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Nwanochie E, Linnes JC. Review of non-invasive detection of SARS-CoV-2 and other respiratory pathogens in exhaled breath condensate. J Breath Res 2022; 16:10.1088/1752-7163/ac59c7. [PMID: 35235925 PMCID: PMC9104940 DOI: 10.1088/1752-7163/ac59c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/02/2022] [Indexed: 11/12/2022]
Abstract
In 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged to cause high viral infectivity and severe respiratory illness in humans (COVID-19). Worldwide, limited pandemic mitigation strategies, including lack of diagnostic test availability, resulted in COVID-19 overrunning health systems and spreading throughout the global population. Currently, proximal respiratory tract (PRT) specimens such as nasopharyngeal swabs are used to diagnose COVID-19 because of their relative ease of collection and applicability in large scale screening. However, localization of SARS-CoV-2 in the distal respiratory tract (DRT) is associated with more severe infection and symptoms. Exhaled breath condensate (EBC) is a sample matrix comprising aerosolized droplets originating from alveolar lining fluid that are further diluted in the DRT and then PRT and collected via condensation during tidal breathing. The COVID-19 pandemic has resulted in recent resurgence of interest in EBC collection as an alternative, non-invasive sampling method for the staging and accurate detection of SARS-CoV-2 infections. Herein, we review the potential utility of EBC collection for detection of SARS-CoV-2 and other respiratory infections. While much remains to be discovered in fundamental EBC physiology, pathogen-airway interactions, and optimal sampling protocols, EBC, combined with emerging detection methods, presents a promising non-invasive sample matrix for detection of SARS-CoV-2.
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Affiliation(s)
- Emeka Nwanochie
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jacqueline C Linnes
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
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Kotru S, Klimuntowski M, Ridha H, Uddin Z, Askhar AA, Singh G, Howlader MMR. Electrochemical sensing: A prognostic tool in the fight against COVID-19. Trends Analyt Chem 2021; 136:116198. [PMID: 33518850 PMCID: PMC7825925 DOI: 10.1016/j.trac.2021.116198] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has devastated the world, despite all efforts in infection control and treatment/vaccine development. Hospitals are currently overcrowded, with health statuses of patients often being hard to gauge. Therefore, methods for determining infection severity need to be developed so that high-risk patients can be prioritized, resources can be efficiently distributed, and fatalities can be prevented. Electrochemical prognostic biosensing of various biomarkers may hold promise in solving these problems as they are low-cost and provide timely results. Therefore, we have reviewed the literature and extracted the most promising biomarkers along with their most favourable electrochemical sensors. The biomarkers discussed in this paper are C-reactive protein (CRP), interleukins (ILs), tumour necrosis factor alpha (TNFα), interferons (IFNs), glutamate, breath pH, lymphocytes, platelets, neutrophils and D-dimer. Metabolic syndrome is also discussed as comorbidity for COVID-19 patients, as it increases infection severity and raises chances of becoming infected. Cannabinoids, especially cannabidiol (CBD), are discussed as a potential adjunct therapy for COVID-19 as their medicinal properties may be desirable in minimizing the neurodegenerative or severe inflammatory damage caused by severe COVID-19 infection. Currently, hospitals are struggling to provide adequate care; thus, point-of-care electrochemical sensor development needs to be prioritized to provide an approximate prognosis for hospital patients. During and following the immediate aftermath of the pandemic, electrochemical sensors can also be integrated into wearable and portable devices to help patients monitor recovery while returning to their daily lives. Beyond the COVID-19 pandemic, these sensors will also prove useful for monitoring inflammation-based diseases such as cancer and cardiovascular disease.
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Affiliation(s)
- Sharda Kotru
- Department of Integrated Biomedical Engineering and Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Martin Klimuntowski
- Department of Electrical and Computer Engineering, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Hashim Ridha
- School of Interdisciplinary Science, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Zakir Uddin
- School of Rehabilitation Science, McMaster University, 1400 Main St W, Hamilton, ON, L8S 1C7, Canada
| | - Ali A Askhar
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Gurmit Singh
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Matiar M R Howlader
- Department of Electrical and Computer Engineering, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Kezeminasab S, Emamalizadeh B, Khoubnasabjafari M, Jouyban A. Exhaled Breath Condensate: A Non-Invasive Source for Tracking of Genetic and Epigenetic Alterations in Lung Diseases. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lung diseases have been recognized as an extensive cause of morbidity and mortality in the worldwide. The high degree of clinical heterogeneity and nonspecific initial symptoms of lung diseases contribute to a delayed diagnosis. So, the molecular and genomic profiling play a pivotal role in promoting the pulmonary diseases. Exhaled breath condensate (EBC) as a novel and potential method for sampling the respiratory epithelial lining fluid is to assess the inflammatory and oxidative stress biomarkers, drugs and genetic alterations in the pathophysiologic processes of lung diseases. The recent studies on the analysis of EBC from both a genetic and epigenetic point of view were searched from database and reviewed. This review provides an overview of the current findings in the tracking of genomic and epigenetic alterations which are potentially effective in better management of cancer detection. In addition, respiratory microbiota DNA using EBC samples in association with pulmonary disease especially lung cancer were investigated. Various studies have concluded that EBC has a great potential for analysis of nuclear and mitochondrial DNA alterations as well as epigenetic modifications and identification of respiratory microbiome. Next-generation sequencing (NGS) based genomic profiling of EBC samples is recommended as a promising approach to establish personalized based prevention, diagnosis, treatment and post-treatment follow-ups for patients with lung diseases especially lung cancer.
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Affiliation(s)
- Somayeh Kezeminasab
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Emamalizadeh
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Khoubnasabjafari
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Kimia Idea Pardaz Azerbaijan (KIPA) Science-Based Company, Tabriz University of Medical Sciences, Tabriz, Iran
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Youssef O, Sarhadi VK, Armengol G, Piirilä P, Knuuttila A, Knuutila S. Exhaled breath condensate as a source of biomarkers for lung carcinomas. A focus on genetic and epigenetic markers-A mini-review. Genes Chromosomes Cancer 2016; 55:905-914. [DOI: 10.1002/gcc.22399] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Omar Youssef
- Faculty of Medicine; Department of Pathology, University of Helsinki; Helsinki Finland
| | - Virinder Kaur Sarhadi
- Faculty of Medicine; Department of Pathology, University of Helsinki; Helsinki Finland
| | - Gemma Armengol
- Unit of Biological Anthropology, Department of Animal Biology, Plant Biology and Ecology, Universitat Autònoma De Barcelona; Barcelona Catalonia Spain
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS-Medical Imaging Center, Helsinki University Hospital and Helsinki University; Helsinki Finland
| | - Aija Knuuttila
- Department of Pulmonary Medicine; University of Helsinki and Helsinki University Hospital, Heart and Lung Center; Helsinki Finland
| | - Sakari Knuutila
- Faculty of Medicine; Department of Pathology, University of Helsinki; Helsinki Finland
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Aldakheel FM, Thomas PS, Bourke JE, Matheson MC, Dharmage SC, Lowe AJ. Relationships between adult asthma and oxidative stress markers and pH in exhaled breath condensate: a systematic review. Allergy 2016; 71:741-57. [PMID: 26896172 DOI: 10.1111/all.12865] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 01/02/2023]
Abstract
Oxidative stress has a recognized role in the pathophysiology of asthma. Recently, interest has increased in the assessment of pH and airway oxidative stress markers. Collection of exhaled breath condensate (EBC) and quantification of biomarkers in breath samples can potentially indicate lung disease activity and help in the study of airway inflammation, and asthma severity. Levels of oxidative stress markers in the EBC have been systematically evaluated in children with asthma; however, there is no such systematic review conducted for adult asthma. A systematic review of oxidative stress markers measured in EBC of adult asthma was conducted, and studies were identified by searching MEDLINE and SCOPUS databases. Sixteen papers met the inclusion criteria. Concentrations of exhaled hydrogen ions, nitric oxide products, hydrogen peroxide and 8-isoprostanes were generally elevated and related to lower lung function tests in adults with asthma compared to healthy subjects. Assessment of EBC markers may be a noninvasive approach to evaluate airway inflammation, exacerbations, and disease severity of asthma, and to monitor the effectiveness of anti-inflammatory treatment regimens. Longitudinal studies, using standardized analytical techniques for EBC collection, are required to establish reference values for the interpretation of EBC markers in the context of asthma.
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Affiliation(s)
- F. M. Aldakheel
- Allergy and Lung Health Unit; The University of Melbourne; Melbourne Australia
- Department of Clinical Laboratory Sciences; College of Applied Medical Sciences; King Saud University; Riyadh Saudi Arabia
| | - P. S. Thomas
- Department of Respiratory Medicine and Prince of Wales Hospital Clinical School; University of New South Wales; Sydney Australia
| | - J. E. Bourke
- Biomedicine Discovery Institute; Department of Pharmacology; Monash University; Clayton Australia
| | - M. C. Matheson
- Allergy and Lung Health Unit; The University of Melbourne; Melbourne Australia
- Murdoch Childrens Research Institute; Melbourne Australia
| | - S. C. Dharmage
- Allergy and Lung Health Unit; The University of Melbourne; Melbourne Australia
- Murdoch Childrens Research Institute; Melbourne Australia
| | - A. J. Lowe
- Allergy and Lung Health Unit; The University of Melbourne; Melbourne Australia
- Murdoch Childrens Research Institute; Melbourne Australia
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Review on Exhaled Hydrogen Peroxide as a Potential Biomarker for Diagnosis of Inflammatory Lung Disease s. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2015. [DOI: 10.4028/www.scientific.net/jbbbe.22.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Exhaled breath (EB) contains thousands of volatile and nonvolatile biomolecules. EB analysis is non-invasive and convenient to patients than blood or urine tests. The exhaled biomolecules have long been studied and recognized to have some potential biomarkers for diagnosis of diseases, evaluation of metabolic disorders and monitoring drug efficiency. For instance, Biomarkers such as exhaled hydrogen peroxide (H2O2) and exhaled nitric oxide are associated with inflammatory lung diseases, ammonia is used as a biomarker for kidney diseases and exhaled acetone is related to glucose concentration in blood and so it is used for diabetes diagnosis. H2O2 concentration in EB increases with the severity of lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and adult respiratory distress syndrome (ARDS). Different methods are used to measure H2O2 in exhaled breath condensate (EBC). In EBC the EB is collected in a condensate unit and then H2O2 concentration in the collected sample is detected using titrimetric, spectrophotometry, fluorescence, chemiluminescence and electrochemical sensors. Recently, some works have been done to measure the concentration of H2O2 in its vapor phase without a need for condensation units. The aim of this paper is to review and summarize the current methods being used to measure the concentration of H2O2 in EB to identify inflammatory lung diseases, and to discuss the advantages and disadvantages of these methods
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Kubáň P, Foret F. Exhaled breath condensate: Determination of non-volatile compounds and their potential for clinical diagnosis and monitoring. A review. Anal Chim Acta 2013; 805:1-18. [DOI: 10.1016/j.aca.2013.07.049] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/16/2013] [Accepted: 07/20/2013] [Indexed: 12/31/2022]
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Murata K, Fujimoto K, Kitaguchi Y, Horiuchi T, Kubo K, Honda T. Hydrogen peroxide content and pH of expired breath condensate from patients with asthma and COPD. COPD 2013; 11:81-7. [PMID: 24111595 DOI: 10.3109/15412555.2013.830094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oxidative stress is implicated in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). Analysis of the expired breath condensate (EBC) has been suggested to provide non-invasive inflammatory markers that reflect oxidative stress in the airways. OBJECTIVE The present study attempts to elucidate whether the hydrogen peroxide (H2O2) levels and pH values in EBC may be useful as biomarkers of the activity or severity of asthma and COPD. METHODS We measured the H2O2 levels and pH values using a derivatives of reactive oxygen metabolites exhalation test kit (Diacron) and a pH analyser, respectively, in EBC obtained using an EcoScreen from 29 patients with asthma, 33 with COPD, and 33 healthy individuals (all non-smokers). We then examined the relationships among oxidative stress and the asthma control test (ACT) or COPD assessment test (CAT) scores, pulmonary function, fractional exhaled nitric oxide (FeNO), and the extent of low attenuation areas on HRCT. RESULTS The H2O2 levels were elevated and pH was lower in both asthma (H2O2; 8.75 ± 0.88 μM, p < 0.01, pH; 7.14 ± 0.07, p < 0.05) and COPD (H2O2; 7.44 ± 0.89 μM, p < 0.01, pH; 6.87 ± 0.10, p < 0.01) compared with control subjects (H2O2; 3.42 ± 0.66 μM, pH; 7.35 ± 0.04). Neither the H2O2 levels nor pH correlated with the ACT scores and FeNO in asthma patients. Neither the H2O2 levels nor pH significantly correlated with the pulmonary function in asthma and COPD. However, the CAT scores significantly correlated with the H2O2 levels in patients with COPD (r = 0.52, p < 0.01). CONCLUSIONS These findings suggest that oxidative stress is involved in the pathogenesis of asthma and COPD and that the H2O2 levels in EBC might reflect the health status in COPD.
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Affiliation(s)
- Kazuya Murata
- 1Department of Laboratory Medicine, Shinshu University School of Medicine , Matsumoto , Japan
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Liang Y, Yeligar SM, Brown LAS. Exhaled breath condensate: a promising source for biomarkers of lung disease. ScientificWorldJournal 2012; 2012:217518. [PMID: 23365513 PMCID: PMC3539342 DOI: 10.1100/2012/217518] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 11/25/2012] [Indexed: 12/26/2022] Open
Abstract
Exhaled breath condensate (EBC) has been increasingly studied as a noninvasive research method for sampling the alveolar and airway space and is recognized as a promising source of biomarkers of lung diseases. Substances measured in EBC include oxidative stress and inflammatory mediators, such as arachidonic acid derivatives, reactive oxygen/nitrogen species, reduced and oxidized glutathione, and inflammatory cytokines. Although EBC has great potential as a source of biomarkers in many lung diseases, the low concentrations of compounds within the EBC present challenges in sample collection and analysis. Although EBC is viewed as a noninvasive method for sampling airway lining fluid (ALF), validation is necessary to confirm that EBC truly represents the ALF. Likewise, a dilution factor for the EBC is needed in order to compare across subjects and determine changes in the ALF. The aims of this paper are to address the characteristics of EBC; strategies to standardize EBC sample collection and review available analytical techniques for EBC analysis.
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Affiliation(s)
- Yan Liang
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University and Emory+Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, GA 30322, USA
| | - Samantha M. Yeligar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University and Emory+Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, GA 30322, USA
- Department of Medicine, Atlanta Veterans' Affairs and Emory University Medical Centers, Decatur, GA 30033, USA
| | - Lou Ann S. Brown
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University and Emory+Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, GA 30322, USA
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Cathcart MP, Love S, Hughes KJ. The application of exhaled breath gas and exhaled breath condensate analysis in the investigation of the lower respiratory tract in veterinary medicine: A review. Vet J 2011; 191:282-91. [PMID: 21908213 DOI: 10.1016/j.tvjl.2011.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 08/12/2011] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
Abstract
The analysis of biomarkers in exhaled breath (EB) and exhaled breath condensate (EBC) may allow non-invasive and repeatable assessment of respiratory health and disease in mammals. Compared to human medicine, however, research data from EB and EBC analysis in veterinary medicine are limited and more patient variables influencing concentrations of EB/EBC analytes may be present. In addition, variations in methodologies between studies may influence results. A comparison of the approaches used in veterinary research by different groups may aid in the identification of potentially reliable and repeatable biomarkers suitable for further investigation. To date, changes in acid-base status and increased concentrations of inflammatory mediators have been the main findings in studies of pulmonary disease states in animals. Whilst these biomarkers are unlikely to represent specific and sensitive diagnostic parameters, they do have potential application in monitoring disease progression and treatment response.
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Affiliation(s)
- M P Cathcart
- Weipers Centre for Equine Welfare, School of Veterinary Medicine, College of Medicine, Veterinary Medicine and Life Sciences, University of Glasgow, Bearsden Road, Glasgow G611QH, UK
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