Investigation of C3-C10 aldehydes in the exhaled breath of healthy subjects using selected ion flow tube-mass spectrometry (SIFT-MS)

Preservation of exhaled breath samples for analysis by off-line SESI-HRMS: proof-of-concept study

Secondary electrospray ionization-high resolution mass spectrometry (SESI-HRMS) is an established technique in the field of breath analysis characterized by its short analysis time, as well as high levels of sensitivity and selectivity. Traditionally, SESI-HRMS has been used for real-time breath analysis, which requires subjects to be at the location of the analytical platform. Therefore, it limits the possibilities for an introduction of this methodology in day-to-day clinical practice. However, recent methodological developments have shown feasibility on the remote sampling of exhaled breath in Nalophan® bags prior to measurement using SESI-HRMS. To further explore the range of applications of this method, we conducted a proof-of-concept study to assess the impact of the storage time of exhaled breath in Nalophan® bags at different temperatures (room temperature and dry ice) on the relative intensities of the compounds. In addition, we performed a detailed study of the storage effect of 27 aldehydes related to oxidative stress. After 2 h of storage, the mean of intensity of allm/zsignals relative to the samples analyzed without prior storage remained above 80% at both room temperature and dry ice. For the 27 aldehydes, the mean relative intensity losses were lower than 20% at 24 h of storage, remaining practically stable since the first hour of storage following sample collection. Furthermore, the mean relative intensity of most aldehydes in samples stored at room temperature was higher than those stored in dry ice, which could be related to water vapor condensation issues. These findings indicate that the exhaled breath samples could be preserved for hours with a low percentage of mean relative intensity loss, thereby allowing more flexibility in the logistics of off-line SESI-HRMS studies.

Exhaled VOC Biomarkers from Rats Injected with PMs from Thirty-One Major Cities in China

Particulate matter (PMs) of different origins can cause diverse health effects. Here, a homemade box was used to facilitate real-time measurements of breath-borne volatile organic compounds (VOCs) by gas chromatography-ion mobility spectrometry. We have tracked exhaled VOC changes in 228 Wistar rats that were injected with water-soluble PM suspension filtrates (after 0.45 μm) from 31 China cities for 1 h to up to 1-6 days during the experiments. Rats exposed to the filtrates exhibited significant changes in breath-borne VOCs within hours, featuring dynamic fluctuations in the levels of acetone, butan-2-one, heptan-2-one-M, acetic acid-M, and ethanol. Subsequently, on the fifth to sixth day after the injection, there was a notable increase in the proportion of aldehydes (including hexanal-M, hexanal-D, pentanal, heptanal-M, and (E)-2-hexenal). The 10 dynamic VOC fingerprint patterns mentioned earlier showcased the capability to indirectly differentiate urban PM toxicity and categorize the 31 cities into four distinct groups based on their health effects. This study provides valuable insights into the mechanisms of exhaled VOCs and underscores their critical role as biomarkers for differentiating the toxicity of different PMs and detecting the early signs of potential diseases. The results from this work also provide a scientific basis for city-specific air pollution control and policy development.

SARS CoV-2 infection screening via the exhaled breath fingerprint obtained by FTIR spectroscopic gas-phase analysis. A proof of concept

The COVID-19 pandemic remains a global challenge now with the long-COVID arising. Mitigation measures focused on case counting, assessment and determination of variants and their likely targets of infection and transmission, the pursuit of drug treatments, use and enhancement of masks, social distancing, vaccination, post-infection rehabilitation, and mass screening. The latter is of utmost importance given the current scenario of infections, reinfections, and long-term health effects. Research on screening platforms has been developed to provide more sensitive, specific, and reliable tests that are accessible to the entire population and can be used to assess the prognosis of the disease as well as the subsequent health follow-up of patients with sequelae of COVID-19. Therefore, the aim of the present study was the simulation of exhaled breath of COVID-19 patients by evaluation of three identified COVID-19 indicator breath biomarkers (acetone (ACE), acetaldehyde (ACH) and nitric oxide (NO)) by gas-phase infrared spectroscopy as a proof-of-concept principle for the detection of infected patients' exhaled breath fingerprint and subsequent follow-up. The specific fingerprints of each of the compounds and the overall fingerprint were obtained. The synthetic exhaled breath evaluation concept revealed a linearity of r = 0.99 for all compounds, and LODs of 6.42, 13.81, 9.22 ppm, and LOQs of 42.26, 52.57, 69.23 ppm for NO, ACE, and ACH, respectively. This study proves the fundamental feasibility of gas-phase infrared spectroscopy for fingerprinting lung damage biomarkers in exhaled breath of patients with COVID-19. This analysis would allow faster and cheaper screening and follow-up of infected individuals, which could improve mass screening in POC settings.

Direct mass spectrometry analysis of exhaled human breath in real-time

The molecular composition of exhaled human breath can reflect various physiological and pathological conditions. Considerable progress has been achieved over the past decade in real-time analysis of exhaled human breath using direct mass spectrometry methods, including selected ion flow tube mass spectrometry, proton transfer reaction mass spectrometry, extractive electrospray ionization mass spectrometry, secondary electrospray ionization mass spectrometry, acetone-assisted negative photoionization mass spectrometry, atmospheric pressure photoionization mass spectrometry, and low-pressure photoionization mass spectrometry. Here, recent developments in direct mass spectrometry analysis of exhaled human breath are reviewed with regard to analytical performance (chemical sensitivity, selectivity, quantitative capabilities) and applications of the developed methods in disease diagnosis, targeted molecular detection, and real-time metabolic monitoring.

Dynamic Breath Limonene Sensing at High Selectivity

Liver diseases (e.g., cirrhosis, cancer) cause more than two million deaths per year worldwide. This is partly attributed to late diagnosis and insufficient screening techniques. A promising biomarker for noninvasive and inexpensive liver disease screening is breath limonene that can indicate a deficiency of the cytochrome P450 liver enzymes. Here, we introduce a compact and low-cost detector for dynamic and selective breath limonene sensing. It comprises a chemoresistive sensor based on Si/WO₃ nanoparticles pre-screened by a packed bed Tenax separation column at room temperature. We demonstrate selective limonene detection down to 20 parts per billion over up to three orders of magnitude higher concentrated acetone, ethanol, hydrogen, methanol, and 2-propanol in gas mixtures, as well as robustness to 10-90% relative humidity. Most importantly, this detector recognizes the individual breath limonene dynamics of four healthy volunteers following the ingestion (swallowing or chewing) of a limonene capsule. Limonene release and subsequent metabolization are monitored from breath measurements in real time and in excellent agreement (R² = 0.98) with high-resolution proton transfer reaction mass spectrometry. This study demonstrates the potential of the detector as a simple-to-use and noninvasive device for the routine monitoring of limonene levels in exhaled breath to facilitate early diagnosis of liver dysfunction.

Development of an analytical chip for colorimetric detection of medium-chain aldehydes by reaction with pararosaniline in porous glass

Medium-chain aldehydes are common human biogases that can be detected in the breath of patients with lung diseases. As such, the measurement of medium-chain aldehyde gases in human breath can provide significant, noninvasive, and diagnostic information related to the potential presence of such diseases. In this study, an analytical chip is developed for the detection of medium-chain aldehydes without interference from short-chain aldehydes. This analytical chip is composed of porous glass impregnated with pararosaniline and an acid (i.e., acetic acid with small amount of phosphoric acid). After exposure to medium-chain aldehydes, the red analytical chip became violet in color, and an absorption peak was observed at 620 nm. It was found that a non-reversible reaction occurred in the porous glass, therefore, the analytical chip functions in a cumulative manner. A linear relationship was determined between the absorbance change of the analytical chip at 620 nm and the nonanal exposure concentration. Importantly, the developed analytical chip successfully detected nonanal at concentrations of 8-270 ppb as calculated from the absorbance change at 620 nm after a 24 h exposure time. In addition, nonanal concentration was estimated using the change in the R value of the analytical chip photograph. This method is suitable for point-of-care breath analysis. Finally, the analytical chip was also found to be active toward octanal and decanal with a relative sensitivity of 0.7 compared to that of nonanal; it was not active toward short-chain aldehydes.

Exhaled Aldehydes as Biomarkers for Lung Diseases: A Narrative Review

Breath analysis provides great potential as a fast and non-invasive diagnostic tool for several diseases. Straight-chain aliphatic aldehydes were repeatedly detected in the breath of patients suffering from lung diseases using a variety of methods, such as mass spectrometry, ion mobility spectrometry, or electro-chemical sensors. Several studies found increased concentrations of exhaled aldehydes in patients suffering from lung cancer, inflammatory and infectious lung diseases, and mechanical lung injury. This article reviews the origin of exhaled straight-chain aliphatic aldehydes, available detection methods, and studies that found increased aldehyde exhalation in lung diseases.

Quantification of Volatile Aldehydes Deriving from In Vitro Lipid Peroxidation in the Breath of Ventilated Patients

Exhaled aliphatic aldehydes were proposed as non-invasive biomarkers to detect increased lipid peroxidation in various diseases. As a prelude to clinical application of the multicapillary column–ion mobility spectrometry for the evaluation of aldehyde exhalation, we, therefore: (1) identified the most abundant volatile aliphatic aldehydes originating from in vitro oxidation of various polyunsaturated fatty acids; (2) evaluated emittance of aldehydes from plastic parts of the breathing circuit; (3) conducted a pilot study for in vivo quantification of exhaled aldehydes in mechanically ventilated patients. Pentanal, hexanal, heptanal, and nonanal were quantifiable in the headspace of oxidizing polyunsaturated fatty acids, with pentanal and hexanal predominating. Plastic parts of the breathing circuit emitted hexanal, octanal, nonanal, and decanal, whereby nonanal and decanal were ubiquitous and pentanal or heptanal not being detected. Only pentanal was quantifiable in breath of mechanically ventilated surgical patients with a mean exhaled concentration of 13 ± 5 ppb. An explorative analysis suggested that pentanal exhalation is associated with mechanical power—a measure for the invasiveness of mechanical ventilation. In conclusion, exhaled pentanal is a promising non-invasive biomarker for lipid peroxidation inducing pathologies, and should be evaluated in future clinical studies, particularly for detection of lung injury.

A literature survey of all volatiles from healthy human breath and bodily fluids: the human volatilome

This paper comprises an updated version of the 2014 review which reported 1846 volatile organic compounds (VOCs) identified from healthy humans. In total over 900 additional VOCs have been reported since the 2014 review and the VOCs from semen have been added. The numbers of VOCs found in breath and the other bodily fluids are: blood 379, breath 1488, faeces 443, milk 290, saliva 549, semen 196, skin 623 and urine 444. Compounds were assigned CAS registry numbers and named according to a common convention where possible. The compounds have been included in a single table with the source reference(s) for each VOC, an update on our 2014 paper. VOCs have also been grouped into tables according to their chemical class or functionality to permit easy comparison. Careful use of the database is needed, as a number of the identified VOCs only have level 2-putative assignment, and only a small fraction of the reported VOCs have been validated by standards. Some clear differences are observed, for instance, a lack of esters in urine with a high number in faeces and breath. However, the lack of compounds from matrices such a semen and milk compared to breath for example could be due to the techniques used or reflect the intensity of effort e.g. there are few publications on VOCs from milk and semen compared to a large number for breath. The large number of volatiles reported from skin is partly due to the methodologies used, e.g. by collecting skin sebum (with dissolved VOCs and semi VOCs) onto glass beads or cotton pads and then heating to a high temperature to desorb VOCs. All compounds have been included as reported (unless there was a clear discrepancy between name and chemical structure), but there may be some mistaken assignations arising from the original publications, particularly for isomers. It is the authors' intention that this work will not only be a useful database of VOCs listed in the literature but will stimulate further study of VOCs from healthy individuals; for example more work is required to confirm the identification of these VOCs adhering to the principles outlined in the metabolomics standards initiative. Establishing a list of volatiles emanating from healthy individuals and increased understanding of VOC metabolic pathways is an important step for differentiating between diseases using VOCs.

Rational Method of Monitoring Molecular Transformations on Metal-Oxide Nanowire Surfaces

Metal-oxide nanowires have demonstrated excellent capability in the electrical detection of various molecules based on their material robustness in liquid and air environments. Although the surface structure of the nanowires essentially determines their interaction with adsorbed molecules, understanding the correlation between an oxide nanowire surface and an adsorbed molecule is still a major challenge. Herein, we propose a rational methodology to obtain this information for low-density molecules adsorbed on metal oxide nanowire surfaces by employing infrared p-polarized multiple-angle incidence resolution spectroscopy and temperature-programmed desorption/gas chromatography-mass spectrometry. As a model system, we studied the surface chemical transformation of an aldehyde (nonanal, a cancer biomarker in breath) on single-crystalline ZnO nanowires. We found that a slight surface reconstruction, induced by the thermal pretreatment, determines the surface chemical reactivity of nonanal. The present results show that the observed surface reaction trend can be interpreted in terms of the density of Zn ions exposed on the nanowire surface and of their corresponding spatial arrangement on the surface, which promotes the reaction between neighboring adsorbed molecules. The proposed methodology will support a better understanding of complex molecular transformations on various nanostructured metal-oxide surfaces.

MEMS sensor array-based electronic nose for breath analysis-a simulation study

The paper presents a simulation study of breath analysis based on theoretical models of microelectromechanical structure (MEMS) cantilever sensor array. The purpose of this study is to suggest a methodology for the development of MEMS electronic nose (e-nose) for monitoring disease-specific volatiles in exhaled breath. Oxidative stress and diabetes are taken as case studies for the assessment of e-nose designs. The detection of ethane for general oxidative stress, isoprene for hypoxia, and acetone for diabetes are considered for targeted detection. A number of volatiles concurrently present in the exhaled breath are taken as interferents. The MEMS cantilevers are coated with volatile-selective polymers and are analyzed in both the static and dynamic modes. The sensor array is defined by polymer selections based on three data mining methods: principal component analysis (PCA), fuzzy c-means clustering (FCM), and fuzzy subtractive clustering (FSC). This utilizes vapor/polymer partition coefficients as a database. Analyses are carried out to find optimal combinations of the polymer selection method and cantilever sensing mode. Virtual breath analysis experiments are analyzed by PCA for target discrimination. It is found that no single combination works best in all conditions. The acetone (diabetes) detection is best in both sensing modes with the polymers selected by FSC; the isoprene (hypoxia) is detectable only in static sensing mode with polymers selected by FCM clustering; and the ethane (oxidative stress) detection is possible by all sensing modes and polymer selections, provided the breath samples are preconcentrated. This study suggests that it is difficult to realize a single general-purpose MEMS breath analyzer. The dedicated analyzers for specific disease indications can however be made with an optimal combination of sensing mode and polymer coatings.

Volatile compounds in blood headspace and nasal breath

Breath analysis is a form of metabolomics that utilises the identification and quantification of volatile chemicals to provide information about physiological or pathological processes occurring within the body. An inherent assumption of such analyses is that the concentration of the exhaled gases correlates with the concentration of the same gas in the tissue of interest. In this study we have investigated this assumption by quantifying some volatile compounds in peripheral venous blood headspace, and in nasal breath collected in Tedlar bags obtained at the same time from 30 healthy volunteers, prior to analysis by selected ion flow tube mass spectrometry. Some endogenous compounds were significantly correlated between blood headspace and nasal breath, such as isoprene (r _p = 0.63) and acetone (r _p = 0.68), however many, such as propanol (r _p = -0.26) and methanol (r _p = 0.23), were not. Furthermore, the relative concentrations of volatiles in blood and breath varied markedly between compounds, with some, such as isoprene and acetone, having similar concentrations in each, while others, such as acetic acid, ammonia and methanol, being significantly more abundant in breath, and others, such as methanal, being detectable only in breath. We also observed that breath propanol and acetic acid concentrations were higher in male compared to female participants, and that the blood headspace methanol concentration was negatively correlated to body mass index. No relationship between volatile concentrations and age was observed. Our data suggest that breath concentrations of volatiles do not necessarily give information about the same compound in the blood stream. This is likely due to the upper airway contributing compounds over and above that originating in the circulation. An investigation of the relationship between breath volatile concentrations and that in the tissue(s) of interest should therefore become a routine part of the development process of breath-based biomarkers.

Ion chemistry at elevated ion–molecule interaction energies in a selected ion flow-drift tube: reactions of H3O+, NO+ and O2+ with saturated aliphatic ketones

Rate coefficients and product ion branching ratios determined for proton transfer, association and charge transfer reactions provide insight into reaction mechanisms.

Markers of lipid oxidative damage in the exhaled breath condensate of nano TiO2 production workers

Nanoscale titanium dioxide (nanoTiO₂) is a commercially important nanomaterial. Animal studies have documented lung injury and inflammation, oxidative stress, cytotoxicity and genotoxicity. Yet, human health data are scarce and quantitative risk assessments and biomonitoring of exposure are lacking. NanoTiO₂ is classified by IARC as a group 2B, possible human carcinogen. In our earlier studies we documented an increase in markers of inflammation, as well as DNA and protein oxidative damage, in exhaled breath condensate (EBC) of workers exposed nanoTiO₂. This study focuses on biomarkers of lipid oxidation. Several established lipid oxidative markers (malondialdehyde, 4-hydroxy-trans-hexenal, 4-hydroxy-trans-nonenal, 8-isoProstaglandin F2α and aldehydes C₆-C₁₂) were studied in EBC and urine of 34 workers and 45 comparable controls. The median particle number concentration in the production line ranged from 1.98 × 10⁴ to 2.32 × 10⁴ particles/cm³ with ∼80% of the particles <100 nm in diameter. Mass concentration varied between 0.40 and 0.65 mg/m³. All 11 markers of lipid oxidation were elevated in production workers relative to the controls (p < 0.001). A significant dose-dependent association was found between exposure to TiO₂ and markers of lipid oxidation in the EBC. These markers were not elevated in the urine samples. Lipid oxidation in the EBC of workers exposed to (nano)TiO₂ complements our earlier findings on DNA and protein damage. These results are consistent with the oxidative stress hypothesis and suggest lung injury at the molecular level. Further studies should focus on clinical markers of potential disease progression. EBC has reemerged as a sensitive technique for noninvasive monitoring of workers exposed to engineered nanoparticles.

Status of selected ion flow tube MS: accomplishments and challenges in breath analysis and other areas

This article reflects our observations of recent accomplishments made using selected ion flow tube MS (SIFT-MS). Only brief descriptions are given of SIFT-MS as an analytical method and of the recent extensions to the underpinning analytical ion chemistry required to realize more robust analyses. The challenge of breath analysis is given special attention because, when achieved, it renders analysis of other air media relatively straightforward. Brief overviews are given of recent SIFT-MS breath analyses by leading research groups, noting the desirability of detection and quantification of single volatile biomarkers rather than reliance on statistical analyses, if breath analysis is to be accepted into clinical practice. A 'strengths, weaknesses, opportunities and threats' analysis of SIFT-MS is made, which should help to increase its utility for trace gas analysis.

SIFT-MS and FA-MS methods for ambient gas phase analysis: developments and applications in the UK

The origins of SIFT created to study interstellar chemistry and SIFT-MS developed for ambient gas and exhaled breath analysis and the UK centres in which these techniques are being exploited.