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1- 13C-propionate breath testing as a surrogate endpoint to assess efficacy of liver-directed therapies in methylmalonic acidemia (MMA). Genet Med 2021; 23:1522-1533. [PMID: 33820958 PMCID: PMC8354855 DOI: 10.1038/s41436-021-01143-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To develop a safe and noninvasive in vivo assay of hepatic propionate oxidative capacity. METHODS A modified 1-13C-propionate breath test was administered to 57 methylmalonic acidemia (MMA) subjects, including 19 transplant recipients, and 16 healthy volunteers. Isotopomer enrichment (13CO2/12CO2) was measured in exhaled breath after an enteral bolus of sodium-1-13C-propionate, and normalized for CO2 production. 1-13C-propionate oxidation was then correlated with clinical, laboratory, and imaging parameters collected via a dedicated natural history protocol. RESULTS Lower propionate oxidation was observed in patients with the severe mut0 and cblB subtypes of MMA, but was near normal in those with the cblA and mut- forms of the disorder. Liver transplant recipients demonstrated complete restoration of 1-13C-propionate oxidation to control levels. 1-13C-propionate oxidation correlated with cognitive test result, growth indices, bone mineral density, renal function, and serum biomarkers. Test repeatability was robust in controls and in MMA subjects (mean coefficient of variation 6.9% and 12.8%, respectively), despite widely variable serum methylmalonic acid concentrations in the patients. CONCLUSION Propionate oxidative capacity, as measured with 1-13C-propionate breath testing, predicts disease severity and clinical outcomes, and could be used to assess the therapeutic effects of liver-targeted genomic therapies for MMA and related disorders of propionate metabolism. TRIAL REGISTRATION This clinical study is registered in www.clinicaltrials.gov with the ID: NCT00078078. Study URL: http://clinicaltrials.gov/ct2/show/NCT00078078.
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Richter V, Gonzalez JO, Hazan S, Gottlieb G, Friedenberg K, Gatof D, Ganeshappa R, Delgado JS, Abramowitz D, Hardi R, Coates A, Haq M, Mehta N, Jones BA, Moss SF, Shirin H. The validity of breath collection bags method in detecting Helicobacter pylori using the novel BreathID ® Hp Lab System: a multicenter clinical study in 257 subjects. Ther Adv Gastrointest Endosc 2019; 12:2631774519843401. [PMID: 31192315 PMCID: PMC6543788 DOI: 10.1177/2631774519843401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/14/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Aim: The BreathID®Hp urea breath test provides several advantages over other 13C breath analyzers for the detection of Helicobacter pylori. We evaluated the sensitivity and specificity of a new BreathID®Hp Lab System (Exalenz Bioscience Ltd, Israel), a 13C-urea breath test system using breath sampling bags that facilitates multiple testing in a multicenter international clinical study. Methods: A total of 257 subjects with evaluable results for urea breath test, rapid urease test, and histology were enrolled into two study groups: 189 naïve subjects were included in the pre-therapy group, and 68 subjects comprised the post-eradication therapy group. Analytical studies were conducted to evaluate the stability, reproducibility, and repeatability of the 13C-urea breath test results using a delta over baseline cut-off value of 5. Results: Among the pre-therapy subjects evaluated with the composite results from the rapid urease test and histology/immunohistochemistry, 176 results matched those of the urea breath test, resulting in an overall agreement of 98.3% with a sensitivity of 100% and specificity of 97.9%. In the post-eradication therapy cohort, the overall agreement between the urea breath test and the biopsy diagnosis was 98.5%; the sensitivity of the urea breath test in this cohort was 92.3% and the specificity was 100%. There was uniformly high overall reproducibility (99.48%) of the test results over different batches of breath sample bags, when analyzed on different days and under different storage conditions, showing stability of the breath samples in the breath collection bags Conclusion: The BreathID®Hp Lab System is a highly accurate and dependable method for the diagnosis of H. pylori infection.
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Affiliation(s)
- Vered Richter
- Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Tel-Aviv University, Zerifin, Israel
| | | | | | | | | | - David Gatof
- Innovative Clinical Research, Lafayette, CO, USA
| | - Ravi Ganeshappa
- Digestive Disease Center of South Texas, P.L.L.C, San Antonio, TX, USA
| | | | - Dov Abramowitz
- Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Tel-Aviv University, Zerifin, Israel
| | - Robert Hardi
- Chevy Chase Clinical Research, Chevy Chase, MD, USA
| | - Allan Coates
- West Michigan Clinical Research Center, Wyoming, MI, USA
| | | | - Nilesh Mehta
- Digestive Disease Care PC, New Hyde Park, NY, USA
| | | | | | - Haim Shirin
- Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Tel-Aviv University, Zerifin, Israel
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