A targeted metabolomic protocol for quantitative analysis of volatile organic compounds in urine of children with celiac disease

Efficacy and safety of gut microbiota-based therapies in autoimmune and rheumatic diseases: a systematic review and meta-analysis of 80 randomized controlled trials

BACKGROUND

Previous randomized controlled trials (RCTs) suggested that gut microbiota-based therapies may be effective in treating autoimmune diseases, but a systematic summary is lacking.

METHODS

Pubmed, EMbase, Sinomed, and other databases were searched for RCTs related to the treatment of autoimmune diseases with probiotics from inception to June 2022. RevMan 5.4 software was used for meta-analysis after 2 investigators independently screened literature, extracted data, and assessed the risk of bias of included studies.

RESULTS

A total of 80 RCTs and 14 types of autoimmune disease [celiac sprue, SLE, and lupus nephritis (LN), RA, juvenile idiopathic arthritis (JIA), spondyloarthritis, psoriasis, fibromyalgia syndrome, MS, systemic sclerosis, type 1 diabetes mellitus (T1DM), oral lichen planus (OLP), Crohn's disease, ulcerative colitis] were included. The results showed that gut microbiota-based therapies may improve the symptoms and/or inflammatory factor of celiac sprue, SLE and LN, JIA, psoriasis, PSS, MS, systemic sclerosis, Crohn's disease, and ulcerative colitis. However, gut microbiota-based therapies may not improve the symptoms and/or inflammatory factor of spondyloarthritis and RA. Gut microbiota-based therapies may relieve the pain of fibromyalgia syndrome, but the effect on fibromyalgia impact questionnaire score is not significant. Gut microbiota-based therapies may improve HbA1c in T1DM, but its effect on total insulin requirement does not seem to be significant. These RCTs showed that probiotics did not increase the incidence of adverse events.

CONCLUSIONS

Gut microbiota-based therapies may improve several autoimmune diseases (celiac sprue, SLE and LN, JIA, psoriasis, fibromyalgia syndrome, PSS, MS, T1DM, Crohn's disease, and ulcerative colitis).

Metabolomic Profiling in Children with Celiac Disease: Beyond the Gluten-Free Diet

Celiac disease (CD) is included in the group of complex or multifactorial diseases, i.e., those caused by the interaction of genetic and environmental factors. Despite a growing understanding of the pathophysiological mechanisms of the disease, diagnosis is still often delayed and there are no effective biomarkers for early diagnosis. The only current treatment, a gluten-free diet (GFD), can alleviate symptoms and restore intestinal villi, but its cellular effects remain poorly understood. To gain a comprehensive understanding of CD's progression, it is crucial to advance knowledge across various scientific disciplines and explore what transpires after disease onset. Metabolomics studies hold particular significance in unravelling the complexities of multifactorial and multisystemic disorders, where environmental factors play a significant role in disease manifestation and progression. By analyzing metabolites, we can gain insights into the reasons behind CD's occurrence, as well as better comprehend the impact of treatment initiation on patients. In this review, we present a collection of articles that showcase the latest breakthroughs in the field of metabolomics in pediatric CD, with the aim of trying to identify CD biomarkers for both early diagnosis and treatment monitoring. These advancements shed light on the potential of metabolomic analysis in enhancing our understanding of the disease and improving diagnostic and therapeutic strategies. More studies need to be designed to cover metabolic profiles in subjects at risk of developing the disease, as well as those analyzing biomarkers for follow-up treatment with a GFD.

A new headspace solid-phase microextraction coupled with gas chromatography-tandem mass spectrometry method for the simultaneous quantification of 21 microbial volatile organic compounds in urine and blood

Mold growth can cause the development of several metabolites including microbial volatile organic compounds (mVOCs). These latter may be considered as potential biomarkers of fungal presence and have been detected in human biological matrices such as urine and blood. Exposure to molds and their metabolites (e.g., mVOCs, mycotoxins) in occupational settings, is responsible for several health effects. Thus, this exposure cannot be neglected and must be evaluated. Herein, a method has been developed to quantify 21 mVOCs in urine and human blood by headspace solid phase micro-extraction (HS-SPME) coupled with gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). The parameters influencing the extraction process, such as the type of fiber, the incubation and extraction time and temperature and the desorption time, have been optimized to ensure better mVOCs extraction. The developed method showed good linearity over the concentration range of the compounds (R² ˃ 0.995) for all the mVOCs in all the matrices. The low limits of detection (LOD) ranging from 0.7 to 417 ng/L in urine and from 1 to 507 ng/L in blood, make the developed methods sensitive and effective for biomonitoring of exposure at low levels. Recoveries, at low and high concentrations, were between 87% and 120% in urine and between 83% and 118% in blood. The repeatability and the intermediate precision in terms of coefficients of variation (CV%) was lower than 13% and 8.58% respectively for all compounds in all matrices. These values show satisfactory accuracy and precision of the developed method. Thus, this practical, simple, and sensitive method is well suited for the simultaneous quantification of target mVOCs.

Impact of the adsorbent material on volatile metabolites during in vitro and in vivo bio-sampling

The increased attraction of biological volatile compounds has opened the route to a wide variety of sampling techniques, amongst which trap tubes packed with adsorbent materials are commonly used. Many types of adsorbent materials are available and the choice of the adsorbent can impact the obtained results in untargeted analysis. Therefore, a proper combination of the adsorbent material and the sample is necessary to increase the robustness and reproducibility of biological studies. In this study, the sampling performance of thermal desorption tubes with six common adsorbent material combinations, i.e., Tenax® TA, Tenax® TA/Carbopack™ B, Tenax® TA/Sulficarb, Tenax® TA/Carbograph™ 5TD, Tenax® TA/Carbograph™ 1TD/Carboxen® 1003, and Carboxen® 1016/Carbograph™ 5TD, was evaluated in two different setups: in vitro and in vivo sampling. The in vitro setup consisted of the headspace dynamic extraction of spiked serum, and a mixture of 19 standards was evaluated in terms of response and reproducibility. The in vivo setup consisted into two parts: the first one was based the evaluation of the standard mixture, which was flash-vaporised into Tedlar® bags containing exhaled breath; the second part was based on the longitudinal monitoring of breath metabolites originating from a beverage intake (i.e., brewed coffee), over a 90 min time period. The tubes were all desorbed and analysed in a comprehensive two-dimensional gas chromatography system coupled to a high-resolution time-of-flight mass spectrometer (GC × GC-HR ToF MS). In both sampling setups, the widest analytes coverage and the overall best extraction yield on the selected compounds were obtained using Tenax® TA, followed by Tenax® TA/Carbopack™ B. Tenax® TA provided the highest sampling reproducibility with 12 %RSD, 10 %RSD and <5 %RSD of the response during the experiments using the in vitro setup, the in vivo setup, and during the longitudinal tracking, respectively.

An Optimization of Liquid-Liquid Extraction of Urinary Volatile and Semi-Volatile Compounds and Its Application for Gas Chromatography-Mass Spectrometry and Proton Nuclear Magnetic Resonance Spectroscopy

Urinary volatile compounds (VCs) have been recently assessed for disease diagnoses. They belong to very diverse chemical classes, and they are characterized by different volatilities, polarities and concentrations, complicating their analysis via a single analytical procedure. There remains a need for better, lower-cost methods for VC biomarker discovery. Thus, there is a strong need for alternative methods, enabling the detection of a broader range of VCs. Therefore, the main aim of this study was to optimize a simple and reliable liquid-liquid extraction (LLE) procedure for the analysis of VCs in urine using gas chromatography-mass spectrometry (GC-MS), in order to obtain the maximum number of responses. Extraction parameters such as pH, type of solvent and ionic strength were optimized. Moreover, the same extracts were analyzed using Proton Nuclear Magnetic Resonance Spectroscopy (1H-NMR), to evaluate the applicability of a single urine extraction for multiplatform purposes. After the evaluation of experimental conditions, an LLE protocol using 2 mL of urine in the presence of 2 mL of 1 M sulfuric acid and sodium sulphate extracted with dichloromethane was found to be optimal. The optimized method was validated with the external standards and was found to be precise and linear, and allowed for detection of >400 peaks in a single run present in at least 50% of six samples-considerably more than the number of peaks detected by solid-phase microextracton fiber pre-concentration-GC-MS (328 ± 6 vs. 234 ± 4). 1H-NMR spectroscopy of the polar and non-polar extracts extended the range to >40 more (mainly low volatility compounds) metabolites (non-destructively), the majority of which were different from GC-MS. The more peaks detectable, the greater the opportunity of assessing a fingerprint of several compounds to aid biomarker discovery. In summary, we have successfully demonstrated the potential of LLE as a cheap and simple alternative for the analysis of VCs in urine, and for the first time the applicability of a single urine solvent extraction procedure for detecting a wide range of analytes using both GC-MS and 1H-NMR analysis to enhance putative biomarker detection. The proposed method will simplify the transport between laboratories and storage of samples, as compared to intact urine samples.

The Profile of Urinary Headspace Volatile Organic Compounds After 12-Week Intake of Oligofructose-Enriched Inulin by Children and Adolescents with Celiac Disease on a Gluten-Free Diet: Results of a Pilot, Randomized, Placebo-Controlled Clinical Trial

The concentration of volatile organic compounds (VOCs) can inform about the metabolic condition of the body. In the small intestine of untreated persons with celiac disease (CD), chronic inflammation can occur, leading to nutritional deficiencies, and consequently to functional impairments of the whole body. Metabolomic studies showed differences in the profile of VOCs in biological fluids of patients with CD in comparison to healthy persons; however, there is scarce quantitative and nutritional intervention information. The aim of this study was to evaluate the effect of the supplementation of a gluten-free diet (GFD) with prebiotic oligofructose-enriched inulin (Synergy 1) on the concentration of VOCs in the urine of children and adolescents with CD. Twenty-three participants were randomized to the group receiving Synergy 1 (10 g per day) or placebo for 12 weeks. Urinary VOCs were analyzed using solid-phase microextraction and gas chromatography⁻mass spectrometry. Sixteen compounds were identified and quantified in urine samples. The supplementation of GFD with Synergy 1 resulted in an average concentration drop (36%) of benzaldehyde in urine samples. In summary, Synergy 1, applied as a supplement of GFD for 12 weeks had a moderate impact on the VOC concentrations in the urine of children with CD.

Advances in celiac disease testing

Celiac disease (CD) is a T cell-mediated inflammatory autoimmune disorder of the upper small intestine caused by the ingestion of gluten. It is increasingly recognized as a global problem by experts and societies. The diagnosis of CD is of crucial importance because its delay strongly affects patient's health and quality of life. The diagnosis of CD is, however, complex and requires reliable, sensitive, specific, rapid, simple, and cost-effective, as well-as non-invasive analytical tools. There is also a high demand to develop simple point-of-care (POC) tests for non-specialists at home or in doctors' offices. Analytical techniques are now moving toward the development of fast, more simple, non-invasive, and POC analyses. The present review focuses on recent advances of CD biomarker detection in body fluids, concerning CD specific autoantibody detection in blood and saliva using electrochemical, optic-fiber, and piezoelectric biosensors and POC finger-prick tests, and identifying CD characteristic volatile organic compounds (VOCs) in urine and feces.