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Glöckler J, Jaeschke C, Padilla M, Mitrovics J, Mizaikoff B. Ultratrace eNose Sensing of VOCs toward Breath Analysis Applications Utilizing an eNose-Based Analyzer. ACS MEASUREMENT SCIENCE AU 2024; 4:184-187. [PMID: 38645578 PMCID: PMC11027196 DOI: 10.1021/acsmeasuresciau.3c00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 04/23/2024]
Abstract
This proof-of-principle study presents the ability of the recently developed iLovEnose to measure ultratrace levels of volatile organic compounds (VOCs) in simulated human breath based on the combination of multiple gas sensors. The iLovEnose was developed by our research team as a test bed for gas sensors that can be hosted in three serially connected compact low-volume and temperature-controlled compartments. Herein, the eNose system was equipped with conventional semiconducting metal oxide (MOX) gas sensors using a variety of base technologies providing 11 different sensor signals that were evaluated to determine six VOCs of interest at eight low to ultralow concentration levels (i.e., ranging from 3 to 0.075 ppm) at humid conditions (90% rh at 22 °C). The measurements were randomized and performed four times over a period of 2 weeks. Partial least-squares regression analysis was applied to estimate the concentration of these six analytes. It was shown that the iLovEnose system is able to discriminate between these VOCs and provide reliable quantitative information relevant for future applications in exhaled breath analysis as a diagnostic disease detection or monitoring device.
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Affiliation(s)
- Johannes Glöckler
- Institute
of Analytical and Bioanalytical Chemistry, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Carsten Jaeschke
- Institute
of Analytical and Bioanalytical Chemistry, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Marta Padilla
- JLM
Innovation GmbH, Vor
dem Kreuzberg 17, 72070 Tübingen, Germany
| | - Jan Mitrovics
- JLM
Innovation GmbH, Vor
dem Kreuzberg 17, 72070 Tübingen, Germany
| | - Boris Mizaikoff
- Institute
of Analytical and Bioanalytical Chemistry, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
- Hahn-Schickard, Sedanstrasse
14, 89077 Ulm, Germany
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2
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Casalinuovo S, Caschera D, Quaranta S, Genova V, Buzzin A, Federici F, de Cesare G, Puglisi D, Caputo D. Gold Nanoparticles-Functionalized Cotton as Promising Flexible and Green Substrate for Impedometric VOC Detection. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5826. [PMID: 37687519 PMCID: PMC10488880 DOI: 10.3390/ma16175826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023]
Abstract
This work focuses on the possible application of gold nanoparticles on flexible cotton fabric as acetone- and ethanol-sensitive substrates by means of impedance measurements. Specifically, citrate- and polyvinylpyrrolidone (PVP)-functionalized gold nanoparticles (Au NPs) were synthesized using green and well-established procedures and deposited on cotton fabric. A complete structural and morphological characterization was conducted using UV-VIS and Fourier transform infrared (FT-IR) spectroscopy, atomic force microscopy (AFM), and scanning electron microscopy (SEM). A detailed dielectric characterization of the blank substrate revealed interfacial polarization effects related to both Au NPs and their specific surface functionalization. For instance, by entirely coating the cotton fabric (i.e., by creating a more insulating matrix), PVP was found to increase the sample resistance, i.e., to decrease the electrical interconnection of Au NPs with respect to citrate functionalized sample. However, it was observed that citrate functionalization provided a uniform distribution of Au NPs, which reduced their spacing and, therefore, facilitated electron transport. Regarding the detection of volatile organic compounds (VOCs), electrochemical impedance spectroscopy (EIS) measurements showed that hydrogen bonding and the resulting proton migration impedance are instrumental in distinguishing ethanol and acetone. Such findings can pave the way for the development of VOC sensors integrated into personal protective equipment and wearable telemedicine devices. This approach may be crucial for early disease diagnosis based on nanomaterials to attain low-cost/low-end and easy-to-use detectors of breath volatiles as disease markers.
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Affiliation(s)
- Silvia Casalinuovo
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy; (S.C.); (A.B.); (G.d.C.); (D.C.)
| | - Daniela Caschera
- Institute for the Study of Nanostructured Materials CNR-ISMN, Strada Provinciale 35d/9 00010, Montelibretti, 00010 Rome, Italy; (S.Q.); (F.F.)
| | - Simone Quaranta
- Institute for the Study of Nanostructured Materials CNR-ISMN, Strada Provinciale 35d/9 00010, Montelibretti, 00010 Rome, Italy; (S.Q.); (F.F.)
| | - Virgilio Genova
- Department of Chemical Engineering, Materials and Environment, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy;
| | - Alessio Buzzin
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy; (S.C.); (A.B.); (G.d.C.); (D.C.)
| | - Fulvio Federici
- Institute for the Study of Nanostructured Materials CNR-ISMN, Strada Provinciale 35d/9 00010, Montelibretti, 00010 Rome, Italy; (S.Q.); (F.F.)
| | - Giampiero de Cesare
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy; (S.C.); (A.B.); (G.d.C.); (D.C.)
| | - Donatella Puglisi
- Division of Sensor and Actuator Systems, Department of Physics, Chemistry and Biology (IFM), Linköping University, Campus Valla, 58183 Linköping, Sweden;
| | - Domenico Caputo
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy; (S.C.); (A.B.); (G.d.C.); (D.C.)
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Potential Role of Oxidative Stress in the Production of Volatile Organic Compounds in Obesity. Antioxidants (Basel) 2023; 12:antiox12010129. [PMID: 36670991 PMCID: PMC9854577 DOI: 10.3390/antiox12010129] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Obesity is associated with numerous health issues such as sleep disorders, asthma, hepatic dysfunction, cancer, renal dysfunction, diabetes, cardiovascular complications, and infertility. Previous research has shown that the distribution of excess body fat, rather than excess body weight, determines obesity-related risk factors. It is widely accepted that abdominal fat is a serious risk factor for illnesses associated with obesity and the accumulation of visceral fat promotes the release of pro-oxidants, pro-inflammatory, and reactive oxygen species (ROS). The metabolic process in the human body produces several volatile organic compounds (VOCs) via urine, saliva, breath, blood, skin secretions, milk, and feces. Several studies have shown that VOCs are released by the interaction of ROS with underlying cellular components leading to increased protein oxidation, lipid peroxidation, or DNA damage. These VOCs released via oxidative stress in obese individuals may serves as a biomarker for obesity-related metabolic alterations and disease. In this review, we focus on the relationship between oxidative stress and VOCs in obesity.
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Annerino A, Faltas M, Srinivasan M, Gouma PI. Towards skin-acetone monitors with selective sensitivity: Dynamics of PANI-CA films. PLoS One 2022; 17:e0267311. [PMID: 35476814 PMCID: PMC9045607 DOI: 10.1371/journal.pone.0267311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Most research aimed at measuring biomarkers on the skin is only concerned with sensing chemicals in sweat using electrical signals, but these methods are not truly non-invasive nor non-intrusive because they require substantial amounts of sweat to get a reading. This project aims to create a truly non-invasive wearable sensor that continuously detects the gaseous acetone (a biomarker related to metabolic disorders) that ambiently comes out of the skin. Composite films of polyaniline and cellulose acetate, exhibiting chemo-mechanical actuation upon exposure to gaseous acetone, were tested in the headspaces above multiple solutions containing acetone, ethanol, and water to gauge response sensitivity, selectivity, and repeatability. The bending of the films in response to exposures to these environments was tracked by an automatic video processing code, which was found to out-perform an off-the-shelf deep neural network-based tracker. Using principal component analysis, we showed that the film bending is low dimensional with over 90% of the shape changes being captured with just two parameters. We constructed forward models to predict shape changes from the known exposure history and found that a linear model can explain 40% of the observed variance in film tip angle changes. We constructed inverse models, going from third order fits of shape changes to acetone concentrations where about 45% of the acetone variation and about 30% of ethanol variation are captured by linear models, and non-linear models did not perform substantially better. This suggests there is sufficient sensitivity and inherent selectivity of the films. These models, however, provide evidence for substantial hysteretic or long-time-scale responses of the PANI films, seemingly due to the presence of water. Further experiments will allow more accurate discrimination of unknown exposure environments. Nevertheless, the sensor will operate with high selectivity in low sweat body locations, like behind the ear or on the nails.
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Affiliation(s)
- Anthony Annerino
- Material Science and Engineering, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Michael Faltas
- Material Science and Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Manoj Srinivasan
- Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States of America
- Program in Biophysics, The Ohio State University, Columbus, OH, United States of America
| | - Pelagia-Irene Gouma
- Material Science and Engineering, The Ohio State University, Columbus, OH, United States of America
- Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States of America
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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: 18] [Impact Index Per Article: 6.0] [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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Song L, Dou K, Wang R, Leng P, Luo L, Xi Y, Kaun CC, Han N, Wang F, Chen Y. Sr-Doped Cubic In 2O 3/Rhombohedral In 2O 3 Homojunction Nanowires for Highly Sensitive and Selective Breath Ethanol Sensing: Experiment and DFT Simulation Studies. ACS APPLIED MATERIALS & INTERFACES 2020; 12:1270-1279. [PMID: 31822058 DOI: 10.1021/acsami.9b15928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In recent years, it is urgent and challenging to fabricate highly sensitive and selective gas sensors for breath analyses. In this work, Sr-doped cubic In2O3/rhombohedral In2O3 homojunction nanowires (NWs) are synthesized by one-step electrospun technology. The Sr doping alters the cubic phase of pure In2O3 into the rhombohedral phase, which is verified by the high-resolution transmittance electron microscopy, X-ray diffraction, and Raman spectroscopy, and is attributable to the low cohesive energy as calculated by the density functional theory (DFT). As a proof-of-concept of fatty liver biomarker sensing, ethanol sensors are fabricated using the electrospun In2O3 NWs. The results show that 8 wt % Sr-doped In2O3 shows the highest ethanol sensing performance with a high response of 21-1 ppm, a high selectivity over other interfering gases such as methanol, acetone, formaldehyde, toluene, xylene, and benzene, a high stability measured in 6 weeks, and also a high resistance to high humidity of 80%. The outstanding ethanol sensing performance is attributable to the enhanced ethanol adsorption by Sr doping as calculated by DFT, the stable rhombohedral phase and the preferred (104) facet exposure, and the formed homojunctions favoring the electron transfer. All these results show the effective structural modification of In2O3 by Sr doping, and also the great potency of the homojunction Sr-doped In2O3 NWs for highly sensitive, selective, and stable breath ethanol sensing.
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Affiliation(s)
- Longfei Song
- College of Physics and Cultivation Base for State Key Laboratory , Qingdao University , Qingdao 266071 , China
- State Key Laboratory of Multiphase Complex Systems , Institute of Process Engineering, Chinese Academy of Sciences , Beijing 100190 , China
| | - Kunpeng Dou
- College of Information Science and Engineering , Ocean University of China , Qingdao 266100 , China
| | - Rongrong Wang
- Department of Pharmacy , The Affiliated Hospital of Qingdao University , Qingdao 266003 , China
| | - Ping Leng
- Department of Pharmacy , The Affiliated Hospital of Qingdao University , Qingdao 266003 , China
| | - Linqu Luo
- College of Physics and Cultivation Base for State Key Laboratory , Qingdao University , Qingdao 266071 , China
| | - Yan Xi
- College of Physics and Cultivation Base for State Key Laboratory , Qingdao University , Qingdao 266071 , China
| | - Chao-Cheng Kaun
- Research Center for Applied Sciences , Academia Sinica , Taipei 11529 , Taiwan
| | - Ning Han
- State Key Laboratory of Multiphase Complex Systems , Institute of Process Engineering, Chinese Academy of Sciences , Beijing 100190 , China
| | - Fengyun Wang
- College of Physics and Cultivation Base for State Key Laboratory , Qingdao University , Qingdao 266071 , China
| | - Yunfa Chen
- State Key Laboratory of Multiphase Complex Systems , Institute of Process Engineering, Chinese Academy of Sciences , Beijing 100190 , China
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Chen H, Zhang M, Fu X, Fusco Z, Bo R, Xing B, Nguyen HT, Barugkin C, Zheng J, Lau CFJ, Huang S, Ho-Baillie AWY, Catchpole KR, Tricoli A. Light-activated inorganic CsPbBr 2I perovskite for room-temperature self-powered chemical sensing. Phys Chem Chem Phys 2019; 21:24187-24193. [PMID: 31658307 DOI: 10.1039/c9cp03059j] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Halide perovskite materials are excellent light harvesters that have generated enormous interest for photovoltaic technology and an increasing number of other optoelectronic applications. Very recently, their use for miniaturized chemical sensors has shown a promising room-temperature response. Here, we present some insights on the use of CsPbBr2I (CPBI) perovskites for self-powered room-temperature sensing of several environmentally and medically relevant compounds demonstrating rapid detection of down to concentrations of 1 ppm. Notably, the photocurrent of these self-powered CPBI-based devices increases under exposure to both reducing (e.g. acetone, propane) and oxidizing (e.g. NO2, O2) gas molecules and decreases rapidly upon reverting to an inert atmosphere. In situ photoluminescence (PL) analysis of the CPBI during exposure to oxidizing molecules reveals a strongly increased PL intensity and longer lifetime indicating a prevalent role of CPBI trap states in the sensing mechanism. These findings provide new insights for the engineering of perovskite-based materials for their future chemical sensing applications.
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Affiliation(s)
- Hongjun Chen
- Nanotechnology Research Laboratory, Research School of Electrical, Energy and Materials Engineering, College of Engineering and Computer Sciences, Australian National University, Canberra 2601, Australia.
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8
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De Vincentis A, Vespasiani-Gentilucci U, Sabatini A, Antonelli-Incalzi R, Picardi A. Exhaled breath analysis in hepatology: State-of-the-art and perspectives. World J Gastroenterol 2019; 25:4043-4050. [PMID: 31435162 PMCID: PMC6700691 DOI: 10.3748/wjg.v25.i30.4043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
Liver disease is characterized by breath exhalation of peculiar volatile organic compounds (VOCs). Thanks to the availability of sensitive technologies for breath analysis, this empiric approach has recently gained increasing attention in the context of hepatology, following the good results obtained in other fields of medicine. After the first studies that led to the identification of selected VOCs for pathophysiological purposes, subsequent research has progressively turned towards the comprehensive assessment of exhaled breath for potential clinical application. Specific VOC patterns were found to discriminate subjects with liver cirrhosis, to rate disease severity, and, eventually, to forecast adverse clinical outcomes even beyond existing scores. Preliminary results suggest that breath analysis could be useful also for detecting and staging hepatic encephalopathy and for predicting steatohepatitis in patients with nonalcoholic fatty liver disease. However, clinical translation is still hampered by a number of methodological limitations, including the lack of standardization and the consequent poor comparability between studies and the absence of external validation of obtained results. Given the low-cost and easy execution at bedside of the new technologies (e-nose), larger and well-structured studies are expected in order to provide the adequate level of evidence to support VOC analysis in clinical practice.
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Affiliation(s)
- Antonio De Vincentis
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
| | - Umberto Vespasiani-Gentilucci
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
| | - Anna Sabatini
- Unit of Electronics for sensor systems, Department of Engineering, University Campus Bio-Medico of Rome, Rome 00128, Italy
| | - Raffaele Antonelli-Incalzi
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
| | - Antonio Picardi
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
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O'Hara ME, Fernández Del Río R, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Limonene in exhaled breath is elevated in hepatic encephalopathy. J Breath Res 2016; 10:046010. [PMID: 27869108 PMCID: PMC5500822 DOI: 10.1088/1752-7155/10/4/046010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol-1 in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol-1, respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10-44) and 42 (32-58) nmol mol-1.
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Affiliation(s)
- M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK. Author to whom any correspondence should be addressed
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Fernández Del Río R, O'Hara ME, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Volatile Biomarkers in Breath Associated With Liver Cirrhosis - Comparisons of Pre- and Post-liver Transplant Breath Samples. EBioMedicine 2015; 2:1243-50. [PMID: 26501124 PMCID: PMC4588000 DOI: 10.1016/j.ebiom.2015.07.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background The burden of liver disease in the UK has risen dramatically and there is a need for improved diagnostics. Aims To determine which breath volatiles are associated with the cirrhotic liver and hence diagnostically useful. Methods A two-stage biomarker discovery procedure was used. Alveolar breath samples of 31 patients with cirrhosis and 30 healthy controls were mass spectrometrically analysed and compared (stage 1). 12 of these patients had their breath analysed after liver transplant (stage 2). Five patients were followed longitudinally as in-patients in the post-transplant period. Results Seven volatiles were elevated in the breath of patients versus controls. Of these, five showed statistically significant decrease post-transplant: limonene, methanol, 2-pentanone, 2-butanone and carbon disulfide. On an individual basis limonene has the best diagnostic capability (the area under a receiver operating characteristic curve (AUROC) is 0.91), but this is improved by combining methanol, 2-pentanone and limonene (AUROC curve 0.95). Following transplant, limonene shows wash-out characteristics. Conclusions Limonene, methanol and 2-pentanone are breath markers for a cirrhotic liver. This study raises the potential to investigate these volatiles as markers for early-stage liver disease. By monitoring the wash-out of limonene following transplant, graft liver function can be non-invasively assessed. Breath volatiles were compared for cirrhotic patients and controls and pre- and post-liver transplant. Three volatiles (limonene, methanol, 2-pentanone) have been found to have excellent diagnostic capabilities. Limonene shows washout characteristics following transplant supporting a hypothesis that it accumulates in fat.
There are numerous previous studies investigating breath volatiles in patients with liver disease but with conflicting results. It is impossible to tell which volatiles from previous studies may be false discoveries, and which are actually associated with the disease. We measured breath samples in patients and controls and in patients after transplant. Methanol, 2-pentanone and limonene show differences not only between patients and controls but also in cases pre- and post-transplant and have excellent diagnostic capabilities. We show evidence that limonene accumulates in the body, probably because the cirrhotic liver fails to metabolise dietary limonene.
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Key Words
- AID, autoimmune liver disease
- ALD, alcoholic liver disease
- AUROC, area under receiver operator curve
- BMI, body mass index
- Breath analysis
- CD, cryptogenic disease
- Cirrhosis
- Diagnosis limonene
- GC, gas chromatography
- HBV, hepatitis B virus
- HCC, hepatocellular cancer
- HCV, hepatitis C virus
- ITU, intensive treatment unit
- LQ, lower quartile
- Liver transplant
- MS, mass spectrometry
- OPU, out-patient clinic
- PBC, primary biliary cirrhosis
- PSC, primary sclerosing cholangitis
- PTR-MS
- PTR-MS, proton transfer reaction mass spectrometry
- ROC, Receiver operating characteristics
- TAC, transplant assessment clinic
- TE, transient elastography
- UKELD, United Kingdom model for end-stage liver disease
- UQ, upper quartile
- VMR, volume mixing ratio
- VOC, volatile organic compounds
- Volatile organic compounds
- ppbv, parts per billion by volume
- ppmv, parts per million by volume
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Affiliation(s)
- R Fernández Del Río
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - A Holt
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - P Pemberton
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Shah
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Whitehouse
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - C A Mayhew
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
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Detection of volatile malodorous compounds in breath: current analytical techniques and implications in human disease. Bioanalysis 2014; 6:357-76. [PMID: 24471956 DOI: 10.4155/bio.13.306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
For the last few decades intense scientific research has been placed on the relationship between trace substances found in exhaled breath such as volatile organic compounds (VOC) and a wide range of local or systemic diseases. Although currently there is no general consensus, results imply that VOC have a different profile depending on the organ or disease that generates them. The association between a specific pathology and exhaled breath odor is particularly evident in patients with medical conditions such as liver, renal or oral diseases. In other cases the unpleasant odors can be associated with the whole body and have a genetic underlying cause. The present review describes the current advances in identifying and quantifying VOC used as biomarkers for a number of systemic diseases. A special focus will be placed on volatiles that characterize unpleasant breath 'fingerprints' such as fetor hepaticus; uremic fetor; fetor ex ore or trimethylaminuria.
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Rattray NJW, Hamrang Z, Trivedi DK, Goodacre R, Fowler SJ. Taking your breath away: metabolomics breathes life in to personalized medicine. Trends Biotechnol 2014; 32:538-48. [PMID: 25179940 DOI: 10.1016/j.tibtech.2014.08.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 01/04/2023]
Abstract
Breath-based metabolomics (breathomics) is an exciting developing area of biotechnology that centers on the capture, identification, and quantification of volatile organic compound (VOC) patterns in human breath and their utilization as tools in the diagnosis of a broad spectrum of medical problems. With the age of personalized medicines demanding rapid bespoke diagnosis and treatment, this area of molecular diagnostics is beginning to see an upsurge in biotechnological advancement. Here, we discuss recent improvements and directions in the development of breath VOC analysis and diagnosis platforms that offer the potential for disease biomarker discovery and disease prognosis.
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Affiliation(s)
- Nicholas J W Rattray
- School of Chemistry and Manchester Institute of Biotechnology, University of Manchester, Manchester, UK.
| | - Zahra Hamrang
- Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - Drupad K Trivedi
- School of Chemistry and Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Royston Goodacre
- School of Chemistry and Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Stephen J Fowler
- University of Manchester, Manchester Academic Health Science Centre, NIHR Respiratory and Allergy Clinical Research Facility, University Hospital of South Manchester, Manchester, UK; Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
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Solga SF. Breath volatile organic compounds for the gut-fatty liver axis: Promise, peril, and path forward. World J Gastroenterol 2014; 20:9017-9025. [PMID: 25083075 PMCID: PMC4112861 DOI: 10.3748/wjg.v20.i27.9017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/15/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
The worldwide interest in the gut microbiome and its impact on the upstream liver highlight a critical upside to breath research: it can uniquely measure otherwise unmeasurable biology. Bacteria make gases [volatile organic compounds (VOCs)] that are directly relevant to pathophysiology of the fatty liver and associated conditions, including obesity. Measurement of these VOCs and their metabolites in the exhaled breath, therefore, present an opportunity to safely and easily evaluate, on both a personal and a population level, some of our most pressing public health threats. This is an opportunity that must be pursued. To date, however, breath analysis remains a slowly evolving field which only occasionally impacts clinical research or patient care. One major obstacle to progress is that breath analysis is inherently and emphatically mutli-disciplinary: it connects engineering, chemistry, breath mechanics, biology and medicine. Unbalanced or incomplete teams may produce inconsistent and often unsatisfactory results. A second impediment is the lack of a well-known stepwise structure for the development of non-invasive diagnostics. As a result, the breath research landscape is replete with orphaned single-center pilot studies. Often, important hypotheses and key observations have not been pursued to maturation. This paper reviews the rationale and requirements for breath VOC research applied to the gut-fatty liver axis and offers some suggestions for future development.
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Oral choline tolerance test as a novel noninvasive method for predicting nonalcoholic steatohepatitis. J Gastroenterol 2014; 49:295-304. [PMID: 23503837 DOI: 10.1007/s00535-013-0776-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although therapeutic intervention for nonalcoholic steatohepatitis (NASH) at an early stage is important owing to the progressive nature of the disease, diagnosis using noninvasive methods remains difficult. We previously demonstrated NASH specific impairment of choline metabolism and the use of fasting plasma free choline (fCh) levels for NASH diagnosis. Here, we investigated the utility of an oral choline tolerance test (OCTT), based on disordered choline metabolism, as a novel noninvasive method for NASH diagnosis. METHODS Sixty-five patients with biopsy proven nonalcoholic fatty liver disease (NAFLD) and 17 healthy controls were enrolled. Blood samples were obtained from all subjects five times during the OCTT (before and 1, 2, 3, and 4 h after oral loading with 260 mg choline). RESULTS Four-hour fCh levels after oral loading choline were markedly increased in NASH patients, compared with non-NASH subjects. For detecting NASH, compared with non-NASH subjects, the area under the curve for 4-h fCh levels was 0.829 on receiver operating characteristic (ROC) analysis. The cut-off level for NASH diagnosis was ≥0.16 mg/dL, and the sensitivity, specificity, positive predictive value, and negative predictive value were 80.1, 82.6, 78.4, and 84.4 %, respectively. Moreover, 4-h fCh levels were significantly associated with the disease activity based on NAFLD activity score in patients with NAFLD. CONCLUSIONS Four-hour fCh levels obtained by an OCTT reflect a NASH specific disorder of choline metabolism, suggesting that the OCTT is a novel and useful noninvasive method for diagnosing NASH at an early stage with sufficient accuracy for clinical practice.
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Chung GE, Kim D. Noninvasive markers: a double-edged sword that stratifies nonalcoholic steatohepatitis. Clin Mol Hepatol 2013; 19:116-9. [PMID: 23837135 PMCID: PMC3701843 DOI: 10.3350/cmh.2013.19.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 05/15/2013] [Indexed: 11/05/2022] Open
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Obese humans with nonalcoholic fatty liver disease display alterations in fecal microbiota and volatile organic compounds. Clin Gastroenterol Hepatol 2013; 11:876-8. [PMID: 23628504 DOI: 10.1016/j.cgh.2013.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 02/07/2023]
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Modak AS. Regulatory issues on breath tests and updates of recent advances on [
13
C]-breath tests. J Breath Res 2013; 7:037103. [DOI: 10.1088/1752-7155/7/3/037103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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18
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Mavrogiannaki AN, Migdalis IN. Nonalcoholic Fatty liver disease, diabetes mellitus and cardiovascular disease: newer data. Int J Endocrinol 2013; 2013:450639. [PMID: 23653642 PMCID: PMC3638654 DOI: 10.1155/2013/450639] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 03/12/2013] [Indexed: 02/07/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common, chronic liver disease worldwide. Within this spectrum, steatosis alone is apparently benign, while nonalcoholic steatohepatitis may progress to cirrhosis and hepatocellular carcinoma. NAFLD is strongly associated with obesity, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. The pathogenesis of hepatic steatosis is not clearly known, but its main characteristics are considered insulin resistance, mitochondrial dysfunction, increased free fatty acids reflux from adipose tissue to the liver, hepatocyte lipotoxicity, stimulation of chronic necroinflammation, and fibrogenic response. With recent advances in technology, advanced imaging techniques provide important information for diagnosis. There is a significant research effort in developing noninvasive monitoring of disease progression to fibrosis and response to therapy with potential novel biomarkers, in order to facilitate diagnosis for the detection of advanced cirrhosis and to minimize the need of liver biopsy. The identification of NAFLD should be sought as part of the routine assessment of type 2 diabetics, as sought the microvascular complications and cardiovascular disease, because it is essential for the early diagnosis and proper intervention. Diet, exercise training, and weight loss provide significant clinical benefits and must be considered of first line for treating NAFLD.
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Affiliation(s)
- A. N. Mavrogiannaki
- 2nd Medical Department and Diabetes Center, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
| | - I. N. Migdalis
- 2nd Medical Department and Diabetes Center, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
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19
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Verdam FJ, Dallinga JW, Driessen A, de Jonge C, Moonen EJC, van Berkel JBN, Luijk J, Bouvy ND, Buurman WA, Rensen SS, Greve JWM, van Schooten FJ. Non-alcoholic steatohepatitis: a non-invasive diagnosis by analysis of exhaled breath. J Hepatol 2013; 58:543-8. [PMID: 23142062 DOI: 10.1016/j.jhep.2012.10.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 10/10/2012] [Accepted: 10/31/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Histological evaluation of a liver biopsy is the current gold standard to diagnose non-alcoholic steatohepatitis (NASH), but the procedure to obtain biopsies is associated with morbidity and high costs. Hence, only subjects at high risk are biopsied, leading to underestimation of NASH prevalence, and undertreatment. Since analysis of volatile organic compounds in breath has been shown to accurately identify subjects with other chronic inflammatory diseases, we investigated its potential as a non-invasive tool to diagnose NASH. METHODS Wedge-shaped liver biopsies from 65 subjects (BMI 24.8-64.3 kg/m(2)) were obtained during surgery and histologically evaluated. The profile of volatile organic compounds in pre-operative breath samples was analyzed by gas chromatography-mass spectrometry and related to liver histology scores and plasma parameters of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). RESULTS Three exhaled compounds were sufficient to distinguish subjects with (n=39) and without NASH (n=26), with an area under the ROC curve of 0.77. The negative and positive predictive values were 82% and 81%. In contrast, elevated ALT levels or increased AST/ALT ratios both showed negative predictive values of 43%, and positive predictive values of 88% and 70%, respectively. The breath test reduced the hypothetical percentage of undiagnosed NASH patients from 67-79% to 10%, and of misdiagnosed subjects from 49-51% to 18%. CONCLUSIONS Analysis of volatile organic compounds in exhaled air is a promising method to indicate NASH presence and absence. In comparison to plasma transaminase levels, the breath test significantly reduced the percentage of missed NASH patients and the number of unnecessarily biopsied subjects.
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Affiliation(s)
- Froukje J Verdam
- Department of General Surgery, Nutrition and Toxicology Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Goerl T, Kischkel S, Sawacki A, Fuchs P, Miekisch W, Schubert JK. Volatile breath biomarkers for patient monitoring during haemodialysis. J Breath Res 2013; 7:017116. [PMID: 23446309 DOI: 10.1088/1752-7155/7/1/017116] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Patients with end-stage renal disease (ESRD) are at risk for a numerous complications. This study was intended to evaluate breath analysis for monitoring and therapy initiation under haemodialysis (HD). Exhaled alveolar air from 30 ESRD patients during 4 h thrice-weekly HD was analysed by means of HS-SPME-GC-MS. Venous blood samples were taken for determination of conventional serum parameters. Exhaled concentrations of isoprene (10-589 ppbV) were dropped at initiation of HD and increased at the end of HD. Isoprene concentration changes were similar to changes of serum LDH activities. Variation of exhaled acetone concentrations (59 to 8509 ppbV) was significantly lower in diabetic patients when compared to non-diabetics. Exhaled pentane (0.3 to 12 ppbV) increased at onset of HD and returned to baseline levels afterwards. Benzene concentrations showed typical washout characteristics. Ethanol and DMS concentrations remained constant during HD. Breath analysis can be used to recognize oxidative stress, metabolic conditions and haemolysis during HD. Hence, non-invasive breath testing could be used to monitor ESRD patients under HD and prevent them from being affected by well-known detrimental side effects of renal replacement therapy.
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Affiliation(s)
- Tina Goerl
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock, Germany
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21
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Lombardo E, van Roomen CPAA, van Puijvelde GH, Ottenhoff R, van Eijk M, Aten J, Kuiper J, Overkleeft HS, Groen AK, Verhoeven AJ, Aerts JMFG, Bietrix F. Correction of liver steatosis by a hydrophobic iminosugar modulating glycosphingolipids metabolism. PLoS One 2012; 7:e38520. [PMID: 23056165 PMCID: PMC3466229 DOI: 10.1371/journal.pone.0038520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 05/05/2012] [Indexed: 02/07/2023] Open
Abstract
The iminosugar N-(5′-adamantane-1′-yl-methoxy)-pentyl-1-deoxynoijirimycin (AMP-DNM), an inhibitor of glycosphingolipid (GSL) biosynthesis is known to ameliorate diabetes, insulin sensitivity and to prevent liver steatosis in ob/ob mice. Thus far the effect of GSL synthesis inhibition on pre-existing NASH has not yet been assessed. To investigate it, LDLR(−/−) mice were kept on a western-type diet for 12 weeks to induce NASH. Next, the diet was continued for 6 weeks in presence or not of AMP-DNM in the diet. AMP-DNM treated mice showed less liver steatosis, inflammation and fibrosis. Induction of fatty acid beta-oxydation was observed, as well as a reduction of plasma lipids. Our study demonstrates that AMP-DNM treatment is able to significantly correct pre-existing NASH, suggesting that inhibiting GSL synthesis may represent a novel strategy for the treatment of this pathology.
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Affiliation(s)
- Elisa Lombardo
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy P. A. A. van Roomen
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Gijs H. van Puijvelde
- Division of Biopharmaceutics, Leiden/Amsterdam Center for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Roelof Ottenhoff
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco van Eijk
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Aten
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johan Kuiper
- Division of Biopharmaceutics, Leiden/Amsterdam Center for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Herman S. Overkleeft
- Division of Biopharmaceutics, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Albert K. Groen
- Department of Pediatrics, University Medical Center Groningen, Groningen, The Netherlands
| | - Arthur J. Verhoeven
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes M. F. G. Aerts
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Florence Bietrix
- Departments of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Filipiak W, Ruzsanyi V, Mochalski P, Filipiak A, Bajtarevic A, Ager C, Denz H, Hilbe W, Jamnig H, Hackl M, Dzien A, Amann A. Dependence of exhaled breath composition on exogenous factors, smoking habits and exposure to air pollutants. J Breath Res 2012; 6:036008. [PMID: 22932429 PMCID: PMC3863686 DOI: 10.1088/1752-7155/6/3/036008] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-invasive disease monitoring on the basis of volatile breath markers is a very attractive but challenging task. Several hundreds of compounds have been detected in exhaled air using modern analytical techniques (e.g. proton-transfer reaction mass spectrometry, gas chromatography-mass spectrometry) and have even been linked to various diseases. However,the biochemical background for most of compounds detected in breath samples has not been elucidated; therefore, the obtained results should be interpreted with care to avoid false correlations. The major aim of this study was to assess the effects of smoking on the composition of exhaled breath. Additionally, the potential origin of breath volatile organic compounds (VOCs) is discussed focusing on diet, environmental exposure and biological pathways based on other's studies. Profiles of VOCs detected in exhaled breath and inspired air samples of 115 subjects with addition of urine headspace derived from 50 volunteers are presented. Samples were analyzed with GC-MS after preconcentration on multibed sorption tubes in case of breath samples and solid phase micro-extraction (SPME) in the case of urine samples. Altogether 266 compounds were found in exhaled breath of at least 10% of the volunteers. From these, 162 compounds were identified by spectral library match and retention time (based on reference standards). It is shown that the composition of exhaled breath is considerably influenced by exposure to pollution and indoor-air contaminants and particularly by smoking. More than 80 organic compounds were found to be significantly related to smoking, the largest group comprising unsaturated hydrocarbons (29 dienes, 27 alkenes and 3 alkynes). On the basis of the presented results, we suggest that for the future understanding of breath data it will be necessary to carefully investigate the potential biological origin of volatiles, e.g., by means of analysis of tissues, isolated cell lines or other body fluids. In particular, VOCs linked to smoking habit or being the results of human exposure should be considered with care for clinical diagnosis since small changes in their concentration profiles(typically in the ppt(v)–ppb(v) range) revealing that the outbreak of certain disease might be hampered by already high background.
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Affiliation(s)
- W Filipiak
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - V Ruzsanyi
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - P Mochalski
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - A Filipiak
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - A Bajtarevic
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - C Ager
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - H Denz
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Landeskrankenhaus Natters, A-6161 Natters, Austria
| | - W Hilbe
- Universitätsklinik für Innere Medizin 5 (Hämatologie und Onkologie), Innsbruck Medical University, A-6020 Innsbruck, Austria
| | - H Jamnig
- Landeskrankenhaus Natters, A-6161 Natters, Austria
| | - M Hackl
- Landeskrankenhaus Natters, A-6161 Natters, Austria
| | - A Dzien
- Department of Internal Medicine, Innsbruck Medical University, Bürgerstraße 2, A-6020 Innsbruck, Austria
| | - A Amann
- Breath Research Institute of the Austrian Academy of Sciences, Rathausplatz 4, A-6850 Dornbirn, Austria
- Department of Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
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Minh TDC, Blake DR, Galassetti PR. The clinical potential of exhaled breath analysis for diabetes mellitus. Diabetes Res Clin Pract 2012; 97:195-205. [PMID: 22410396 PMCID: PMC3384765 DOI: 10.1016/j.diabres.2012.02.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/02/2012] [Accepted: 02/12/2012] [Indexed: 01/15/2023]
Abstract
Various compounds in present human breath have long been loosely associated with pathological states (including acetone smell in uncontrolled diabetes). Only recently, however, the precise measurement of exhaled volatile organic compounds (VOCs) and aerosolized particles was made possible at extremely low concentrations by advances in several analytical methodologies, described in detail in the international literature and each suitable for specific subsets of exhaled compounds. Exhaled gases may be generated endogenously (in the pulmonary tract, blood, or peripheral tissues), as metabolic by-products of human cells or colonizing micro-organisms, or may be inhaled as atmospheric pollutants; growing evidence indicates that several of these molecules have distinct cell-to-cell signaling functions. Independent of origin and physiological role, exhaled VOCs are attractive candidates as biomarkers of cellular activity/metabolism, and could be incorporated in future non-invasive clinical testing devices. Indeed, several recent studies reported altered exhaled gas profiles in dysmetabolic conditions and relatively accurate predictions of glucose concentrations, at least in controlled experimental conditions, for healthy and diabetic subjects over a broad range of glycemic values. Optimization of this methodology and validation in large-scale trials under a wider range of conditions is needed to determine its true potential to transition into practical clinical use.
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Affiliation(s)
- Timothy Do Chau Minh
- Department of Pharmacology, University of California, Irvine, Irvine, CA 92697-1385, United States.
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Imajo K, Fujita K, Yoneda M, Shinohara Y, Suzuki K, Mawatari H, Takahashi J, Nozaki Y, Sumida Y, Kirikoshi H, Saito S, Nakamuta M, Matsuhashi N, Wada K, Nakajima A. Plasma free choline is a novel non-invasive biomarker for early-stage non-alcoholic steatohepatitis: A multi-center validation study. Hepatol Res 2012; 42:757-66. [PMID: 22780848 DOI: 10.1111/j.1872-034x.2012.00976.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Choline is a dietary component that is crucial for normal cellular function. Choline is predominantly absorbed from the small intestine and completely metabolized in the liver. We recently demonstrated that free choline (fCh) levels in blood reflect the level of phosphatidylcholine synthesis in the liver and is correlated with the onset of non-alcoholic steatohepatitis (NASH). Our aim here was to validate the utility of this biomarker for NASH diagnosis. METHODS Our cohort consisted of 110 patients with biopsy proven non-alcoholic fatty liver disease (NAFLD) from four centers across Japan and 25 age-matched healthy controls. Plasma fCh levels were measured using high-performance liquid chromatography. RESULTS Patients with diagnosed or borderline NASH had significantly increased plasma fCh levels when compared with control subjects, or patients not diagnosed with NASH. Interestingly, an association between plasma fCh levels and expression of microsomal triglyceride transfer protein, which catalyzes the transfer of triglyceride, was reflected in the markedly negative correlation between these two variables in patients with NAFLD. Moreover, the grade of liver steatosis and fibrosis stage increased with increasing plasma fCh levels (P < 0.05). The area under the receiver-operating characteristic (ROC) curves for NASH, including borderline diagnosis, was 0.811. Additionally, the areas under the ROC for fibrosis stage were 0.816 for >stage 1, 0.805 for >stage 2, 0.809 for >stage 3 and 0.818 for >stage 4. CONCLUSION Plasma fCh levels are closely related to the grade of liver steatosis and fibrosis, and predict NASH severity. Plasma fCh levels are therefore a potential diagnostic marker for early-stage NASH in clinical practice.
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Affiliation(s)
- Kento Imajo
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama Skylight Biotech Inc, Akita Center for Digestive and Liver Diseases, Nara City Hospital, Nara Division of Gastroenterology, National Kyusyu Medical Center Hospital, Fukuoka Division of Gastroenterology, NTT Medical Center, Tokyo Department of Pharmacology, Graduate School of Dentistry, Osaka University, Osaka, Japan
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25
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Valdecantos MP, Pérez-Matute P, Prieto-Hontoria PL, Sánchez-Campayo E, Moreno-Aliaga MJ, Martínez JA. Erythrocyte antioxidant defenses as a potential biomarker of liver mitochondrial status in different oxidative conditions. Biomarkers 2011; 16:670-8. [PMID: 21999619 DOI: 10.3109/1354750x.2011.625504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The need for minimally invasive biomarkers to predict the progression of non-alcoholic fatty liver disease to non-alcoholic steatohepatitis is a priority. Oxidative stress and mitochondrial dysfunction contribute in this physiopathological process. The aim of this study was to analyze the potential role of erythrocytes as surrogate biomarkers of hepatic mitochondrial oxidative status in an animal model under different dietary oxidative conditions. Interestingly, we found that erythrocyte antioxidant status correlated with triglyceride content (p < 0.05-p < 0.001), thiobarbituric acid reactive species levels (p < 0.001) and with liver mitochondrial antioxidant levels (p < 0.001). These data suggest that erythrocyte antioxidant defenses could be used as sensitive and minimally invasive biomarkers of mitochondrial status in diverse oxidative conditions.
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Affiliation(s)
- M Pilar Valdecantos
- Department of Nutrition, Food Science, Physiology and Toxicology University of Navarra, Pamplona, Spain
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26
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Frigolet ME, Ramos Barragán VE, Tamez González M. Low-carbohydrate diets: a matter of love or hate. ANNALS OF NUTRITION AND METABOLISM 2011; 58:320-34. [PMID: 21985780 DOI: 10.1159/000331994] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 08/18/2011] [Indexed: 12/14/2022]
Abstract
Low-carbohydrate diets (LChD) have become very popular among the general population. These diets have been used to lose body weight and to ameliorate various abnormalities like diabetes, nonalcoholic fatty liver disease, polycystic ovary syndrome, narcolepsy, epilepsy, and others. Reports suggest that body weight reduction and glycemic control could be attained while following LChD. However, these advantages are more notably found in short periods of time consuming an LChD. Indeed, the safety and efficacy of the latter diets in the long term have not been sufficiently explored. In contrast to what has been proposed, other mentioned pathologies are not improved or are even worsened by carbohydrate restriction. Therefore, the aim of this review is to define the concept of LChD and to explain their clinical effects in the short and long term, their influence on metabolism, and the opinion of nutrition or health authorities. Finally, evincing the research gaps of LChD that are here exposed will later allow us to reach a consensus with regard to their utilization.
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Minh TDC, Oliver SR, Ngo J, Flores R, Midyett J, Meinardi S, Carlson MK, Rowland FS, Blake DR, Galassetti PR. Noninvasive measurement of plasma glucose from exhaled breath in healthy and type 1 diabetic subjects. Am J Physiol Endocrinol Metab 2011; 300:E1166-75. [PMID: 21467303 PMCID: PMC3118590 DOI: 10.1152/ajpendo.00634.2010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Effective management of diabetes mellitus, affecting tens of millions of patients, requires frequent assessment of plasma glucose. Patient compliance for sufficient testing is often reduced by the unpleasantness of current methodologies, which require blood samples and often cause pain and skin callusing. We propose that the analysis of volatile organic compounds (VOCs) in exhaled breath can be used as a novel, alternative, noninvasive means to monitor glycemia in these patients. Seventeen healthy (9 females and 8 males, 28.0 ± 1.0 yr) and eight type 1 diabetic (T1DM) volunteers (5 females and 3 males, 25.8 ± 1.7 yr) were enrolled in a 240-min triphasic intravenous dextrose infusion protocol (baseline, hyperglycemia, euglycemia-hyperinsulinemia). In T1DM patients, insulin was also administered (using differing protocols on 2 repeated visits to separate the effects of insulinemia on breath composition). Exhaled breath and room air samples were collected at 12 time points, and concentrations of ~100 VOCs were determined by gas chromatography and matched with direct plasma glucose measurements. Standard least squares regression was used on several subsets of exhaled gases to generate multilinear models to predict plasma glucose for each subject. Plasma glucose estimates based on two groups of four gases each (cluster A: acetone, methyl nitrate, ethanol, and ethyl benzene; cluster B: 2-pentyl nitrate, propane, methanol, and acetone) displayed very strong correlations with glucose concentrations (0.883 and 0.869 for clusters A and B, respectively) across nearly 300 measurements. Our study demonstrates the feasibility to accurately predict glycemia through exhaled breath analysis over a broad range of clinically relevant concentrations in both healthy and T1DM subjects.
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Affiliation(s)
- Timothy D C Minh
- Department of Pharmacology, University of California Irvine, Irvine, CA 92697, USA.
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Stefan N, Häring HU. Nichtalkoholische Steatohepatitis. Internist (Berl) 2011; 52:389-94. [DOI: 10.1007/s00108-010-2712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Woodard GA, Downey J, Hernandez-Boussard T, Morton JM. Impaired alcohol metabolism after gastric bypass surgery: a case-crossover trial. J Am Coll Surg 2011; 212:209-14. [PMID: 21183366 DOI: 10.1016/j.jamcollsurg.2010.09.020] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Severe obesity remains the leading public health crisis of the industrialized world, with bariatric surgery the only effective and enduring treatment. Poor psychological adjustment has been occasionally reported postoperatively. In addition, evidence suggests that patients can metabolize alcohol differently after gastric bypass. STUDY DESIGN Preoperatively and at 3 and 6 months postoperatively, 19 Roux-en-Y gastric bypass (RYGB) patients' breath alcohol content (BAC) was measured every 5 minutes after drinking 5 oz red wine to determine peak BAC and time until sober in a case-crossover design preoperatively and at 6 months postoperatively. RESULTS Patients reported symptoms experienced when intoxicated and answered a questionnaire of drinking habits. The peak BAC in patients after RYGB was considerably higher at 3 months (0.059%) and 6 months (0.088%) postoperatively than matched preoperative levels (0.024%). Patients also took considerably more time to return to sober at 3 months (61 minutes) and 6 months (88 minutes) than preoperatively (49 minutes). Postoperative intoxication was associated with lower levels of diaphoresis, flushing, and hyperactivity and higher levels of dizziness, warmth, and double vision. Postoperative patients reported drinking considerably less alcohol, fewer preferred beer, and more preferred wine than before surgery. CONCLUSIONS This is the first study to match preoperative and postoperative alcohol metabolism in gastric bypass patients. Post-RYGB patients have much higher peak BAC after ingesting alcohol and require more time to become sober. Patients who drink alcohol after gastric bypass surgery should exercise caution.
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Affiliation(s)
- Gavitt A Woodard
- Department of Surgery, Section of Minimally Invasive and BariatricSurgery, Stanford University School of Medicine, Stanford, CA, USA
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30
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Millonig G, Praun S, Netzer M, Baumgartner C, Dornauer A, Mueller S, Villinger J, Vogel W. Non-invasive diagnosis of liver diseases by breath analysis using an optimized ion-molecule reaction-mass spectrometry approach: a pilot study. Biomarkers 2010; 15:297-306. [PMID: 20151876 DOI: 10.3109/13547501003624512] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Breath composition is altered in liver diseases. We tested if ion-molecule-reaction mass spectrometry (IMR-MS) combined with a new statistical modality improves the diagnostic accuracy of breath analysis in liver diseases. We analysed 114 molecules in the breath of 126 individuals (healthy controls, and patients with non-alcoholic and alcoholic fatty liver disease and liver cirrhosis) by IMR-MS. Characteristic exhalation patterns were identified for each group. Combining two to seven molecules in the new stacked feature ranking model reached a diagnostic accuracy (area under the curve) for individual liver diseases between 0.88 and 0.97. IMR-MS followed by sophisticated statistical analysis is a promising tool for liver diagnostics by breath analysis.
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Affiliation(s)
- Gunda Millonig
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Innsbruck, Austria.
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31
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Feldstein AE, Lopez R, Tamimi TAR, Yerian L, Chung YM, Berk M, Zhang R, McIntyre TM, Hazen SL. Mass spectrometric profiling of oxidized lipid products in human nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J Lipid Res 2010; 51:3046-54. [PMID: 20631297 DOI: 10.1194/jlr.m007096] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Oxidative stress is a core abnormality responsible for disease progression in nonalcoholic fatty liver disease (NAFLD). However, the pathways that contribute to oxidative damage in vivo are poorly understood. Our aims were to define the circulating profile of lipid oxidation products in NAFLD patients, the source of these products, and assess whether their circulating levels reflect histological changes in the liver. The levels of multiple structurally specific oxidized fatty acids, including individual hydroxy-eicosatetraenoic acids (HETE), hydroxy-octadecadenoic acids (HODE), and oxo-octadecadenoic acids (oxoODE), were measured by mass spectrometry in plasma at time of liver biopsy in an initial cohort of 73 and a validation cohort of 49 consecutive patients. Of the markers monitored, 9- and 13-HODEs and 9- and 13-oxoODEs, products of free radical-mediated oxidation of linoleic acid (LA), were significantly elevated in patients with nonalcoholic steatohepatitis (NASH), compared with patients with steatosis. A strong correlation was revealed between these oxidation products and liver histopathology (inflammation, fibrosis, and steatosis). Further analyses of HODEs showed equivalent R and S chiral distribution. A risk score for NASH (oxNASH) was developed in the initial clinical cohort and shown to have high diagnostic accuracy for NASH versus steatosis in the independent validation cohort. Subjects with elevated oxNASH levels (top tertile) were 9.7-fold (P < 0.0001) more likely to have NASH than those with low levels (bottom tertile). Collectively, these findings support a key role for free radical-mediated linoleic acid oxidation in human NASH and define a risk score, oxNASH, for noninvasive detection of the presence of NASH.
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Affiliation(s)
- Ariel E Feldstein
- Department of Cell Biology, Cleveland Clinic College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Ratziu V, Martin L, Fedchuk L, Poynard T. Can nonalcoholic steatohepatitis be diagnosed without liver biopsy? Biomark Med 2010; 3:353-61. [PMID: 20477484 DOI: 10.2217/bmm.09.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. The main cause of NAFLD is insulin resistance; therefore, it is necessary to assess liver injury in patients with overweight and insulin resistance-related complications. The two main forms of primary NAFLD, steatosis and steatohepatitis (NASH), most likely represent distinct conditions. At present, the diagnosis of NASH presents drawbacks, including the lack of consensus regarding diagnostic criteria, sampling variability, cost and the invasiveness of the procedure. Based on a critical assessment of the literature, this article aims to determine whether the diagnosis of NASH is clinically useful, and whether it is feasible with noninvasive strategies instead of liver biopsy. A noninvasive diagnosis of NASH would facilitate screening and monitoring of populations at risk, as well as the conduct of therapeutic trials.
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Affiliation(s)
- Vlad Ratziu
- Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, INSERM UMRS_893, CdR Saint-Antoine, Paris, France.
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Rodríguez-Suárez E, Duce AM, Caballería J, Arrieta FM, Fernández E, Gómara C, Alkorta N, Ariz U, Martínez-Chantar ML, Lu SC, Elortza F, Mato JM. Non-alcoholic fatty liver disease proteomics. Proteomics Clin Appl 2010; 4:362-71. [PMID: 21137056 PMCID: PMC3040121 DOI: 10.1002/prca.200900119] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 01/11/2010] [Accepted: 01/18/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) is an important cause of chronic liver injury that has gained concern in clinical hepatology. The principal aim of this study was to find differences in protein expression between patients with NAFLD and healthy controls. EXPERIMENTAL DESIGN Changes in protein expression of liver samples from each of the three groups of subjects, controls, non-alcoholic steatosis, and non-alcoholic steatohepatitis (NASH), were analyzed by DIGE combined with MALDI TOF/TOF analysis, a proteomic approach that allows to compare hundreds of proteins simultaneously. RESULTS Forty-three proteins exhibiting significant changes (ratio ≥1.5, p<0.05) were characterized, 22 comparing steatosis samples versus control samples and 21 comparing NASH versus control samples. Ten of these proteins were further analyzed by Western blot in tissue samples to confirm the observed changes of protein expression using DIGE. The proteins validated were further tested in serum samples of different cohorts of patients. CONCLUSIONS AND CLINICAL RELEVANCE Following this approach we identified two candidate markers, carbamoyl phosphate synthase 1 and 78 kDa glucose-regulated protein, differentially expressed between control and NASH. This proteomics approach demonstrates that DIGE combined with MALDI TOF/TOF and Western blot analysis of tissue and serum samples is a useful approach to identify candidate markers associated with NAFLD, resulting in proteins whose level of expression can be correlated to a disease state.
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Affiliation(s)
- Eva Rodríguez-Suárez
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - Antonio M Duce
- Departamento de Enfermería, Universidad Alcalá, Madrid, Spain
| | | | | | - Estefanía Fernández
- Metabolomics Unit, CIC bioGUNE, CIBERehd, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - Carolina Gómara
- Metabolomics Unit, CIC bioGUNE, CIBERehd, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - Nere Alkorta
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - Usue Ariz
- Metabolomics Unit, CIC bioGUNE, CIBERehd, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - M Luz Martínez-Chantar
- Metabolomics Unit, CIC bioGUNE, CIBERehd, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - Shelly C. Lu
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University Southern California, Los Angeles, CA
| | - Felix Elortza
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed, Technology Park of Bizkaia, Derio, Bizkaia, Spain
| | - José M Mato
- Metabolomics Unit, CIC bioGUNE, CIBERehd, Technology Park of Bizkaia, Derio, Bizkaia, Spain
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Ariz U, Mato JM, Lu SC, Martínez Chantar ML. Nonalcoholic steatohepatitis, animal models, and biomarkers: what is new? Methods Mol Biol 2010; 593:109-36. [PMID: 19957147 DOI: 10.1007/978-1-60327-194-3_6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a clinicopathological term that encompasses a spectrum of abnormalities ranging from simple triglyceride accumulation in the hepatocytes (hepatic steatosis) to hepatic steatosis with inflammation (steatohepatitis, also known as nonalcoholic steatohepatitis or NASH). NASH can also progress to cirrhosis and hepatocellular carcinoma (HCC). Steatohepatitis has been estimated to affect around 5% of the total population and 20% of those who are overweight. The mechanisms leading to NASH and its progression to cirrhosis and HCC remain unclear, but it is a condition typically associated with obesity, insulin resistance, diabetes, and hypertriglyceridemia. This point corroborates the need for animal models and molecular markers that allow us to understand the mechanisms underlying this disease. Nowadays, there are numerous mice models to study abnormal liver function such as steatosis, NASH, and hepatocellular carcinoma. The study of the established animal models has provided many clues in the pathogenesis of steatosis and steatohepatitis, although these remain incompletely understood and no mice model completely fulfills the clinical features observed in humans. In addition, there is a lack of accurate sensitive diagnostic tests that do not involve invasive procedures. Current laboratory tests include some biochemical analysis, but their utility for diagnosing NASH is still poor. For that reason, a great effort is being made toward the identification and validation of novel biomarkers to assess NASH using high-throughput analysis based on genomics, proteomics, and metabolomics. The most recent discoveries and their validation will be discussed.
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Affiliation(s)
- Usue Ariz
- Metabolomics, Parque Technológico de Bizkaia, Derio, Spain
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35
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Predictors of steatohepatitis and advanced fibrosis in non-alcoholic fatty liver disease. Clin Liver Dis 2009; 13:591-606. [PMID: 19818307 DOI: 10.1016/j.cld.2009.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the United States. The development of non-alcoholic steatohepatitis increases the risk for cirrhosis and its complications. The gold standard for diagnosis is liver biopsy, the costs and risks of which make it impractical. Some demographic factors, blood tests, and imaging studies can be used to predict a higher risk of steatohepatitis or advanced fibrosis, but are of limited sensitivity and specificity. More accurate predictors and scoring systems would allow identifying who would benefit most from liver biopsy and monitor disease progression and response to therapy.
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36
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Feldstein AE, Wieckowska A, Lopez AR, Liu YC, Zein NN, McCullough AJ. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study. Hepatology 2009; 50:1072-8. [PMID: 19585618 PMCID: PMC2757511 DOI: 10.1002/hep.23050] [Citation(s) in RCA: 484] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED Liver biopsy remains the gold standard for diagnosing nonalcoholic steatohepatitis (NASH). We have recently demonstrated that plasma cytokeratin 18 (CK-18) fragment levels correlate with the magnitude of hepatocyte apoptosis and independently predict the presence of NASH. The goal of this study was to validate the use of this biomarker for NASH diagnosis. The study was an ancillary study of the NASH Clinical Research Network (NASH CRN). Our cohort consisted of 139 patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) from eight CRN participant centers across the United States and 150 age-matched healthy controls. CK-18 fragments were measured using a specific enzyme-linked immunosorbent assay. Histology was assessed centrally by study pathologists. CK-18 fragments were markedly increased in patients with NASH versus those without NASH and borderline diagnosis (median [25th, 75th percentile], 335 [196, 511], 194 [151, 270], 200 [148, 284], respectively; P < 0.001). Moreover, the odds of having fibrosis on liver biopsy increased with increasing plasma CK-18 fragment levels (P < 0.001). On multivariate regression analysis, CK-18 fragments remained an independent predictor of NASH after adjusting for variables associated with CK-18 fragments or NASH on univariate analysis (fibrosis, alanine aminotransferase, aspartate aminotransferase, age, biopsy length). The area under the receiver operating characteristic curve for NASH diagnosis was estimated to be 0.83 (0.75, 0.91). CONCLUSION Determination of CK-18 fragments in the blood predicts histological NASH and severity of disease in a large, diverse population of patients with biopsy-proven NAFLD, supporting the potential usefulness of this test in clinical practice.
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Affiliation(s)
- Ariel E. Feldstein
- Department of Pediatric Gastroenterology, MetroHealth Center, Cleveland Ohio,Department of Cell Biology, MetroHealth Center, Cleveland Ohio
| | - Anna Wieckowska
- Department of Pediatric Gastroenterology, MetroHealth Center, Cleveland Ohio
| | - A. Rocio Lopez
- Department of Quantitative Health Sciences, MetroHealth Center, Cleveland Ohio
| | - Yao-Chang Liu
- Department of Anatomical Pathology, MetroHealth Center, Cleveland Ohio
| | - Nizar N. Zein
- Department of Gastroenterology and Hepatology, Cleveland Clinic, MetroHealth Center, Cleveland Ohio
| | - Arthur J. McCullough
- Department of Gastroenterology and Hepatology, Cleveland Clinic, MetroHealth Center, Cleveland Ohio,Department of Pathobiology, MetroHealth Center, Cleveland Ohio
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Gorham KA, Sulbaek Andersen MP, Meinardi S, Delfino RJ, Staimer N, Tjoa T, Rowland FS, Blake DR. Ethane and n-pentane in exhaled breath are biomarkers of exposure not effect. Biomarkers 2009; 14:17-25. [PMID: 19283520 DOI: 10.1080/13547500902730680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The relationship of exhaled ethane and n-pentane to exhaled NO, carbonylated proteins, and indoor/outdoor atmospheric pollutants were examined in order to evaluate ethane and n-pentane as potential markers of airway inflammation and/or oxidative stress. Exhaled NO and carbonylated proteins were found to have no significant associations with either ethane (p = 0.96 and p = 0.81, respectively) or n-pentane (p = 0.44 and 0.28, respectively) when outliers were included. In the case where outliers were removed n-pentane was found to be inversely associated with carbonylated proteins. Exhaled hydrocarbons adjusted for indoor hydrocarbon concentrations were instead found to be positively associated with air pollutants (NO, NO(2) and CO), suggesting pollutant exposure is driving exhaled hydrocarbon concentrations. Given these findings, ethane and n-pentane do not appear to be markers of airway inflammation or oxidative stress.
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Affiliation(s)
- Katrine A Gorham
- Department of Chemistry, University of California, Irvine, CA 92697, USA.
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38
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Vuppalanchi R, Chalasani N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management. Hepatology 2009; 49:306-17. [PMID: 19065650 PMCID: PMC2766096 DOI: 10.1002/hep.22603] [Citation(s) in RCA: 406] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease in the western world. It is now recognized that these patients have myriad of important co-morbidities (e.g., diabetes, hypothyroidism and metabolic syndrome). The workup of patients with suspected NAFLD should consist of excluding competing etiologies and systemic evaluation of metabolic comorbidities. NAFLD is histologically categorized into steatosis and steatohepatitis, two states with fairly dichotomous natural history. While significant progress has been made in terms of noninvasively predicting advanced fibrosis, insufficient progress has been made in predicting steatohepatitis. Currently, liver biopsy remains the gold standard for the histological stratification of NAFLD. While sustained weight loss can be effective to treat NASH, it is often difficult to achieve. Foregut bariatric surgery can be quite effective in improving hepatic histology in selected patients without liver failure or significant portal hypertension. Thiazolidinediones have shown promise and the results from the ongoing, large multicenter study should become available soon. Large multicenter studies of CB, receptor anatagonists are also underway but their results will not be available for several years. Several recent studies have highlighted that cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. CONCLUSION Health care providers should not only focus on liver disease but also concentrate on aggressively modifying and treating their cardiovascular risk factors.
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Affiliation(s)
- Raj Vuppalanchi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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de Lacy Costello BPJ, Ewen RJ, Ratcliffe NM, Richards M. The characteristics of novel low-cost sensors for volatile biomarker detection. J Breath Res 2008; 2:037017. [DOI: 10.1088/1752-7155/2/3/037017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bambha K, Yee HF. In search of an ideal biomarker for nonalcoholic fatty liver disease. Am J Gastroenterol 2008; 103:1380-2. [PMID: 18510615 DOI: 10.1111/j.1572-0241.2007.01783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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41
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van Ginneken V, Verhey E, Poelmann R, Ramakers R, van Dijk KW, Ham L, Voshol P, Havekes L, Van Eck M, van der Greef J. Metabolomics (liver and blood profiling) in a mouse model in response to fasting: a study of hepatic steatosis. Biochim Biophys Acta Mol Cell Biol Lipids 2007; 1771:1263-70. [PMID: 17904417 DOI: 10.1016/j.bbalip.2007.07.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 07/26/2007] [Accepted: 07/27/2007] [Indexed: 12/12/2022]
Abstract
A metabolomic approach was applied to a mouse model of starvation-induced hepatic steatosis. After 24 h of fasting it appears that starvation reduced the phospholipids (PL), free cholesterol (FC), and cholesterol esters (CE) content of low-density lipoproteins (LDL). In liver lipid profiles major changes were observed using different techniques. High performance thin layer chromatography (HPTLC)-measurements of liver-homogenates indicated a significant rise of FC with 192%, triacylglycerols (TG) with 456% and cholesterol esters (CE) with 268% after 24 h of starvation in comparison with the control group. Reversed phase liquid chromatography coupled to mass spectrometry measurements (LC-MS) of liver homogenate indicated that the intensity of Phosphatidylcholine (PC) in the 24-h starvation group dropped to 90% of the value in the control group while the intensity of CE and TG increased to 157% and 331%, respectively, of the control group. Interestingly, a 49:4-TG with an odd number of C atoms appeared during starvation. This unique triacylglycerol has all characteristics of a biomarker for detection of hepatic steatosis. These observations indicate that in mammals liver lipid profiles are a dynamic system which are readily modulated by environmental factors like starvation.
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Affiliation(s)
- V van Ginneken
- Department of Anatomy and Embryology, Leiden University Medical Center (LUMC) P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Wieckowska A, McCullough AJ, Feldstein AE. Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future. Hepatology 2007; 46:582-9. [PMID: 17661414 DOI: 10.1002/hep.21768] [Citation(s) in RCA: 299] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, and its prevalence is increasing worldwide. It currently affects approximately 30% of adults and 10% of children in the United States. NAFLD represents a wide spectrum of conditions ranging from simple fatty liver which in general follows a benign nonprogressive clinical course, to nonalcoholic steatohepatitis (NASH), which is a more serious form of NAFLD that may progress to cirrhosis and end-stage liver disease. At present, a liver biopsy remains the only reliable way to diagnose NASH and establish the presence of fibrosis. Current noninvasive clinically available tests lack accuracy and reliability. In light of the dramatic increase in the prevalence of NAFLD in conjunction with the significant research effort in developing novel therapies for patients with NASH, noninvasive, simple, reproducible, and reliable biomarkers are greatly needed. They will not only help in the diagnosis of NASH, but also be useful for assessment of treatment response and prognosis and remain a research priority in the NAFLD field.
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Affiliation(s)
- Anna Wieckowska
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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