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Liver Impairment-The Potential Application of Volatile Organic Compounds in Hepatology. Metabolites 2021; 11:metabo11090618. [PMID: 34564434 PMCID: PMC8471934 DOI: 10.3390/metabo11090618] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022] Open
Abstract
Liver diseases are currently diagnosed through liver biopsy. Its invasiveness, costs, and relatively low diagnostic accuracy require new techniques to be sought. Analysis of volatile organic compounds (VOCs) in human bio-matrices has received a lot of attention. It is known that a musty odour characterises liver impairment, resulting in the elucidation of volatile chemicals in the breath and other body fluids such as urine and stool, which may serve as biomarkers of a disease. Aims: This study aims to review all the studies found in the literature regarding VOCs in liver diseases, and to summarise all the identified compounds that could be used as diagnostic or prognostic biomarkers. The literature search was conducted on ScienceDirect and PubMed, and each eligible publication was qualitatively assessed by two independent evaluators using the SANRA critical appraisal tool. Results: In the search, 58 publications were found, and 28 were kept for inclusion: 23 were about VOCs in the breath, one in the bile, three in urine, and one in faeces. Each publication was graded from zero to ten. A graphical summary of the metabolic pathways showcasing the known liver disease-related VOCs and suggestions on how VOC analysis on liver impairment could be applied in clinical practice are given.
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Kaiser A, Torres Ceja E, Liu Y, Huber F, Müller R, Herr U, Thonke K. H 2S sensing for breath analysis with Au functionalized ZnO nanowires. NANOTECHNOLOGY 2021; 32:205505. [PMID: 33498025 DOI: 10.1088/1361-6528/abe004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This work presents a H2S selective resistive gas sensor design based on a chemical field effect transistor (ChemFET) with open gate formed by hundreds of high temperature chemical vapour deposition (CVD) grown zinc oxide nanowires (ZnO NW). The sensing ability of pristine ZnO NWs and surface functionalized ZnO NWs for H2S is analysed systematically. ZnO NWs are functionalized by deposition of discontinuous gold (Au) nanoparticle films of different thicknesses of catalyst layer ranging from 1 to 10 nm and are compared in their gas sensing properties. All experiments were performed in a temperature stabilized small volume compartment with adjustable gas mixture at room temperature. The results allow for a well-founded understanding of signal-to-noise ratio, enhanced response, and improved limit of detection due to the Au functionalisation. Comprehension and controlled application of the beneficial effects of Au catalyst on ZnO NWs allow for the detection of very low H2S concentrations down to 10 ppb, and a theoretically estimated 500 ppt in synthetic air at room temperature.
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Affiliation(s)
- Angelika Kaiser
- Institute of Quantum Matter/Semiconductor Physics Group, Ulm University, D-89069 Ulm, Germany
| | - Erick Torres Ceja
- Institute of Quantum Matter/Semiconductor Physics Group, Ulm University, D-89069 Ulm, Germany
| | - Yujia Liu
- Institute of Quantum Matter/Semiconductor Physics Group, Ulm University, D-89069 Ulm, Germany
| | - Florian Huber
- Institute of Quantum Matter/Semiconductor Physics Group, Ulm University, D-89069 Ulm, Germany
| | - Raphael Müller
- Institute of Quantum Matter/Semiconductor Physics Group, Ulm University, D-89069 Ulm, Germany
| | - Ulrich Herr
- Institute of Functional Nanosystems, Ulm University, D-89069 Ulm, Germany
| | - Klaus Thonke
- Institute of Quantum Matter/Semiconductor Physics Group, Ulm University, D-89069 Ulm, Germany
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Andrews BT, Das P, Denzer W, Ritchie GA, Peverall R, Hamade AM, Hancock G. Breath testing for intra-abdominal infection: appendicitis, a preliminary study. J Breath Res 2020; 15:016002. [PMID: 33089830 DOI: 10.1088/1752-7163/abba88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the current pilot study we aimed to determine whether breath analysis could be used to help recognise intra-abdominal infection, using acute appendicitis as an exemplar condition. Our study included 53 patients (aged 18-88 years) divided into three groups: appendix group, 26 (13 male) patients suffering from acute appendicitis; control group 20 (seven male) patients undergoing elective abdominal surgery; normal group, seven patients who were clinically diagnosed with appendicitis, but whose appendix was normal on histological examination. Samples of breath were analysed using ion molecule reaction mass spectroscopy measuring the concentration of volatile compounds (VCs) with molecular masses 27-123. Intraperitoneal gas samples were collected from a subset of 23 patients (nine diagnosed with acute appendicitis). Statistically significant differences in the concentration of VCs in breath were found between the three groups. Acetone, isopropanol, propanol, butyric acid, and further unassigned VCs with molecular mass/charge ratio (m/z) 56, 61 and 87 were all identified with significant endogenous contributions. Principle component analysis was able to separate the control and appendicitis groups for seven variables: m/z = 56, 58, 59, 60, 61, 87 and 88. Comparing breath and intraperitoneal samples showed significant relationships for acetone and the VC with m/z = 61. Our data suggest that it may be possible to help diagnose acute appendicitis by breath analysis; however, factors such as length of starvation remain to be properly accounted for and the management or mitigation of background levels needs to be properly addressed, and larger studies relating breath VCs to the causative organisms may help to highlight the relative importance of individual VCs.
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Affiliation(s)
- B T Andrews
- Department of Surgery, Medway Maritime Hospital, Gillingham, United Kingdom
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De Vincentis A, Vespasiani-Gentilucci U, Sabatini A, Antonelli-Incalzi R, Picardi A. Exhaled breath analysis in hepatology: State-of-the-art and perspectives. World J Gastroenterol 2019; 25:4043-4050. [PMID: 31435162 PMCID: PMC6700691 DOI: 10.3748/wjg.v25.i30.4043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
Liver disease is characterized by breath exhalation of peculiar volatile organic compounds (VOCs). Thanks to the availability of sensitive technologies for breath analysis, this empiric approach has recently gained increasing attention in the context of hepatology, following the good results obtained in other fields of medicine. After the first studies that led to the identification of selected VOCs for pathophysiological purposes, subsequent research has progressively turned towards the comprehensive assessment of exhaled breath for potential clinical application. Specific VOC patterns were found to discriminate subjects with liver cirrhosis, to rate disease severity, and, eventually, to forecast adverse clinical outcomes even beyond existing scores. Preliminary results suggest that breath analysis could be useful also for detecting and staging hepatic encephalopathy and for predicting steatohepatitis in patients with nonalcoholic fatty liver disease. However, clinical translation is still hampered by a number of methodological limitations, including the lack of standardization and the consequent poor comparability between studies and the absence of external validation of obtained results. Given the low-cost and easy execution at bedside of the new technologies (e-nose), larger and well-structured studies are expected in order to provide the adequate level of evidence to support VOC analysis in clinical practice.
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Affiliation(s)
- Antonio De Vincentis
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
| | - Umberto Vespasiani-Gentilucci
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
| | - Anna Sabatini
- Unit of Electronics for sensor systems, Department of Engineering, University Campus Bio-Medico of Rome, Rome 00128, Italy
| | - Raffaele Antonelli-Incalzi
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
| | - Antonio Picardi
- Unit of Clinical Medicine and Hepatology, Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University Hospital, Rome 00128, Italy
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5
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Catino A, de Gennaro G, Di Gilio A, Facchini L, Galetta D, Palmisani J, Porcelli F, Varesano N. Breath Analysis: A Systematic Review of Volatile Organic Compounds (VOCs) in Diagnostic and Therapeutic Management of Pleural Mesothelioma. Cancers (Basel) 2019; 11:E831. [PMID: 31207975 PMCID: PMC6627570 DOI: 10.3390/cancers11060831] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare neoplasm related to asbestos exposure and with high mortality rate. The management of patients with MPM is complex and controversial, particularly with regard to early diagnosis. In the last few years, breath analysis has been greatly implemented with this aim. In this review the strengths of breath analysis and preliminary results in searching breath biomarkers of MPM are highlighted and discussed, respectively. Through a systematic electronic literature search, collecting papers published from 2000 until December 2018, fifteen relevant scientific papers were selected. All papers considered were prospective, comparative, observational case-control studies although every single one pilot and based on a relatively small number of samples. The identification of diagnostic VOCs pattern, through breath sample characterization and the statistical data treatment, allows to obtain a strategic information for clinical diagnostics. To date the collected data provide just preliminary information and, despite the promising results and diagnostic accuracy, conclusions cannot be generalized due to the limited number of individuals included in each cohort study. Furthermore none of studies was externally validated, although validation process is a necessary step towards clinical implementation. Breathomics-based biomarker approach should be further explored to confirm and validate preliminary findings and to evaluate its potential role in monitoring the therapeutic response.
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Affiliation(s)
- Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Centre "Giovanni Paolo II", 70124 Bari, Italy.
| | | | | | - Laura Facchini
- Department of Biology, University of Bari, 70125 Bari, Italy.
| | - Domenico Galetta
- Thoracic Oncology Unit, Clinical Cancer Centre "Giovanni Paolo II", 70124 Bari, Italy.
| | | | | | - Niccolò Varesano
- Thoracic Oncology Unit, Clinical Cancer Centre "Giovanni Paolo II", 70124 Bari, Italy.
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Zhou W, Huang C, Zou X, Lu Y, Shen C, Ding X, Wang H, Jiang H, Chu Y. Exhaled breath online measurement for cervical cancer patients and healthy subjects by proton transfer reaction mass spectrometry. Anal Bioanal Chem 2017; 409:5603-5612. [DOI: 10.1007/s00216-017-0498-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
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O'Hara ME, Fernández Del Río R, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Limonene in exhaled breath is elevated in hepatic encephalopathy. J Breath Res 2016; 10:046010. [PMID: 27869108 PMCID: PMC5500822 DOI: 10.1088/1752-7155/10/4/046010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol-1 in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol-1, respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10-44) and 42 (32-58) nmol mol-1.
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Affiliation(s)
- M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK. Author to whom any correspondence should be addressed
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De Vincentis A, Pennazza G, Santonico M, Vespasiani-Gentilucci U, Galati G, Gallo P, Vernile C, Pedone C, Antonelli Incalzi R, Picardi A. Breath-print analysis by e-nose for classifying and monitoring chronic liver disease: a proof-of-concept study. Sci Rep 2016; 6:25337. [PMID: 27145718 PMCID: PMC4857073 DOI: 10.1038/srep25337] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 04/06/2016] [Indexed: 12/19/2022] Open
Abstract
Since the liver plays a key metabolic role, volatile organic compounds in the exhaled breath might change with type and severity of chronic liver disease (CLD). In this study we analysed breath-prints (BPs) of 65 patients with liver cirrhosis (LC), 39 with non-cirrhotic CLD (NC-CLD) and 56 healthy controls by the e-nose. Distinctive BPs characterized LC, NC-CLD and healthy controls, and, among LC patients, the different Child-Pugh classes (sensitivity 86.2% and specificity 98.2% for CLD vs healthy controls, and 87.5% and 69.2% for LC vs NC-CLD). Moreover, the area under the BP profile, derived from radar-plot representation of BPs, showed an area under the ROC curve of 0.84 (95% CI 0.76–0.91) for CLD, of 0.76 (95% CI 0.66–0.85) for LC, and of 0.70 (95% CI 0.55–0.81) for decompensated LC. By applying the cut-off values of 862 and 812, LC and decompensated LC could be predicted with high accuracy (PPV 96.6% and 88.5%, respectively). These results are proof-of-concept that the e-nose could be a valid non-invasive instrument for characterizing CLD and monitoring hepatic function over time. The observed classificatory properties might be further improved by refining stage-specific breath-prints and considering the impact of comorbidities in a larger series of patients.
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Affiliation(s)
- Antonio De Vincentis
- Clinical Medicine and Hepatology Department, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Marco Santonico
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Umberto Vespasiani-Gentilucci
- Clinical Medicine and Hepatology Department, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Giovanni Galati
- Clinical Medicine and Hepatology Department, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Paolo Gallo
- Clinical Medicine and Hepatology Department, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Chiara Vernile
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Claudio Pedone
- Chair of Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Raffaele Antonelli Incalzi
- Chair of Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy.,San Raffaele- Cittadella della Carità Foundation, Taranto, Italy
| | - Antonio Picardi
- Clinical Medicine and Hepatology Department, Campus Bio-Medico University, via Alvaro del Portillo 200, 00128 Rome, Italy
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Dolch ME, Janitza S, Boulesteix AL, Graßmann-Lichtenauer C, Praun S, Denzer W, Schelling G, Schubert S. Gram-negative and -positive bacteria differentiation in blood culture samples by headspace volatile compound analysis. ACTA ACUST UNITED AC 2016; 23:3. [PMID: 26973820 PMCID: PMC4788920 DOI: 10.1186/s40709-016-0040-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/29/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Identification of microorganisms in positive blood cultures still relies on standard techniques such as Gram staining followed by culturing with definite microorganism identification. Alternatively, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or the analysis of headspace volatile compound (VC) composition produced by cultures can help to differentiate between microorganisms under experimental conditions. This study assessed the efficacy of volatile compound based microorganism differentiation into Gram-negatives and -positives in unselected positive blood culture samples from patients. METHODS Headspace gas samples of positive blood culture samples were transferred to sterilized, sealed, and evacuated 20 ml glass vials and stored at -30 °C until batch analysis. Headspace gas VC content analysis was carried out via an auto sampler connected to an ion-molecule reaction mass spectrometer (IMR-MS). Measurements covered a mass range from 16 to 135 u including CO2, H2, N2, and O2. Prediction rules for microorganism identification based on VC composition were derived using a training data set and evaluated using a validation data set within a random split validation procedure. RESULTS One-hundred-fifty-two aerobic samples growing 27 Gram-negatives, 106 Gram-positives, and 19 fungi and 130 anaerobic samples growing 37 Gram-negatives, 91 Gram-positives, and two fungi were analysed. In anaerobic samples, ten discriminators were identified by the random forest method allowing for bacteria differentiation into Gram-negative and -positive (error rate: 16.7 % in validation data set). For aerobic samples the error rate was not better than random. CONCLUSIONS In anaerobic blood culture samples of patients IMR-MS based headspace VC composition analysis facilitates bacteria differentiation into Gram-negative and -positive.
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Affiliation(s)
- Michael E Dolch
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81366 Munich, Germany
| | - Silke Janitza
- Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81366 Munich, Germany
| | - Anne-Laure Boulesteix
- Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81366 Munich, Germany
| | - Carola Graßmann-Lichtenauer
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81366 Munich, Germany
| | | | - Wolfgang Denzer
- Wolfden Scientific Consulting, Calle Rio Segura 26, 30600 Archena, Murcia, Spain
| | - Gustav Schelling
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81366 Munich, Germany
| | - Sören Schubert
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig-Maximilians-Universität München, Pettenkoferstraße 9a, 80336 Munich, Germany
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A profile of volatile organic compounds in exhaled air as a potential non-invasive biomarker for liver cirrhosis. Sci Rep 2016; 6:19903. [PMID: 26822454 PMCID: PMC4731784 DOI: 10.1038/srep19903] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022] Open
Abstract
Early diagnosis of liver cirrhosis may prevent progression and development of complications. Liver biopsy is the current standard, but is invasive and associated with morbidity. We aimed to identify exhaled volatiles within a heterogeneous group of chronic liver disease (CLD) patients that discriminates those with compensated cirrhosis (CIR) from those without cirrhosis, and compare this with serological markers. Breath samples were collected from 87 CLD and 34 CIR patients. Volatiles in exhaled air were measured by gas chromatography mass spectrometry. Discriminant Analysis was performed to identify the optimal panel of serological markers and VOCs for classifying our patients using a random training set of 27 CIR and 27 CLD patients. Two randomly selected independent internal validation sets and permutation test were used to validate the model. 5 serological markers were found to distinguish CIR and CLD patients with a sensitivity of 0.71 and specificity of 0.84. A set of 11 volatiles discriminated CIR from CLD patients with sensitivity of 0.83 and specificity of 0.87. Combining both did not further improve accuracy. A specific exhaled volatile profile can predict the presence of compensated cirrhosis among CLD patients with a higher accuracy than serological markers and can aid in reducing liver biopsies.
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Baumgartner C. The Era of Big Data: From Data-Driven Research to Data-Driven Clinical Care. TRANSLATIONAL BIOINFORMATICS 2016. [DOI: 10.1007/978-94-017-7543-4_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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Fernández Del Río R, O'Hara ME, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Volatile Biomarkers in Breath Associated With Liver Cirrhosis - Comparisons of Pre- and Post-liver Transplant Breath Samples. EBioMedicine 2015; 2:1243-50. [PMID: 26501124 PMCID: PMC4588000 DOI: 10.1016/j.ebiom.2015.07.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background The burden of liver disease in the UK has risen dramatically and there is a need for improved diagnostics. Aims To determine which breath volatiles are associated with the cirrhotic liver and hence diagnostically useful. Methods A two-stage biomarker discovery procedure was used. Alveolar breath samples of 31 patients with cirrhosis and 30 healthy controls were mass spectrometrically analysed and compared (stage 1). 12 of these patients had their breath analysed after liver transplant (stage 2). Five patients were followed longitudinally as in-patients in the post-transplant period. Results Seven volatiles were elevated in the breath of patients versus controls. Of these, five showed statistically significant decrease post-transplant: limonene, methanol, 2-pentanone, 2-butanone and carbon disulfide. On an individual basis limonene has the best diagnostic capability (the area under a receiver operating characteristic curve (AUROC) is 0.91), but this is improved by combining methanol, 2-pentanone and limonene (AUROC curve 0.95). Following transplant, limonene shows wash-out characteristics. Conclusions Limonene, methanol and 2-pentanone are breath markers for a cirrhotic liver. This study raises the potential to investigate these volatiles as markers for early-stage liver disease. By monitoring the wash-out of limonene following transplant, graft liver function can be non-invasively assessed. Breath volatiles were compared for cirrhotic patients and controls and pre- and post-liver transplant. Three volatiles (limonene, methanol, 2-pentanone) have been found to have excellent diagnostic capabilities. Limonene shows washout characteristics following transplant supporting a hypothesis that it accumulates in fat.
There are numerous previous studies investigating breath volatiles in patients with liver disease but with conflicting results. It is impossible to tell which volatiles from previous studies may be false discoveries, and which are actually associated with the disease. We measured breath samples in patients and controls and in patients after transplant. Methanol, 2-pentanone and limonene show differences not only between patients and controls but also in cases pre- and post-transplant and have excellent diagnostic capabilities. We show evidence that limonene accumulates in the body, probably because the cirrhotic liver fails to metabolise dietary limonene.
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Key Words
- AID, autoimmune liver disease
- ALD, alcoholic liver disease
- AUROC, area under receiver operator curve
- BMI, body mass index
- Breath analysis
- CD, cryptogenic disease
- Cirrhosis
- Diagnosis limonene
- GC, gas chromatography
- HBV, hepatitis B virus
- HCC, hepatocellular cancer
- HCV, hepatitis C virus
- ITU, intensive treatment unit
- LQ, lower quartile
- Liver transplant
- MS, mass spectrometry
- OPU, out-patient clinic
- PBC, primary biliary cirrhosis
- PSC, primary sclerosing cholangitis
- PTR-MS
- PTR-MS, proton transfer reaction mass spectrometry
- ROC, Receiver operating characteristics
- TAC, transplant assessment clinic
- TE, transient elastography
- UKELD, United Kingdom model for end-stage liver disease
- UQ, upper quartile
- VMR, volume mixing ratio
- VOC, volatile organic compounds
- Volatile organic compounds
- ppbv, parts per billion by volume
- ppmv, parts per million by volume
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Affiliation(s)
- R Fernández Del Río
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - A Holt
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - P Pemberton
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Shah
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Whitehouse
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - C A Mayhew
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
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Mueller S, Seitz HK, Rausch V. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20:14626-41. [PMID: 25356026 PMCID: PMC4209529 DOI: 10.3748/wjg.v20.i40.14626] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/30/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
Alcoholic liver disease (ALD) is the most common liver disease in the Western world. For many reasons, it is underestimated and underdiagnosed. An early diagnosis is absolutely essential since it (1) helps to identify patients at genetic risk for ALD; (2) can trigger efficient abstinence namely in non-addicted patients; and (3) initiate screening programs to prevent life-threatening complications such as bleeding from varices, spontaneous bacterial peritonitis or hepatocellular cancer. The two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis (AH). The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on a combination of laboratory, clinical and imaging findings. It is not widely conceived that conventional screening tools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca. 40% of manifest alcoholic liver cirrhosis. Non-invasive methods such as transient elastography (Fibroscan), acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of alcoholic cirrhosis. Present algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca. 95% of patients. The correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase levels. Other non-invasive methods such as controlled attenuation parameter, serum levels of M30 or M65, susceptometry or breath tests are under current evaluation to assess the degree of steatosis, apoptosis and iron overload in these patients. Liver biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.
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Detection of volatile organic compounds as biomarkers in breath analysis by different analytical techniques. Bioanalysis 2013; 5:2287-306. [DOI: 10.4155/bio.13.183] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Breath is a rich mixture containing numerous volatile organic compounds at trace amounts (ppbv–pptv level) such as: hydrocarbons, alcohols, ketones, aldehydes, esters or heterocycles. The presence of some of them depends on health status. Therefore, breath analysis might be useful for clinical diagnostics, therapy monitoring and control of metabolic or biochemical cell cycle products. This Review presents an update on the latest developments in breath analysis applied to diagnosing different diseases with the help of high-quality equipment. Efforts were made to fully and accurately describe traditional and modern techniques used to determine the components of breath. The techniques were compared in terms of design, function and also detection limit of different volatile organic compounds. GC with different detectors, MS, optical sensor and laser spectroscopic detection techniques are also discussed.
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Verdam FJ, Dallinga JW, Driessen A, de Jonge C, Moonen EJC, van Berkel JBN, Luijk J, Bouvy ND, Buurman WA, Rensen SS, Greve JWM, van Schooten FJ. Non-alcoholic steatohepatitis: a non-invasive diagnosis by analysis of exhaled breath. J Hepatol 2013; 58:543-8. [PMID: 23142062 DOI: 10.1016/j.jhep.2012.10.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 10/10/2012] [Accepted: 10/31/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Histological evaluation of a liver biopsy is the current gold standard to diagnose non-alcoholic steatohepatitis (NASH), but the procedure to obtain biopsies is associated with morbidity and high costs. Hence, only subjects at high risk are biopsied, leading to underestimation of NASH prevalence, and undertreatment. Since analysis of volatile organic compounds in breath has been shown to accurately identify subjects with other chronic inflammatory diseases, we investigated its potential as a non-invasive tool to diagnose NASH. METHODS Wedge-shaped liver biopsies from 65 subjects (BMI 24.8-64.3 kg/m(2)) were obtained during surgery and histologically evaluated. The profile of volatile organic compounds in pre-operative breath samples was analyzed by gas chromatography-mass spectrometry and related to liver histology scores and plasma parameters of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). RESULTS Three exhaled compounds were sufficient to distinguish subjects with (n=39) and without NASH (n=26), with an area under the ROC curve of 0.77. The negative and positive predictive values were 82% and 81%. In contrast, elevated ALT levels or increased AST/ALT ratios both showed negative predictive values of 43%, and positive predictive values of 88% and 70%, respectively. The breath test reduced the hypothetical percentage of undiagnosed NASH patients from 67-79% to 10%, and of misdiagnosed subjects from 49-51% to 18%. CONCLUSIONS Analysis of volatile organic compounds in exhaled air is a promising method to indicate NASH presence and absence. In comparison to plasma transaminase levels, the breath test significantly reduced the percentage of missed NASH patients and the number of unnecessarily biopsied subjects.
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Affiliation(s)
- Froukje J Verdam
- Department of General Surgery, Nutrition and Toxicology Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Dolch ME, Hornuss C, Klocke C, Praun S, Villinger J, Denzer W, Schelling G, Schubert S. Volatile compound profiling for the identification of Gram-negative bacteria by ion-molecule reaction-mass spectrometry. J Appl Microbiol 2012; 113:1097-105. [PMID: 22830412 DOI: 10.1111/j.1365-2672.2012.05414.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/29/2012] [Accepted: 07/24/2012] [Indexed: 12/12/2022]
Abstract
AIMS Fast and reliable methods for the early detection and identification of micro-organism are of high interest. In addition to established methods, direct mass spectrometry-based analysis of volatile compounds (VCs) emitted by micro-organisms has recently been shown to allow species differentiation. Thus, a large number of pathogenic Gram-negative bacteria, which comprised Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Pseudomonas aeruginosa, Proteus vulgaris and Serratia marcescens, were subjected to headspace VC composition analysis using direct mass spectrometry in a low sample volume that allows for automation. METHODS AND RESULTS Ion-molecule reaction-mass spectrometry (IMR-MS) was applied to headspace analysis of the above bacterial samples incubated at 37°C starting with 10(2) CFU ml(-1) . Measurements of sample VC composition were performed at 4, 8 and 24 h. Microbial growth was detected in all samples after 8 h. After 24 h, species-specific mass spectra were obtained allowing differentiation between bacterial species. CONCLUSIONS IMR-MS provided rapid growth detection and identification of micro-organisms using a cumulative end-point model with a short analysis time of 3 min per sample. SIGNIFICANCE AND IMPACT OF THE STUDY Following further validation, the presented method of bacterial sample headspace VC analysis has the potential to be used for bacteria differentiation.
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Affiliation(s)
- M E Dolch
- Department of Anesthesiology, University Hospital Großhadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Valdecantos MP, Pérez-Matute P, Prieto-Hontoria PL, Sánchez-Campayo E, Moreno-Aliaga MJ, Martínez JA. Erythrocyte antioxidant defenses as a potential biomarker of liver mitochondrial status in different oxidative conditions. Biomarkers 2011; 16:670-8. [PMID: 21999619 DOI: 10.3109/1354750x.2011.625504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The need for minimally invasive biomarkers to predict the progression of non-alcoholic fatty liver disease to non-alcoholic steatohepatitis is a priority. Oxidative stress and mitochondrial dysfunction contribute in this physiopathological process. The aim of this study was to analyze the potential role of erythrocytes as surrogate biomarkers of hepatic mitochondrial oxidative status in an animal model under different dietary oxidative conditions. Interestingly, we found that erythrocyte antioxidant status correlated with triglyceride content (p < 0.05-p < 0.001), thiobarbituric acid reactive species levels (p < 0.001) and with liver mitochondrial antioxidant levels (p < 0.001). These data suggest that erythrocyte antioxidant defenses could be used as sensitive and minimally invasive biomarkers of mitochondrial status in diverse oxidative conditions.
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Affiliation(s)
- M Pilar Valdecantos
- Department of Nutrition, Food Science, Physiology and Toxicology University of Navarra, Pamplona, Spain
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Ciaffoni L, Peverall R, Ritchie GAD. Laser spectroscopy on volatile sulfur compounds: possibilities for breath analysis. J Breath Res 2011; 5:024002. [PMID: 21593551 DOI: 10.1088/1752-7155/5/2/024002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is an emerging interest in the detection of volatile sulfur compounds (VSCs) in the breath environment, given their biological relevance as potential signatures of several pathological conditions. Particularly, laser-based spectroscopic sensors are candidates for conducting accurate breath diagnostics in clinical settings. With these aims in mind, the current status of VSC sensing via laser absorption spectroscopy is reviewed in this paper. Attention has been focused on the most promising exhaled markers of pathological conditions, namely hydrogen sulfide, carbonyl sulfide, methanethiol, carbon disulfide and dimethyl sulfide. Details of the most relevant spectroscopic studies conducted on such molecules are presented, together with suggestions on the future direction of this challenging analytical field.
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Affiliation(s)
- L Ciaffoni
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford, OX1 3QZ, UK
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Baumgartner C, Osl M, Netzer M, Baumgartner D. Bioinformatic-driven search for metabolic biomarkers in disease. J Clin Bioinforma 2011; 1:2. [PMID: 21884622 PMCID: PMC3143899 DOI: 10.1186/2043-9113-1-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 01/20/2011] [Indexed: 02/06/2023] Open
Abstract
The search and validation of novel disease biomarkers requires the complementary power of professional study planning and execution, modern profiling technologies and related bioinformatics tools for data analysis and interpretation. Biomarkers have considerable impact on the care of patients and are urgently needed for advancing diagnostics, prognostics and treatment of disease. This survey article highlights emerging bioinformatics methods for biomarker discovery in clinical metabolomics, focusing on the problem of data preprocessing and consolidation, the data-driven search, verification, prioritization and biological interpretation of putative metabolic candidate biomarkers in disease. In particular, data mining tools suitable for the application to omic data gathered from most frequently-used type of experimental designs, such as case-control or longitudinal biomarker cohort studies, are reviewed and case examples of selected discovery steps are delineated in more detail. This review demonstrates that clinical bioinformatics has evolved into an essential element of biomarker discovery, translating new innovations and successes in profiling technologies and bioinformatics to clinical application.
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Affiliation(s)
- Christian Baumgartner
- Research Group for Clinical Bioinformatics, Institute of Electrical, Electronic and Bioengineering, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | - Melanie Osl
- Research Group for Clinical Bioinformatics, Institute of Electrical, Electronic and Bioengineering, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | - Michael Netzer
- Research Group for Clinical Bioinformatics, Institute of Electrical, Electronic and Bioengineering, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | - Daniela Baumgartner
- Clinical Division of Pediatric Cardiology, Department of Pediatrics, Innsbruck Medical University, Austria
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