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Zaky ZA, Al-Dossari M, Hendy AS, Badawy WM, Aly AH. Periodic open and closed resonators as a biosensor using two computational methods. Sci Rep 2024; 14:11943. [PMID: 38789449 PMCID: PMC11126621 DOI: 10.1038/s41598-024-61987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
The volatile particles and molecules in our dry exhaled breath can reveal enormous information about the health of any person, such as the person's respiratory and metabolic functioning. Beyond the carbon dioxide level is an indicator of life, it provides important health-related data like people's metabolic rate. This study considers periodic open and closed resonators for measuring carbon dioxide concentration in dry exhaled breath. Transfer matrix and green methods are used to simulate the interaction between acoustic waves and the proposed sensor. The band gaps using the green method coincide with the transmittance spectra by the transfer matrix. The suggested sensor recorded a sensitivity of 5.3 H z . m - 1 . s , a figure of merit of 10,254m - 1 . s , a detection limit of 5 × 10 - 6 m . s - 1 , and a quality factor of 3 × 10 6 . Furthermore, the efficiency shows that the proposed design is appropriate as a diagnostic sensor for different diseases such as chronic obstructive pulmonary. Besides, cylindrical-adapted sensors are urgently needed in medicine, industry, and biology because they can simultaneously be used for fluid transport and detection.
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Affiliation(s)
- Zaky A Zaky
- TH-PPM Group, Physics Department, Faculty of Science, Beni-Suef University, Beni-Suef, 62521, Egypt.
| | - M Al-Dossari
- Department of Physics, Faculty of Science, King Khalid University, 62529, Abha, Saudi Arabia
| | - Ahmed S Hendy
- Department of Computational Mathematics and Computer Science, Institute of Natural Sciences and Mathematics, Ural Federal University, 19 Mira St., Yekaterinburg, Russia, 620002
| | - Wael M Badawy
- Frank Laboratory of Neutron Physics, Joint Institute for Nuclear Research, Dubna, Russian Federation, 141980
- Radiation Protection and Civil Defense Department, Nuclear Research Center, Egyptian Atomic Energy Authority, Cairo, 13759, Egypt
| | - Arafa H Aly
- TH-PPM Group, Physics Department, Faculty of Science, Beni-Suef University, Beni-Suef, 62521, Egypt
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2
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Chou H, Arthur K, Shaw E, Schaber C, Boyle B, Allsworth M, Kelley EF, Stewart GM, Wheatley CM, Schwartz J, Fermoyle CC, Ziegler BL, Johnson KA, Robach P, Basset P, Johnson BD. Metabolic insights at the finish line: deciphering physiological changes in ultramarathon runners through breath VOC analysis. J Breath Res 2024; 18:026008. [PMID: 38290132 DOI: 10.1088/1752-7163/ad23f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/30/2024] [Indexed: 02/01/2024]
Abstract
Exhaustive exercise can induce unique physiological responses in the lungs and other parts of the human body. The volatile organic compounds (VOCs) in exhaled breath are ideal for studying the effects of exhaustive exercise on the lungs due to the proximity of the breath matrix to the respiratory tract. As breath VOCs can originate from the bloodstream, changes in abundance should also indicate broader physiological effects of exhaustive exercise on the body. Currently, there is limited published data on the effects of exhaustive exercise on breath VOCs. Breath has great potential for biomarker analysis as it can be collected non-invasively, and capture real-time metabolic changes to better understand the effects of exhaustive exercise. In this study, we collected breath samples from a small group of elite runners participating in the 2019 Ultra-Trail du Mont Blanc ultra-marathon. The final analysis included matched paired samples collected before and after the race from 24 subjects. All 48 samples were analyzed using the Breath Biopsy Platform with GC-Orbitrap™ via thermal desorption gas chromatography-mass spectrometry. The Wilcoxon signed-rank test was used to determine whether VOC abundances differed between pre- and post-race breath samples (adjustedP-value < .05). We identified a total of 793 VOCs in the breath samples of elite runners. Of these, 63 showed significant differences between pre- and post-race samples after correction for multiple testing (12 decreased, 51 increased). The specific VOCs identified suggest the involvement of fatty acid oxidation, inflammation, and possible altered gut microbiome activity in response to exhaustive exercise. This study demonstrates significant changes in VOC abundance resulting from exhaustive exercise. Further investigation of VOC changes along with other physiological measurements can help improve our understanding of the effect of exhaustive exercise on the body and subsequent differences in VOCs in exhaled breath.
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Affiliation(s)
- Hsuan Chou
- Owlstone Medical, Cambridge, United Kingdom
| | | | - Elen Shaw
- Owlstone Medical, Cambridge, United Kingdom
| | | | | | | | - Eli F Kelley
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Courtney M Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Jesse Schwartz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Caitlin C Fermoyle
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- Utah Vascular Research Laboratory, Salt Lake City, UT, United States of America
| | - Briana L Ziegler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Kay A Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Paul Robach
- Ecole Nationale des Sports de Montagne, Chamonix, France
| | | | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
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3
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Katsaros G, Smith SA, Shacklette S, Trivedi J, Garr S, Parrish LW, Xie Z, Fu XA, Powell K, Pantalos G, van Berkel V. Identification of a marker of infection in the breath using a porcine pneumonia model. JTCVS OPEN 2023; 16:1063-1069. [PMID: 38204632 PMCID: PMC10775109 DOI: 10.1016/j.xjon.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/22/2023] [Accepted: 10/14/2023] [Indexed: 01/12/2024]
Abstract
Objective Pneumonia, both in the community and the hospital setting, represents a significant cause of morbidity and mortality in the cardiothoracic patient population. Diagnosis of pneumonia can be masked by other disease processes and is often diagnosed after the patient is already experiencing the disease. A noninvasive, sensitive test for pneumonia could decrease hospitalizations and length of stay for patients. We have developed a porcine model of pneumonia and evaluated the exhaled breath of infected pigs for biomarkers of infection. Methods Anesthetized 60-kg adult pigs were intubated, and a bronchoscope was used to instill a solution containing 12 × 108 cfu of methicillin-sensitive Staphylococcus aureus or a control solution without bacteria (Sham) into the distal airways. The pigs were then reintubated on postoperative days 3, 6, and 9, with bronchoscopic bronchial lavages taken at each time point. At each time point, a 500-mL breath was captured from each pig. The breath was evacuated over a silicon microchip, with the volatile carbonyl compounds from the breath captured via oximation reaction, and the results of this capture were analyzed by ultra-high performance liquid chromatography mass spectrometry. Results A total of 64% of the pigs inoculated with methicillin-sensitive S. aureus demonstrated consolidation on chest radiography and increasing counts of methicillin-sensitive S. aureus in the bronchial lavages over the span of the experiment, consistent with development of pneumonia. Analysis of the exhaled breath demonstrated 1 carbonyl compound (2-pentenal) that increased 10-fold over the span of the experiment, from an average of 0.0294 nmol/L before infection to an average of 0.3836 nmol/L on postoperative day 9. The amount of 2-pentenal present was greater in the breath of infected pigs than in the noninfected pigs or the sham inoculated pigs at postoperative days 6 and 9. Using an elevated concentration of 2-pentenal as a marker of infection yielded a sensitivity of 88% and specificity of 92% at postoperative day 6, and a sensitivity and specificity of 100% at postoperative day 9. Conclusions We were able to successfully develop a clinical pneumonia in adult 60-kg pigs. The concentration of 2-pentenal correlated with the presence of pneumonia, demonstrating the potential for this compound to function as a biomarker for methicillin-sensitive S. aureus infection in pigs.
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Affiliation(s)
- Gianna Katsaros
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Susan Ansley Smith
- Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Sienna Shacklette
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, Ky
| | - Jaimin Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Stephanie Garr
- Department of Medicine, University of Louisville School of Medicine, Louisville, Ky
| | - Leslie Wolf Parrish
- Department of Medicine, University of Louisville School of Medicine, Louisville, Ky
| | - Zhenzhen Xie
- Department of Chemical Engineering, University of Louisville Speed School of Engineering, Louisville, Ky
| | - Xiao-An Fu
- Department of Chemical Engineering, University of Louisville Speed School of Engineering, Louisville, Ky
| | - Karen Powell
- Comparative Medicine Research Unit, University of Louisville, Louisville, Ky
| | - George Pantalos
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Victor van Berkel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Ky
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4
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Cao H, Shi H, Tang J, Xu Y, Ling Y, Lu X, Yang Y, Zhang X, Wang H. Ultrasensitive discrimination of volatile organic compounds using a microfluidic silicon SERS artificial intelligence chip. iScience 2023; 26:107821. [PMID: 37731613 PMCID: PMC10507157 DOI: 10.1016/j.isci.2023.107821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/06/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
Current gaseous sensors hardly discriminate trace volatile organic compounds at the ppt level. Herein, we present an integrated platform for simultaneously enabling rapid preconcentration, reliable surface-enhanced Raman scattering, (SERS) detection and automatic identification of trace aldehydes at the ppt level. For rapid preconcentration, we demonstrate that the nozzle-like microfluidic concentrator allows the enrichment of rare gaseous analytes by five-fold in only 0.01 ms. The enriched gas is subsequently captured and detected by an integrated silicon-based SERS chip, which is made of zeolitic imidazolate framework-8 coated silver nanoparticles grown in situ on a silicon wafer. After SERS measurement, a fully connected deep neural network is built to extract faint features in the spectral dataset and discriminate volatile organic compound classes. We demonstrate that six kinds of gaseous aldehydes at 100 ppt could be detected and classified with an identification accuracy of ∼80.9% by using this platform.
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Affiliation(s)
- Haiting Cao
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
| | - Huayi Shi
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
| | - Jie Tang
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
| | - Yanan Xu
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
| | - Yufan Ling
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Xing Lu
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Xiaojie Zhang
- Department of Experimental Center, Medical College of Soochow University, Suzhou, Jiangsu 215123, China
| | - Houyu Wang
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
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5
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Ahmed WM, Fenn D, White IR, Dixon B, Nijsen TME, Knobel HH, Brinkman P, Van Oort PMP, Schultz MJ, Dark P, Goodacre R, Felton T, Bos LDJ, Fowler SJ. Microbial Volatiles as Diagnostic Biomarkers of Bacterial Lung Infection in Mechanically Ventilated Patients. Clin Infect Dis 2023; 76:1059-1066. [PMID: 36310531 PMCID: PMC10029988 DOI: 10.1093/cid/ciac859] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early and accurate recognition of respiratory pathogens is crucial to prevent increased risk of mortality in critically ill patients. Microbial-derived volatile organic compounds (mVOCs) in exhaled breath could be used as noninvasive biomarkers of infection to support clinical diagnosis. METHODS In this study, we investigated the diagnostic potential of in vitro-confirmed mVOCs in the exhaled breath of patients under mechanical ventilation from the BreathDx study. Samples were analyzed by thermal desorption-gas chromatography-mass spectrometry. RESULTS Pathogens from bronchoalveolar lavage (BAL) cultures were identified in 45 of 89 patients and Staphylococcus aureus was the most commonly identified pathogen (n = 15). Of 19 mVOCs detected in the in vitro culture headspace of 4 common respiratory pathogens (S. aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli), 14 were found in exhaled breath samples. Higher concentrations of 2 mVOCs were found in the exhaled breath of patients infected with S. aureus compared to those without (3-methylbutanal: P < .01, area under the receiver operating characteristic curve [AUROC] = 0.81-0.87; and 3-methylbutanoic acid: P = .01, AUROC = 0.79-0.80). In addition, bacteria identified from BAL cultures that are known to metabolize tryptophan (E. coli, Klebsiella oxytoca, and Haemophilus influenzae) were grouped and found to produce higher concentrations of indole compared to breath samples with culture-negative (P = .034) and other pathogen-positive (P = .049) samples. CONCLUSIONS This study demonstrates the capability of using mVOCs to detect the presence of specific pathogen groups with potential to support clinical diagnosis. Although not all mVOCs were found in patient samples within this small pilot study, further targeted and qualitative investigation is warranted using multicenter clinical studies.
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Affiliation(s)
- Waqar M Ahmed
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Dominic Fenn
- Department of Respiratory Medicine, Amsterdam UMC-location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Center (UMC), Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Iain R White
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
- Laboratory for Environmental and Life Science, University of Nova Gorica, Nova Gorica, Slovenia
| | - Breanna Dixon
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | | | - Hugo H Knobel
- Eurofins Materials Science Netherlands BV, High Tech Campus, Eindhoven, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC-location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pouline M P Van Oort
- Department of Anaesthesiology, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Clinical Affairs, Hamilton Medical AG, Chur, Switzerland
| | - Paul Dark
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
- Critical Care Unit, Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Group, Manchester, United Kingdom
| | - Royston Goodacre
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Timothy Felton
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Lieuwe D J Bos
- Department of Respiratory Medicine, Amsterdam UMC-location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Center (UMC), Academic Medical Center (AMC), Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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6
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Fenn D, Lilien TA, Hagens LA, Smit MR, Heijnen NF, Tuip-de Boer AM, Neerincx AH, Golebski K, Bergmans DC, Schnabel RM, Schultz MJ, Maitland-van der Zee AH, Brinkman P, Bos LD. Validation of volatile metabolites of pulmonary oxidative injury: a bench to bedside study. ERJ Open Res 2023; 9:00427-2022. [PMID: 36949963 PMCID: PMC10026006 DOI: 10.1183/23120541.00427-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background Changes in exhaled volatile organic compounds (VOCs) can be used to discriminate between respiratory diseases, and increased concentrations of hydrocarbons are commonly linked to oxidative stress. However, the VOCs identified are inconsistent between studies, and translational studies are lacking. Methods In this bench to bedside study, we captured VOCs in the headspace of A549 epithelial cells after exposure to hydrogen peroxide (H2O2), to induce oxidative stress, using high-capacity polydimethylsiloxane sorbent fibres. Exposed and unexposed cells were compared using targeted and untargeted analysis. Breath samples of invasively ventilated intensive care unit patients (n=489) were collected on sorbent tubes and associated with the inspiratory oxygen fraction (F IO2 ) to reflect pulmonary oxidative stress. Headspace samples and breath samples were analysed using gas chromatography and mass spectrometry. Results In the cell, headspace octane concentration was decreased after oxidative stress (p=0.0013), while the other VOCs were not affected. 2-ethyl-1-hexanol showed an increased concentration in the headspace of cells undergoing oxidative stress in untargeted analysis (p=0.00014). None of the VOCs that were linked to oxidative stress showed a significant correlation with F IO2 (Rs range: -0.015 to -0.065) or discriminated between patients with F IO2 ≥0.6 or below (area under the curve range: 0.48 to 0.55). Conclusion Despite a comprehensive translational approach, validation of known and novel volatile biomarkers of oxidative stress was not possible in patients at risk of pulmonary oxidative injury. The inconsistencies observed highlight the difficulties faced in VOC biomarker validation, and that caution is warranted in the interpretation of the pathophysiological origin of discovered exhaled breath biomarkers.
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Affiliation(s)
- Dominic Fenn
- Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam, Netherlands
- Corresponding author: Dominic Fenn ()
| | - Thijs A. Lilien
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Paediatric Intensive Care, Amsterdam, Netherlands
| | - Laura A. Hagens
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Amsterdam, Netherlands
| | - Marry R. Smit
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Amsterdam, Netherlands
| | - Nanon F.L. Heijnen
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Anita M. Tuip-de Boer
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam, Netherlands
| | - Anne H. Neerincx
- Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, Netherlands
| | - Korneliusz Golebski
- Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Experimental Immunology, Amsterdam, Netherlands
| | - Dennis C.J.J. Bergmans
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Ronny M. Schnabel
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marcus J. Schultz
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Amsterdam, Netherlands
| | | | - Paul Brinkman
- Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, Netherlands
| | - Lieuwe D.J. Bos
- Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Amsterdam, Netherlands
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7
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Póvoa P, Bos LDJ, Coelho L. The role of proteomics and metabolomics in severe infections. Curr Opin Crit Care 2022; 28:534-539. [PMID: 35942690 DOI: 10.1097/mcc.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Severe infections are a common cause of ICU admission, with a high morbidity and mortality. Omics, namely proteomics and metabolomics, aim to identify, characterize, and quantify biological molecules to achieve a systems-level understanding of disease. The aim of this review is to provide a clear overview of the current evidence of the role of proteomics and metabolomics in severe infections. RECENT FINDINGS Proteomics and metabolomics are technologies that are being used to explore new markers of diagnosis and prognosis, clarify mechanisms of disease, and consequently discover potential targets of therapy and finally of a better disease phenotyping. These technologies are starting to be used but not yet in clinical use. SUMMARY Our traditional way of approaching the disease as sepsis is believing that a process can be broken into its parts and that the whole can be explained by the sum of each part. This approach is highly reductionist and does not take the system complexity nor the nonlinear dynamics of the processes. Proteomics and metabolomics allow the analysis of several proteins and metabolites simultaneously, thereby generating diagnostic and prognostic signatures. An exciting future prospect for proteomics and metabolomics is their employment towards precision medicine.
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Affiliation(s)
- Pedro Póvoa
- NOVA Medical School, CHRC, New University of Lisbon
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Lieuwe D J Bos
- Intensive Care, Infection and Immunity
- Department of Respiratory Medicine, Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Luís Coelho
- NOVA Medical School, CHRC, New University of Lisbon
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
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8
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Riccò M, Zaniboni A, Satta E, Ranzieri S, Marchesi F. Potential Use of Exhaled Breath Condensate for Diagnosis of SARS-CoV-2 Infections: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092245. [PMID: 36140647 PMCID: PMC9497929 DOI: 10.3390/diagnostics12092245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Reverse-transcriptase polymerase chain reaction (RT-qPCR) assays performed on respiratory samples collected through nasal swabs still represent the gold standard for COVID-19 diagnosis. Alternative methods to this invasive and time-consuming options are still being inquired, including the collection of airways lining fluids through exhaled breath condensate (EBC). Materials and Methods. We performed a systematic review and meta-analysis in order to explore the reliability of EBC as a way to collect respiratory specimens for RT-qPCR for diagnosis of COVID-19. Results. A total of 4 studies (205 specimens), were ultimately collected, with a pooled sensitivity of 69.5% (95%CI 26.8–93.4), and a pooled specificity of 98.3% (95%CI 87.8–99.8), associated with high heterogeneity and scarce diagnostic agreement with the gold standard represented by nasal swabs (Cohen’s kappa = 0.585). Discussion. Even though non-invasive options for diagnosis of COVID-19 are still necessary, EBC-based RT-qPCR showed scarce diagnostic performances, ultimately impairing its implementation in real-world settings. However, as few studies have been carried out to date, and the studies included in the present review are characterized by low numbers and low sample power, further research are requested to fully characterize the actual reliability of EBC-based RT-qPCR in the diagnosis of COVID-19.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Via Amendola n.2, I-42122 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-339-2994-343
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
| | - Elia Satta
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
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9
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Hidayat SN, Julian T, Dharmawan AB, Puspita M, Chandra L, Rohman A, Julia M, Rianjanu A, Nurputra DK, Triyana K, Wasisto HS. Hybrid learning method based on feature clustering and scoring for enhanced COVID-19 breath analysis by an electronic nose. Artif Intell Med 2022; 129:102323. [PMID: 35659391 PMCID: PMC9110307 DOI: 10.1016/j.artmed.2022.102323] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 01/31/2023]
Abstract
Breath pattern analysis based on an electronic nose (e-nose), which is a noninvasive, fast, and low-cost method, has been continuously used for detecting human diseases, including the coronavirus disease 2019 (COVID-19). Nevertheless, having big data with several available features is not always beneficial because only a few of them will be relevant and useful to distinguish different breath samples (i.e., positive and negative COVID-19 samples). In this study, we develop a hybrid machine learning-based algorithm combining hierarchical agglomerative clustering analysis and permutation feature importance method to improve the data analysis of a portable e-nose for COVID-19 detection (GeNose C19). Utilizing this learning approach, we can obtain an effective and optimum feature combination, enabling the reduction by half of the number of employed sensors without downgrading the classification model performance. Based on the cross-validation test results on the training data, the hybrid algorithm can result in accuracy, sensitivity, and specificity values of (86 ± 3)%, (88 ± 6)%, and (84 ± 6)%, respectively. Meanwhile, for the testing data, a value of 87% is obtained for all the three metrics. These results exhibit the feasibility of using this hybrid filter-wrapper feature-selection method to pave the way for optimizing the GeNose C19 performance.
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Affiliation(s)
- Shidiq Nur Hidayat
- PT Nanosense Instrument Indonesia, Umbulharjo, Yogyakarta 55167, Indonesia,Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Sekip Utara, BLS 21, Yogyakarta 55281, Indonesia
| | - Trisna Julian
- PT Nanosense Instrument Indonesia, Umbulharjo, Yogyakarta 55167, Indonesia
| | - Agus Budi Dharmawan
- PT Nanosense Instrument Indonesia, Umbulharjo, Yogyakarta 55167, Indonesia,Faculty of Information Technology, Universitas Tarumanagara, Jl. Letjen S. Parman No. 1, Jakarta 11440, Indonesia
| | - Mayumi Puspita
- PT Nanosense Instrument Indonesia, Umbulharjo, Yogyakarta 55167, Indonesia
| | - Lily Chandra
- RS Bhayangkara Polda Daerah Istimewa Yogyakarta, Jl. Raya Solo-Yogyakarta KM. 14, Sleman 55571, Indonesia
| | - Abdul Rohman
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta 55281, Indonesia
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta 55281, Indonesia
| | - Aditya Rianjanu
- Department of Materials Engineering, Institut Teknologi Sumatera, Terusan Ryacudu, Way Hui, Jati Agung, Lampung 35365, Indonesia
| | - Dian Kesumapramudya Nurputra
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta 55281, Indonesia
| | - Kuwat Triyana
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Sekip Utara, BLS 21, Yogyakarta 55281, Indonesia,Corresponding author
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10
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pyAIR-A New Software Tool for Breathomics Applications-Searching for Markers in TD-GC-HRMS Analysis. Molecules 2022; 27:molecules27072063. [PMID: 35408461 PMCID: PMC9000534 DOI: 10.3390/molecules27072063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Volatile metabolites in exhaled air have promising potential as diagnostic biomarkers. However, the combination of low mass, similar chemical composition, and low concentrations introduces the challenge of sorting the data to identify markers of value. In this paper, we report the development of pyAIR, a software tool for searching for volatile organic compounds (VOCs) markers in multi-group datasets, tailored for Thermal-Desorption Gas-Chromatography High Resolution Mass-Spectrometry (TD-GC-HRMS) output. pyAIR aligns the compounds between samples by spectral similarity coupled with retention times (RT), and statistically compares the groups for compounds that differ by intensity. This workflow was successfully tested and evaluated on gaseous samples spiked with 27 model VOCs at six concentrations, divided into three groups, down to 0.3 nL/L. All analytes were correctly detected and aligned. More than 80% were found to be significant markers with a p-value < 0.05; several were classified as possibly significant markers (p-value < 0.1), while a few were removed due to background level. In all group comparisons, low rates of false markers were found. These results showed the potential of pyAIR in the field of trace-level breathomics, with the capability to differentially examine several groups, such as stages of illness.
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11
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Burillo A, Bouza E. Faster infection diagnostics for intensive care unit (ICU) patients. Expert Rev Mol Diagn 2022; 22:347-360. [PMID: 35152813 DOI: 10.1080/14737159.2022.2037422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : The patient admitted to intensive care units (ICU) is critically ill, to some extent immunosuppressed, with a high risk of infection, sometimes by multidrug-resistant microorganisms. In this context, the intensivist expects from the microbiology service quick and understandable information so that appropriate antimicrobial treatment for that particular patient and infection can be initiated. AREAS COVERED : In this review of recent literature (2015-2021), we identified diagnostic methods for the most prevalent infections in these patients through a search of the databases Pubmed, evidence-based medicine online, York University reviewers group, Cochrane, MBE-Trip, and Sumsearch using the terms: adult, clinical laboratory techniques, critical care, early diagnosis, microbiology, molecular diagnostic techniques, spectrometry and metagenomics. EXPERT OPINION : There has been an exponential surge in diagnostic systems used directly on blood and other samples to expedite microbial identification and antimicrobial susceptibility testing of pathogens. Few studies have thus far assessed their clinical impact; final outcomes will also depend on preanalytical and post-analytical factors. Besides, many of the resistance mechanisms cannot yet be detected with molecular techniques, which impairs the prediction of the actual resistance phenotype. Nonetheless, this is an exciting field with much yet to explore.
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Affiliation(s)
- Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, Ciudad Universitaria, 28040 Madrid, Spain.,Gregorio Marañón Health Research Institute, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, Ciudad Universitaria, 28040 Madrid, Spain.,Gregorio Marañón Health Research Institute, Doctor Esquerdo 46, 28007, Madrid, Spain.,CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Av. Monforte de Lemos 3-5, Pabellón 11, Planta, 28029 Madrid, Spain
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12
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Rolland-Debord C, D'Haenens A, Mendiluce L, Spurr L, Konda S, Cherneva R, Lhuillier E, Heunks L, Patout M. ERS International Congress 2020 Virtual: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2021; 7:00214-2021. [PMID: 34790814 PMCID: PMC8591268 DOI: 10.1183/23120541.00214-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022] Open
Abstract
During the virtual European Respiratory Society Congress 2020, early career members summarised the sessions organised by the Respiratory Intensive Care Assembly. The topics covered included diagnostic strategies in patients admitted to the intensive care unit with acute respiratory failure, with a focus on patients with interstitial lung disease and for obvious reasons, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These sessions are summarised in this article, with take-home messages highlighted. Updates from #ERSCongress 2020 on diagnostic strategies in patients admitted to the ICU with acute respiratory failure and on the management of #SARSCoV2 infectionhttps://bit.ly/38cx0Pi
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Affiliation(s)
- Camille Rolland-Debord
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service des Explorations Fonctionnelles de la Respiration de l'Exercice et de la Dyspnée, Hôpital Tenon, Paris, France
| | | | - Leire Mendiluce
- Ventilation Unit and Respiratory Semi-Critical Care Unit, Dept of Respiratory Medicine, University Hospital Germans Trias i Pujol, Universitat de Barcelona, Barcelona, Spain
| | - Lydia Spurr
- Academic and Clinical Dept of Sleep and Breathing, Royal Brompton and Harefield Hospitals, London, UK
| | - Shruthi Konda
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Radostina Cherneva
- Medical University, Sofia, Dept of Respiratory Diseases, University Hospital 'St Sophia', Sofia, Bulgaria
| | - Elodie Lhuillier
- Unité de recherche clinique, Centre Henri Becquerel, Rouen, France
| | - Leo Heunks
- Dept of Intensive Care, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service des Pathologies du Sommeil (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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13
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Li ZT, Zeng PY, Chen ZM, Guan WJ, Wang T, Lin Y, Li SQ, Zhang ZJ, Zhan YQ, Wang MD, Tan GB, Li X, Ye F. Exhaled Volatile Organic Compounds for Identifying Patients With Chronic Pulmonary Aspergillosis. Front Med (Lausanne) 2021; 8:720119. [PMID: 34631744 PMCID: PMC8495266 DOI: 10.3389/fmed.2021.720119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Diagnosing chronic pulmonary aspergillosis is a major challenge in clinical practice. The development and validation of a novel, sensitive and specific assay for diagnosing chronic pulmonary aspergillosis is urgently needed. Methods: From April 2018 to June 2019, 53 patients with chronic pulmonary aspergillosis (CPA), 32 patients with community-acquired pneumonia (CAP) and 48 healthy controls were recruited from the First Affiliated Hospital of Guangzhou Medical University. Clinical characteristics and samples were collected at enrollment. All exhaled breath samples were analyzed offline using thermal desorption single-photon ionization time-of-flight mass spectrometry; to analyze the metabolic pathways of the characteristic volatile organic compounds, serum samples were subjected to ultrahigh-performance liquid chromatography. Results: We identified characteristic volatile organic compounds in patients with chronic pulmonary aspergillosis, which mainly consisted of phenol, neopentyl alcohol, toluene, limonene and ethylbenzene. These compounds were assessed using a logistic regression model. The sensitivity and specificity were 95.8 and 96.9% for discriminating patients in the CPA group from those in the CAP group and 95.8 and 97.9% for discriminating patients in the CPA group from healthy controls, respectively. The concentration of limonene (m/z 136) correlated significantly positively with anti-Aspergillus fumigatus IgG antibody titers (r = 0.420, P < 0.01). After antifungal treatment, serum IgG and the concentration of limonene (m/z 136) decreased in the subgroup of patients with chronic pulmonary aspergillosis. Conclusions: We identified VOCs that can be used as biomarkers for differential diagnosis and therapeutic response prediction in patients with chronic pulmonary aspergillosis.
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Affiliation(s)
- Zheng-Tu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pei-Ying Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhao-Ming Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tong Wang
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China
| | - Ye Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shao-Qiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Juan Zhang
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China.,College of Pharmacy, Hena University of Chinese Medicine, Zhengzhou, China
| | - Yang-Qing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming-Die Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Bin Tan
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China.,Guangzhou Hexin Instrument Co., Ltd., Guangzhou, China
| | - Xue Li
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou, China.,Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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14
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Póvoa P, Coelho L. Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis? Semin Respir Crit Care Med 2021; 42:662-671. [PMID: 34544183 DOI: 10.1055/s-0041-1735148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community and in hospital, and probably the main drive for antibiotic resistance. Biomarkers have been studied and used in several clinical settings as surrogate markers of infection to improve their diagnostic accuracy as well as in the assessment of response to antibiotics and in antibiotic stewardship programs. The aim of this review is to provide a clear overview of the current evidence of usefulness of biomarkers in several clinical scenarios, namely, to diagnose infection to prescribe antibiotics, to exclude infection to withhold antibiotics, and to identify the causative pathogen to target antimicrobial treatment. In recent years, new evidence with "old" biomarkers, like C-reactive protein and procalcitonin, as well as new biomarkers and molecular tests, as breathomics or bacterial DNA identification by polymerase chain reaction, increased markedly in different areas adding useful information for clinical decision making at the bedside when adequately used. The recent evidence shows that the information given by biomarkers can support the suspicion of infection and pathogen identification but also, and not less important, can exclude its diagnosis. Although the ideal biomarker has not yet been found, there are various promising biomarkers that represent true evolutions in the diagnosis of infection in patients with suspected sepsis.
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Affiliation(s)
- Pedro Póvoa
- Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.,Nova Medical School, Clinical Medicine, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Luis Coelho
- Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.,Nova Medical School, Clinical Medicine, CHRC, New University of Lisbon, Lisbon, Portugal
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15
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Pulido H, Stanczyk NM, De Moraes CM, Mescher MC. A unique volatile signature distinguishes malaria infection from other conditions that cause similar symptoms. Sci Rep 2021; 11:13928. [PMID: 34230505 PMCID: PMC8260776 DOI: 10.1038/s41598-021-92962-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/06/2021] [Indexed: 01/18/2023] Open
Abstract
Recent findings suggest that changes in human odors caused by malaria infection have significant potential as diagnostic biomarkers. However, uncertainty remains regarding the specificity of such biomarkers, particularly in populations where many different pathological conditions may elicit similar symptoms. We explored the ability of volatile biomarkers to predict malaria infection status in Kenyan schoolchildren exhibiting a range of malaria-like symptoms. Using genetic algorithm models to explore data from skin volatile collections, we were able to identify malaria infection with 100% accuracy among children with fever and 75% accuracy among children with other symptoms. While we observed characteristic changes in volatile patterns driven by symptomatology, our models also identified malaria-specific biomarkers with robust predictive capability even in the presence of other pathogens that elicit similar symptoms.
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Affiliation(s)
- Hannier Pulido
- Department of Environmental Systems Science, ETH Zürich, 8092, Zürich, Switzerland
| | - Nina M Stanczyk
- Department of Environmental Systems Science, ETH Zürich, 8092, Zürich, Switzerland
| | - Consuelo M De Moraes
- Department of Environmental Systems Science, ETH Zürich, 8092, Zürich, Switzerland
| | - Mark C Mescher
- Department of Environmental Systems Science, ETH Zürich, 8092, Zürich, Switzerland.
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16
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Determination of nitric oxide using light-emitting diode-based colorimeter with tubular porous polypropylene membrane cuvette. Anal Bioanal Chem 2021; 413:5301-5307. [PMID: 34212212 DOI: 10.1007/s00216-021-03503-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022]
Abstract
On the basis of the Griess-Saltzman (GS) reaction, an optical device for nitric oxide (NO) detection in exhaled breath and atmosphere was developed by employing the light-emitting diode (LED, 560 nm) as the light source, light-to-voltage converter (LVC) as the detector, and porous polypropylene membrane tube (PPMT) as the cuvette. The PPMT was filled with GS reagents and covered with a coaxial jacket tube for gas collection and color reaction; two ends of the PPMT were connected with the LED and LVC to detect the change of light transmissivity in the wavelength range of 530 to 590 nm mainly. A gas absorber filled with GS reagents was installed prior to another absorber filled with KMnO4 solution to eliminate the interference of coexisting NO2. Under the optimized experimental conditions, the device achieved a limit of detection (3σ/k) of 4.4 ppbv for NO detection. The linearity range of this device was divided into two segments, i.e., 25 to 100 ppbv and 50 to 1000 ppbv, with both coefficients of determination > 0.99. The relative standard deviation was 2.7% (n = 9, c = 100 ppbv), and the analytical time was 5.5 min per detection. The minimum detectable quantity was decreased to 1.18 ng, which was ~ 100 times lower than the original GS method (115 ng). The present device was applied for determination of NO in exhaled breath, vehicle exhaust, and air. In addition to satisfactory spiking recoveries (i.e., 103% and 107%), the analytical results of the present device were in agreement with the results obtained by the standard method. These results assured the practicality of the developed device for NO detection in real environmental samples.
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17
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Millet P, Martin T, Opiekun M, Beauchamp GK, Kimball BA. Differing Alterations of Odor Volatiles Among Pathogenic Stimuli. Chem Senses 2021; 46:6300881. [PMID: 34133735 DOI: 10.1093/chemse/bjab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Alterations of the volatile metabolome (the collection of volatiles present in secretions and other emanations) that occur in response to inflammation can be detected by conspecifics and chemometric analyses. Using a model system where mouse urinary metabolites are altered by treatment with lipopolysaccharide (found in the outer cell membrane of gram-negative bacteria), we hypothesized that alteration of body odor volatiles will vary according to the pathogen responsible for inducing the inflammation. We tested this hypothesis by treating mice with different immunogens that engage different immune signaling pathways. Results suggest that alterations of body odor volatiles resulting from inflammation do contain detailed information about the type of pathogen that instigated the inflammation and these differences are not merely dependent on the severity of the inflammatory event. These results are encouraging for the future of differential medical diagnosis of febrile diseases by analysis of the volatile metabolome. In particular, our data support the possibility that bacterial infections can be differentiated from viral infections such that antibiotic drug stewardship could be drastically improved by reducing unneeded treatments with antibiotics.
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Affiliation(s)
- Patrick Millet
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA, USA
| | - Talia Martin
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA, USA
| | - Maryanne Opiekun
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA, USA
| | - Gary K Beauchamp
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA, USA
| | - Bruce A Kimball
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA, USA
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18
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van Oort PM, Nijsen TM, White IR, Knobel HH, Felton T, Rattray N, Lawal O, Bulut M, Ahmed W, Artigas A, Povoa PR, Martin-Loeches I, Weda H, Goodacre R, Schultz MJ, Dark PM, Fowler SJ, Bos LD. Untargeted Molecular Analysis of Exhaled Breath as a Diagnostic Test for Ventilator-Associated Lower Respiratory Tract Infections (BreathDx). Thorax 2021; 77:79-81. [PMID: 34088787 PMCID: PMC8685633 DOI: 10.1136/thoraxjnl-2021-217362] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
Patients suspected of ventilator-associated lower respiratory tract infections (VA-LRTIs) commonly receive broad-spectrum antimicrobial therapy unnecessarily. We tested whether exhaled breath analysis can discriminate between patients suspected of VA-LRTI with confirmed infection, from patients with negative cultures. Breath from 108 patients suspected of VA-LRTI was analysed by gas chromatography-mass spectrometry. The breath test had a sensitivity of 98% at a specificity of 49%, confirmed with a second analytical method. The breath test had a negative predictive value of 96% and excluded pneumonia in half of the patients with negative cultures. Trial registration number: UKCRN ID number 19086, registered May 2015.
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Affiliation(s)
| | | | - Iain R White
- Laboratory for Environmental and Life Sciences, University of Nova Gorica, Nova Gorica, Slovenia.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Hugo H Knobel
- Materials Analysis, Eurofins Materials Science Netherlands BV, Eindhoven, The Netherlands
| | - Timothy Felton
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | | | - Oluwasola Lawal
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | | | - Waqar Ahmed
- Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Antonio Artigas
- Critical Care Centre, Corporació Sanitària I Universitaria Parc Taulí-Hospital De Sabadell-Ciber Enfermedades Respiratorias, Sabadell, Barcelona, Spain
| | - Pedro R Povoa
- Intensive Care, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | | | | | - Royston Goodacre
- Department of Biochemistry, University of Liverpool, Liverpool, UK
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Paul M Dark
- Intensive care, University of Manchester, Manchester, UK
| | - Stephen J Fowler
- Manchester University NHS Foundation Trust - Wythenshawe Hospital, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, NIHR's Manchester Biomedical Research Centre (BRC), the University of Manchester, Manchester, UK
| | - Lieuwe D Bos
- Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands .,Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
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19
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Ibrahim W, Carr L, Cordell R, Wilde MJ, Salman D, Monks PS, Thomas P, Brightling CE, Siddiqui S, Greening NJ. Breathomics for the clinician: the use of volatile organic compounds in respiratory diseases. Thorax 2021; 76:514-521. [PMID: 33414240 PMCID: PMC7611078 DOI: 10.1136/thoraxjnl-2020-215667] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 01/17/2023]
Abstract
Exhaled breath analysis has the potential to provide valuable insight on the status of various metabolic pathways taking place in the lungs locally and other vital organs, via systemic circulation. For years, volatile organic compounds (VOCs) have been proposed as feasible alternative diagnostic and prognostic biomarkers for different respiratory pathologies.We reviewed the currently published literature on the discovery of exhaled breath VOCs and their utilisation in various respiratory diseasesKey barriers in the development of clinical breath tests include the lack of unified consensus for breath collection and analysis and the complexity of understanding the relationship between the exhaled VOCs and the underlying metabolic pathways. We present a comprehensive overview, in light of published literature and our experience from coordinating a national breathomics centre, of the progress made to date and some of the key challenges in the field and ways to overcome them. We particularly focus on the relevance of breathomics to clinicians and the valuable insights it adds to diagnostics and disease monitoring.Breathomics holds great promise and our findings merit further large-scale multicentre diagnostic studies using standardised protocols to help position this novel technology at the centre of respiratory disease diagnostics.
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Affiliation(s)
- Wadah Ibrahim
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Liesl Carr
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | | | | | - Dahlia Salman
- Department of Chemistry, Loughborough University, Loughborough, UK
| | - Paul S Monks
- School of Chemistry, University of Leicester, Leicester, UK
| | - Paul Thomas
- Department of Chemistry, Loughborough University, Loughborough, UK
| | - Chris E Brightling
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Salman Siddiqui
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Neil J Greening
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
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20
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Kunze-Szikszay N, Euler M, Kuhns M, Thieß M, Groß U, Quintel M, Perl T. Headspace analyses using multi-capillary column-ion mobility spectrometry allow rapid pathogen differentiation in hospital-acquired pneumonia relevant bacteria. BMC Microbiol 2021; 21:69. [PMID: 33641676 PMCID: PMC7916313 DOI: 10.1186/s12866-021-02102-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is a common problem in intensive care medicine and the patient outcome depends on the fast beginning of adequate antibiotic therapy. Until today pathogen identification is performed using conventional microbiological methods with turnaround times of at least 24 h for the first results. It was the aim of this study to investigate the potential of headspace analyses detecting bacterial species-specific patterns of volatile organic compounds (VOCs) for the rapid differentiation of HAP-relevant bacteria. Methods Eleven HAP-relevant bacteria (Acinetobacter baumanii, Acinetobacter pittii, Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Serratia marcescens) were each grown for 6 hours in Lysogeny Broth and the headspace over the grown cultures was investigated using multi-capillary column-ion mobility spectrometry (MCC-IMS) to detect differences in the VOC composition between the bacteria in the panel. Peak areas with changing signal intensities were statistically analysed, including significance testing using one-way ANOVA or Kruskal-Wallis test (p < 0.05). Results 30 VOC signals (23 in the positive ion mode and 7 in the negative ion mode of the MCC-IMS) showed statistically significant differences in at least one of the investigated bacteria. The VOC patterns of the bacteria within the HAP panel differed substantially and allowed species differentiation. Conclusions MCC-IMS headspace analyses allow differentiation of bacteria within HAP-relevant panel after 6 h of incubation in a complex fluid growth medium. The method has the potential to be developed towards a feasible point-of-care diagnostic tool for pathogen differentiation on HAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02102-8.
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Affiliation(s)
- Nils Kunze-Szikszay
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Maximilian Euler
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Martin Kuhns
- Institute for Medical Microbiology, University of Göttingen, Kreuzbergring 57, 37075, Göttingen, Germany
| | - Melanie Thieß
- Institute of Plant Science and Microbiology, Molecular Plant Genetics, University of Hamburg, Ohnhornstraße 18, 22609, Hamburg, Germany
| | - Uwe Groß
- Institute for Medical Microbiology, University of Göttingen, Kreuzbergring 57, 37075, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Thorsten Perl
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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21
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Abstract
PURPOSE OF REVIEW Pneumonia is the main global cause of sepsis, and has been associated with high morbidity and high short and long-term mortality rates. As it may be caused by a wide spectrum of microorganisms, microbial diagnosis is challenging and the choice of adequate therapy remains an important problem. This review focuses on recently published studies of microbiological diagnostic tests and clinical assessments for pneumonia, including community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. RECENT FINDINGS Over the past decade, the microbiological diagnosis of pneumonia has improved significantly - thanks to the development and implementation of molecular diagnostic tests for identifying the most frequent pathogens causing pneumonia and for determining their patterns of resistance. Molecular methods for the diagnosis of pneumonia focus on multiple target detection systems and pathogen detection arrays, and, more recently, have been used in combination with mass spectrometry. SUMMARY The implementation of rapid diagnostic techniques in routine clinical practice able to identify and determine the resistance patterns of the causative microbes may transform the management of pneumonia, improving the selection and administration of antimicrobial therapies especially in critically ill patients. The validation of new diagnostic technology platforms is crucial in order to assess their usefulness and to guide antimicrobial treatment in this population.
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22
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van Oort PMP, White IR, Ahmed W, Johnson C, Bannard-Smith J, Felton T, Bos LD, Goodacre R, Dark P, Fowler SJ. Detection and quantification of exhaled volatile organic compounds in mechanically ventilated patients - comparison of two sampling methods. Analyst 2021; 146:222-231. [PMID: 33103170 DOI: 10.1039/c9an01134j] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Exhaled breath analysis is a promising new diagnostic tool, but currently no standardised method for sampling is available in mechanically ventilated patients. We compared two breath sampling methods, first using an artificial ventilator circuit, then in "real life" in mechanically ventilated patients on the intensive care unit. In the laboratory circuit, a 24-component synthetic-breath volatile organic compound (VOC) mixture was injected into the system as air was sampled: (A) through a port on the exhalation limb of the circuit and (B) through a closed endo-bronchial suction catheter. Sorbent tubes were used to collect samples for analysis by thermal desorption-gas chromatography-mass spectrometry. Realistic mechanical ventilation rates and breath pressure-volume loops were established and method detection limits (MDLs) were calculated for all VOCs. Higher yields of VOCs were retrieved using the closed suction catheter; however, for several VOCs MDLs were compromised due to the background signal associated with plastic and rubber components in the catheters. Different brands of suction catheter were compared. Exhaled VOC data from 40 patient samples collected at two sites were then used to calculate the proportion of data analysed above the MDL. The relative performance of the two methods differed depending on the VOC under study and both methods showed sensitivity towards different exhaled VOCs. Furthermore, method performance differed depending on recruitment site, as the centres were equipped with different brands of respiratory equipment, an important consideration for the design of multicentre studies investigating exhaled VOCs in mechanically ventilated patients.
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Affiliation(s)
- Pouline M P van Oort
- Department of Intensive Care, Amsterdam UMC - location Academic Medical Centre (AMC), Amsterdam, the Netherlands
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23
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Lammers A, van Bragt J, Brinkman P, Neerincx A, Bos L, Vijverberg S, Maitland-van der Zee A. Breathomics in Chronic Airway Diseases. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11589-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Abstract
Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients. Diagnosing pulmonary infection in ARDS patients is challenging, and requires a combination of clinical, biological and microbiological criteria. The role of modern tools (e.g., molecular methods, metagenomic sequencing, etc.) remains to be evaluated in this setting. One of the challenges of antimicrobial treatment is antibiotics diffusion into the lungs. Although targeted delivery of antibiotics using nebulization may be interesting, their place in ARDS patients remains to be explored. The use of extracorporeal membrane oxygenation in the most severe patients is associated with a high rate of infection and raises several challenges, diagnostic issues and pharmacokinetics/pharmacodynamics changes being at the top. Prevention of pulmonary infection is a key issue in ARDS patients, but there is no specific measure for these high-risk patients. Reinforcing preventive measures using bundles seems to be the best option.
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25
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Pass HI, Alimi M, Carbone M, Yang H, Goparaju CM. Mesothelioma Biomarkers: Discovery in Search of Validation. Thorac Surg Clin 2020; 30:395-423. [PMID: 33012429 DOI: 10.1016/j.thorsurg.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an asbestos-related neoplasm that can only be treated successfully when correctly diagnosed and treated early. The asbestos-exposed population is a high-risk group that could benefit from sensitive and specific blood- or tissue-based biomarkers. We review recent work with biomarker development in MPM and literature of the last 20 years on the most promising blood- and tissue-based biomarkers. Proteomic, genomic, and epigenomic platforms are covered. SMRP is the only validated blood-based biomarker with diagnostic, monitoring and prognostic value. To strengthen development and testing of MPM biomarkers, cohorts for validation must be established by enlisting worldwide collaborations.
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Affiliation(s)
- Harvey I Pass
- Research, Department of Cardiothoracic Surgery, General Thoracic Surgery, NYU Langone Medical Center, 530 First Avenue, 9V, New York, NY 10016, USA.
| | - Marjan Alimi
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 First Avenue, 9V, New York, NY 10016, USA
| | - Michele Carbone
- Department of Thoracic Oncology, John A. Burns School of Medicine, University of Hawaii Cancer Center, 701 Ilalo Street, Room 437, Honolulu, HI 96813, USA
| | - Haining Yang
- Department of Thoracic Oncology, John A. Burns School of Medicine, University of Hawaii Cancer Center, 701 Ilalo Street, Room 437, Honolulu, HI 96813, USA
| | - Chandra M Goparaju
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 First Avenue, 9V, New York, NY 10016, USA
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26
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Chan LW, Anahtar MN, Ong TH, Hern KE, Kunz RR, Bhatia SN. Engineering synthetic breath biomarkers for respiratory disease. NATURE NANOTECHNOLOGY 2020; 15:792-800. [PMID: 32690884 PMCID: PMC8173716 DOI: 10.1038/s41565-020-0723-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 06/02/2020] [Indexed: 05/10/2023]
Abstract
Human breath contains many volatile metabolites. However, few breath tests are currently used in the clinic to monitor disease due to bottlenecks in biomarker identification. Here we engineered breath biomarkers for respiratory disease by local delivery of protease-sensing nanoparticles to the lungs. The nanosensors shed volatile reporters upon cleavage by neutrophil elastase, an inflammation-associated protease with elevated activity in lung diseases such as bacterial infection and alpha-1 antitrypsin deficiency. After intrapulmonary delivery into mouse models with acute lung inflammation, the volatile reporters are released and expelled in breath at levels detectable by mass spectrometry. These breath signals can identify diseased mice with high sensitivity as early as 10 min after nanosensor administration. Using these nanosensors, we performed serial breath tests to monitor dynamic changes in neutrophil elastase activity during lung infection and to assess the efficacy of a protease inhibitor therapy targeting neutrophil elastase for the treatment of alpha-1 antitrypsin deficiency.
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Affiliation(s)
- Leslie W Chan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Melodi N Anahtar
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ta-Hsuan Ong
- Biological and Chemical Technologies Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, USA
| | - Kelsey E Hern
- Harvard-MIT Division of Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Roderick R Kunz
- Biological and Chemical Technologies Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, USA
| | - Sangeeta N Bhatia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Harvard-MIT Division of Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Broad Institute, Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
- Howard Hughes Medical Institute, Cambridge, MA, USA.
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Walker HJ, Burrell MM. Could breath analysis by MS could be a solution to rapid, non-invasive testing for COVID-19? Bioanalysis 2020; 12:1213-1217. [PMID: 32734782 PMCID: PMC7466950 DOI: 10.4155/bio-2020-0125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/11/2020] [Indexed: 01/13/2023] Open
Affiliation(s)
- Heather J Walker
- biOMICS Facility, Department of Animal & Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK
| | - Michael M Burrell
- biOMICS Facility, Department of Animal & Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK
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28
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Dospinescu VM, Tiele A, Covington JA. Sniffing Out Urinary Tract Infection-Diagnosis Based on Volatile Organic Compounds and Smell Profile. BIOSENSORS 2020; 10:E83. [PMID: 32717983 PMCID: PMC7460005 DOI: 10.3390/bios10080083] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 02/08/2023]
Abstract
Current available methods for the clinical diagnosis of urinary tract infection (UTI) rely on a urine dipstick test or culturing of pathogens. The dipstick test is rapid (available in 1-2 min), but has a low positive predictive value, while culturing is time-consuming and delays diagnosis (24-72 h between sample collection and pathogen identification). Due to this delay, broad-spectrum antibiotics are often prescribed immediately. The over-prescription of antibiotics should be limited, in order to prevent the development of antimicrobial resistance. As a result, there is a growing need for alternative diagnostic tools. This paper reviews applications of chemical-analysis instruments, such as gas chromatography-mass spectrometry (GC-MS), selected ion flow tube mass spectrometry (SIFT-MS), ion mobility spectrometry (IMS), field asymmetric ion mobility spectrometry (FAIMS) and electronic noses (eNoses) used for the diagnosis of UTI. These methods analyse volatile organic compounds (VOCs) that emanate from the headspace of collected urine samples to identify the bacterial pathogen and even determine the causative agent's resistance to different antibiotics. There is great potential for these technologies to gain wide-spread and routine use in clinical settings, since the analysis can be automated, and test results can be available within minutes after sample collection. This could significantly reduce the necessity to prescribe broad-spectrum antibiotics and allow the faster and more effective use of narrow-spectrum antibiotics.
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Affiliation(s)
| | - Akira Tiele
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK;
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29
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Pass HI, Alimi M, Carbone M, Yang H, Goparaju CM. Mesothelioma Biomarkers: A Review Highlighting Contributions from the Early Detection Research Network. Cancer Epidemiol Biomarkers Prev 2020; 29:2524-2540. [PMID: 32699075 DOI: 10.1158/1055-9965.epi-20-0083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/22/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an asbestos-related neoplasm, which can be treated successfully only if correctly diagnosed and treated in early stages. The asbestos-exposed population serves as a high-risk group that could benefit from sensitive and specific blood- or tissue-based biomarkers. This review details the recent work with biomarker development in MPM and the contributions of the NCI Early Detection Research Network Biomarker Developmental Laboratory of NYU Langone Medical Center. The literature of the last 20 years was reviewed to comment on the most promising of the blood- and tissue-based biomarkers. Proteomic, genomic, and epigenomic platforms as well as novel studies such as "breath testing" are covered. Soluble mesothelin-related proteins (SMRP) have been characterized extensively and constitute an FDA-approved biomarker in plasma with diagnostic, monitoring, and prognostic value in MPM. Osteopontin is found to be a valuable prognostic biomarker for MPM, while its utility in diagnosis is slightly lower. Other biomarkers, such as calretinin, fibulin 3, and High-Mobility Group Box 1 (HMGB1), remain under study and need international validation trials with large cohorts of cases and controls to demonstrate any utility. The EDRN has played a key role in the development and testing of MPM biomarkers by enlisting collaborations all over the world. A comprehensive understanding of previously investigated biomarkers and their utility in screening and early diagnosis of MPM will provide guidance for further future research.See all articles in this CEBP Focus section, "NCI Early Detection Research Network: Making Cancer Detection Possible."
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Affiliation(s)
- Harvey I Pass
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York.
| | - Marjan Alimi
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York
| | - Michele Carbone
- John A. Burns School of Medicine, Department of Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Haining Yang
- John A. Burns School of Medicine, Department of Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Chandra M Goparaju
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York
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30
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Harshman SW, Pitsch RL, Davidson CN, Lee EM, Scott AM, Hill EM, Mainali P, Brooks ZE, Strayer KE, Schaeublin NM, Wiens TL, Brothers MC, Drummond LA, Yamamoto DP, Martin JA. Evaluation of a standardized collection device for exhaled breath sampling onto thermal desorption tubes. J Breath Res 2020; 14:036004. [PMID: 32155613 DOI: 10.1088/1752-7163/ab7e3b] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Respiration Collector for In Vitro Analysis (ReCIVA) sampler, marketed by Owlstone Medical, provides a step forward in exhaled breath sampling through active sampling directly onto thermal desorption (TD) tubes. Although an improvement to the issues surrounding breath bag sampling, the ReCIVA device, first released in 2015, is a relatively new research and clinical tool that requires further exploration. Here, data are presented comparing two distinct ReCIVA devices. The results, comparing ReCIVA serial numbers #33 and #65, demonstrate that overall statistically insignificant results are obtained via targeted isoprene quantitation (p > 0.05). However, when the data are parsed by the TD tube type used to capture breath volatiles, either Tenax TA or the dual bed Tenax/Carbograph 5TD (5TD), a statistical difference (p < 0.05) among the two different TD tubes was present. These data, comparing the two ReCIVA devices with both Tenax TA and 5TD tubes, are further supported by a global metabolomics analysis yielding 85% of z-scores, comparing ReCIVA devices, below the limit for significance. Experiments to determine the effect of breathing rate on ReCIVA function, using guided breathing for low (7.5 breaths min-1) and high (15 breaths min-1) breathing rates, demonstrate the ReCIVA device shows no statistical difference among breathing rates for quantitated isoprene (p > 0.05). Global metabolomics analysis of the guided breathing rate data shows more than 87% of the z-scores, comparing high and low breathing rates using both the Tenax and the 5TD tubes, are below the level for significance. Finally, data are provided from a single participant who displayed background levels of isoprene while illustrating levels of acetone consistent with the remaining participants. Collectively, these data support the use of multiple ReCIVA devices for exhaled breath collection and provide evidence for an instance where exhaled isoprene is consistent with background levels.
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Affiliation(s)
- Sean W Harshman
- UES Inc., Air Force Research Laboratory, 711th Human Performance Wing/RHBB, 2510 Fifth Street, Area B, Building 840, Wright-Patterson Air Force Base, OH 45433, United States of America. Author to whom any correspondence should be addressed
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Gomez JL, Himes BE, Kaminski N. Molecular Diagnostics in Pulmonary Infections. PRECISION IN PULMONARY, CRITICAL CARE, AND SLEEP MEDICINE 2020. [PMCID: PMC7121992 DOI: 10.1007/978-3-030-31507-8_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Infection of the lung parenchyma, or pneumonia, accounts for over four million deaths per year worldwide (Ferkol and Schraufnagel, Ann Am Thorac Soc 11:404–406, 2014). The condition is common, but also over-diagnosed, in part due to relatively poor laboratory and radiographic diagnostics. Indeed, we continue to rely on antiquated tools such as sputum culture and chest X-ray – the former of which lacks speed and sensitivity, and the latter specificity (Albaum et al. Chest 110:343–50, 1996). The resulting presumptive diagnoses of pneumonia lead to excessive use of empiric broad spectrum antibiotics; indeed, by some estimates, 30–70% of antibiotic prescriptions for lower respiratory tract infection are inappropriate (Kraus, PLoS One 12(3): e0174584, 2017). This approach begets microbial resistance, exposes patients to medication side effects, and puts patients at risk of potentially life-threatening complications including Clostridium difficile colitis. To improve diagnostic certainty in patients with suspected pneumonia, we must begin to consider and implement emerging technologies for efficient and accurate characterization of host responses to infection and identification of pathogens. In this chapter, we will discuss precision diagnostics already in common practice and those poised to be, and how these tools may ultimately enable personalization in the diagnosis of pneumonia.
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Affiliation(s)
- Jose L. Gomez
- Assistant Professor Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Blanca E. Himes
- Assistant Professor of Informatics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA USA
| | - Naftali Kaminski
- Boehringer-Ingelheim Endowed, Professor of Internal Medicine, Chief of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT USA
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Abstract
One of the most logical applications of modern breath analysis techniques is to provide information on respiratory infections. Ongoing work in various types of pulmonary infections has begun to denote candidate breath biomarkers of bacterial, viral, and fungal lung infections. Groundbreaking studies have been performed in naturally occurring cases with humans and with animal models of the disease. This has been coupled with cell culture work to understand the nature of the origins of breath biomarkers generated from the pathogen itself as it proliferates. Much work remains to be done, and the published studies described in this chapter are helping to set a foundation for this research area.
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Volatile scents of influenza A and S. pyogenes (co-)infected cells. Sci Rep 2019; 9:18894. [PMID: 31827195 PMCID: PMC6906285 DOI: 10.1038/s41598-019-55334-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
Influenza A is a serious pathogen itself, but often leads to dangerous co-infections in combination with bacterial species such as Streptococcus pyogenes. In comparison to classical biochemical methods, analysis of volatile organic compounds (VOCs) in headspace above cultures can enable destruction free monitoring of metabolic processes in vitro. Thus, volatile biomarkers emitted from biological cell cultures and pathogens could serve for monitoring of infection processes in vitro. In this study we analysed VOCs from headspace above (co)-infected human cells by using a customized sampling system. For investigating the influenza A mono-infection and the viral-bacterial co-infection in vitro, we analysed VOCs from Detroit cells inoculated with influenza A virus and S. pyogenes by means of needle-trap micro-extraction (NTME) and gas chromatography mass spectrometry (GC-MS). Besides the determination of microbiological data such as cell count, cytokines, virus load and bacterial load, emissions from cell medium, uninfected cells and bacteria mono-infected cells were analysed. Significant differences in emitted VOC concentrations were identified between non-infected and infected cells. After inoculation with S. pyogenes, bacterial infection was mirrored by increased emissions of acetaldehyde and propanal. N-propyl acetate was linked to viral infection. Non-destructive monitoring of infections by means of VOC analysis may open a new window for infection research and clinical applications. VOC analysis could enable early recognition of pathogen presence and in-depth understanding of their etiopathology.
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Zhou Q, Wang Q, Chen B, Han Y, Cheng L, Shen Y, Hao P, Zhang Z. Factors influencing breath analysis results in patients with diabetes mellitus. J Breath Res 2019; 13:046012. [PMID: 31489846 DOI: 10.1088/1752-7163/ab285a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breath analysis is used to detect the composition of exhaled gas. As a quick and non-invasive detection method, breath analysis provides deep insights into the progression of various kinds of diseases, especially those with metabolism disorders. Abundant information on volatile compounds in diabetic patients has been studied in numerous articles in the literature. However, exhaled gas in diabetic patients can be altered by various complications. So far, little attention has been paid to this alteration. In our paper, we found that under air pollution conditions, diabetic patients exhale more nitric oxide. Diabetic patients with heart failure exhale more acetone than those without heart failure. After 13C-labeled glucose intake, patients infected with Helicobacter pylori exhaled more 13C and less 18O than those without infection. Exhalation with chronic kidney disease changes volatile organic compounds on a large scale. Diabetic patients with ketoacidosis exhale more acetone than those without ketoacidosis. Some specific volatile organic compounds also emanate from diabetic feet. By monitoring breath frequency, diabetic patients with obstructive sleep apnea syndrome exhibit a unique breath pattern and rhythm as compared with other diabetic patients, and sleep apnea is prevalent among diabetic patients. In addition to clinical findings, we analyzed the underlying mechanisms at the levels of molecules, cells and whole bodies, and provided suggestions for further studies.
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Affiliation(s)
- Qing Zhou
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Department of Cardiology, Shandong University Qilu Hospital, and School of Medicine of Shandong University, Jinan, 250012, Shandong, People's Republic of China
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Bruderer T, Gaisl T, Gaugg MT, Nowak N, Streckenbach B, Müller S, Moeller A, Kohler M, Zenobi R. On-Line Analysis of Exhaled Breath Focus Review. Chem Rev 2019; 119:10803-10828. [PMID: 31594311 DOI: 10.1021/acs.chemrev.9b00005] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
On-line analysis of exhaled breath offers insight into a person's metabolism without the need for sample preparation or sample collection. Due to its noninvasive nature and the possibility to sample continuously, the analysis of breath has great clinical potential. The unique features of this technology make it an attractive candidate for applications in medicine, beyond the task of diagnosis. We review the current methodologies for on-line breath analysis, discuss current and future applications, and critically evaluate challenges and pitfalls such as the need for standardization. Special emphasis is given to the use of the technology in diagnosing respiratory diseases, potential niche applications, and the promise of breath analysis for personalized medicine. The analytical methodologies used range from very small and low-cost chemical sensors, which are ideal for continuous monitoring of disease status, to optical spectroscopy and state-of-the-art, high-resolution mass spectrometry. The latter can be utilized for untargeted analysis of exhaled breath, with the capability to identify hitherto unknown molecules. The interpretation of the resulting big data sets is complex and often constrained due to a limited number of participants. Even larger data sets will be needed for assessing reproducibility and for validation of biomarker candidates. In addition, molecular structures and quantification of compounds are generally not easily available from on-line measurements and require complementary measurements, for example, a separation method coupled to mass spectrometry. Furthermore, a lack of standardization still hampers the application of the technique to screen larger cohorts of patients. This review summarizes the present status and continuous improvements of the principal on-line breath analysis methods and evaluates obstacles for their wider application.
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Affiliation(s)
- Tobias Bruderer
- Department of Chemistry and Applied Biosciences , Swiss Federal Institute of Technology , CH-8093 Zurich , Switzerland.,Division of Respiratory Medicine , University Children's Hospital Zurich and Children's Research Center Zurich , CH-8032 Zurich , Switzerland
| | - Thomas Gaisl
- Department of Pulmonology , University Hospital Zurich , CH-8091 Zurich , Switzerland.,Zurich Center for Interdisciplinary Sleep Research , University of Zurich , CH-8091 Zurich , Switzerland
| | - Martin T Gaugg
- Department of Chemistry and Applied Biosciences , Swiss Federal Institute of Technology , CH-8093 Zurich , Switzerland
| | - Nora Nowak
- Department of Chemistry and Applied Biosciences , Swiss Federal Institute of Technology , CH-8093 Zurich , Switzerland
| | - Bettina Streckenbach
- Department of Chemistry and Applied Biosciences , Swiss Federal Institute of Technology , CH-8093 Zurich , Switzerland
| | - Simona Müller
- Department of Chemistry and Applied Biosciences , Swiss Federal Institute of Technology , CH-8093 Zurich , Switzerland
| | - Alexander Moeller
- Division of Respiratory Medicine , University Children's Hospital Zurich and Children's Research Center Zurich , CH-8032 Zurich , Switzerland
| | - Malcolm Kohler
- Department of Pulmonology , University Hospital Zurich , CH-8091 Zurich , Switzerland.,Center for Integrative Human Physiology , University of Zurich , CH-8091 Zurich , Switzerland.,Zurich Center for Interdisciplinary Sleep Research , University of Zurich , CH-8091 Zurich , Switzerland
| | - Renato Zenobi
- Department of Chemistry and Applied Biosciences , Swiss Federal Institute of Technology , CH-8093 Zurich , Switzerland
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Terrington DL, Hayton C, Peel A, Fowler SJ, Fraser W, Wilson AM. The role of measuring exhaled breath biomarkers in sarcoidosis: a systematic review. J Breath Res 2019; 13:036015. [DOI: 10.1088/1752-7163/ab1284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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van Oort PM, Brinkman P, Slingers G, Koppen G, Maas A, Roelofs JJ, Schnabel R, Bergmans DC, Raes M, Goodacre R, Fowler SJ, Schultz MJ, Bos LD. Exhaled breath metabolomics reveals a pathogen-specific response in a rat pneumonia model for two human pathogenic bacteria: a proof-of-concept study. Am J Physiol Lung Cell Mol Physiol 2019; 316:L751-L756. [DOI: 10.1152/ajplung.00449.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Volatile organic compounds in breath can reflect host and pathogen metabolism and might be used to diagnose pneumonia. We hypothesized that rats with Streptococcus pneumoniae ( SP) or Pseudomonas aeruginosa ( PA) pneumonia can be discriminated from uninfected controls by thermal desorption-gas chromatography-mass-spectrometry (TD-GC-MS) and selected ion flow tube-mass spectrometry (SIFT-MS) of exhaled breath. Male adult rats ( n = 50) received an intratracheal inoculation of 1) 200 µl saline, or 2) 1 × 107 colony-forming units of SP or 3) 1 × 107 CFU of PA. Twenty-four hours later the rats were anaesthetized, tracheotomized, and mechanically ventilated. Exhaled breath was analyzed via TD-GC-MS and SIFT-MS. Area under the receiver operating characteristic curves (AUROCCs) and correct classification rate (CCRs) were calculated after leave-one-out cross-validation of sparse partial least squares-discriminant analysis. Analysis of GC-MS data showed an AUROCC (95% confidence interval) of 0.85 (0.73–0.96) and CCR of 94.6% for infected versus noninfected animals, AUROCC of 0.98 (0.94–1) and CCR of 99.9% for SP versus PA, 0.92 (0.83–1.00), CCR of 98.1% for SP versus controls and 0.97 (0.92–1.00), and CCR of 99.9% for PA versus controls. For these comparisons the SIFT-MS data showed AUROCCs of 0.54, 0.89, 0.63, and 0.79, respectively. Exhaled breath analysis discriminated between respiratory infection and no infection but with even better accuracy between specific pathogens. Future clinical studies should not only focus on the presence of respiratory infection but also on the discrimination between specific pathogens.
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Affiliation(s)
- Pouline M. van Oort
- Department of Intensive Care, Amsterdam University Medical Center–Academic Medical Centre, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Intensive Care, Amsterdam University Medical Center–Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Gudrun Koppen
- Flemish Institute for Technological Research, Mol, Belgium
| | - Adrie Maas
- Department of Intensive Care, Amsterdam University Medical Center–Academic Medical Centre, Amsterdam, The Netherlands
| | - Joris J. Roelofs
- Department of Intensive Care, Amsterdam University Medical Center–Academic Medical Centre, Amsterdam, The Netherlands
| | - Ronny Schnabel
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - M. Raes
- Hasselt University, Hasselt, Belgium
| | - Royston Goodacre
- Manchester Institute of Biotechnology, Manchester, United Kingdom
| | | | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Center–Academic Medical Centre, Amsterdam, The Netherlands
| | - Lieuwe D. Bos
- Department of Intensive Care, Amsterdam University Medical Center–Academic Medical Centre, Amsterdam, The Netherlands
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Detecting Early Markers of Ventilator-Associated Pneumonia by Analysis of Exhaled Gas. Crit Care Med 2019; 47:e234-e240. [DOI: 10.1097/ccm.0000000000003573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Pesesse R, Stefanuto PH, Schleich F, Louis R, Focant JF. Multimodal chemometric approach for the analysis of human exhaled breath in lung cancer patients by TD-GC × GC-TOFMS. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1114-1115:146-153. [PMID: 30745111 DOI: 10.1016/j.jchromb.2019.01.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/18/2018] [Accepted: 01/17/2019] [Indexed: 12/21/2022]
Abstract
Lung cancer is the deadliest cancer in developed countries. To reduce its mortality rate, it is important to enhance our capability to detect it at earlier stages by developing early diagnostic methods. In that context, the analysis of exhaled breath is an interesting approach because of the simplicity of the medical act and its non-invasiveness. Thermal desorption comprehensive two-dimensional gas chromatography time of flight mass spectrometry (TD-GC × GC-TOFMS) has been used to characterize and compare the volatile content of human breath of lung cancer patients and healthy volunteers. On the sampling side, the contaminations induced by the bags membrane and further environmental migration of VOCs during and after the sampling have also been investigated. Over a realistic period of 6 h, the concentration of contaminants inside the bag can increase from 2 to 3 folds based on simulated breath samples. On the data processing side, Fisher ratio (FR) and random forest (RF) approaches were applied and compared in regards to their ability to reduce the data dimensionality and to extract the significant information. Both approaches allow to efficiently smooth the background signal and extract significant features (27 for FR and 17 for RF). Principal component analysis (PCA) was used to evaluate the clustering capacity of the different models. For both approaches, a separation along PC-1 was obtained with a variance score around 35%. The combined model provides a partial separation with a PC-1 score of 52%. This proof-of-concept study further confirms the potential of breath analysis for cancer detection but also underlines the importance of quality control over the full analytical procedure, including the processing of the data.
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Affiliation(s)
- R Pesesse
- Organic and Biological Analytical Chemistry Group, MolSys Research Unit, University of Liège, B6c, Agora District, 4000 Liège, Belgium
| | - P-H Stefanuto
- Organic and Biological Analytical Chemistry Group, MolSys Research Unit, University of Liège, B6c, Agora District, 4000 Liège, Belgium
| | - F Schleich
- Pneumology and Allergology, GIGA Research Group, CHU of Liège, University of Liege, B35, Hospital District, Liege, Belgium
| | - R Louis
- Pneumology and Allergology, GIGA Research Group, CHU of Liège, University of Liege, B35, Hospital District, Liege, Belgium
| | - J-F Focant
- Organic and Biological Analytical Chemistry Group, MolSys Research Unit, University of Liège, B6c, Agora District, 4000 Liège, Belgium.
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Hayton C, Terrington D, Wilson AM, Chaudhuri N, Leonard C, Fowler SJ. Breath biomarkers in idiopathic pulmonary fibrosis: a systematic review. Respir Res 2019; 20:7. [PMID: 30634961 PMCID: PMC6329167 DOI: 10.1186/s12931-019-0971-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/01/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Exhaled biomarkers may be related to disease processes in idiopathic pulmonary fibrosis (IPF) however their clinical role remains unclear. We performed a systematic review to investigate whether breath biomarkers discriminate between patients with IPF and healthy controls. We also assessed correlation with lung function, ability to distinguish diagnostic subgroups and change in response to treatment. METHODS MEDLINE, EMBASE and Web of Science databases were searched. Study selection was limited to adults with a diagnosis of IPF as per international guidelines. RESULTS Of 1014 studies screened, fourteen fulfilled selection criteria and included 257 IPF patients. Twenty individual biomarkers discriminated between IPF and controls and four showed correlation with lung function. Meta-analysis of three studies indicated mean (± SD) alveolar nitric oxide (CalvNO) levels were significantly higher in IPF (8.5 ± 5.5 ppb) than controls (4.4 ± 2.2 ppb). Markers of oxidative stress in exhaled breath condensate, such as hydrogen peroxide and 8-isoprostane, were also discriminatory. Two breathomic studies have isolated discriminative compounds using mass spectrometry. There was a lack of studies assessing relevant treatment and none assessed differences in diagnostic subgroups. CONCLUSIONS Evidence suggests CalvNO is higher in IPF, although studies were limited by small sample size. Further breathomic work may identify biomarkers with diagnostic and prognostic potential.
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Affiliation(s)
- Conal Hayton
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK.
| | | | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nazia Chaudhuri
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Colm Leonard
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Traxler S, Bischoff AC, Saß R, Trefz P, Gierschner P, Brock B, Schwaiger T, Karte C, Blohm U, Schröder C, Miekisch W, Schubert JK. VOC breath profile in spontaneously breathing awake swine during Influenza A infection. Sci Rep 2018; 8:14857. [PMID: 30291257 PMCID: PMC6173698 DOI: 10.1038/s41598-018-33061-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/21/2018] [Indexed: 12/23/2022] Open
Abstract
Influenza is one of the most common causes of virus diseases worldwide. Virus detection requires determination of Influenza RNA in the upper respiratory tract. Efficient screening is not possible in this way. Analysis of volatile organic compounds (VOCs) in breath holds promise for non-invasive and fast monitoring of disease progression. Breath VOC profiles of 14 (3 controls and 11 infected animals) swine were repeatedly analyzed during a complete infection cycle of Influenza A under high safety conditions. Breath VOCs were pre-concentrated by means of needle trap micro-extraction and analysed by gas chromatography mass spectrometry before infection, during virus presence in the nasal cavity, and after recovery. Six VOCs could be related to disease progression: acetaldehyde, propanal, n-propyl acetate, methyl methacrylate, styrene and 1,1-dipropoxypropane. As early as on day four after inoculation, when animals were tested positive for Influenza A, differentiation between control and infected animals was possible. VOC based information on virus infection could enable early detection of Influenza A. As VOC analysis is completely non-invasive it has potential for large scale screening purposes. In a perspective, breath analysis may offer a novel tool for Influenza monitoring in human medicine, animal health control or border protection.
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Affiliation(s)
- Selina Traxler
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
| | - Ann-Christin Bischoff
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
| | - Radost Saß
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
| | - Phillip Trefz
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
| | - Peter Gierschner
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
| | - Beate Brock
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
| | - Theresa Schwaiger
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institute, Südufer 10, 17493, Greifswald- Insel Riems, Germany
| | - Claudia Karte
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institute, Südufer 10, 17493, Greifswald-Insel Riems, Germany
| | - Ulrike Blohm
- Institute of Immunology, Friedrich-Loeffler-Institute, Südufer 10, 17493, Greifswald-Insel Riems, Germany
| | - Charlotte Schröder
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institute, Südufer 10, 17493, Greifswald- Insel Riems, Germany
| | - Wolfram Miekisch
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany.
| | - Jochen K Schubert
- Department of Anaesthesiology and Intensive Care, Rostock University Medical Center, ROMBAT, Schillingallee 35, 18057, Rostock, Germany
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Brusselmans L, Arnouts L, Millevert C, Vandersnickt J, van Meerbeeck JP, Lamote K. Breath analysis as a diagnostic and screening tool for malignant pleural mesothelioma: a systematic review. Transl Lung Cancer Res 2018; 7:520-536. [PMID: 30450290 PMCID: PMC6204411 DOI: 10.21037/tlcr.2018.04.09] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a tumour related to a historical exposure to asbestos fibres. Currently, the definite diagnosis is made only by the histological examination of a biopsy obtained through an invasive thoracoscopy. However, diagnosis is made too late for curative treatment because of non-specific symptoms mainly appearing at advanced stage disease. Hence, due to its biologic aggressiveness and the late diagnosis, survival rate is low and the patients' outcome poor. In addition, radiological imaging, like computed tomographic scans, and blood biomarkers are found not to be sensitive enough to be used as an early diagnostic tool. Detection in an early stage is assumed to improve the patients' outcome but is hampered due to non-specific and late symptomology. Hence, there is a need for a new screening and diagnostic test which could improve the patients' outcome. Despite extensive research has focused on blood biomarkers, not a single has been shown clinically useful, and therefore research recently shifted to "breathomics" techniques to recognize specific volatile organic compounds (VOCs) in the breath of the patient as potential non-invasive biomarkers for disease. In this review, we summarize the acquired knowledge about using breath analysis for diagnosing and monitoring MPM and asbestos-related disorders (ARD). Gas chromatography-mass spectrometry (GC-MS), the gold standard of breath analysis, appears to be the method with the highest accuracy (97%) to differentiate MPM patients from at risk asbestos-exposed subjects. There have already been found some interesting biomarkers that are significantly elevated in asbestosis (NO, 8-isoprostane, leukotriene B4, α-Pinene…) and MPM (cyclohexane) patients. Regrettably, the different techniques and the plethora of studies suffer some limitations. Most studies are pilot studies with the inclusion of a limited number of patients. Nevertheless, given the promising results and easy sampling methods, we can conclude that breath analysis may become a useful tool in the future to screen for MPM, but further research is warranted.
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Affiliation(s)
- Lisa Brusselmans
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Lieselot Arnouts
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Charissa Millevert
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Joyce Vandersnickt
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Jan P. van Meerbeeck
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
- Internal Medicine, Ghent University, Ghent, Belgium
- Department of Pneumology, Antwerp University Hospital, Edegem, Belgium
| | - Kevin Lamote
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
- Internal Medicine, Ghent University, Ghent, Belgium
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Lydon EC, Ko ER, Tsalik EL. The host response as a tool for infectious disease diagnosis and management. Expert Rev Mol Diagn 2018; 18:723-738. [PMID: 29939801 DOI: 10.1080/14737159.2018.1493378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A century of advances in infectious disease diagnosis and treatment changed the face of medicine. However, challenges continue to develop including multi-drug resistance, globalization that increases pandemic risks, and high mortality from severe infections. These challenges can be mitigated through improved diagnostics, and over the past decade, there has been a particular focus on the host response. Since this article was originally published in 2015, there have been significant developments in the field of host response diagnostics, warranting this updated review. Areas Covered: This review begins by discussing developments in single biomarkers and pauci-analyte biomarker panels. It then delves into 'omics, an area where there has been truly exciting progress. Specifically, progress has been made in sepsis diagnosis and prognosis; differentiating viral, bacterial, and fungal pathogen classes; pre-symptomatic diagnosis; and understanding disease-specific diagnostic challenges in tuberculosis, Lyme disease, and Ebola. Expert Commentary: As 'omics have become faster, more precise, and less expensive, the door has been opened for academic, industry, and government efforts to develop host-based infectious disease classifiers. While there are still obstacles to overcome, the chasm separating these scientific advances from the patient's bedside is shrinking.
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Affiliation(s)
- Emily C Lydon
- a Duke University School of Medicine , Duke University , Durham , NC , USA
| | - Emily R Ko
- b Duke Center for Applied Genomics & Precision Medicine, Department of Medicine , Duke University , Durham , NC , USA.,c Duke Regional Hospital, Department of Medicine , Duke University , Durham , NC , USA
| | - Ephraim L Tsalik
- b Duke Center for Applied Genomics & Precision Medicine, Department of Medicine , Duke University , Durham , NC , USA.,d Division of Infectious Diseases & International Health, Department of Medicine , Duke University , Durham , NC , USA.,e Emergency Medicine Service , Durham Veterans Affairs Health Care System , Durham , NC , USA
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Bos LD. Contrary to popular belief, ventilator-associated lower respiratory tract infections are less common in immunocompromised patients. Eur Respir J 2018. [PMID: 29519906 DOI: 10.1183/13993003.00228-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lieuwe D Bos
- Dept of Respiratory Medicine, Academic Medical Center Amsterdam, Amsterdam, The Netherlands .,Intensive Care, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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