancer-derived volatiles in exhaled breath and in vitro models. Exp Biol Med (Maywood) 2022; 247:1179-1190. [PMID: 35410512 PMCID: PMC9335511 DOI: 10.1177/15353702221082634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Lung cancer is one of the leading causes of cancer incidence and cancer-related deaths in the world. Early diagnosis of pulmonary tumors results in improved survival compared to diagnosis with more advanced disease, yet early disease is not reliably indicated by symptoms. Despite of the improved testing and monitoring techniques for lung cancer in the past decades, most diagnostic tests, such as sputum cytology or tissue biopsies, are invasive and risky, rendering them unfeasible for large population screening. The non-invasive analysis of exhaled breath has gained attentions as an innovative screening method to measure chemical alterations within the human volatilome profile as a result of oncogenesis. More importantly, volatile organic compounds (VOCs) have been correlated to the pathophysiology of disease since the source of volatile compounds relies mostly on endogenous metabolic processes that are altered as a result of disease onset. Therefore, studying VOCs emitted from human breath may assist lung cancer diagnosis, treatment monitoring, and other surveillance of this devastating disease. In this mini review, we evaluated recent human studies that have attempted to identify lung cancer-derived volatiles in exhaled breath of patients. We also examined reported volatiles in cell cultures of lung cancer to better understand the origins of cancer-associated VOCs. We highlight the metabolic processes of lung cancer that could be responsible for the endogenous synthesis of these VOCs and pinpoint the protein-encoding genes involved in these pathways. Finally, we highlight the potential value of a breath test in lung cancer and propose prominent areas for future research required for the incorporation of VOCs-based testing into clinical settings.
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Affiliation(s)
- Fouad Choueiry
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210-1132, USA
| | - Addison Barham
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210-1132, USA
| | - Jiangjiang Zhu
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210-1132, USA,James Comprehensive Cancer Center, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA,Jiangjiang Zhu.
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22
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Filianoti A, Costantini M, Bove AM, Anceschi U, Brassetti A, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Ciliberto G, Simone G. Volatilome Analysis in Prostate Cancer by Electronic Nose: A Pilot Monocentric Study. Cancers (Basel) 2022; 14:cancers14122927. [PMID: 35740593 PMCID: PMC9220860 DOI: 10.3390/cancers14122927] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023] Open
Abstract
Urine analysis via an electronic nose provides volatile organic compounds easily usable in the diagnosis of urological diseases. Although challenging and highly expensive for health systems worldwide, no useful markers are available in clinical practice that aim to anticipate prostate cancer (PCa) diagnosis in the early stages in the context of wide population screening. Some previous works suggested that dogs trained to smell urine could recognize several types of cancers with various success rates. We hypothesized that urinary volatilome profiling may distinguish PCa patients from healthy controls. In this study, 272 individuals, 133 patients, and 139 healthy controls participated. Urine samples were collected, stabilized at 37 °C, and analyzed using a commercially available electronic nose (Cyranose C320). Statistical analysis of the sensor responses was performed off-line using principal component (PCA) analyses, discriminant analysis (CDA), and ROC curves. Principal components best discriminating groups were identified with univariable ANOVA analysis. groups were identified with univariable ANOVA analysis. Here, 110/133 and 123/139 cases were correctly identified in the PCa and healthy control cohorts, respectively (sensitivity 82.7%, specificity 88.5%; positive predictive value 87.3%, negative predictive value 84.2%). The Cross Validated Accuracy (CVA 85.3%, p < 0.001) was calculated. Using ROC analysis, the area under the curve was 0.9. Urine volatilome profiling via an electronic nose seems a promising non-invasive diagnostic tool.
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Affiliation(s)
- Alessio Filianoti
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
- Department of Urology, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Umberto Anceschi
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Aldo Brassetti
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Riccardo Mastroianni
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
| | - Gennaro Ciliberto
- Scientific Direction, “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Giuseppe Simone
- Department of Urology, IRCCS—“Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.F.); (M.C.); (A.M.B.); (U.A.); (A.B.); (M.F.); (R.M.); (L.M.); (G.T.)
- Correspondence:
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Scheepers MHMC, Al-Difaie Z, Brandts L, Peeters A, van Grinsven B, Bouvy ND. Diagnostic Performance of Electronic Noses in Cancer Diagnoses Using Exhaled Breath: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2219372. [PMID: 35767259 PMCID: PMC9244610 DOI: 10.1001/jamanetworkopen.2022.19372] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE There has been a growing interest in the use of electronic noses (e-noses) in detecting volatile organic compounds in exhaled breath for the diagnosis of cancer. However, no systematic evaluation has been performed of the overall diagnostic accuracy and methodologic challenges of using e-noses for cancer detection in exhaled breath. OBJECTIVE To provide an overview of the diagnostic accuracy and methodologic challenges of using e-noses for the detection of cancer. DATA SOURCES An electronic search was performed in the PubMed and Embase databases (January 1, 2000, to July 1, 2021). STUDY SELECTION Inclusion criteria were the following: (1) use of e-nose technology, (2) detection of cancer, and (3) analysis of exhaled breath. Exclusion criteria were (1) studies published before 2000; (2) studies not performed in humans; (3) studies not performed in adults; (4) studies that only analyzed biofluids; and (5) studies that exclusively used gas chromatography-mass spectrometry to analyze exhaled breath samples. DATA EXTRACTION AND SYNTHESIS PRISMA guidelines were used for the identification, screening, eligibility, and selection process. Quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2. Generalized mixed-effects bivariate meta-analysis was performed. MAIN OUTCOMES AND MEASURES Main outcomes were sensitivity, specificity, and mean area under the receiver operating characteristic curve. RESULTS This review identified 52 articles with a total of 3677 patients with cancer. All studies were feasibility studies. The sensitivity of e-noses ranged from 48.3% to 95.8% and the specificity from 10.0% to 100.0%. Pooled analysis resulted in a mean (SE) area under the receiver operating characteristic curve of 94% (95% CI, 92%-96%), a sensitivity of 90% (95% CI, 88%-92%), and a specificity of 87% (95% CI, 81%-92%). Considerable heterogeneity existed among the studies because of differences in the selection of patients, endogenous and exogenous factors, and collection of exhaled breath. CONCLUSIONS AND RELEVANCE Results of this review indicate that e-noses have a high diagnostic accuracy for the detection of cancer in exhaled breath. However, most studies were feasibility studies with small sample sizes, a lack of standardization, and a high risk of bias. The lack of standardization and reproducibility of e-nose research should be addressed in future research.
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Affiliation(s)
- Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, the Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, the Netherlands
| | - Bart van Grinsven
- Sensor Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Exhaled Breath Volatile Organic Compound Analysis for the Detection of Lung Cancer- A Systematic Review. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2022. [DOI: 10.4028/p-dab04j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapid and effective diagnostic method is essential for lung cancer since it shows symptoms only at its advanced stage. Research is being carried out in the area of exhaled breath analysis for the diagnosis of various pulmonary diseases including lung cancer. In this method exhaled breath volatile organic compounds (VOC) are analyzed with various techniques such as gas chromatography-mass spectrometry, ion mobility spectrometry, and electronic noses. The VOC analysis is suitable for lung cancer detection since it is non-invasive, fast, and also a low-cost method. In addition, this technique can detect primary stage nodules. This paper presents a systematic review of the various method employed by researchers in the breath analysis field. The articles were selected through various search engines like EMBASE, Google Scholar, Pubmed, and Google. In the initial screening process, 214 research papers were selected using various inclusion and exclusion criteria and finally, 55 articles were selected for the review. The results of the reviewed studies show that detection of lung cancer can be effectively done using the VOC analysis of exhaled breath. The results also show that this method can be used for detecting the different stages and histology of lung cancer. The exhaled breath VOC analysis technique will be popular in the future, bypassing the existing imaging techniques. This systematic review conveys the recent research opportunities, obstacles, difficulties, motivations, and suggestions associated with the breath analysis method for lung cancer detection.
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25
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Xuan W, Zheng L, Bunes BR, Crane N, Zhou F, Zang L. Engineering solutions to breath tests based on an e-nose system for silicosis screening and early detection in miners. J Breath Res 2022; 16. [PMID: 35303733 DOI: 10.1088/1752-7163/ac5f13] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aims to develop an engineering solution to breath tests using an electronic nose (e-nose), and evaluate its diagnosis accuracy for silicosis. Influencing factors of this technique were explored. METHODS 398 non-silicosis miners and 221 silicosis miners were enrolled in this cross-sectional study. Exhaled breath was analyzed by an array of 16 organic nanofiber sensors along with a customized sample processing system. Principal Component Analysis was used to visualize the breath data, and classifiers were trained by two improved cost-sensitive ensemble algorithms (RF and XGBoost) and two classical algorithms (KNN and SVM). All subjects were included to train the screening model, and an early detection model was run with silicosis cases in stage I. Both 5-fold cross-validation and external validation were adopted. Difference in classifiers caused by algorithms and subjects was quantified using a two-factor analysis of variance. The association between personal smoking habits and classification was investigated by the chi-square test. RESULTS Classifiers of ensemble learning performed well in both screening and early detection model, with an accuracy range of 0.817 to 0.987. Classical classifiers showed relatively worse performance. Besides, the ensemble algorithm type and silicosis cases inclusion had no significant effect on classification (p>0.05). There was no connection between personal smoking habits and classification accuracy. CONCLUSION Breath tests based on an e-nose consisted of 16x sensor array performed well in silicosis screening and early detection. Raw data input showed a more significant effect on classification compared with the algorithm. Personal smoking habits had little impact on models, supporting the applicability of models in large-scale silicosis screening. The e-nose technique and the breath analysis methods reported are expected to provide a quick and accurate screening for silicosis, and extensible for other diseases.
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Affiliation(s)
- Wufan Xuan
- China University of Mining and Technology, School of Safety Engineering, Xuzhou, 221116, CHINA
| | - Lina Zheng
- China University of Mining and Technology, School of Safety Engineering, Xuzhou, 221116, CHINA
| | - Benjamin R Bunes
- Vaporsens, Inc, 419 Wakara Way, Salt Lake City, Utah, 84108, UNITED STATES
| | - Nichole Crane
- Vaporsens, Inc, 419 Wakara Way, Salt Lake City, Utah, UT 84108, UNITED STATES
| | - Fubao Zhou
- China University of Mining and Technology, School of Safety Engineering, Xuzhou, 221116, CHINA
| | - Ling Zang
- Nano Institute of Utah, 36 South Wasatch Drive, Salt Lake City, Utah, 84112-8924, UNITED STATES
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26
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Nematode-Applied Technology for Human Tumor Microenvironment Research and Development. Curr Issues Mol Biol 2022; 44:988-997. [PMID: 35723350 PMCID: PMC8929040 DOI: 10.3390/cimb44020065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Nematodes, such as Caenorhabditis elegans, have been instrumental to the study of cancer. Recently, their significance as powerful cancer biodiagnostic tools has emerged, but also for mechanism analysis and drug discovery. It is expected that nematode-applied technology will facilitate research and development on the human tumor microenvironment. In the history of cancer research, which has been spurred by numerous discoveries since the last century, nematodes have been important model organisms for the discovery of cancer microenvironment. First, microRNAs (miRNAs), which are noncoding small RNAs that exert various functions to control cell differentiation, were first discovered in C. elegans and have been actively incorporated into cancer research, especially in the study of cancer genome defects. Second, the excellent sense of smell of nematodes has been applied to the diagnosis of diseases, especially refractory tumors, such as human pancreatic cancer, by sensing complex volatile compounds derived from heterogeneous cancer microenvironment, which are difficult to analyze using ordinary analytical methods. Third, a nematode model system can help evaluate invadosomes, the phenomenon of cell invasion by direct observation, which has provided a new direction for cancer research by contributing to the elucidation of complex cell–cell communications. In this cutting-edge review, we highlight milestones in cancer research history and, from a unique viewpoint, focus on recent information on the contributions of nematodes in cancer research towards precision medicine in humans.
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Kaloumenou M, Skotadis E, Lagopati N, Efstathopoulos E, Tsoukalas D. Breath Analysis: A Promising Tool for Disease Diagnosis-The Role of Sensors. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22031238. [PMID: 35161984 PMCID: PMC8840008 DOI: 10.3390/s22031238] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 05/07/2023]
Abstract
Early-stage disease diagnosis is of particular importance for effective patient identification as well as their treatment. Lack of patient compliance for the existing diagnostic methods, however, limits prompt diagnosis, rendering the development of non-invasive diagnostic tools mandatory. One of the most promising non-invasive diagnostic methods that has also attracted great research interest during the last years is breath analysis; the method detects gas-analytes such as exhaled volatile organic compounds (VOCs) and inorganic gases that are considered to be important biomarkers for various disease-types. The diagnostic ability of gas-pattern detection using analytical techniques and especially sensors has been widely discussed in the literature; however, the incorporation of novel nanomaterials in sensor-development has also proved to enhance sensor performance, for both selective and cross-reactive applications. The aim of the first part of this review is to provide an up-to-date overview of the main categories of sensors studied for disease diagnosis applications via the detection of exhaled gas-analytes and to highlight the role of nanomaterials. The second and most novel part of this review concentrates on the remarkable applicability of breath analysis in differential diagnosis, phenotyping, and the staging of several disease-types, which are currently amongst the most pressing challenges in the field.
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Affiliation(s)
- Maria Kaloumenou
- Department of Applied Physics, National Technical University of Athens, 15780 Athens, Greece; (M.K.); (D.T.)
| | - Evangelos Skotadis
- Department of Applied Physics, National Technical University of Athens, 15780 Athens, Greece; (M.K.); (D.T.)
- Correspondence:
| | - Nefeli Lagopati
- Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.L.); (E.E.)
| | - Efstathios Efstathopoulos
- Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.L.); (E.E.)
| | - Dimitris Tsoukalas
- Department of Applied Physics, National Technical University of Athens, 15780 Athens, Greece; (M.K.); (D.T.)
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28
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Exploring breath biomarkers in BLM-induced pulmonary fibrosis mice with associative ionization time-of-flight mass spectrometry. Talanta 2021; 239:123120. [PMID: 34864537 DOI: 10.1016/j.talanta.2021.123120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary fibrosis (PF) is a common but fatal disease that threatens human health worldwide. Developing effective diagnostic methods is of great importance for the early detection of PF in patients. In this study, bleomycin (BLM) was used in mice to mimic idiopathic pulmonary fibrosis (IPF). The exhaled breath of BLM-induced PF, PF plus DDAH1 overexpression, and healthy control mice were analyzed in real-time using a newly developed associative ionization time-of-flight mass spectrometry method (AI-TOFMS), which is uniquely sensitive, especially to oxygenated volatile organic compounds (VOCs). Multivariate data analyses and discriminant modeling analyses revealed that four exhaled compounds, i.e., acrolein, ethanol, nitric oxide, and ammonia, had a strong correlation with PF symptoms. An Orthogonal Partial Least Square Discriminant Analysis (OPLS-DA) score plot showed an excellent separation between these three groups. The area under the receiver operating characteristic (ROC) curve for these four compounds distinguished PF mice from healthy controls at 0.989. In addition, the degrees of acute inflammation and fibrosis were assessed with Hematoxylin and Eosin (H&E) staining and Masson's Trichrome staining. Finally, combined with pathological characteristics and mRNA expression levels, the formation of the above-mentioned volatile compounds was explored. The obtained experimental results indicated that these four breath compounds, acrolein, ethanol, nitric oxide, and ammonia, were potential exhaled biomarkers for pulmonary fibrosis.
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29
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Comparative analysis of volatile organic compounds of breath and urine for distinguishing patients with liver cirrhosis from healthy controls by using electronic nose and voltammetric electronic tongue. Anal Chim Acta 2021; 1184:339028. [PMID: 34625262 DOI: 10.1016/j.aca.2021.339028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
Advanced stage detection of liver cirrhosis (LCi) would lead to high mortality rates in patients. Therefore, accurate and non-invasive tools for its early detection are highly needed using human emanations that may reflect this disease. Human breath, along with urine and blood, has long been one of the three main biological media for assessing human health and environmental exposure. The primary objective of this study was to explore the potential of using volatile organic compounds (VOCs) assay of exhaled breath and urine samples for the diagnosis of patients with LCi and healthy controls (HC). For this purpose, we used a hybrid electronic nose (E-nose) combining two sensor families, consisting of an array of five commercial chemical gas sensors and six interdigitated chemical gas sensors based on pristine or metal-doped WO3 nanowires for sensing volatile gases in exhaled breath. A voltammetric electronic tongue (VE-tongue), composed of five working electrodes, was dedicated to the analysis of urinary VOCs using cyclic voltammetry as a measurement technique. 54 patients were recruited for this study, comprising 22 patients with LCi, and 32 HC. The two-sensing systems coupled with pattern recognition methods, namely Principal Component Analysis (PCA) and Discriminant Function Analysis (DFA), were trained to classify data clusters associated with the health status of the two groups. The diagnostic performances of the E-nose and VE-tongue systems were studied by using the receiver operating characteristic (ROC) method. The use of the E-nose or the VE-tongue separately, trained with these appropriate classifiers, showed a slight overlap indicating no clear discrimination between LCi patients and HC. To improve the performance of both electronic sensing devices, an emerging strategy, namely a multi-sensor data fusion technique, was proposed as a second aim to overcome this shortcoming. The data fusion approach of the two systems, at a medium level of abstraction, has demonstrated the ability to assess human health and disease status using non-invasive screening tools based on exhaled breath and urinary VOC analysis. This suggests that exhaled breath as well as urinary VOCs are specific to a disease state and could potentially be used as diagnostic methods.
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30
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Gouzerh F, Bessière JM, Ujvari B, Thomas F, Dujon AM, Dormont L. Odors and cancer: Current status and future directions. Biochim Biophys Acta Rev Cancer 2021; 1877:188644. [PMID: 34737023 DOI: 10.1016/j.bbcan.2021.188644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023]
Abstract
Cancer is the second leading cause of death in the world. Because tumors detected at early stages are easier to treat, the search for biomarkers-especially non-invasive ones-that allow early detection of malignancies remains a central goal to reduce cancer mortality. Cancer, like other pathologies, often alters body odors, and much has been done by scientists over the last few decades to assess the value of volatile organic compounds (VOCs) as signatures of cancers. We present here a quantitative review of 208 studies carried out between 1984 and 2020 that explore VOCs as potential biomarkers of cancers. We analyzed the main findings of these studies, listing and classifying VOCs related to different cancer types while considering both sampling methods and analysis techniques. Considering this synthesis, we discuss several of the challenges and the most promising prospects of this research direction in the war against cancer.
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Affiliation(s)
- Flora Gouzerh
- CREEC/CANECEV (CREES), Montpellier, France; MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France; CEFE, Univ Montpellier, CNRS, EPHE, IRD, Univ Paul Valéry Montpellier 3, Montpellier, France.
| | - Jean-Marie Bessière
- Ecole Nationale de Chimie de Montpellier, Laboratoire de Chimie Appliquée, Montpellier, France
| | - Beata Ujvari
- Deakin University, School of Life and Environmental Sciences, Centre for Integrative Ecology, Waurn Ponds, Vic 3216, Australia
| | - Frédéric Thomas
- CREEC/CANECEV (CREES), Montpellier, France; MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Antoine M Dujon
- CREEC/CANECEV (CREES), Montpellier, France; MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France; Deakin University, School of Life and Environmental Sciences, Centre for Integrative Ecology, Waurn Ponds, Vic 3216, Australia
| | - Laurent Dormont
- CEFE, Univ Montpellier, CNRS, EPHE, IRD, Univ Paul Valéry Montpellier 3, Montpellier, France
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van der Sar IG, Wijbenga N, Nakshbandi G, Aerts JGJV, Manintveld OC, Wijsenbeek MS, Hellemons ME, Moor CC. The smell of lung disease: a review of the current status of electronic nose technology. Respir Res 2021; 22:246. [PMID: 34535144 PMCID: PMC8448171 DOI: 10.1186/s12931-021-01835-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
There is a need for timely, accurate diagnosis, and personalised management in lung diseases. Exhaled breath reflects inflammatory and metabolic processes in the human body, especially in the lungs. The analysis of exhaled breath using electronic nose (eNose) technology has gained increasing attention in the past years. This technique has great potential to be used in clinical practice as a real-time non-invasive diagnostic tool, and for monitoring disease course and therapeutic effects. To date, multiple eNoses have been developed and evaluated in clinical studies across a wide spectrum of lung diseases, mainly for diagnostic purposes. Heterogeneity in study design, analysis techniques, and differences between eNose devices currently hamper generalization and comparison of study results. Moreover, many pilot studies have been performed, while validation and implementation studies are scarce. These studies are needed before implementation in clinical practice can be realised. This review summarises the technical aspects of available eNose devices and the available evidence for clinical application of eNose technology in different lung diseases. Furthermore, recommendations for future research to pave the way for clinical implementation of eNose technology are provided.
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Affiliation(s)
- I G van der Sar
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N Wijbenga
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Nakshbandi
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - O C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C C Moor
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Liver Impairment-The Potential Application of Volatile Organic Compounds in Hepatology. Metabolites 2021; 11:metabo11090618. [PMID: 34564434 PMCID: PMC8471934 DOI: 10.3390/metabo11090618] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022] Open
Abstract
Liver diseases are currently diagnosed through liver biopsy. Its invasiveness, costs, and relatively low diagnostic accuracy require new techniques to be sought. Analysis of volatile organic compounds (VOCs) in human bio-matrices has received a lot of attention. It is known that a musty odour characterises liver impairment, resulting in the elucidation of volatile chemicals in the breath and other body fluids such as urine and stool, which may serve as biomarkers of a disease. Aims: This study aims to review all the studies found in the literature regarding VOCs in liver diseases, and to summarise all the identified compounds that could be used as diagnostic or prognostic biomarkers. The literature search was conducted on ScienceDirect and PubMed, and each eligible publication was qualitatively assessed by two independent evaluators using the SANRA critical appraisal tool. Results: In the search, 58 publications were found, and 28 were kept for inclusion: 23 were about VOCs in the breath, one in the bile, three in urine, and one in faeces. Each publication was graded from zero to ten. A graphical summary of the metabolic pathways showcasing the known liver disease-related VOCs and suggestions on how VOC analysis on liver impairment could be applied in clinical practice are given.
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Noninvasive detection of COPD and Lung Cancer through breath analysis using MOS Sensor array based e-nose. Expert Rev Mol Diagn 2021; 21:1223-1233. [PMID: 34415806 DOI: 10.1080/14737159.2021.1971079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This paper describes the research work done toward the development of a breath analyzing electronic nose (e-nose), and the results obtained from testing patients with lung cancer, patients with chronic obstructive pulmonary disease (COPD), and healthy controls. Pulmonary diseases like COPD and lung cancer are detected with MOS sensor array-based e-noses. The e-nose device with the sensor array, data acquisition system, and pattern recognition can detect the variations of volatile organic compounds (VOC) present in the expelled breath of patients and healthy controls. MATERIALS AND METHODS This work presents the e-nose equipment design, study subjects selection, breath sampling procedures, and various data analysis tools. The developed e-nose system is tested in 40 patients with lung cancer, 48 patients with COPD, and 90 healthy controls. RESULTS In differentiating lung cancer and COPD from controls, support vector machine (SVM) with 3-fold cross-validation outperformed all other classifiers with an accuracy of 92.3% in cross-validation. In external validation, the same discrimination was achieved by k-nearest neighbors (k-NN) with 75.0% accuracy. CONCLUSION The reported results show that the VOC analysis with an e-nose system holds exceptional possibilities in noninvasive disease diagnosis applications.
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Binson VA, Subramoniam M, Mathew L. Discrimination of COPD and lung cancer from controls through breath analysis using a self-developed e-nose. J Breath Res 2021; 15. [PMID: 34243176 DOI: 10.1088/1752-7163/ac1326] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/09/2021] [Indexed: 01/22/2023]
Abstract
This work details the application of a metal oxide semiconductor (MOS) sensor based electronic nose (e-nose) system in the discrimination of lung cancer and chronic obstructive pulmonary disease (COPD) from healthy controls. The sensor array integrated with supervised classification algorithms was able to detect and classify exhaled breath samples from healthy controls, patients with COPD, and lung cancer by recognizing the amount of volatile organic compounds present in it. This paper details the e-nose design, participant selection, sampling methods, and data analysis. The clinical feasibility of the system was checked in 32 lung cancer patients, 38 COPD patients, and 72 healthy controls including smokers and non-smokers. One of the advantages of the equipment design was portability and robustness since the system was conditioned with elements that allowed its easy movement. In the discrimination of lung cancer from controls, the k-nearest neighbors gave an acceptable accuracy, sensitivity, and specificity of 91.3%, 84.4%, and 94.4% respectively. The support vector machine gave better results for COPD discrimination from controls with 90.9% accuracy, 81.6% sensitivity, and 95.8% specificity. Even though the attained results were good, further examinations are essential to enhance the sensor array system, investigate the long-run reproducibility, repeatability, and enlarge its relevancy.
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Affiliation(s)
- V A Binson
- Department of Electronics Engineering, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India.,Department of Electronics Engineering, Saintgits College of Engineering, Kottayam, Kerala, India
| | - M Subramoniam
- Department of Electronics Engineering, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Luke Mathew
- Department of Pulmonology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
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Gashimova E, Osipova A, Temerdashev A, Porkhanov V, Polyakov I, Perunov D, Dmitrieva E. Study of confounding factors influence on lung cancer diagnostics effectiveness using gas chromatography-mass spectrometry analysis of exhaled breath. Biomark Med 2021; 15:821-829. [PMID: 34223778 DOI: 10.2217/bmm-2020-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim: The purpose of this study was to estimate volatile organic compounds (VOCs) ability to distinguish exhaled breath samples of lung cancer patients and healthy volunteers and to assess the effect of smoking status and gender on parameters. Patients & methods: Exhaled breath samples of 40 lung cancer patients and 40 healthy individuals were analyzed using gas chromatography-mass spectrometry. Influence of other factors on the exhaled breath VOCs profile was investigated. Results: Some parameters correlating with the disease status were affected by other factors. Excluding these parameters allows creating a logistic regression diagnostic model with 83% sensitivity and 81% specificity. Conclusion: Influence of other factors on the exhaled breath VOCs profile has to be taken into account to avoid misleading results.
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Affiliation(s)
- Elina Gashimova
- Department of Analytical Chemistry, Kuban State University, Krasnodar, Russia
| | - Anna Osipova
- Department of Analytical Chemistry, Kuban State University, Krasnodar, Russia
| | - Azamat Temerdashev
- Department of Analytical Chemistry, Kuban State University, Krasnodar, Russia
| | - Vladimir Porkhanov
- Research Institute - Regional Clinical Hospital No. 1 named after Prof. SV Ochapovsky, Krasnodar, Russia
| | - Igor Polyakov
- Research Institute - Regional Clinical Hospital No. 1 named after Prof. SV Ochapovsky, Krasnodar, Russia
| | - Dmitry Perunov
- Research Institute - Regional Clinical Hospital No. 1 named after Prof. SV Ochapovsky, Krasnodar, Russia
| | - Ekaterina Dmitrieva
- Department of Analytical Chemistry, Kuban State University, Krasnodar, Russia
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Ibrahim W, Natarajan S, Wilde M, Cordell R, Monks PS, Greening N, Brightling CE, Evans R, Siddiqui S. A systematic review of the diagnostic accuracy of volatile organic compounds in airway diseases and their relation to markers of type-2 inflammation. ERJ Open Res 2021; 7:00030-2021. [PMID: 34476250 PMCID: PMC8405872 DOI: 10.1183/23120541.00030-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asthma and COPD continue to cause considerable diagnostic and treatment stratification challenges. Volatile organic compounds (VOCs) have been proposed as feasible diagnostic and monitoring biomarkers in airway diseases. AIMS To 1) conduct a systematic review evaluating the diagnostic accuracy of VOCs in diagnosing airway diseases; 2) understand the relationship between reported VOCs and biomarkers of type-2 inflammation; 3) assess the standardisation of reporting according to STARD and TRIPOD criteria; 4) review current methods of breath sampling and analysis. METHODS A PRISMA-oriented systematic search was conducted (January 1997 to December 2020). Search terms included: "asthma", "volatile organic compound(s)", "VOC" and "COPD". Two independent reviewers examined the extracted titles against review objectives. RESULTS 44 full-text papers were included; 40/44 studies were cross-sectional and four studies were interventional in design; 17/44 studies used sensor-array technologies (e.g. eNose). Cross-study comparison was not possible across identified studies due to the heterogeneity in design. The commonest airway diseases differentiating VOCs belonged to carbonyl-containing classes (i.e. aldehydes, esters and ketones) and hydrocarbons (i.e. alkanes and alkenes). Although individual markers that are associated with clinical biomarkers of type-2 inflammation were recognised (i.e. ethane and 3,7-dimethylnonane for asthma and α-methylstyrene and decane for COPD), these were not consistently identified across studies. Only 3/44 reported following STARD or TRIPOD criteria for diagnostic accuracy and multivariate reporting, respectively. CONCLUSIONS Breath VOCs show promise as diagnostic biomarkers of airway diseases and for type-2 inflammation profiling. However, future studies should focus on transparent reporting of diagnostic accuracy and multivariate models and continue to focus on chemical identification of volatile metabolites.
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Affiliation(s)
- Wadah Ibrahim
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
- Dept of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- These authors contributed equally
| | - Sushiladevi Natarajan
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
- Dept of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- These authors contributed equally
| | - Michael Wilde
- Dept of Chemistry, University of Leicester, Leicester, UK
| | | | - Paul S. Monks
- Dept of Chemistry, University of Leicester, Leicester, UK
| | - Neil Greening
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
- Dept of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Christopher E. Brightling
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
- Dept of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachael Evans
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
- Dept of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Salman Siddiqui
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
- Dept of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- See Acknowledgements for contributors
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Jaeschke C, Padilla M, Glöckler J, Polaka I, Leja M, Veliks V, Mitrovics J, Leja M, Mizaikoff B. Modular Breath Analyzer (MBA): Introduction of a Breath Analyzer Platform Based on an Innovative and Unique, Modular eNose Concept for Breath Diagnostics and Utilization of Calibration Transfer Methods in Breath Analysis Studies. Molecules 2021; 26:3776. [PMID: 34205805 PMCID: PMC8235513 DOI: 10.3390/molecules26123776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Exhaled breath analysis for early disease detection may provide a convenient method for painless and non-invasive diagnosis. In this work, a novel, compact and easy-to-use breath analyzer platform with a modular sensing chamber and direct breath sampling unit is presented. The developed analyzer system comprises a compact, low volume, temperature-controlled sensing chamber in three modules that can host any type of resistive gas sensor arrays. Furthermore, in this study three modular breath analyzers are explicitly tested for reproducibility in a real-life breath analysis experiment with several calibration transfer (CT) techniques using transfer samples from the experiment. The experiment consists of classifying breath samples from 15 subjects before and after eating a specific meal using three instruments. We investigate the possibility to transfer calibration models across instruments using transfer samples from the experiment under study, since representative samples of human breath at some conditions are difficult to simulate in a laboratory. For example, exhaled breath from subjects suffering from a disease for which the biomarkers are mostly unknown. Results show that many transfer samples of all the classes under study (in our case meal/no meal) are needed, although some CT methods present reasonably good results with only one class.
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Affiliation(s)
- Carsten Jaeschke
- Institute of Analytical and Bioanalytical Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany; (C.J.); (J.G.)
| | - Marta Padilla
- JLM Innovation GmbH, Vor dem Kreuzberg 17, 72070 Tuebingen, Germany; (M.P.); (J.M.)
| | - Johannes Glöckler
- Institute of Analytical and Bioanalytical Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany; (C.J.); (J.G.)
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Martins Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Viktors Veliks
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Jan Mitrovics
- JLM Innovation GmbH, Vor dem Kreuzberg 17, 72070 Tuebingen, Germany; (M.P.); (J.M.)
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Boris Mizaikoff
- Institute of Analytical and Bioanalytical Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany; (C.J.); (J.G.)
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Ghosh C, Leon A, Koshy S, Aloum O, Al-Jabawi Y, Ismail N, Weiss ZF, Koo S. Breath-Based Diagnosis of Infectious Diseases: A Review of the Current Landscape. Clin Lab Med 2021; 41:185-202. [PMID: 34020759 DOI: 10.1016/j.cll.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Various analytical methods can be applied to concentrate, separate, and examine trace volatile organic metabolites in the breath, with the potential for noninvasive, rapid, real-time identification of various disease processes, including an array of microbial infections. Although biomarker discovery and validation in microbial infections can be technically challenging, it is an approach that has shown great promise, especially for infections that are particularly difficult to identify with standard culture and molecular amplification-based approaches. This article discusses the current state of breath analysis for the diagnosis of infectious diseases.
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Affiliation(s)
- Chiranjit Ghosh
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Armando Leon
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Seena Koshy
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Obadah Aloum
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Yazan Al-Jabawi
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Nour Ismail
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Zoe Freeman Weiss
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sophia Koo
- Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Avenue, MCP642, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Ibrahim W, Carr L, Cordell R, Wilde MJ, Salman D, Monks PS, Thomas P, Brightling CE, Siddiqui S, Greening NJ. Breathomics for the clinician: the use of volatile organic compounds in respiratory diseases. Thorax 2021; 76:514-521. [PMID: 33414240 PMCID: PMC7611078 DOI: 10.1136/thoraxjnl-2020-215667] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 01/17/2023]
Abstract
Exhaled breath analysis has the potential to provide valuable insight on the status of various metabolic pathways taking place in the lungs locally and other vital organs, via systemic circulation. For years, volatile organic compounds (VOCs) have been proposed as feasible alternative diagnostic and prognostic biomarkers for different respiratory pathologies.We reviewed the currently published literature on the discovery of exhaled breath VOCs and their utilisation in various respiratory diseasesKey barriers in the development of clinical breath tests include the lack of unified consensus for breath collection and analysis and the complexity of understanding the relationship between the exhaled VOCs and the underlying metabolic pathways. We present a comprehensive overview, in light of published literature and our experience from coordinating a national breathomics centre, of the progress made to date and some of the key challenges in the field and ways to overcome them. We particularly focus on the relevance of breathomics to clinicians and the valuable insights it adds to diagnostics and disease monitoring.Breathomics holds great promise and our findings merit further large-scale multicentre diagnostic studies using standardised protocols to help position this novel technology at the centre of respiratory disease diagnostics.
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Affiliation(s)
- Wadah Ibrahim
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Liesl Carr
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | | | | | - Dahlia Salman
- Department of Chemistry, Loughborough University, Loughborough, UK
| | - Paul S Monks
- School of Chemistry, University of Leicester, Leicester, UK
| | - Paul Thomas
- Department of Chemistry, Loughborough University, Loughborough, UK
| | - Chris E Brightling
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Salman Siddiqui
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Neil J Greening
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
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Application of chemoresistive gas sensors and chemometric analysis to differentiate the fingerprints of global volatile organic compounds from diseases. Preliminary results of COPD, lung cancer and breast cancer. Clin Chim Acta 2021; 518:83-92. [PMID: 33766555 DOI: 10.1016/j.cca.2021.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/20/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Analysis of volatile organic compounds (VOCs) in exhaled breath has been proposed as a screening method that discriminates between disease and healthy subjects, few studies evaluate whether these chemical fingerprints are specific when compared between diseases. We evaluated global VOCs and their discrimination capacity in chronic obstructive pulmonary disease (COPD), lung cancer, breast cancer and healthy subjects by chemoresistive sensors and chemometric analysis. METHODS A cross-sectional study was conducted with the participation of 30 patients with lung cancer, 50 with breast cancer, 50 with COPD and 50 control subjects. Each participant's exhaled breath was analyzed with the electronic nose. A multivariate analysis was carried: principal component analysis (PCA) and, canonical analysis of principal coordinates (CAP). Twenty single-blind samples from the 4 study groups were evaluated by CAP. RESULTS A separation between the groups of patients to the controls was achieved through PCA with explanations of >90% of the data and with a correct classification of 100%. In the CAP of the 4 study groups, discrimination between the diseases was obtained with 2 canonical axes with a correct general classification of 91.35%. This model was used for the prediction of the single-blind samples resulting in correct classification of 100%. CONCLUSIONS The application of chemoresistive gas sensors and chemometric analysis can be used as a useful tool for a screening test for lung cancer, breast cancer and COPD since this equipment detects the set of VOCs present in the exhaled breath to generate a characteristic chemical fingerprint of each disease.
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Recognizing lung cancer and stages using a self-developed electronic nose system. Comput Biol Med 2021; 131:104294. [PMID: 33647830 DOI: 10.1016/j.compbiomed.2021.104294] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/25/2022]
Abstract
Exhaled breath contains thousands of gaseous volatile organic compounds (VOCs) that could be used as non-invasive biomarkers of lung cancer. Breath-based lung cancer screening has attracted wide attention on account of its convenience, low cost and easy popularization. In this paper, the research of lung cancer detection and staging is conducted by the self-developed electronic nose (e-nose) system. In order to investigate the performance of the device in distinguishing lung cancer patients from healthy controls, two feature extraction methods and two different classification models were adopted. Among all the models, kernel principal component analysis (KPCA) combined with extreme gradient boosting (XGBoost) achieved the best results among 235 breath samples. The accuracy, sensitivity and specificity of e-nose system were 93.59%, 95.60% and 91.09%, respectively. Meanwhile, the device could innovatively classify stages of 90 lung cancer patients (i.e., 44 stage III and 46 stage IV). Experimental results indicated that the recognition accuracy of lung cancer stages was more than 80%. Further experiments of this research also showed that the combination of sensor array and pattern recognition algorithms could identify and distinguish the expiratory characteristics of lung cancer, smoking and other respiratory diseases.
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Chen X, Muhammad KG, Madeeha C, Fu W, Xu L, Hu Y, Liu J, Ying K, Chen L, Yurievna GO. Calculated indices of volatile organic compounds (VOCs) in exhalation for lung cancer screening and early detection. Lung Cancer 2021; 154:197-205. [PMID: 33653598 DOI: 10.1016/j.lungcan.2021.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Breath analysis is a promising noninvasive technique that offers a wide range of opportunities to facilitate early diagnosis of lung cancer (LC). METHOD Exhaled breath samples of 352 subjects including 160 with lung cancer (LC), 70 with benign pulmonary nodule (BPN) and 122 healthy controls (HC) were analyzed through thermal desorption coupled with gas chromatography-mass spectrometry (TD-GC-MS) to obtain the metabolic information from volatile organic compounds (VOCs). Statistical classification models were used to find diagnostic clusters of VOCs for the discrimination of HC, BPN and LC patients' early and advanced stages, as well as subtypes of LC. Receiver operator characteristics (ROC) curves with 5-fold validations were used to evaluate the accuracy of these models. RESULTS The analysis revealed that 20, 19, 19, and 20 VOCs discriminated LC from HC, LC from BPN, histology and LC stages respectively. The calculated diagnostic indices showed a large area under the curve (AUC) to distinguish HC from LC (AUC: 0.987, 95 % confidence interval (CI): 0.976-0.997), BPN from LC (AUC: 0.809, 95 % CI: 0.758-0.860), NSCLC from SCLC (AUC: 0.939, 95 % CI: 0.875-0.995) and Stage III from stage III-IV (AUC: 0.827, 95 % CI: 0.768-0.886). The comparison between the high-risk groups (BPN and HC smokers) and early stages LC resulted in the AUC of 0.756 (95 %CI: 0.681-0.817) for BPN vs. early stage LC and AUC of 0.986 (95 % CI: 0.972-0.994) for HC smoker vs. early stage LC. CONCLUSION Volatome of breath of the LC patients was significantly different from that of both BPN patients and HC and showed an ability of distinguishing early from advance stage LC and NSCLC from SCLC. We conclude that the volatome has a potential to help improve early diagnosis of LC.
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Affiliation(s)
- Xing Chen
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Kanhar Ghulam Muhammad
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Channa Madeeha
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Wei Fu
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Linxin Xu
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yanjie Hu
- Zhejiang Sir Run Run Shaw Hospital, Department of Medicine, Zhejiang University, Hangzhou, China.
| | - Jun Liu
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Kejing Ying
- Zhejiang Sir Run Run Shaw Hospital, Department of Medicine, Zhejiang University, Hangzhou, China.
| | - Liying Chen
- Zhejiang Sir Run Run Shaw Hospital, Department of Medicine, Zhejiang University, Hangzhou, China.
| | - Gorlova Olga Yurievna
- Department of Medicine Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA.
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Liu L, Li W, He Z, Chen W, Liu H, Chen K, Pi X. Detection of lung cancer with electronic nose using a novel ensemble learning framework. J Breath Res 2021; 15. [PMID: 33578407 DOI: 10.1088/1752-7163/abe5c9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
Breath analysis based on electronic nose (e-nose) is a promising new technology for the detection of lung cancer that is non-invasive, simple to operate and cost-effective. Lung cancer screening by e-nose relies on predictive models established using machine learning methods. However, using only a single machine learning method to detect lung cancer has some disadvantages, including low detection accuracy and high false negative rate. To address these problems, groups of individual learning models with excellent performance were selected from classic models, including Support Vector Machine, Decision Tree, Random Forest, Logistic Regression and K-nearest neighbor regression, to build an ensemble learning framework (PCA-SVE). The output result of the PCA-SVE framework was obtained by voting. To test this approach, we analyzed 214 breath samples measured by e-nose with 11 gas sensors of four types using the proposed PCA-SVE framework. Experimental results indicated that the accuracy, sensitivity, and specificity of the proposed framework were 95.75%, 94.78%, and 96.96%, respectively. This framework overcomes the disadvantages of a single model, thereby providing an improved, practical alternative for exhaled breath analysis by e-nose.
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Affiliation(s)
- Lei Liu
- Key Laboratory of Biotechnology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, P.R. China, Chongqing, Chongqing, 400044, CHINA
| | - Wang Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, No.174 Shazhengjie, Shapingba, Chongqing, Chongqing, 400044, CHINA
| | - ZiChun He
- Chongqing Red Cross Hospital (People's Hospital of Jiangbei District), Chongqing Red Cross Hospital, 168 Hai'er Rd, Chongqing, 400020 , CHINA
| | - Weimin Chen
- Kunming University, No.727 South Jingming Rd, Chenggong District, Kunming, Yunnan, 650500, CHINA
| | - Hongying Liu
- Key Laboratory of Biotechnology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, No.174 Shazhengjie, Shapingba, Chongqing, Chongqing, 400044, CHINA
| | - Ke Chen
- Key Laboratory of Biotechnology Science and Technology, Ministry of Education, College of Bioengineering, , Chongqing University, No.174 Shazhengjie, Shapingba, Chongqing, Chongqing, 400044, CHINA
| | - Xitian Pi
- Key Laboratory of Biotechnology Science and Technology, Ministry of Education, College of Bioengineering, , Chongqing University, No.174 Shazhengjie, Shapingba, Chongqing, Chongqing, 400044, CHINA
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Tozlu BH, Şimşek C, Aydemir O, Karavelioglu Y. A High performance electronic nose system for the recognition of myocardial infarction and coronary artery diseases. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lammers A, van Bragt J, Brinkman P, Neerincx A, Bos L, Vijverberg S, Maitland-van der Zee A. Breathomics in Chronic Airway Diseases. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11589-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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46
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Li Q, Xiaoan F, Xu K, He H, Jiang N. A stability study of carbonyl compounds in Tedlar bags by a fabricated MEMS microreactor approach. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhong W, Zhang X, Zeng Y, Lin D, Wu J. Recent applications and strategies in nanotechnology for lung diseases. NANO RESEARCH 2021; 14:2067-2089. [PMID: 33456721 PMCID: PMC7796694 DOI: 10.1007/s12274-020-3180-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/11/2020] [Accepted: 10/11/2020] [Indexed: 05/14/2023]
Abstract
Lung diseases, including COVID-19 and lung cancers, is a huge threat to human health. However, for the treatment and diagnosis of various lung diseases, such as pneumonia, asthma, cancer, and pulmonary tuberculosis, are becoming increasingly challenging. Currently, several types of treatments and/or diagnostic methods are used to treat lung diseases; however, the occurrence of adverse reactions to chemotherapy, drug-resistant bacteria, side effects that can be significantly toxic, and poor drug delivery necessitates the development of more promising treatments. Nanotechnology, as an emerging technology, has been extensively studied in medicine. Several studies have shown that nano-delivery systems can significantly enhance the targeting of drug delivery. When compared to traditional delivery methods, several nanoparticle delivery strategies are used to improve the detection methods and drug treatment efficacy. Transporting nanoparticles to the lungs, loading appropriate therapeutic drugs, and the incorporation of intelligent functions to overcome various lung barriers have broad prospects as they can aid in locating target tissues and can enhance the therapeutic effect while minimizing systemic side effects. In addition, as a new and highly contagious respiratory infection disease, COVID-19 is spreading worldwide. However, there is no specific drug for COVID-19. Clinical trials are being conducted in several countries to develop antiviral drugs or vaccines. In recent years, nanotechnology has provided a feasible platform for improving the diagnosis and treatment of diseases, nanotechnology-based strategies may have broad prospects in the diagnosis and treatment of COVID-19. This article reviews the latest developments in nanotechnology drug delivery strategies in the lungs in recent years and studies the clinical application value of nanomedicine in the drug delivery strategy pertaining to the lung.
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Affiliation(s)
- Wenhao Zhong
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Xinyu Zhang
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Yunxin Zeng
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Dongjun Lin
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Jun Wu
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006 China
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Mule NM, Patil DD, Kaur M. A comprehensive survey on investigation techniques of exhaled breath (EB) for diagnosis of diseases in human body. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100715] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Volatile Organic Compounds in Exhaled Breath as Fingerprints of Lung Cancer, Asthma and COPD. J Clin Med 2020; 10:jcm10010032. [PMID: 33374433 PMCID: PMC7796324 DOI: 10.3390/jcm10010032] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Lung cancer, chronic obstructive pulmonary disease (COPD) and asthma are inflammatory diseases that have risen worldwide, posing a major public health issue, encompassing not only physical and psychological morbidity and mortality, but also incurring significant societal costs. The leading cause of death worldwide by cancer is that of the lung, which, in large part, is a result of the disease often not being detected until a late stage. Although COPD and asthma are conditions with considerably lower mortality, they are extremely distressful to people and involve high healthcare overheads. Moreover, for these diseases, diagnostic methods are not only costly but are also invasive, thereby adding to people’s stress. It has been appreciated for many decades that the analysis of trace volatile organic compounds (VOCs) in exhaled breath could potentially provide cheaper, rapid, and non-invasive screening procedures to diagnose and monitor the above diseases of the lung. However, after decades of research associated with breath biomarker discovery, no breath VOC tests are clinically available. Reasons for this include the little consensus as to which breath volatiles (or pattern of volatiles) can be used to discriminate people with lung diseases, and our limited understanding of the biological origin of the identified VOCs. Lung disease diagnosis using breath VOCs is challenging. Nevertheless, the numerous studies of breath volatiles and lung disease provide guidance as to what volatiles need further investigation for use in differential diagnosis, highlight the urgent need for non-invasive clinical breath tests, illustrate the way forward for future studies, and provide significant guidance to achieve the goal of developing non-invasive diagnostic tests for lung disease. This review provides an overview of these issues from evaluating key studies that have been undertaken in the years 2010–2019, in order to present objective and comprehensive updated information that presents the progress that has been made in this field. The potential of this approach is highlighted, while strengths, weaknesses, opportunities, and threats are discussed. This review will be of interest to chemists, biologists, medical doctors and researchers involved in the development of analytical instruments for breath diagnosis.
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Potential of the Electronic Nose for the Detection of Respiratory Diseases with and without Infection. Int J Mol Sci 2020; 21:ijms21249416. [PMID: 33321951 PMCID: PMC7763696 DOI: 10.3390/ijms21249416] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Respiratory tract infections are common, and when affecting the lower airways and lungs, can result in significant morbidity and mortality. There is an unfilled need for simple, non-invasive tools that can be used to screen for such infections at the clinical point of care. The electronic nose (eNose) is a novel technology that detects volatile organic compounds (VOCs). Early studies have shown that certain diseases and infections can result in characteristic changes in VOC profiles in the exhaled breath. This review summarizes current knowledge on breath analysis by the electronic nose and its potential for the detection of respiratory diseases with and without infection.
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