Changes of salivary biomarkers under different storage conditions: effects of temperature and length of storage

Salivary biomarkers as pioneering indicators for diagnosis and severity stratification of pediatric long COVID

Introduction

Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), manifests as persistent and often debilitating symptoms enduring well beyond the initial COVID-19 infection. This disease is especially worrying in children since it can seriously alter their development. Presently, a specific diagnostic test or definitive biomarker set for confirming long COVID is lacking, relying instead on the protracted presence of symptoms post-acute infection.

Methods

We measured the levels of 13 biomarkers in 105 saliva samples (49 from children with long COVID and 56 controls), and the Pearson correlation coefficient was used to analyse the correlations between the levels of the different salivary biomarkers. Multivariate logistic regression analyses were performed to determine which of the 13 analysed salivary biomarkers were useful to discriminate between children with long COVID and controls, as well as between children with mild and severe long COVID symptoms.

Results

Pediatric long COVID exhibited increased oxidant biomarkers and decreased antioxidant, immune response, and stress-related biomarkers. Correlation analyses unveiled distinct patterns between biomarkers in long COVID and controls. Notably, a multivariate logistic regression pinpointed TOS, ADA2, total proteins, and AOPP as pivotal variables, culminating in a remarkably accurate predictive model distinguishing long COVID from controls. Furthermore, total proteins and ADA1 were instrumental in discerning between mild and severe long COVID symptoms.

Discussion

This research sheds light on the potential clinical utility of salivary biomarkers in diagnosing and categorizing the severity of pediatric long COVID. It also lays the groundwork for future investigations aimed at unravelling the prognostic value of these biomarkers in predicting the trajectory of long COVID in affected individuals.

Effect of thermal and chemical treatments used for SARS-COV-2 inactivation in the measurement of saliva analytes

The present study aims to assess the effects of thermal and chemical inactivating procedures, that can be used for SARS-CoV-2 inactivation, on different salivary analytes. SDS–Polyacrylamide Gel Electrophoresis (SDS-PAGE) protein profile and a panel of 25 specific biomarkers of oxidative status, stress, metabolism and tissue damage were evaluated in samples subjected to different treatments: thermal (65 °C or 92 °C) and chemical with detergents [sodium dodecyl sulphate (SDS), Triton X-100 or NP-40]. Salivary SDS-PAGE profile was most affected by heating at 92 °C, with three and two protein bands decreasing and increasing their expression levels, respectively. This treatment also affected the results of several enzymes, with some of them being also affected by heating at 65 °C and incubation with SDS. The use of Triton X-100 or NP-40 resulted in increased values of cortisol, triglycerides and glucose, not affecting the other tested biomarkers. The present results will help researchers and clinicians to select the best protocols to work in safe conditions with saliva, taking into account the target analyte planned to be measured.

Basics for the potential use of saliva to evaluate stress, inflammation, immune system, and redox homeostasis in pigs

The use of saliva as a biological sample has many advantages, being especially relevant in pigs where the blood collection is highly stressful and painful, both for the animal and the staff in charge of the sampling. Currently one of the main uses of saliva is for diagnosis and detection of infectious diseases, but the saliva can also be used to measure biomarkers that can provide information of stress, inflammation, immune response and redox homeostasis. This review will be focused on the analytes that can be used for such evaluations. Emphasis will be given in providing data of practical use about their physiological basis, how they can be measured, and their interpretation. In addition, some general rules regarding sampling and saliva storage are provided and the concept of sialochemistry will be addressed. There is still a need for more data and knowledge for most of these biomarkers to optimize their use, application, and interpretation. However, this review provides updated data to illustrate that besides the detection of pathogens in saliva, additional interesting applicative information regarding pigs´ welfare and health can be obtained from this fluid. Information that can potentially be applied to other animal species as well as to humans.

Changes Occurring on the Activity of Salivary Alpha-Amylase Proteoforms in Two Naturalistic Situations Using a Spectrophotometric Assay

Simple Summary

Salivary alpha-amylase (sAA) is considered a biomarker of acute stress since this enzyme is released in saliva after autonomic nervous system activation, in response to psychological or physical stress situations. This enzyme has different isoforms that could be differentially expressed depending on the stressful situation. The aims of the present research were (1) to develop and validate an easy and fast method to estimate the activity of the major sAA proteoforms (both non-glycosylated and glycosylated proteoforms) in saliva samples, and (2) to evaluate the possible changes occurring in the activity of both proteoforms when measured by this method in two different stress models (physical effort and psychological challenge). This new method was precise and, when applied to the different stress models, allowed to detect changes of different magnitudes in both proteoforms. Therefore, this research opens a new field for the evaluation of isoforms of sAA as potential biomarkers of stress.

Abstract

This study aimed to evaluate the changes in the activity of total salivary alpha-amylase (TsAA) and both the non-glycosylated and glycosylated salivary alpha-amylase proteoforms (NGsAA and GsAA, respectively) in physical and psychological stress models, estimated using a simple and easily set-up method. The method used was a spectrophotometric assay with 2-chloro-4-nitrophenyl-α-D-maltotriose (CNPG3) as a substrate, incubated with Concanavalin A (ConA) to remove most of the glycosylated protein from the sample. This method allowed the measurement of TsAA and estimation of NGsAA and GsAA activities with imprecision lower than 10%. When this method was applied to two different stress models, differences in the responses of the proteoforms were observed, with the NGsAA activity showing changes of higher magnitude after stress induction than the GsAA activity, and the highest correlation with the State–Trait Anxiety Inventory Scale in the Trier Social Stress Test (TSST). In conclusion, the activity of the two main sAA proteoforms can be easily estimated in saliva, and their measurement can provide additional information on TsAA activity in physical or psychological stress situations.

Evaluation of Saliva Stability for NMR Metabolomics: Collection and Handling Protocols

Maintaining a salivary metabolic profile upon sample collection and preparation is determinant in metabolomics. Nuclear magnetic resonance (NMR) spectroscopy was used to identify metabolite changes during short-term storage, at room temperature (RT)/4 °C/-20 °C, and after sample preparation, at RT/4 °C (mimicking typical clinical/laboratory settings). Interestingly, significant metabolic inter-individual and inter-day variability were noted, probably determining sample stability to some extent. After collection, no changes were noted at -20 °C (at least for 4 weeks). RT storage induced decreases in methylated macromolecules (6 h); lactate (8 h); alanine (12 h); galactose, hypoxanthine, pyruvate (24 h); sarcosine, betaine, choline, N-acetyl-glycoproteins (48 h), while acetate increased (48 h). Less, but different, changes were observed at 4 °C, suggesting different oral and microbial status at different temperatures (with a possible contribution from inter-individual and inter-day variability), and identifying galactose, hypoxanthine, and possibly, choline esters, as potential general stability indicators. After preparation, addition of NaN3 did not impact significantly on saliva stabilization, neither at RT nor at 4 °C, although its absence was accompanied by slight increases in fucose (6.5 h) and proline (8 h) at RT, and in xylose (24 h) at 4 °C. The putative metabolic origins of the above variations are discussed, with basis on the salivary microbiome. In summary, after collection, saliva can be stored at RT/4 °C for up to 6 h and at -20 °C for at least 4 weeks. Upon preparation for NMR analysis, samples are highly stable at 25 °C up to 8 h and at 4 °C up to 48 h, with NaN3 addition preventing possible early changes in fucose, proline (6-8 h), and xylose (24 h) levels.

Delays in processing and storage of pig seminal plasma alters levels of contained antioxidants

Seminal plasma (SP) antioxidants are considered biomarkers of sperm function and fertility for AI-boars. The current protocol for their measurement implies the SP was harvested immediately after ejaculation and prompt stored at -80 °C until analysis. Such protocol may be impractical for AI-centers. This study evaluated how SP levels of antioxidants were influenced by delays in (1) SP-harvesting (0 [control], 2 or 24 h at 17 °C after ejaculate collection), in (2) SP-freezing (0 [control] or 24 h at 17 °C after SP-harvesting) or (3) the temperature of storage (-80 °C [control] or - 20 °C). The SP-antioxidants evaluated were: glutathione peroxidase [GPx], superoxide dismutase [SOD], paraoxonase-1 [PON-1], trolox equivalent antioxidant capacity [TEAC] and oxidative stress index [OSI]. A total of 120 aliquots from 10 entire ejaculates were handled in three trials. They were centrifuged (1500 g, 10 min) for harvesting SP and antioxidants were measured with an Automatic Chemistry Analyzer. A 24 h-delay in harvesting the SP led to an increase (p˂0.001) in TEAC and SOD SP-levels, and a decrease (p˂0.05) of OSI and PON-1. Similarly, a 24 h-delay to freeze the SP increased (p˂0.01) TEAC values and decreased (p˂0.01) PON-1 and GPx activity levels. Finally, storing the SP at -20 °C decreased (p˂0.001) SP-levels of TEAC, PON-1 and GPx, and increased (p˂0.01) OSI values. Strong positive relationships (p˂0.001) were found between antioxidant SP-levels in processed samples and their respective controls. In sum, handling and SP storage influence antioxidant measurements in AI-boars. Reliable levels of SP-antioxidants can only be warranted if a strict protocol for harvesting and SP storage is followed.

Changes in Markers of Oxidative Stress and α-Amylase in Saliva of Children Associated with a Tennis Competition

The purpose of this paper was to analyze the changes caused by a one-day tennis tournament in biomarkers of oxidative stress and α-amylase in saliva in children. The sample was 20 male active children with the following characteristics: (a) age of players = 9.46 ± 0.66 years; (b) weight = 34.8 ± 6.5 kg; (c) height = 136.0 ± 7.9 cm; (d) mean weekly training tennis = 2.9 ± 1.0 h. The tennis competition ran for one day, with four matches for each player. Data were taken from the average duration per match and the rating of perceived exertion (RPE). Four biomarkers of antioxidant status: uric acid (AU), Trolox equivalent antioxidant capacity (TEAC), ferric reducing ability of saliva (FRAS, cupric reducing antioxidant capacity (CUPRAC) and salivary alpha-amylase (sAA) as a biomarker of psychological stress were measured in saliva. The time points were baseline (at home before the tournament), pre-competition (immediately before the first match) and post-match (after each match) measurements. The four biomarkers of antioxidant status showed a similar dynamic with lower values at baseline and a progressive increase during the four matches. Overall one-day tennis competition in children showed a tendency to increase antioxidant biomarkers in saliva. In addition, there was an increase in pre-competition sAA possibly associated with psychological stress. Further studies about the possible physiological implications of these findings should be performed in the future.

The CRESS checklist for reporting stability studies: on behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE)

To ensure that clinical laboratories produce results that are both accurate and of clinical utility it is essential that only samples of adequate quality are analysed. Although various studies and databases assessing the stability of analytes in different settings do exist, guidance on how to perform and report stability studies is lacking. This results in studies that often do not report essential information, thus compromising transferability of the data. The aim of this manuscript is to describe the C hecklist for R eporting S tability S tudies (CRESS) against which future studies should be reported to ensure standardisation of reporting and easy assessment of transferability of studies to other healthcare settings. The EFLM WG-PRE (European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase) produced the CRESS checklist following a detailed literature review and extensive discussions resulting in consensus agreement. The checklist consists of 20 items covering all the aspects that should be considered when producing a report on a stability study including details of what should be included for each item and a rationale as to why. Adherence to the CRESS checklist will ensure that studies are reported in a transparent and replicable way. This will allow other laboratories to assess whether published data meet the stability criteria required in their own particular healthcare scenario. The EFLM WG-PRE encourage researchers and authors to use the CRESS checklist as a guide to planning stability studies and to produce standardised reporting of future stability studies.

Salivary biomarkers in breast cancer: a cross-sectional study

AIM

The objective was to evaluate the diagnostic value of salivary biomarkers in breast cancer.

MATERIALS AND METHODS

A prospective study was carried out of 91 consecutive breast cancer patients and 60 controls without neoplastic disease. Demographic data were recorded, along with the Hospital Anxiety Depression (HAD), risk for development periodontal diseases questionnaire and Mini-Nutritional Assessment (MNA) scores, and the TNM classification and stage of the primary tumor. Unstimulated basal saliva samples were collected and stored at - 80 °C until analysis.

RESULTS

The mean salivary CA125 concentration was 102.1 pg/ml in the control group and 267.6 pg/ml in the breast cancer group (p = 0.005). The soluble Fas (sFas) concentration in turn was 84.1 pg/ml and 145.9 pg/ml, respectively (p = 0.008). None of the biomarkers was related to questionnaire-assessed risk for development of periodontal diseases. The area under the ROC curve was 0.68 for CA125 (95% CI, 0.05-0.56) and 0.67 for sFas (95% CI, 0.08-0.55).

CONCLUSIONS

The salivary biomarkers CA125 and sFas appear to be promising tools in the diagnosis of breast cancer.

In Vitro Evaluation of Iron-Induced Salivary Lipid Oxidation Associated with Exposure to Iron Nanoparticles: Application Possibilities and Limitations for Food and Exposure Sciences

Zerovalent iron nanotechnologies are widely used for groundwater remediation and increasingly considered for advance oxidation treatment in drinking water applications. Iron nanoparticles have been detected in drinking water systems and considered for food fortification; therefore, the potential for human exposure through ingestion can be a concern. This study aimed to assess whether ingestion of iron nanoparticles from drinking water could be detected through flavor perception using In Vitro salivary lipid oxidation as an indicator for metallic flavor perception. Ten female subjects, aged 29–59 years, donated saliva samples for use in the In Vitro experiments. Test samples consisted of 1:1 mixture of saliva and bottled drinking water (control) and three treatment solutions, spiked with ferrous sulfate, stabilized zerovalent iron nanoparticles (nZVI), and an aggregated/microsized suspension of mixed zerovalent iron and microsized suspension of iron and iron oxide metal powder, (mZVI). Upon mixing, samples were subjected to 15 min incubation at 37 °C to resemble oral conditions. Salivary lipid oxidation (SLO) was measured in all samples as micromoles of thiobarbituric acid reactive substances (TBARS)/mg Fe. Exposure to iron in all three forms induced significant amount of SLO in all treatment samples as compared to the control (p < 0.0001). The mean SLO levels were the highest in the ferrous treatment, followed by nZVI and mZVI treatments; the differences in the mean SLO levels were significant (p < 0.05). The findings indicate that oral exposure to stabilized ZVI nanoparticles may induce sensory properties different from that of ferrous salt, likely predictive of diminished detection of metallic flavor by humans.

Use of Saliva for Diagnosis and Monitoring the SARS-CoV-2: A General Perspective

In this report, updated information and future perspectives about the use of saliva as a sample for laboratory analysis of the Covid-19 are highlighted. Saliva can be used for the direct detection of the SARS-CoV-2 virus, the quantification of the specific immunoglobulins produced against it, and for the evaluation of the non-specific, innate immune response of the patient. Moreover, a deeper knowledge of potential changes in the saliva proteome in this disease may allow the identification of new diagnostic and prognostic biomarkers, or even help our understanding of the mechanisms associated with the disease. With the development of appropriate sample collection and processing methods and the use of adequate assays, saliva can provide useful clinical information about the disease and could be potentially included in guidelines for sample collection for the diagnosis, disease management, and control of Covid-19.

Understanding human salivary esterase activity and its variation under wine consumption conditions

Salivary esterase enzymes have been related to the in vitro hydrolysis of carboxylic esters associated with fruity and pleasant aroma nuances in many types of wine. However, very little is known about human total salivary esterase activity (TSEA) under physiological conditions. The purpose of this study is to gain understanding of TSEA and its relevance under wine consumption conditions. To do this, a methodology for TSEA measurement was optimised and applied to examine inter-individual differences (n = 10). Furthermore, TSEA was correlated with other salivary parameters (flow, pH, total protein content). The effect of the oral exposure to different types of wine-like solutions with different composition (ethanol, phenolic and aroma compounds) on TSEA was also assessed. Results showed large inter-individual differences, up to 86%, on TSEA values. Additionally, TSEA was positively correlated with the total salivary protein content (TPC) and negatively correlated with salivary pH and flow. After the oral exposure to wine-like solutions, the combined presence of ethanol, carboxylic esters and phenolic compounds produced the highest TSEA value. Results from this work prove that human salivary esterase is active during wine consumption, and adds support to the involvement of this enzymatic activity on wine aroma perception during wine intake, which will require future studies.

Human salivary esterase is active during wine consumption supporting its potential involvement on the perception of odorant esters during wine intake.

Analysis of bicarbonate, phosphate and other anions in saliva by capillary electrophoresis with capacitively coupled contactless conductivity detection in diagnostics of gastroesophageal reflux disease

Bicarbonate and phosphate constitute major salivary buffering components, and their importance consists in the neutralization of acidic gastric contents during reflux episodes. In this work, capillary electrophoresis with capacitively coupled contactless conductivity detector was applied for the analysis of bicarbonate, phosphate, and another inorganic (chloride, nitrite, nitrate, sulfate, thiocyanate) and organic anions (acetate, butyrate) to evaluate their levels in saliva. The background electrolytes of different composition and pH between 6.02-9.41 were assessed for the bicarbonate and phosphate determination by comparison of the real analyses of a model solution with the simulation by PeakMaster software. The optimized background electrolyte was composed of 10 mM 2-(N-morpholino)ethanesulfonic acid, 20 mM arginine, and 30 µM cetyltrimethylammonium bromide, pH 8.95. Using this BGE, the anion levels were compared in saliva from 20 patients suffering from gastroesophageal reflux disease (GERD) and saliva from 12 healthy subjects. Bicarbonate levels were significantly elevated in saliva from GERD patients suggesting the possible applicability of bicarbonate as a biomarker in non-invasive diagnostics of GERD by CE-C⁴ D.

Acute phase proteins, saliva and education in laboratory science: an update and some reflections

This manuscript provides updated knowledge and some ideas and reflections about three areas which are currently of interest in the field of the animal laboratory science. These areas are the study of acute phase proteins (APPs) as biomarkers of inflammation, the use of saliva as a non-invasive sample for analyte measurements, and the development of education in the field of laboratory medicine. In the APPs, a seven-point plan for their interpretation in all veterinary species containing updated knowledge and future perspectives is described. Regarding the saliva, general concepts, examples of practical applications and the limitations and points to improve for the use of this fluid are explained. Finally, the recent evolution, current situation and possible ideas for future development of education in this field are commented. In addition to review the knowledge in these three specific areas, this report can help to provide a wide vision of the potential and future perspectives in veterinary laboratory science.