Endogenous volatile organic compounds in acute myeloid leukemia: origins and potential clinical applications

Miniaturized Sniffing Device based on an Array of Fluorescent Carbon Quantum Dots and Metallic Nanoclusters Efficiently Identifies Hematologic Malignancy in Adults

The study demonstrates the potential of an optical nose made by depositing an array of fluorescent nanomaterials on a paper substrate for the early detection of leukemia in adults. This is based on the fact that blood volatile organic compounds (VOCs) are useful leukemia biomarkers. The integrated design was miniaturized and comprised both sensing zones and a sample holding zone, which were installed on a small sheet of paper within a miniature cubic reaction chamber fabricated by using 3D printing technology. The sensing device, comprising seven fluorescent sensing elements, namely, metal nanoclusters, quantum dots, and carbon dots was capable of detecting VOCs in the blood headspace and providing a colorimetric signature that could discriminate between blood samples from healthy and cancerous individuals. A total of 70 new leukemia cases and 51 healthy controls aged 20-50 years were studied. The device required a 60 μL portion of the blood sample and reacted to blood VOCs after 3 h when kept at 50 °C. The imaging data from the device was processed by linear discriminant analysis, and the results confirmed efficient identification of patient samples from healthy samples with 100% accuracy. Overall, the array system is noninvasive (or minimally invasive), portable, fast, inexpensive, and requires only a small amount of blood sample.

Establishment of a headspace-thermal desorption and gas chromatography-mass spectrometry method (HS-TD-GC-MS) for simultaneous detection of 51 volatile organic compounds in human urine: Application in occupational exposure assessment

Volatile organic compounds (VOCs) are a group of ubiquitous environment pollutants especially released into the workplace. Assessment of VOCs exposure in occupational populations is therefore a crucial issue for occupational health. However, simultaneous biomonitoring of a variety of VOCs is less studied. In this study, a simple and sensitive method was developed for the simultaneous determination of 51 prototype VOCs in urine by headspace-thermal desorption coupled to gas chromatography-mass spectrometry (HS-TD-GC-MS). The urinary sample was pretreated with only adding 0.50 g of sodium chloride to 2 mL of urine and 51 VOCs should be determined with limits of detection (LODs) between 13.6 ng/L and 24.5 ng/L. The method linearity ranged from 0.005 to 10 μg/L with correlation coefficients (r) of 0.991 to 0.999. The precision for intraday and inter-day, measured by the variation coefficient (CV) at three levels of concentration, was below 15 %, except for 4-isopropyl toluene, dichloromethane, and trichloromethane at low concentration. For medium and high levels, recoveries of all target VOCs were within the standard range, but 1,1-dichloropropene and styrene, which were slightly under 80 % at low levels. In addition, the proposed method has been used to determine urine samples collected in three times (before, during and after working) from 152 workers at four different factories. 41 types of prototype VOCs were detected in workers urine. Significant differences (Kruskal-Wallis chi-squared = 117.18, df = 1, P < 0.05) in the concentration levels of VOCs between the exposed and unexposed groups were observed, but not between the three sampling times (Kruskal-Wallis chi-squared = 3.39, df = 2, P = 0.183). The present study provides an alternative method for biomonitoring and assessing mixed exposures to VOCs in occupational populations.

Volatile Phases Derived from Serum, DC, or MLC Culture Supernatants to Deduce a VOC-Based Diagnostic Profiling Strategy for Leukemic Diseases

Volatile organic compounds (VOCs) reflect the metabolism in healthy and pathological conditions, and can be collected easily in a noninvasive manner. They are directly measured using electronical nose (eNose), and may qualify as a systemic tool to monitor biomarkers related to disease. Myeloid leukemic blasts can be transformed into leukemia-derived dendritic cells (DC_leu) able to improve (anti-leukemic) immune responses. To profile immunological changes in healthy and acute myeloid leukemic (AML) patients' ex vivo cell cultures, we correlated the cell biological data with the profiles of cell culture supernatant-derived VOCs. DC/DC_leu from leukemic or healthy whole blood (WB) were generated without (Control) or with immunomodulatory Kit M (Granulocyte macrophage-colony-stimulating-factor (GM-CSF) + prostaglandin E₁ (PGE₁)) in dendritic cell cultures (DC culture). Kit-pretreated/not pretreated WB was used to stimulate T cell-enriched immunoreactive cells in mixed lymphocyte cultures (MLC culture). Leukemia-specific adaptive and innate immune cells were detected with a degranulation assay (Deg) and an intracellular cytokine assay (InCyt). Anti-leukemic cytotoxicity was explored with a cytotoxicity fluorolysis assay (CTX). VOCs collected from serum or DC- and MLC culture supernatants (with vs. without Kit M pretreatment and before vs. after culture) were measured using eNose. Compared to the Control (without treatment), Kit M-pretreated leukemic and healthy WB gave rise to higher frequencies of mature (leukemia-derived) DC subtypes of activated and (memory) T cells after MLC. Moreover, antigen (leukemia)-specific cells of several lines (innate and adaptive immunity cells) were induced, giving rise to blast-lysing cells. The eNose could significantly distinguish between healthy and leukemic patients' serum, DC and MLC culture supernatant-derived volatile phases and could significantly separate several supernatant (with vs. without Kit M treatment, cultured vs. uncultured)-derived VOCs within subgroups (healthy DC or leukemic DC, or healthy MLC or leukemic MLC supernatants). Interestingly, the eNose could indicate a Kit M- and culture-associated effect. The eNose may be a prospective option for the deduction of a VOC-based profiling strategy using serum or cell culture supernatants and could be a useful diagnostic tool to recognize or qualify AML disease.

Liquid biopsies and minimal residual disease in myeloid malignancies

Minimal residual disease (MRD) assessment through blood component sampling by liquid biopsies (LBs) is increasingly being investigated in myeloid malignancies. Blood components then undergo molecular analysis by flow cytometry or sequencing techniques and can be used as a powerful tool for prognostic and predictive purposes in myeloid malignancies. There is evidence and more is evolving about the quantification and identification of cell-based and gene-based biomarkers in myeloid malignancies to monitor treatment response. MRD based acute myeloid leukemia protocol and clinical trials are currently incorporating LB testing and preliminary results are encouraging for potential widespread use in clinic in the near future. MRD monitoring using LBs are not standard in myelodysplastic syndrome (MDS) but this is an area of active investigation. In the future, LBs can replace more invasive techniques such as bone marrow biopsies. However, the routine clinical application of these markers continues to be an issue due to lack of standardization and limited number of studies investigating their specificities. Integrating artificial intelligence (AI) could help simplify the complex interpretation of molecular testing and reduce errors related to operator dependency. Though the field is rapidly evolving, the applicability of MRD testing using LB is mostly limited to research setting at this time due to the need for validation, regulatory approval, payer coverage, and cost issues. This review focuses on the types of biomarkers, most recent research exploring MRD and LB in myeloid malignancies, ongoing clinical trials, and the future of LB in the setting of AI.

Artificially Intelligent Nanoarray Detects Various Cancers by Liquid Biopsy of Volatile Markers

Cancer is usually not symptomatic in its early stages. However, early detection can vastly improve prognosis. Liquid biopsy holds great promise for early detection, although it still suffers from many disadvantages, mainly searching for specific cancer biomarkers. Here, a new approach for liquid biopsies is proposed, based on volatile organic compound (VOC) patterns in the blood headspace. An artificial intelligence nanoarray based on a varied set of chemi-sensitive nano-based structured films is developed and used to detect and stage cancer. As a proof-of-concept, three cancer models are tested showing high incidence and mortality rates in the population: breast cancer, ovarian cancer, and pancreatic cancer. The nanoarray has >84% accuracy, >81% sensitivity, and >80% specificity for early detection and >97% accuracy, 100% sensitivity, and >88% specificity for metastasis detection. Complementary mass spectrometry analysis validates these results. The ability to analyze such a complex biological fluid as blood, while considering data of many VOCs at a time using the artificially intelligent nanoarray, increases the sensitivity of predictive models and leads to a potential efficient early diagnosis and disease-monitoring tool for cancer.

Detection of Single Cancer Cells in Blood with Artificially Intelligent Nanoarray

Detection and monitoring of single cancer cells (SCCs), such as circulating tumor cells (CTCs), would be of aid in an efficient early detection of cancer, a tailored (personalized) therapy, and in a fast bedside assessment of treatment efficacy. Nevertheless, currently available techniques, which mostly rely on the isolation of SCCs based on their physical or biological properties, suffer from low sensitivity, complicated technical procedures, low cost-effectiveness, and being unsuitable for continuous monitoring. We report here on the design and use of an artificially intelligent nanoarray based on a heterogeneous set of chemisensitive nanostructured films for the detection of SCCs using volatile organic compounds emanating in the air trapped above blood samples containing SCCs. For demonstration purposes, we have focused on samples containing A549 lung cancer cells (hereafter, SCC^A549). The nanoarray developed to detect SCC^A549 has >90% accuracy, >85% sensitivity, and >95% specificity. Detection works irrespective of the medium and/or the environment. These results were validated by complementary mass spectrometry. The ability to continuously record, store, and preprocess the signals increases the chances that this nanotechnology might also be useful in the early detection of cancer cells in the blood and continuous monitoring of their possible progression.

Exhaled Breath Analysis in Diagnosis of Malignant Pleural Mesothelioma: Systematic Review

Malignant pleural mesothelioma (MPM) is mainly related to previous asbestos exposure. There is still dearth of information on non-invasive biomarkers to detect MPM at early stages. Human studies on exhaled breath biomarkers of cancer and asbestos-related diseases show encouraging results. The aim of this systematic review was to provide an overview on the current knowledge about exhaled breath analysis in MPM diagnosis. A systematic review was conducted on MEDLINE (PubMed), EMBASE and Web of Science databases to identify relevant studies. Quality assessment was done by the Newcastle-Ottawa Scale. Six studies were identified, all of which showed fair quality and explored volatile organic compounds (VOC) based breath profile using Gas Chromatography Coupled to Mass Spectrometry (GC-MS), Ion Mobility Spectrometry Coupled to Multi-capillary Columns (IMS-MCC) or pattern-recognition technologies. Sample sizes varied between 39 and 330. Some compounds (i.e, cyclohexane, P3, P5, P50, P71, diethyl ether, limonene, nonanal, VOC IK 1287) that can be indicative of MPM development in asbestos exposed population were identified with high diagnostic accuracy rates. E-nose studies reported breathprints being able to distinguish MPM from asbestos exposed individuals with high sensitivity and a negative predictive value. Small sample sizes and methodological diversities among studies limit the translation of results into clinical practice. More prospective studies with standardized methodologies should be conducted on larger populations.

Solid-phase microextraction: An appealing alternative for the determination of endogenous substances - A review

The determination of endogenous substances is of great significance for obtaining important biotic information such as biological components, metabolic pathways and disease biomarkers in different living organisms (e.g. plants, insects, animals and humans). However, due to the complex matrix and the trace concentrations of target analytes, the sample preparation procedure is an essential step before the analytes of interest are introduced into a detection instrument. Solid-phase microextraction (SPME), an emerging sample preparation technique that integrates sampling, extraction, concentration, and sample introduction into one step, has gained wide acceptance in various research fields, including in the determination of endogenous compounds. In this review, recent developments and applications of SPME for the determination of endogenous substances over the past five years are summarized. Several aspects, including the design of SPME devices (sampling configuration and coating), applications (in vitro and in vivo sampling), and coupling with emerging instruments (comprehensive two-dimensional gas chromatography (GC × GC), ambient mass spectrometry (AMS) and surface enhanced Raman scattering (SERS)) are involved. Finally, the challenges and opportunities of SPME methods in endogenous substances analysis are also discussed.