An Optimistic Vision of Future: Diagnosis of Bacterial Infections by Sensing Their Associated Volatile Organic Compounds

Volatilomes of human infection

The human volatilome comprises a vast mixture of volatile emissions produced by the human body and its microbiomes. Following infection, the human volatilome undergoes significant shifts, and presents a unique medium for non-invasive biomarker discovery. In this review, we examine how the onset of infection impacts the production of volatile metabolites that reflects dysbiosis by pathogenic microbes. We describe key analytical workflows applied across both microbial and clinical volatilomics and emphasize the value in linking microbial studies to clinical investigations to robustly elucidate the metabolic species and pathways leading to the observed volatile signatures. We review the current state of the art across microbial and clinical volatilomics, outlining common objectives and successes of microbial-clinical volatilomic workflows. Finally, we propose key challenges, as well as our perspectives on emerging opportunities for developing clinically useful and targeted workflows that could significantly enhance and expedite current practices in infection diagnosis and monitoring.

Identification of volatile biomarkers of Trichomonas vaginalis infection in vaginal discharge and urine

Trichomoniasis, a disease caused by Trichomonas vaginalis, is the most common non-viral sexually transmitted infection worldwide. The importance of its diagnosis lies in its ease of transmission and the absence of symptoms in most cases, as occurs in men, which have a significant role as asymptomatic carriers. The most widely used diagnostic methods are the fresh examination of vaginal or urethral secretions and molecular techniques. However, as they have some disadvantages and, sometimes, low sensitivity, new trichomoniasis diagnostic methods are necessary. Volatile organic compounds in clinical samples are effective in the diagnosis of different diseases. This work aimed to study, for the first time, those present in vaginal discharge and urine of patients with Trichomonas vaginalis infection to look for volatile biomarkers. The results showed that volatile compounds such as 2-methyl-1-propanol and cyclohexanone could serve as biomarkers in vaginal discharge samples, as well as 2-octen-1-ol and 3-nonanone in urine. Moreover, 3-hydroxy-2,4,4-trimethylpentyl 2-methylpropanoate found in vaginal discharge, highly correlated to positive patients, is also highly related to urines of patients with trichomoniasis. The biomarkers described in this study might be a promising diagnostic tool. KEY POINTS: • The incidence of Trichomonas vaginalis infection is increasing • Trichomonas vaginalis VOC study in vaginal discharge and urine was performed • The identification of volatile biomarkers could allow a new diagnostic method.

Rapid Identification of Carbapenemase-Producing Klebsiella pneumoniae Using Headspace Solid-Phase Microextraction Combined with Gas Chromatography-Mass Spectrometry

Background

Carbapenemase-producing Klebsiella pneumoniae is an unprecedented threat to public health, and its detection remains challenging. Analysis of microbial volatile organic compounds (VOCs) may offer a rapid way to determine bacterial antibiotic susceptibility.

Purpose

The aim of this study was to explore the VOCs released by carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) using headspace solid-phase microextraction/gas chromatography-mass spectrometry (HS-SPME/GC-MS).

Methods

Test bacteria were incubated in trypticase soy broth to the end of exponential growth phase, and imipenem was added in the middle time. Headspace VOCs were concentrated and analyzed using HS-SPME/GC-MS.

Results

The compound 3-methyl-1-butanol was found to be a biomarker among the 26 bacterial isolates (10 KPC-positive, 10 NDM-positive, 2 IMP-positive, 2 carbapenemase-negative CRKP, and 2 carbapenem-susceptible K. pneumonoiae).

Conclusion

This study explored a promising new strategy for the screening of carbapenemase-producing CRKP strains. Further research with larger sample sizes will potentially accelerate the application of biomarkers in routine microbiology.

Advances in microbial analysis: based on volatile organic compounds of microorganisms in food

In recent years, microbial volatile organic compounds (mVOCs) produced by microbial metabolism have attracted more and more attention because they can be used to detect food early contamination and flaws. So far, many analytical methods have been reported for the determination of mVOCs in food, but few integrated review articles discussing these methods are published. Consequently, mVOCs as indicators of food microbiological contamination and their generation mechanism including carbohydrate, amino acid, and fatty acid metabolism are introduced. Meanwhile, a detailed summary of the mVOCs sampling methods such as headspace, purge trap, solid phase microextraction, and needle trap is presented, and a systematic and critical review of the analytical methods (ion mobility spectrometry, electronic nose, biosensor, and so on) of mVOCs and their application in the detection of food microbial contamination is highlighted. Finally, the future concepts that can help improve the detection of food mVOCs are prospected.

The neglected potential of invertebrates in detecting disease via olfaction

Agents that cause disease alter the cell metabolism of their hosts. Cells with an altered metabolism produce particular profiles of biomolecules, which are different from those of healthy cells. Such differences may be detected by olfaction. Historically, physicians used olfactory cues to diagnose sickness by smelling the breath or the urine of patients. However, other species have been shown to possess excellent olfactory abilities. Dogs, for instance, have been frequently used as biodetectors of human diseases, including cancer, viral and bacterial infections. Other mammalian species, such as rats, have been trained to perform similar tasks, but their disease detection abilities remain poorly explored. Here, we focus on the overlooked potential of invertebrate species and we review the current literature on olfactory detection of diseases by these animals. We discuss the possible advantages of exploring further the abilities of invertebrates as detection tools for human disease.

Piezoelectric Gas Sensors with Polycomposite Coatings in Biomedical Application

When developing methods for diagnosing pathologies and diseases in humans and animals using electronic noses, one of the important trends is the miniaturization of devices, while maintaining significant information for diagnostic purposes. A combination of several sorbents that have unique sorption features of volatile organic compounds (VOCs) on one transducer is a possible option for the miniaturization of sensors for gas analysis. This paper considers the principles of creating polycomposite coatings on the electrodes of piezoelectric quartz resonators, including the choice of sorbents for the formation of sensitive layers, determining the mass and geometry of the formation of sensitive layers in a polycomposite coating, as well as an algorithm for processing the output data of sensors to obtain maximum information about the qualitative and quantitative composition of the gas phase. A comparative analysis of the efficiency and kinetics of VOC vapor sorption by sensors with polycomposite coatings and a set of sensors with relevant single coatings has been carried out. Regression equations have been obtained to predict the molar-specific sensitivity of the microbalance of VOC vapors by a sensor with a polycomposite coating of three sorbents with an error of 5-15% based on the results of the microbalance of VOC vapors on single coatings. A method for creating "visual prints" of sensor signals with polycomposite coatings is shown, with results comparable to those from an array of sensors. The parameters A_ij∑ are proposed for obtaining information on the qualitative composition of the gas phase when processing the output data of sensors with polycomposite coatings. A biochemical study of exhaled breath condensate (EBC) samples, a microbiological investigation of calf tracheal washes, and a clinical examination were conducted to assess the presence of bovine respiratory disease (BRD). An analysis of the gas phase over EBC samples with an array of sensors with polycomposite coatings was also carried out. The "visual prints" of the responses of sensors with polycomposite coatings and the results of the identification of VOCs in the gas phase over EBC samples were compared to the results of bacteriological studies of tracheal washes of the studied calves. A connection was found between the parameters A_ij∑ of a group of sensors with polycomposite coatings and the biochemical parameters of biosamples. The adequacy of replacing an array of piezoelectric sensors with single coatings by the sensors with polycomposite coatings is shown.

Noninvasive Detection of Bacterial Infection in Children Using Piezoelectric E-Nose

Currently, antibiotics are often prescribed to children without reason due to the inability to quickly establish the presence of a bacterial etiology of the disease. One way to obtain additional diagnostic information quickly is to study the volatile metabolome of biosamples using arrays of sensors. The goal of this work was to assess the possibility of using an array of chemical sensors with various sensitive coatings to determine the presence of a bacterial infection in children by analyzing the equilibrium gas phase (EGP) of urine samples. The EGP of 90 urine samples from children with and without a bacterial infection (urinary tract infection, soft tissue infection) was studied on the "MAG-8" device with seven piezoelectric sensors in a hospital. General urine analysis with sediment microscopy was performed using a Uriscan Pro analyzer and using an Olympus CX31 microscope. After surgical removal of the source of inflammation, the microbiological studies of the biomaterial were performed to determine the presence and type of the pathogen. The most informative output data of an array of sensors have been established for diagnosing bacterial pathology. Regression models were built to predict the presence of a bacterial infection in children with an error of no more than 15%. An indicator of infection is proposed to predict the presence of a bacterial infection in children with a high sensitivity of 96%.

Prebiotic effect of fructans from Agave salmiana on probiotic lactic acid bacteria and in children as a supplement for malnutrition

An imbalanced gut microbiota predisposes the development of nutritional disorders and chronic gastrointestinal diseases. Several studies have shown improvements on the host's health by enhancing the microbiota with prebiotics that stimulate probiotic microorganisms. This study describes the prebiotic effect of fructans from Agave salmiana consumed by children as a supplement for malnutrition. We report the extraction and degree of polymerization of fructans from A. salmiana, food safety and inflammatory analyses, and their effect in vitro on probiotic lactic acid bacteria (LAB). These fructans were included in the diet of 5-year-old normal-weight and malnourished children in double-blind, two-week interventions that compared the effects on their weight, bacterial count, and volatile organic compounds (VOCs). The extracted powdered fructans from A. salmiana had a composition comparable to inulin, were safe for human consumption, and stimulated the growth in vitro of three characteristic LAB. The children who consumed these fructans had a considerable weight gain, an increased number of LAB, and a decreased concentration of VOCs (indicative of less dysbiosis), demonstrating positive effects of this prebiotic on their microbiota, which were more significant in malnourished children. Fructans from A. salmiana induced in malnourished children significant weight gain and improved the functionality of their gut microbiota.

Micro-Chamber/Thermal Extractor (µ-CTE) as a new sampling system for VOCs emitted by feces

VOCs (volatile organic compounds) are increasingly wished to be used in diagnosis of diseases. They present strategic advantages, when compared to classical methods used, such as simplicity and current availability of performant non-invasive sample collection methods/systems. However, standardized sampling methods are required in order to achieve reproducible results. In the current study we developed a method to be used for feces sampling using a Micro-Chamber/Thermal Extractor (µ-CTE). Design Expert software (with Box-Behnken design) was used to predict the solutions. Therefore, by using the simulation experimental plan that was further experimentally verified, extraction time of 19.6 min, at extraction temperature of 30.6 °C by using a flow rate of 48.7 mL/min provided the higher response. The developed method was validated by using correlation tests and Network analysis, which both proved the validity of the developed model.

Application of Volatilome Analysis to the Diagnosis of Mycobacteria Infection in Livestock

Volatile organic compounds (VOCs) are small molecular mass metabolites which compose the volatilome, whose analysis has been widely employed in different areas. This innovative approach has emerged in research as a diagnostic alternative to different diseases in human and veterinary medicine, which still present constraints regarding analytical and diagnostic sensitivity. Such is the case of the infection by mycobacteria responsible for tuberculosis and paratuberculosis in livestock. Although eradication and control programs have been partly managed with success in many countries worldwide, the often low sensitivity of the current diagnostic techniques against Mycobacterium bovis (as well as other mycobacteria from Mycobacterium tuberculosis complex) and Mycobacterium avium subsp. paratuberculosis together with other hurdles such as low mycobacteria loads in samples, a tedious process of microbiological culture, inhibition by many variables, or intermittent shedding of the mycobacteria highlight the importance of evaluating new techniques that open different options and complement the diagnostic paradigm. In this sense, volatilome analysis stands as a potential option because it fulfills part of the mycobacterial diagnosis requirements. The aim of the present review is to compile the information related to the diagnosis of tuberculosis and paratuberculosis in livestock through the analysis of VOCs by using different biological matrices. The analytical techniques used for the evaluation of VOCs are discussed focusing on the advantages and drawbacks offered compared with the routine diagnostic tools. In addition, the differences described in the literature among in vivo and in vitro assays, natural and experimental infections, and the use of specific VOCs (targeted analysis) and complete VOC pattern (non-targeted analysis) are highlighted. This review emphasizes how this methodology could be useful in the problematic diagnosis of tuberculosis and paratuberculosis in livestock and poses challenges to be addressed in future research.

Eco-Friendly Direct GC–MS Method for Estimation of Niacin and Related Impurities Involving Pyridine in Food Supplements

Niacin is a water-soluble vitamin whose deficiency causes many disorders and diseases, including pellagra and high blood cholesterol. Herein, niacin and four common impurities, isonicotinic acid (ISO), 5-ethyl-2-methylpyridine (MP), pyridine-2, 5-dicarboxylic acid (PDC) and pyridine PYR, are simultaneously analyzed, where PYR is known as potentially nephrotoxic and hepatotoxic. The separation of a mixture using gas chromatography–mass spectroscopy (GC–MS) without any derivatization steps was the main target. Many studies have been published to study Niacin and its impurities using colorimetry and HPLC. GC–MS was selected to study the analyzed mixture owing to its known sensitivity and selectivity. In this study, a single quadrupole mass spectrometer operated in selected ion monitoring (SIM) mode at an electron ionization energy of 70 eV was applied for the quantitative analysis of Niacin. Helium was used as the carrier gas and adjusted to run through an HP-5ms (5%-phenyl)-methylpolysiloxane column. Statistical analysis proved that this method is equally effective as the previously reported method. Importantly, this study was eco-friendly as compared to the reported high performance thin layer chromatographic method (HPTLC). Finally, this study provides a new and valid eco-friendly method analysis to determine the concentration of niacin and its common impurities at very low concentration. Conclusion: A simple, rapid accurate and green GC–MS analytical method was developed and validated to determine niacin and its related official impurities.

Needle Trap Device-GC-MS for Characterization of Lung Diseases Based on Breath VOC Profiles

Volatile organic compounds (VOCs) have been assessed in breath samples as possible indicators of diseases. The present study aimed to quantify 29 VOCs (previously reported as potential biomarkers of lung diseases) in breath samples collected from controls and individuals with lung cancer, chronic obstructive pulmonary disease and asthma. Besides that, global VOC profiles were investigated. A needle trap device (NTD) was used as pre-concentration technique, associated to gas chromatography-mass spectrometry (GC-MS) analysis. Univariate and multivariate approaches were applied to assess VOC distributions according to the studied diseases. Limits of quantitation ranged from 0.003 to 6.21 ppbv and calculated relative standard deviations did not exceed 10%. At least 15 of the quantified targets presented themselves as discriminating features. A random forest (RF) method was performed in order to classify enrolled conditions according to VOCs' latent patterns, considering VOCs responses in global profiles. The developed model was based on 12 discriminating features and provided overall balanced accuracy of 85.7%. Ultimately, multinomial logistic regression (MLR) analysis was conducted using the concentration of the nine most discriminative targets (2-propanol, 3-methylpentane, (E)-ocimene, limonene, m-cymene, benzonitrile, undecane, terpineol, phenol) as input and provided an average overall accuracy of 95.5% for multiclass prediction.

Volatile Organic Compounds in Exhaled Breath as Fingerprints of Lung Cancer, Asthma and COPD

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.

Hunting for Toxic Industrial Chemicals: Real-Time Detection of Carbon Disulfide Traces by Means of Ion Mobility Spectrometry

Sensitive real-time detection of vapors produced by toxic industrial chemicals (TICs) represents a stringent priority nowadays. Carbon disulfide (CS₂) is such a chemical, being widely used in manufacturing synthetic textile fibers and as a solvent. CS₂ is simultaneously a very reactive, highly flammable, irritant, corrosive, and highly toxic compound, affecting the central nervous system, cardiovascular system, eyes, kidneys, liver, skin, and reproductive system. This study was directed towards quick detection and quantification of CS₂ in air, using time-of-flight ion mobility spectrometry (IMS); photoionization detection (PID) was also used as confirmatory technique. Results obtained indicated that IMS can detect CS₂ at trace levels in air. The ion mobility spectrometric response was in the negative ion mode and presented one product ion, at a reduced ion mobility (K₀) of 2.25 cm² V⁻¹ s⁻¹. Our study demonstrated that by using a portable, commercial IMS system (model Mini IMS, I.U.T. GmbH Berlin Germany) one can easily measure CS₂ at concentrations of 0.1 ppm_v (0.3 mg m⁻³) in the negative ion mode, which is below the lowest threshold value of 1 ppm_v given for industrial hygiene. A limit of detection (LOD) of ca. 30 ppb_v (0.1 mg m⁻³) was also estimated.

Sensing Precursors of Illegal Drugs-Rapid Detection of Acetic Anhydride Vapors at Trace Levels Using Photoionization Detection and Ion Mobility Spectrometry

Sensitive real-time detection of vapors produced by the precursors, reagents and solvents used in the illegal drugs manufacture represents a priority nowadays. Acetic anhydride (AA) is the key chemical used as acetylation agent in producing the illegal drugs heroin and methaqualone. This study was directed towards quick detection and quantification of AA in air, using two fast and very sensitive analytical techniques: photoionization detection (PID) and ion mobility spectrometry (IMS). Results obtained indicated that both PID and IMS can sense AA at ultra-trace levels in air, but while PID produces a non-selective response, IMS offers richer information. Ion mobility spectrometric response in the positive ion mode presented one product ion, at reduced ion mobility K₀ of 1.89 cm² V⁻¹ s⁻¹ (almost overlapped with positive reactant ion peak), while in the negative ion mode two well separated product ions, with K₀ of 1.90 and 1.71 cm² V⁻¹ s⁻¹, were noticed. Our study showed that by using a portable, commercial IMS system (model Mini IMS, I.U.T. GmbH Berlin) AA can be easily measured at concentrations of 0.05 ppm_v (0.2 mg m⁻³) in negative ion mode. Best selectivity and sensitivity of the IMS response were therefore achieved in the negative operation mode.

Two-step investigation of lung cancer detection by sniffer dogs

Early detection of lung cancer (LC) is a priority since LC is characterized by symptoms mimicking other respiratory conditions, but it remains the leading cause of oncological disease death. Properly trained dogs can perceive the volatile organic compounds (VOCs) related to cancer thanks to their acute sense of smell. The use of dogs for LC detection could be advantageous: reliably trained dogs would represent a valuable, cost-effective, non-invasive method of screening, which gives a clear-cut yes/no response. However, whether sniffer dogs are able to maintain their discriminative capacity under long-term control, and in different types of environments, needs further investigation. In this study, we sought to test two hypotheses: firstly, if dogs can be trained to perceive LC-related VOCs in human urine, a substrate which is not influenced by the carrier materials and may thus be a good candidate for large-number screening; and secondly, whether trained dogs retain their performance stability over time, even if the environment in which the tests are carried out varies. We have selected three family dogs that underwent a one-year training period (two weekly training sessions) by the clicker training method. At the end of the training, the dogs underwent two separate test phases, in two different locations, one year apart. All the other procedures had been maintained unchanged. The donors of the samples submitted to the dogs were recruited by the European Institute of Oncology (IEO), Milan, Italy. The results show that the dogs had different sensitivity (range: 45%-73%) and specificity rates (range: 89%-91%), and were deceived neither by lung conditions (that the dogs did not consider) nor by the existence of tumors in the beginning stage, that were correctly reported by the dogs. The one-year interruption of the research work and the changes in the test environment did not induce statistically significant differences in the dogs' perceptive capacity. To our knowledge, so far, these issues have never been highlighted.

Evolution and Evaluation of GC Columns

A chromatographic column is the fundamental element required for gas-chromatographic analysis. The separation of components coming from complex mixtures, prior to their detection was leading to a prominent revolution in different areas of science. Moreover, current advances in gas chromatographic (GC) columns technology and development have been providing almost unlimited possibilities for analysis employing diverse matrices. We aim through this review article to describe the evolution of chromatographic columns, by pointing the most important stages, as well as the new trends and future perspectives predicted for the new generation of GC columns. Furthermore, it was in our scope to present the main fundamentals regarding the theoretical relationships that describe the chromatographic separation, to introduce concepts related to columns selection in accordance with the required application as well as to discuss the available evaluation parameters for columns efficiency. Consequently, the early stages of first columns preparation up to the development of GC capillary columns used nowadays, together with examples of their applications are also reported and described in detail.