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Kiss H, Örlős Z, Gellért Á, Megyesfalvi Z, Mikáczó A, Sárközi A, Vaskó A, Miklós Z, Horváth I. Exhaled Biomarkers for Point-of-Care Diagnosis: Recent Advances and New Challenges in Breathomics. MICROMACHINES 2023; 14:391. [PMID: 36838091 PMCID: PMC9964519 DOI: 10.3390/mi14020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Cancers, chronic diseases and respiratory infections are major causes of mortality and present diagnostic and therapeutic challenges for health care. There is an unmet medical need for non-invasive, easy-to-use biomarkers for the early diagnosis, phenotyping, predicting and monitoring of the therapeutic responses of these disorders. Exhaled breath sampling is an attractive choice that has gained attention in recent years. Exhaled nitric oxide measurement used as a predictive biomarker of the response to anti-eosinophil therapy in severe asthma has paved the way for other exhaled breath biomarkers. Advances in laser and nanosensor technologies and spectrometry together with widespread use of algorithms and artificial intelligence have facilitated research on volatile organic compounds and artificial olfaction systems to develop new exhaled biomarkers. We aim to provide an overview of the recent advances in and challenges of exhaled biomarker measurements with an emphasis on the applicability of their measurement as a non-invasive, point-of-care diagnostic and monitoring tool.
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Affiliation(s)
- Helga Kiss
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Zoltán Örlős
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Áron Gellért
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Zsolt Megyesfalvi
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Angéla Mikáczó
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Anna Sárközi
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Attila Vaskó
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Zsuzsanna Miklós
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Ildikó Horváth
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
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Garcia-Rio F, Miravitlles M, Soriano JB, Cosío BG, Soler-Cataluña JJ, Casanova C, de Lucas P, Alfageme I, Rodríguez González-Moro JM, Sánchez Herrero MG, Ancochea J. Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study. BMJ Open Respir Res 2023; 10:e001468. [PMID: 36707127 PMCID: PMC9884864 DOI: 10.1136/bmjresp-2022-001468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/22/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Population distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications. METHODS A sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) >0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness. RESULTS In never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p<0.05), with no significant differences in other chronic respiratory symptoms or CT findings. FVC and exhaled CO were identified as independent risk factors for low DLCO. CONCLUSION Reduced DLCO is a frequent disorder among smokers without airflow limitation, associated with decreased exercise capacity and with CT findings suggesting that it may be a marker of smoking-induced early vascular damage. TRIAL REGISTRATION NUMBER NCT03028207.
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Affiliation(s)
- Francisco Garcia-Rio
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Medicina, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pneumology Department, Hospital Universitary Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Joan B Soriano
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Universitario La Princesa; Universidad Autónoma de Madrid, Madrid, Spain
| | - Borja G Cosío
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Universitario Son Espases-IdiSBa, Palma de Mallorca, Spain
| | - Juan José Soler-Cataluña
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Ciro Casanova
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pulmonary Deparment-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Tenerife, Spain
| | - Pilar de Lucas
- Servicio de Neumología, Hospital General Gregorio Marañón, Madrid, Spain
| | - Inmaculada Alfageme
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain
| | | | | | - Julio Ancochea
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Universitario La Princesa; Universidad Autónoma de Madrid, Madrid, Spain
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Brenckmann V, Briot R, Ventrillard I, Romanini D, Barbado M, Jaulin K, Trocme C, De Wolf J, Glorion M, Sage É. Continuous Endogenous Exhaled CO Monitoring by Laser Spectrometer in Human EVLP Before Lung Transplantation. Transpl Int 2022; 35:10455. [PMID: 35711322 PMCID: PMC9192958 DOI: 10.3389/ti.2022.10455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022]
Abstract
Endogenous production of carbon monoxide (CO) is affected by inflammatory phenomena and ischemia-reperfusion injury. Precise measurement of exhaled endogenous CO (eCO) is possible thanks to a laser spectrometer (ProCeas® from AP2E company). We assessed eCO levels of human lung grafts during the normothermic Ex-Vivo Lung Perfusion (EVLP). ProCeas® was connected in bypass to the ventilation circuit. The surgical team took the decision to transplant the lungs without knowing eCO values. We compared eCO between accepted and rejected grafts. EVLP parameters and recipient outcomes were also compared with eCO values. Over 7 months, eCO was analyzed in 21 consecutive EVLP grafts. Two pairs of lungs were rejected by the surgical team. In these two cases, there was a tendency for higher eCO values (0.358 ± 0.52 ppm) compared to transplanted lungs (0.240 ± 0.76 ppm). During the EVLP procedure, eCO was correlated with glucose consumption and lactate production. However, there was no association of eCO neither with edema formation nor with the PO2/FiO2 ratio per EVLP. Regarding post-operative data, every patient transplanted with grafts exhaling high eCO levels (>0.235 ppm) during EVLP presented a Primary Graft Dysfunction score of 3 within the 72 h post-transplantation. There was also a tendency for a longer stay in ICU for recipients with grafts exhaling high eCO levels during EVLP. eCO can be continuously monitored during EVLP. It could serve as an additional and early marker in the evaluation of the lung grafts providing relevant information for post-operative resuscitation care.
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Affiliation(s)
- Vivien Brenckmann
- Emergency Department, Grenoble-Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, TIMC-IMAG, Grenoble, France
| | - Raphael Briot
- Emergency Department, Grenoble-Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, TIMC-IMAG, Grenoble, France
- *Correspondence: Raphael Briot,
| | | | | | - Maud Barbado
- Clinical Investigation Centre for Innovative Technology (CIC-IT), Grenoble-Alpes University Hospital, Grenoble, France
| | | | - Candice Trocme
- Biochemistry Proteins and Enzymes Laboratory, Grenoble-Alpes University Hospital, Grenoble, France
| | - Julien De Wolf
- Department of Thoracic Surgery, Foch Hospital, Suresnes, France
| | | | - Édouard Sage
- Department of Thoracic Surgery, Foch Hospital, Suresnes, France
- UMR 0892, Virologie et Immunologie Moléculaires, Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Lozar Krivec J, Lozar Manfreda K, Paro-Panjan D. Clinical Factors Influencing Endogenous Carbon Monoxide Production and Carboxyhemoglobin Levels in Neonates. J Pediatr Hematol Oncol 2022; 44:e84-e90. [PMID: 33735151 DOI: 10.1097/mph.0000000000002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
Carboxyhemoglobin (COHb) is an index of endogenous carbon monoxide formation during the hem degradation process and could be used to confirm hemolysis in neonates. The influence of other clinical factors on COHb values in neonates has not been fully investigated. We aimed to evaluate the influence of hemolysis, sepsis, respiratory distress, and postnatal age on COHb values. We retrospectively analyzed COHb measurements determined with a carbon monoxide-oximeter in 4 groups of term neonates: A-sepsis, B-respiratory distress, C-hemolysis, and D-healthy neonates. The mean COHb values were 1.41% (SD: 0.26), 1.32% (SD: 0.27), 2.5% (SD: 0.69), and 1.27% (SD: 0.19) (P<0.001) in groups A (n=8), B (n=37), C (n=16), and D (n=76), respectively. COHb in group C was significantly higher than in the other groups. There was a negative correlation between postnatal age and COHb in healthy neonates. A cut-off level of 1.7% had 93% (95% confidence interval [CI]: 89%-97%) sensitivity and 94% (95% CI: 90%-98%) specificity for diagnosis of hemolysis. COHb values were higher during the first days of life. We found that COHb levels in neonates with hemolysis were significantly higher and that the influence of sepsis and respiratory distress on COHb values was insignificant.
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Affiliation(s)
- Jana Lozar Krivec
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Faculty of Medicine
| | | | - Darja Paro-Panjan
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Faculty of Medicine
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5
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Ghorbani R, Blomberg A, Schmidt FM. Impact of breath sampling on exhaled carbon monoxide. J Breath Res 2020; 14:047105. [PMID: 33021205 DOI: 10.1088/1752-7163/abb479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The influence of breath sampling on exhaled carbon monoxide (eCO) and related pulmonary gas exchange parameters is investigated in a study with 32 healthy non-smokers. Mid-infrared tunable diode laser absorption spectroscopy and well-controlled online sampling is used to precisely measure mouth- and nose-exhaled CO expirograms at exhalation flow rates (EFRs) of 250, 120 and 60 ml s-1, and for 10 s of breath-holding followed by exhalation at 120 ml s-1. A trumpet model with axial diffusion is employed to fit simulated exhalation profiles to the experimental expirograms, which provides equilibrium airway and alveolar CO concentrations and the average lung diffusing capacity in addition to end-tidal concentrations. For all breathing maneuvers, excellent agreement is found between mouth- and nose-exhaled end-tidal CO (ETCO), and the individual values for ETCO and alveolar diffusing capacity are consistent across maneuvers. The eCO parameters clearly show a dependence on EFR, where the lung diffusing capacity increases with EFR, while ETCO slightly decreases. End-tidal CO is largely independent of ambient air CO and alveolar diffusing capacity. While airway CO is slightly higher than, and correlates strongly with, ambient air CO, and there is a weak correlation with ETCO, the results point to negligible endogenous airway CO production in healthy subjects. An EFR of around 120 ml s-1 can be recommended for clinical eCO measurements. The employed method provides means to measure variations in endogenous CO, which can improve the interpretation of exhaled CO concentrations and the diagnostic value of eCO tests in clinical studies. Clinical trial registration number: 2017/306-31.
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Affiliation(s)
- Ramin Ghorbani
- Department of Applied Physics and Electronics, Umeå University, Umeå SE-90187, Sweden
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High inhaled oxygen concentration quadruples exhaled CO in healthy volunteers monitored by a highly sensitive laser spectrometer. Sci Rep 2019; 9:12259. [PMID: 31439950 PMCID: PMC6706429 DOI: 10.1038/s41598-019-48789-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022] Open
Abstract
Carbon monoxide (CO) monitoring in human breath is the focus of many investigations as CO could possibly be used as a marker of various diseases. Detecting CO in human breath remains a challenge because low concentrations (<ppm) must be selectively detected and short response time resolution is needed to detect the end expiratory values reflecting actual alveolar concentrations. A laser spectroscopy based instrument was developed (ProCeas) that fulfils these requirements. The aim of this study was to validate the use of a ProCeas for human breath analysis in order to measure the changes of endogenous exhaled CO (eCO) induced by different inspired fractions of oxygen (FiO2) ranging between 21% and 100%. This study was performed on healthy volunteers. 30 healthy awaked volunteers (including asymptomatic smokers) breathed spontaneously through a facial mask connected to the respiratory circuit of an anesthesiology station. FiO2 was fixed to 21%, 50% and 100% for periods of 5 minutes. CO concentrations were continuously monitored throughout the experiment with a ProCeas connected to the airway circuit. The respiratory cycles being resolved, eCO concentration is defined by the difference between the value at the end of the exhalation phase and the level during inhalation phase. Inhalation of 100% FiO2 increased eCO levels by a factor of four in every subjects (smokers and non smokers). eCO returned in a few minutes to the initial value when FiO2 was switched back to 21%. This magnification of eCO at 21% and 100% FiO2 is greater than those described in previous publications. We hypothesize that these results can be explained by the healthy status of our subjects (with low basal levels of eCO) and also by the better measurement precision of ProCeas.
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7
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Kis A, Meszaros M, Tarnoki DL, Tarnoki AD, Lazar Z, Horvath P, Kunos L, Bikov A. Exhaled carbon monoxide levels in obstructive sleep apnoea. J Breath Res 2019; 13:036012. [DOI: 10.1088/1752-7163/ab231d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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8
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Ghorbani R, Schmidt FM. Fitting of single-exhalation profiles using a pulmonary gas exchange model—application to carbon monoxide. J Breath Res 2019; 13:026001. [DOI: 10.1088/1752-7163/aafc91] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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9
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Pereira AA, Pollard SL, Locke R, Romero K, Lima JJ, Hansel NN, Checkley W. Association between exhaled carbon monoxide and asthma outcomes in Peruvian children. Respir Med 2018; 145:212-216. [PMID: 30509712 DOI: 10.1016/j.rmed.2018.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma prevalence continues to increase in low and middle-income countries, presenting challenges in assessing asthma control in resource-poor settings. Previous studies suggest that exhaled carbon monoxide (eCO) is higher with asthma severity and lower with treatment. We hypothesized that eCO levels may be elevated in children with asthma, particularly in children with partially controlled or uncontrolled asthma in a low-resource setting in Lima, Peru. METHODS We compared average eCO levels between 248 children with asthma and 221 healthy controls as well as the odds of asthma by eCO quartiles (0-1, 2, 3, and ≥4 ppm) using multivariable linear and logistic regression. eCO quartiles were also used to compare the odds of partially controlled or uncontrolled asthma (score ≤19 on the Asthma Control Test) in a multivariable logistic regression model. FINDINGS Average adjusted eCO level was 0.56 ppm (95% CI 0.07-1.05) higher in children with asthma. The adjusted odds of asthma were 1.22 (95% CI 0.75-1.97), 1.46 (0.81-2.63), and 1.76 (0.96-3.23) in the second, third, and fourth eCO quartiles compared to the first eCO quartile, respectively. Among children with asthma, the adjusted odds of partially controlled or uncontrolled asthma in those in the second, third, and fourth eCO quartiles, compared to the first, were 1.61 (95% CI 0.74-3.48), 3.66 (95% CI 1.51-8.87), and 2.50 (95% CI 1.06-5.90), respectively. INTERPRETATION eCO may serve as an inexpensive biomarker for asthma control, particularly in low-resource settings.
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Affiliation(s)
- Amanda A Pereira
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Suzanne L Pollard
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Robert Locke
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Karina Romero
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - William Checkley
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Biomedical Research Unit, A.B. PRISMA, Lima, Peru.
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10
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Samra M, Nam SK, Lim DH, Kim DH, Yang J, Kim YK, Kim JH. Urine Bacteria-Derived Extracellular Vesicles and Allergic Airway Diseases in Children. Int Arch Allergy Immunol 2018; 178:150-158. [PMID: 30415264 DOI: 10.1159/000492677] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Microbiota and human allergic airway diseases have been proven to be interrelated. Bacteria-derived extracellular vesicle (EV)s are known to play important roles in interbacterial and human-bacteria communications, but their relationship with allergies has not been examined yet. Urine EVs were investigated to determine whether they could be used as biomarkers for monitoring allergic airway diseases in children. METHODS Subjects were 4 groups of chronic rhinitis (CR), allergic rhinitis (AR), atopic asthma (AS) and healthy controls. Single voided urine samples were collected. Urine EVs were isolated and their DNA was extracted for 16S-rDNA pyrosequencing. RESULTS A total of 118 children participated in this study; 27, 39, 19, and 33 were in the CR, AR, AS, and control group, respectively. The AR had a significantly high Chao-1 index than that of controls. Principal component analysis revealed dysbiosis in the CR, AR, and AS compared to the controls. One phylum and 19 families and genera were significantly enriched or depleted in the disease groups compared to the controls; the Actinobacteria phylum and the Sphingomonadaceae family were more abundant in the AS and CR, the Comamonadaceae family, the Propionibacteraceae family, Propionibacterium and Enhydrobacter were more enriched in the CR, and the Methylobacteriaceae family and Methylobacterium were more abundant in each disease group, while the Enterobacteriaceae family was depleted in each disease group. CONCLUSIONS CR, AR, and AS had a distinct composition of urine EVs. Urine EVs could be an indicator for assessing allergic airway diseases in children.
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Affiliation(s)
- Mona Samra
- Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea.,Environmental Health Center of Allergic Rhinitis, Inha University Hospital, Incheon, Republic of Korea
| | - Soo Kyung Nam
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea.,Environmental Health Center of Allergic Rhinitis, Inha University Hospital, Incheon, Republic of Korea.,Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Dong Hyun Kim
- Environmental Health Center of Allergic Rhinitis, Inha University Hospital, Incheon, Republic of Korea.,Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Jinho Yang
- MD Healthcare Inc., Seoul, Republic of Korea
| | | | - Jeong Hee Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea, .,Environmental Health Center of Allergic Rhinitis, Inha University Hospital, Incheon, Republic of Korea, .,Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea,
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11
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Yoshida N, Baba Y, Kuroda D, Miyamoto Y, Iwatsuki M, Hiyoshi Y, Ishimoto T, Sawayama H, Imamura Y, Watanabe M, Baba H. Clinical utility of exhaled carbon monoxide in assessing preoperative smoking status and risks of postoperative morbidity after esophagectomy. Dis Esophagus 2018; 31:5035740. [PMID: 29893796 DOI: 10.1093/dote/doy024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Whereas smoking constitutes a significant risk factor for postesophagectomy morbidity, there is no reliable method to assess the smoking status of patients prior to the procedure. Since exhaled carbon monoxide (CO) is an indicator of recent smoking, this paper hypothesizes that this is a useful parameter in assessing current smoking status and may help predict morbidity following esophagectomy. Sixty-nine patients, who had undergone elective three-incision esophagectomy with two- or three-field lymphadenectomy for esophageal cancer, were prospectively studied between February 2015 and September 2017. At surgical admission, they were asked about their smoking history, their exhaled CO levels were evaluated, and they were grouped into three based on their CO levels. These were 0 parts per million (ppm), >0 and <7 ppm, and ≥7 ppm. Their postoperative morbidity was also assessed. Approximately 13.5% of the patients showed high levels of exhaled CO ≥ 7 ppm, despite preoperatively reporting smoking cessation for over a month. Morbidities of the Clavien-Dindo classification (CDc) ≥ II increased as exhaled CO levels increased and severe morbidity of CDc ≥ IIIb frequently was observed in patients with exhaled CO levels ≥7 ppm. The logistic regression analysis showed that exhaled CO level ≥7 ppm was an independent risk factor for severe postesophagectomy morbidity. Overall, the results of this study suggest that exhaled CO levels may be useful in estimating current smoking status and that it may also help give an estimation of the risk of postesophagectomy morbidity.
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Affiliation(s)
- N Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - Y Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - D Kuroda
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - Y Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - M Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - Y Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - T Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - H Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
| | - Y Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - M Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, and
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12
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Ghorbani R, Blomberg A, Schmidt FM. Modeling Pulmonary Gas Exchange and Single-Exhalation Profiles of Carbon Monoxide. Front Physiol 2018; 9:927. [PMID: 30104980 PMCID: PMC6077244 DOI: 10.3389/fphys.2018.00927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Exhaled breath carbon monoxide (eCO) is a candidate biomarker for non-invasive assessment of oxidative stress and respiratory diseases. Standard end-tidal CO analysis, however, cannot distinguish, whether eCO reflects endogenous CO production, lung diffusion properties or exogenous sources, and is unable to resolve a potential airway contribution. Coupling real-time breath gas analysis to pulmonary gas exchange modeling holds promise to improve the diagnostic value of eCO. A trumpet model with axial diffusion (TMAD) is used to simulate the dynamics of CO gas exchange in the respiratory system and corresponding eCO concentrations for the first time. The mass balance equation is numerically solved employing a computationally inexpensive routine implementing the method of lines, which provides the distribution of CO in the respiratory tract during inhalation, breath-holding, and exhalation with 1 mm spatial and 0.01 s temporal resolution. Initial estimates of the main TMAD parameters, the maximum CO fluxes and diffusing capacities in alveoli and airways, are obtained using healthy population tissue, blood and anatomical data. To verify the model, mouth-exhaled expirograms from two healthy subjects, measured with a novel, home-built laser-based CO sensor, are compared to single-exhalation profiles simulated using actual breath sampling data, such as exhalation flow rate (EFR) and volume. A very good agreement is obtained in exhalation phases I and III for EFRs between 55 and 220 ml/s and after 10 and 20 s of breath-holding, yielding a unique set of TMAD parameters. The results confirm the recently observed EFR dependence of CO expirograms and suggest that measured end-tidal eCO is always lower than alveolar and capillary CO. Breath-holding allows the observation of close-to-alveolar CO concentrations and increases the sensitivity to the airway TMAD parameters in exhalation phase I. A parametric simulation study shows that a small increase in airway flux can be distinguished from an increase in alveolar flux, and that slight changes in alveolar flux and diffusing capacity have a significantly different effect on phase III of the eCO profiles.
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Affiliation(s)
- Ramin Ghorbani
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Anders Blomberg
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Florian M Schmidt
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
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13
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Karrasch S, Behr J, Huber RM, Nowak D, Peters A, Peters S, Holle R, Jörres RA, Schulz H. Heterogeneous pattern of differences in respiratory parameters between elderly with either good or poor FEV 1. BMC Pulm Med 2018; 18:27. [PMID: 29409487 PMCID: PMC5801692 DOI: 10.1186/s12890-018-0582-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background The relationship of spirometric values to other respiratory and functional parameters in advanced age is not well studied. We assessed this relationship in elderly subjects with either good or poor spirometric parameters to reveal whether different domains of lung function show comparable differences between the two groups. Methods Among subjects of the population-based KORA-Age cohort (n = 935, 65-90y; 51% male) two groups were selected from either the lower (LED; n = 51) or the upper (UED; n = 72) end of the FEV1 distribution. All subjects did not have a history of lung disease and were non-smokers at the time of the study. Measurements included spirometry, body plethysmography, diffusing capacity for NO and CO, respiratory pump function and exhaled NO (FeNO). In addition, 6-min walking distance as a functional overall measure, as well as telomere length of blood leukocytes and serum 8-hydroxydeoxyguanosine (8-OHdG) as potential markers of overall biological ageing and stress were determined. Results In the majority of parameters, LED subjects showed significantly impaired values compared to UED subjects. Differences in spirometric parameters, airway resistance and respiratory pump function ranged between 10% and more than 90% in terms of predicted values. In contrast, volume-related CO and NO diffusing capacity showed differences between groups of lower than 5%, while telomere length, 8-OHdG and FeNO were similar. This was reflected in the differences in “functional age” as derived from prediction equations. Conclusions In elderly subjects without a history of lung disease differences in spirometric parameters were associated with differences in other lung-mechanical parameters including body plethysmography but not with differences in volume-corrected gas exchange measures. Thus, the concept of a general “lung age” as suggested by the widespread use of this term in connection with spirometry should be considered with caution. Electronic supplementary material The online version of this article (10.1186/s12890-018-0582-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Karrasch
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, D-85764, Neuherberg, Germany. .,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, 80336, Munich, Germany. .,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany.
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center Munich, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, 80336, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany
| | - Rudolf M Huber
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany.,Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine, Innenstadt, Ludwig-Maximilians-University, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, 80336, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Stefan Peters
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, 80336, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany
| | - Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, D-85764, Neuherberg, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany
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14
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Zhao C, Yu S, Li J, Xu W, Ge R. Changes in IL-4 and IL-13 expression in allergic-rhinitis treated with hydrogen-rich saline in guinea-pig model. Allergol Immunopathol (Madr) 2017; 45:350-355. [PMID: 28215576 DOI: 10.1016/j.aller.2016.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/31/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Medical gas hydrogen (H2) has a special role in airway inflammation; however, the effect of H2 on allergic rhinitis (AR) remains unclear. This study explored the possible roles of H2 on the pathogenesis of AR and observed the influences of H2 on cytokines IL-4 and IL-13. METHODS An AR guinea pig model was established by nasal ovalbumin sensitisation. Eighteen guinea pigs were divided into three groups, namely, saline control, AR-sensitised, and hydrogen-rich saline (HRS)-treated groups, with each group having six guinea pigs. The frequencies of sneezing and scratching were recorded. The IgE level and cytokine (IL-4 and IL-13) levels in the serum were measured. The expression levels of IL-4 and IL-13 mRNA and protein in the nasal mucosa were also determined by real-time reverse transcriptase-polymerase chain reaction and Western blot. We also observed the infiltration of cytokine (IL-4 and IL-13) in nasal mucosa by immunofluorescence. RESULTS The frequencies of sneezing and scratching, as well as the levels of IgE, IL-4, and IL-13, in the serum were higher in the AR group than in the control group (p<0.01), whereas all these parameters were decreased significantly after HRS treatment (p<0.05). The expression levels of IL-4 and IL-13 mRNA and protein in the nasal mucosa were also lower in guinea pigs treated with HRS than those in the AR group (p<0.05). CONCLUSIONS HRS could affect anti-inflammation in AR and decreased the expression of IL-4 and IL-13.
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Affiliation(s)
- C Zhao
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - S Yu
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai 200065, China.
| | - J Li
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - W Xu
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - R Ge
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai 200065, China
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15
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Ghorbani R, Schmidt FM. ICL-based TDLAS sensor for real-time breath gas analysis of carbon monoxide isotopes. OPTICS EXPRESS 2017; 25:12743-12752. [PMID: 28786628 DOI: 10.1364/oe.25.012743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/16/2017] [Indexed: 06/07/2023]
Abstract
We present a compact sensor for carbon monoxide (CO) in air and exhaled breath based on a room temperature interband cascade laser (ICL) operating at 4.69 µm, a low-volume circular multipass cell and wavelength modulation absorption spectroscopy. A fringe-limited (1σ) sensitivity of 6.5 × 10-8 cm-1Hz-1/2 and a detection limit of 9 ± 5 ppbv at 0.07 s acquisition time are achieved, which constitutes a 25-fold improvement compared to direct absorption spectroscopy. Integration over 10 s increases the precision to 0.6 ppbv. The setup also allows measuring the stable isotope 13CO in breath. We demonstrate quantification of indoor air CO and real-time detection of CO expirograms from healthy non-smokers and a healthy smoker before and after smoking. Isotope ratio analysis indicates depletion of 13CO in breath compared to natural abundance.
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16
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van Bon L, Cossu M, Scharstuhl A, Pennings BWC, Vonk MC, Vreman HJ, Lafyatis RL, van den Berg W, Wagener FADTG, Radstake TRDJ. Low heme oxygenase-1 levels in patients with systemic sclerosis are associated with an altered Toll-like receptor response: another role for CXCL4? Rheumatology (Oxford) 2016; 55:2066-2073. [PMID: 27411481 DOI: 10.1093/rheumatology/kew251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 05/19/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE SSc is a disease characterized by inflammation and fibrosis. Heme Oxygenase-1 (HO-1) is a haem-degrading enzyme that mediates resolution of inflammation and is induced upon mediators abundantly present in SSc. We aimed to assess whether HO-1 expression/function is disturbed in SSc patients and could therefore be contributing to the ongoing inflammation. METHODS In total, 92 SSc patients and 48 healthy controls were included. By measuring total bilirubin in plasma in vivo, HO-activity was assessed. HO-1 expression levels were determined with western blot in monocytes before and after induction of HO-1 with cobalt protoporphyrin (CoPP) with or without CXCL4. Monocyte-derived dendritic cells (DCs) were stimulated with several Toll-like receptor (TLR) ligands with or without pre-stimulation with CoPP for 24 h. Cytokine levels were measured in the supernatants using the Luminex Bead Array. RESULTS SSc patients have lower plasma levels of bilirubin, suggestive of an aberrant HO-1 function. We demonstrated low HO-1 expression in immune cells from SSc patients, whereas induction with CoPP was able to restore HO-1 levels in DCs from SSc patients, almost normalizing the increased TLR response observed in SSc. Co-exposure to CXCL4 completely abrogated CoPP-induced HO-1 expression, suggesting that the high CXCL4 levels present in SSc patients block the normal induction of HO-1 and its function. CONCLUSION We demonstrate that HO activity in SSc patients is decreased and show its functional consequences. Since CXCL4 blocks the induction of HO-1 expression, neutralization of CXCL4 in SSc patients could have clinical benefits by diminishing overactivation of immune cells and other anti-inflammatory effects of HO-1.
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Affiliation(s)
- Lenny van Bon
- Department of Rheumatology & Clinical Immunology and Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht.,Department of Rheumatology
| | - Marta Cossu
- Department of Rheumatology & Clinical Immunology and Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht
| | - Alwin Scharstuhl
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bas W C Pennings
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Hendrik J Vreman
- Neonatal and Developmental Medicine Laboratory, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Robert L Lafyatis
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | | | - Frank A D T G Wagener
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Timothy R D J Radstake
- Department of Rheumatology & Clinical Immunology and Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht .,Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC
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17
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Bikov A, Hull JH, Kunos L. Exhaled breath analysis, a simple tool to study the pathophysiology of obstructive sleep apnoea. Sleep Med Rev 2016; 27:1-8. [DOI: 10.1016/j.smrv.2015.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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18
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Zhong W, Di C, Lv J, Zhang Y, Lin X, Yuan Y, Lv J, Xia Z. Heme oxygenase-1 inhibits basophil maturation and activation but promotes its apoptosis in T helper type 2-mediated allergic airway inflammation. Immunology 2016; 147:321-37. [PMID: 26879758 DOI: 10.1111/imm.12564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/26/2015] [Accepted: 12/04/2015] [Indexed: 12/17/2022] Open
Abstract
The anti-inflammatory role of heme oxygenase-1 (HO-1) has been studied extensively in many disease models including asthma. Many cell types are anti-inflammatory targets of HO-1, such as dendritic cells and regulatory T cells. In contrast to previous reports that HO-1 had limited effects on basophils, which participate in T helper type 2 immune responses and antigen-induced allergic airway inflammation, we demonstrated in this study, for the first time, that the up-regulation of HO-1 significantly suppressed the maturation of mouse basophils, decreased the expression of CD40, CD80, MHC-II and activation marker CD200R on basophils, blocked DQ-ovalbumin uptake and promoted basophil apoptosis both in vitro and in vivo, leading to the inhibition of T helper type 2 polarization. These effects of HO-1 were mimicked by exogenous carbon monoxide, which is one of the catalytic products of HO-1. Furthermore, adoptive transfer of HO-1-modified basophils reduced ovalbumin-induced allergic airway inflammation. The above effects of HO-1 can be reversed by the HO-1 inhibitor Sn-protoporphyrin IX. Moreover, conditional depletion of basophils accompanying hemin treatment further attenuated airway inflammation compared with the hemin group, indicating that the protective role of HO-1 may involve multiple immune cells. Collectively, our findings demonstrated that HO-1 exerted its anti-inflammatory function through suppression of basophil maturation and activation, but promotion of basophil apoptosis, providing a possible novel therapeutic target in allergic asthma.
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Affiliation(s)
- Wenwei Zhong
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Paediatrics, Shanghai Children's Medical Centre affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caixia Di
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajia Lv
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanjie Zhang
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoliang Lin
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufan Yuan
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Lv
- Department of Paediatrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenwei Xia
- Department of Paediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Mirowsky J, Gordon T. Noninvasive effects measurements for air pollution human studies: methods, analysis, and implications. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:354-80. [PMID: 25605444 PMCID: PMC6659729 DOI: 10.1038/jes.2014.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/26/2014] [Accepted: 11/05/2014] [Indexed: 05/09/2023]
Abstract
Human exposure studies, compared with cell and animal models, are heavily relied upon to study the associations between health effects in humans and air pollutant inhalation. Human studies vary in exposure methodology, with some work conducted in controlled settings, whereas other studies are conducted in ambient environments. Human studies can also vary in the health metrics explored, as there exists a myriad of health effect end points commonly measured. In this review, we compiled mini reviews of the most commonly used noninvasive health effect end points that are suitable for panel studies of air pollution, broken into cardiovascular end points, respiratory end points, and biomarkers of effect from biological specimens. Pertinent information regarding each health end point and the suggested methods for mobile collection in the field are assessed. In addition, the clinical implications for each health end point are summarized, along with the factors identified that can modify each measurement. Finally, the important research findings regarding each health end point and air pollutant exposures were reviewed. It appeared that most of the adverse health effects end points explored were found to positively correlate with pollutant levels, although differences in study design, pollutants measured, and study population were found to influence the magnitude of these effects. Thus, this review is intended to act as a guide for researchers interested in conducting human exposure studies of air pollutants while in the field, although there can be a wider application for using these end points in many epidemiological study designs.
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Affiliation(s)
- Jaime Mirowsky
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
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20
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Yu S, Yan Z, Che N, Zhang X, Ge R. Impact of Carbon Monoxide/Heme Oxygenase on Hydrogen Sulfide/Cystathionine-γ-lyase Pathway in the Pathogenesis of Allergic Rhinitis in Guinea Pigs. Otolaryngol Head Neck Surg 2015; 152:470-6. [PMID: 25583855 DOI: 10.1177/0194599814567112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The discovery of carbon monoxide (CO) and hydrogen sulfide (H2S) as pathogenic signaling molecules in airway-related diseases has led to significant insights into the pathophysiologic mechanisms underlying the development of allergic rhinitis (AR). The potential crosstalk between CO and H2S signaling pathways in AR has not been adequately investigated. This study was performed to elucidate the mechanistic relationship between CO and H2S in AR. Study Design Experimental prospective animal study. Setting Animal laboratory of Tongji Hospital, Tongji University, Shanghai, China. Subjects and Methods A well-established model of AR was used whereby guinea pigs (N = 24) were randomly divided into 4 treatment groups (n = 6 for each group): The first group received ovalbumin only; the second group was administered exogenous hemin, a CO-binding metalloporphyrin; the third group received zinc protoporphyrin, an inhibitor of heme oxygenase-1. A control group was challenged using only saline. Symptoms of AR were recorded, and quantitation of plasma CO and H2S levels was performed. Expression of heme oxygenase-1 and H2S-generating enzyme cystathionine-γ-lyase (CSE) were measured from nasal mucosa. Results Plasma CO and heme oxygenase-1 expression levels of nasal mucosa were significantly increased in the AR group compared to controls, whereas H2S concentrations were significantly decreased. Exogenous administration of CO exacerbated allergic symptoms, resulting in higher levels of both CO and heme oxygenase-1 expression, and a further reduction in H2S levels and CSE expression. Zinc protoporphyrin decreased CO concentrations and increased levels of both H2S and CSE expression. Conclusions Results indicated an inverse relationship between H2S levels and CO in the pathogenesis of AR.
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Affiliation(s)
- Shaoqing Yu
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai, China
| | - Zhiqiang Yan
- Department of Otolaryngology, Xuzhou 97th Hospital of PLA, Jiangshu, China
| | - Na Che
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai, China
| | - Xiaolin Zhang
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai, China
| | - Rongming Ge
- Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai, China
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21
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Corradi M, Goldoni M, Mutti A. A review on airway biomarkers: exposure, effect and susceptibility. Expert Rev Respir Med 2015; 9:205-20. [PMID: 25561087 DOI: 10.1586/17476348.2015.1001373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current research in pulmonology requires the use of biomarkers to investigate airway exposure and diseases, for both diagnostic and prognostic purposes. The traditional approach based on invasive approaches (lung lavages and biopsies) can now be replaced, at least in part, through the use of non invasively collected specimens (sputum and breath), in which biomarkers of exposure, effect and susceptibility can be searched. The discovery of specific lung-related proteins, which can spill over in blood or excreted in urine, further enhanced the spectrum of airway specific biomarkers to be studied. The recent introduction of high-performance 'omic' technologies - genomics, proteomics and metabolomics, and the rate at which biomarker candidates are being discovered, will permit the use of a combination of biomarkers for a more precise selection of patient with different outcomes and responses to therapies. The aim of this review is to critically evaluate the use of airway biomarkers in the context of research and clinical practice.
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Affiliation(s)
- Massimo Corradi
- Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43123 Parma, Italy
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22
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Jesenak M, Banovcin P, Havlicekova Z, Dobrota D, Babusikova E. Factors influencing the levels of exhaled carbon monoxide in asthmatic children. J Asthma 2014; 51:900-6. [PMID: 24945941 DOI: 10.3109/02770903.2014.936448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Bronchial asthma is characterised by chronic airway inflammation commonly associated with increased oxidative stress. Exhaled carbon monoxide (eCO) levels could act as markers of both oxidative stress and allergic inflammation. We aimed to study eCO levels in asthmatics and detect the possible factors influencing them. METHODS We studied 241 asthmatic children and 75 healthy children. The differences in eCO levels among various asthmatic phenotypes and the correlations between eCO and other measured parameters (spirometric indices, Asthma Control Test score, exhaled nitric oxide, total IgE, blood eosinophils and marker of oxidative damage of proteins) were analysed. RESULTS Levels of eCO widely differed according to the selected characteristics of asthma. Asthmatics showed higher eCO concentrations than controls (1.44 ± 0.12 ppm vs. 0.91 ± 0.11 ppm, p < 0.001). Acute exacerbation of asthma was accompanied by a significant increase in eCO compared to the clinically controlled stage (2.17 ± 0.36 ppm vs. 1.33 ± 0.13 ppm, p < 0.001). Atopic, non-atopic asthma and asthma associated with allergic rhinitis (AR) showed elevated levels of eCO. The levels of eCO negatively correlated with the marker of protein oxidation in asthmatics, especially in atopic form and during acute exacerbation. CONCLUSIONS In a population of asthmatic children, eCO levels could be considered as a marker of both allergic inflammation and oxidative stress in the airways. Concomitant AR and asthma control were the most important factors affecting the levels of eCO in asthmatic children. However, our results do not support the use of routine eCO in the clinical practice.
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Maignan M, Briot R, Romanini D, Gennai S, Hazane-Puch F, Brouta A, Debaty G, Ventrillard I. Real-time measurements of endogenous carbon monoxide production in isolated pig lungs. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:047001. [PMID: 24699633 DOI: 10.1117/1.jbo.19.4.047001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 03/10/2014] [Indexed: 06/03/2023]
Abstract
Ischemia-reperfusion injuries are a critical determinant of lung transplantation success. The endogenous production of carbon monoxide (CO) is triggered by ischemia-reperfusion injuries. Our aim was, therefore, to assess the feasibility of exhaled CO measurements during the ex vivo evaluation of lungs submitted to ischemia-reperfusion injuries. Five pigs were euthanized and their lungs removed after pneumoplegia. After cold storage (30 min, 4°C), the lungs were connected to an extracorporeal membrane oxygenation circuit, slowly warmed-up, and ventilated. At the end of a 45-min steady state, CO measurements were performed by optical-feedback cavity-enhanced absorption spectroscopy, a specific laser-based technique for noninvasive and real-time low gas concentration measurements. Exhaled CO concentration from isolated lungs reached 0.45±0.19 ppmv and was above CO concentration in ambient air and in medical gas. CO variations peaked during the expiratory phase. Changes in CO concentration in ambient air did not alter CO concentrations in isolated lungs. Exhaled CO level was also found to be uncorrelated to heme oxygenase (HO-1) gene expression. These results confirm the feasibility of accurate and real-time CO measurement in isolated lungs. The presented technology could help establishing the exhaled CO concentration as a biomarker of ischemia-reperfusion injury in ex vivo lung perfusion.
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Affiliation(s)
- Maxime Maignan
- Centre Hospitalier Universitaire Michallon, Emergency Department and Mobile Intensive Care Unit, 38043 Grenoble Cedex 09, FrancebUniversité Joseph Fourier Grenoble 1, /CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble F-38041, France
| | - Raphael Briot
- Centre Hospitalier Universitaire Michallon, Emergency Department and Mobile Intensive Care Unit, 38043 Grenoble Cedex 09, FrancebUniversité Joseph Fourier Grenoble 1, /CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble F-38041, France
| | - Daniel Romanini
- Université Grenoble 1/CNRS, LiPhy UMR 5588, Grenoble F-38041, France
| | - Stephane Gennai
- Centre Hospitalier Universitaire Michallon, Emergency Department and Mobile Intensive Care Unit, 38043 Grenoble Cedex 09, FrancebUniversité Joseph Fourier Grenoble 1, /CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble F-38041, France
| | - Florence Hazane-Puch
- Centre Hospitalier Universitaire de Grenoble, Institut de Biologie et de Pathologie, Département de Biochimie, Toxicologie et Pharmacologie, Unité de Biochimie Hormonale et Nutritionnelle, CS 10217, 38043 Grenoble, France
| | - Angelique Brouta
- Université Joseph Fourier Grenoble 1, /CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble F-38041, France
| | - Guillaume Debaty
- Centre Hospitalier Universitaire Michallon, Emergency Department and Mobile Intensive Care Unit, 38043 Grenoble Cedex 09, FrancebUniversité Joseph Fourier Grenoble 1, /CNRS/TIMC-IMAG UMR 5525/PRETA Team, Grenoble F-38041, France
| | - Irene Ventrillard
- Université Grenoble 1/CNRS, LiPhy UMR 5588, Grenoble F-38041, France
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The haptoglobin-CD163-heme oxygenase-1 pathway for hemoglobin scavenging. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:523652. [PMID: 23781295 PMCID: PMC3678498 DOI: 10.1155/2013/523652] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/09/2013] [Accepted: 05/13/2013] [Indexed: 12/30/2022]
Abstract
The haptoglobin- (Hp-) CD163-heme oxygenase-1 (HO-1) pathway is an efficient captor-receptor-enzyme system to circumvent the hemoglobin (Hb)/heme-induced toxicity during physiological and pathological hemolyses. In this pathway, Hb tightly binds to Hp leading to CD163-mediated uptake of the complex in macrophages followed by lysosomal Hp-Hb breakdown and HO-1-catalyzed conversion of heme into the metabolites carbon monoxide (CO), biliverdin, and iron. The plasma concentration of Hp is a limiting factor as evident during accelerated hemolysis, where the Hp depletion may cause serious Hb-induced toxicity and put pressure on backup protecting systems such as the hemopexin-CD91-HO pathway. The Hp-CD163-HO-1 pathway proteins are regulated by the acute phase mediator interleukin-6 (IL-6), but other regulatory factors indicate that this upregulation is a counteracting anti-inflammatory response during inflammation. The heme metabolites including bilirubin converted from biliverdin have overall an anti-inflammatory effect and thus reinforce the anti-inflammatory efficacy of the Hp-CD163-HO-1 pathway. Future studies of animal models of inflammation should further define the importance of the pathway in the anti-inflammatory response.
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Kurlandsky LE. Elevated Carboxyhemoglobin in Active Asthma and Allergic Rhinitis as Measured by Pulse CO-Oximetry. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:35-37. [PMID: 35927843 DOI: 10.1089/ped.2012.0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Elevated levels of exhaled carbon monoxide have been reported in patients with active or persistent asthma or allergic rhinitis. With the recent availability of a noninvasive pulse CO-Oximeter that measures carboxyhemoglobin, measurements were made on healthy clinic staff as well as children with controlled or active asthma and asymptomatic or active allergic rhinitis to assess whether this test might have applicability in these diseases. Carboxyhemoglobin (SpCO%) was measured by a pulse CO-Oximeter during an initial clinic assessment of patients by a single physician in a Pediatric Pulmonary Clinic. Fifty-one patients with uncontrolled asthma (average age 7.8 years) had an average SpCO% of 4.8%, and 87 patients with controlled asthma (average age 8.8 years) had an average SpCO% of 0.3%, a significant difference, P<0.001. Seven patients with vocal cord dysfunction (average age 13.6 years) had an average SpCO% of 0.43%. In regard to allergic rhinitis, 122 symptomatic patients (average age 6.9 years) had an average SpCO% of 7.3%, while 40 asymptomatic patients (average age 7.4 years) had an average SpCO% of 1.5%, P<0.001%. These preliminary observations suggest that SpCO% may be a useful, noninvasive measure of asthma or allergic rhinitis activity.
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Affiliation(s)
- Lawrence E Kurlandsky
- Department of Pediatrics, Division of Pediatric Pulmonology and Cystic Fibrosis, Upstate Medical University, Syracuse, New York
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Abstract
Carbon monoxide (CO), a low molecular weight gas, is a ubiquitous environmental product of organic combustion, which is also produced endogenously in the body, as the byproduct of heme metabolism. CO binds to hemoglobin, resulting in decreased oxygen delivery to bodily tissues at toxicological concentrations. At physiological concentrations, CO may have endogenous roles as a potential signaling mediator in vascular function and cellular homeostasis. Exhaled CO (eCO), similar to exhaled nitric oxide (eNO), has been evaluated as a candidate breath biomarker of pathophysiological states, including smoking status, and inflammatory diseases of the lung and other organs. eCO values have been evaluated as potential indicators of inflammation in asthma, stable COPD and exacerbations, cystic fibrosis, lung cancer, or during surgery or critical care. The utility of eCO as a marker of inflammation and its potential diagnostic value remain incompletely characterized. Among other candidate 'medicinal gases' with therapeutic potential, (e.g., NO and H2S), CO has been shown to act as an effective anti-inflammatory agent in preclinical animal models of inflammatory disease, acute lung injury, sepsis, ischemia/reperfusion injury and organ graft rejection. Current and future clinical trials will evaluate the clinical applicability of this gas as a biomarker and/or therapeutic in human disease.
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Affiliation(s)
- Stefan W Ryter
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Kovacs D, Bikov A, Losonczy G, Murakozy G, Horvath I. Follow up of lung transplant recipients using an electronic nose. J Breath Res 2013; 7:017117. [DOI: 10.1088/1752-7155/7/1/017117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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You H, Li X, Pei T, Huang Q, Liu F, Gao Y. Predictive Value of Basal Exhaled Nitric Oxide and Carbon Monoxide for Acute Mountain Sickness. Wilderness Environ Med 2012; 23:316-24. [DOI: 10.1016/j.wem.2012.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 04/15/2012] [Accepted: 04/17/2012] [Indexed: 11/27/2022]
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Abd El Khalek KA, El Seify MY, Youssef OI, Badr MM. Diagnostic value of exhaled carbon monoxide as an early marker of exacerbation in children with chronic lung diseases. ISRN PEDIATRICS 2012; 2012:859873. [PMID: 22997589 PMCID: PMC3446676 DOI: 10.5402/2012/859873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/09/2012] [Indexed: 12/21/2022]
Abstract
Chronic airways infection and inflammation are leading causes of morbidity and mortality in chronic lung diseases (CLD). Pulmonary exacerbations are major causes of morbidity in CLD. Exhaled carbon monoxide (eCO) is a product of endogenous metabolic processes whose presence in exhaled breath is considered an index of inflammatory processes. Objective. To evaluate carbon monoxide (eCO) as inflammatory marker for early detection of acute exacerbation in CLD. Methods. Case control study included 40 children with CLD (twenty in exacerbation, group I and twenty in quiescent period, group II) recruited from the Chest Clinic, Children's Hospital, Ain Shams University. Twenty apparently healthy children were included as controls (group III). Results. Patients' mean age was 9.98 ± 3.29 years: 24 (60%) males and 16 (40%) females. The mean eCO level among patients during exacerbation was 5.35 ± 1.35 (ppm) compared to 2.65 ± 0.49 (ppm) in quiescent stage and 1.30 ± 0.47 (ppm) in controls. eCO cutoff value discriminating cases and control was 1.5 (ppm) (sensitivity; 100% and specificity 70%) and cutoff value discriminating group I from group II was 3 (ppm) (sensitivity: 100% and specificity: 100%). Conclusion. Exhaled CO can be considered a noninvasive early marker of acute exacerbation of CLD.
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Chen Y, Wang R. The message in the air: hydrogen sulfide metabolism in chronic respiratory diseases. Respir Physiol Neurobiol 2012; 184:130-8. [PMID: 22476058 DOI: 10.1016/j.resp.2012.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 12/20/2022]
Abstract
Hydrogen sulfide (H(2)S) is an important gasotransmitter in the mammalian respiratory system. The enzymes that produce H(2)S - mainly cystathionine-β-synthase and cystathionine-γ-lyase - are expressed in pulmonary and airway tissues. Endogenous H(2)S participates in the regulation of the respiratory system's physiological functions and pathophysiological alterations, such as chronic obstructive pulmonary disease, asthma, pulmonary fibrosis and hypoxia-induced pulmonary hypertension, to name a few. The cellular targets of H(2)S in the respiratory system are diverse, including airway smooth muscle cells, epithelial cells, fibroblasts, and pulmonary artery smooth muscle cells. H(2)S also regulates respiratory functions such as airway constriction, pulmonary circulation, cell proliferation or apoptosis, fibrosis, oxidative stress, and neurogenic inflammation. Cross-talk between H(2)S and other gasotransmitters also affects the net outcome of lung function. The metabolism of H(2)S in the lungs and airway may serve as a biomarker for specific respiratory diseases. It is expected that strategies targeted at the metabolism and function of H(2)S will prove useful for the prevention and treatment of selective chronic respiratory diseases.
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Affiliation(s)
- Yahong Chen
- Respiratory Department, Peking University Third Hospital, Beijing, China
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Shorter JH, Nelson DD, McManus JB, Zahniser MS, Sama SR, Milton DK. Clinical study of multiple breath biomarkers of asthma and COPD (NO, CO(2), CO and N(2)O) by infrared laser spectroscopy. J Breath Res 2011; 5:037108. [PMID: 21757803 DOI: 10.1088/1752-7155/5/3/037108] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breath analysis is a powerful non-invasive technique for the diagnosis and monitoring of respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD). Exhaled nitric oxide (NO) and carbon monoxide (CO) are markers of airway inflammation and can indicate the extent of respiratory diseases. We have developed a compact fast response quantum cascade laser system for analysis of multiple gases by tunable infrared absorption spectroscopy. The ARI breath analysis instrument has been deployed in a study of exhaled breath from patients with asthma or COPD. A total of 173 subjects participated, including both adult and pediatric patients. Patients in asthma or COPD exacerbations were evaluated twice-during the exacerbation and at a follow-up visit-to compare variations in breath biomarkers during these events. The change in exhaled NO levels between exacerbation and 'well' visits is consistent with spirometry data collected. Respiratory models are important for understanding the exchange dynamics of nitric oxide and other species in the lungs and airways. At each patient's visit, tests were conducted at four expiratory flow rates. We have applied a trumpet model with axial diffusion to the multi-flow exhaled nitric oxide data, obtaining NO alveolar concentrations and airway fluxes. We found higher airway fluxes for those with more severe asthma and during exacerbation events. The alveolar concentrations from the model were higher in adults with asthma and COPD, but this trend was less clear among the pediatric subjects.
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Affiliation(s)
- Joanne H Shorter
- Center for Atmospheric and Environmental Chemistry, Aerodyne Research, Inc., Billerica, MA, USA.
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