Analysis of VOCs in Urine Samples Directed towards of Bladder Cancer Detection

Clinical applications of volatilomic assays

The study of metabolomics is revealing immense potential for diagnosis, therapy monitoring, and understanding of pathogenesis processes. Volatilomics is a subcategory of metabolomics interested in the detection of molecules that are small enough to be released in the gas phase. Volatile compounds produced by cellular processes are released into the blood and lymph, and can reach the external environment through different pathways, such as the blood-air interface in the lung that are detected in breath, or the blood-water interface in the kidney that leads to volatile compounds detected in urine. Besides breath and urine, additional sources of volatile compounds such as saliva, blood, feces, and skin are available. Volatilomics traces its roots back over fifty years to the pioneering investigations in the 1970s. Despite extensive research, the field remains in its infancy, hindered by a lack of standardization despite ample experimental evidence. The proliferation of analytical instrumentations, sample preparations and methods of volatilome sampling still make it difficult to compare results from different studies and to establish a common standard approach to volatilomics. This review aims to provide an overview of volatilomics' diagnostic potential, focusing on two key technical aspects: sampling and analysis. Sampling poses a challenge due to the susceptibility of human samples to contamination and confounding factors from various sources like the environment and lifestyle. The discussion then delves into targeted and untargeted approaches in volatilomics. Some case studies are presented to exemplify the results obtained so far. Finally, the review concludes with a discussion on the necessary steps to fully integrate volatilomics into clinical practice.

Evaluation of N-NOSE as a surveillance tool for recurrence in gastric and esophageal cancers: a prospective cohort study

OBJECTIVE

Early detection of recurrent gastric and esophageal cancers remains a critical challenge. Innovative and non-invasive cancer screening technologies, such as N-NOSE, can improve early detection. N-NOSE is a urine-based scent test that leverages the olfactory abilities of the nematode C. elegans. For the first time, this prospective study evaluates the efficacy of the N-NOSE chemotaxis index as a novel biomarker for postoperative surveillance and recurrence in patients with upper gastrointestinal cancers.

METHODS

A two-year prospective cohort study was conducted at The University of Tokyo Hospital, involving 40 patients with gastric and esophageal cancers. Urine samples were collected pre- and postoperatively and analysed using the N-NOSE technique.

RESULTS

In cases of recurrence with vascular invasion, the chemotaxis index at 100-fold urine dilution was significantly elevated compared to the non-recurrence group.

CONCLUSION

This study suggests the potential of N-NOSE as an effective follow-up tool for patients with upper gastrointestinal cancer, particularly those with vascular invasion. While N-NOSE has been validated to distinguish between cancer and non-cancer, and its performance compared to traditional markers has been proven, it has not been studied for recurrence. Our data highlights, for the first time, the capability of N-NOSE in the surveillance of cancer recurrence.

Exploring Components, Sensors, and Techniques for Cancer Detection via eNose Technology: A Systematic Review

This paper offers a systematic review of advancements in electronic nose technologies for early cancer detection with a particular focus on the detection and analysis of volatile organic compounds present in biomarkers such as breath, urine, saliva, and blood. Our objective is to comprehensively explore how these biomarkers can serve as early indicators of various cancers, enhancing diagnostic precision and reducing invasiveness. A total of 120 studies published between 2018 and 2023 were examined through systematic mapping and literature review methodologies, employing the PICOS (Population, Intervention, Comparison, Outcome, and Study design) methodology to guide the analysis. Of these studies, 65.83% were ranked in Q1 journals, illustrating the scientific rigor of the included research. Our review synthesizes both technical and clinical perspectives, evaluating sensor-based devices such as gas chromatography-mass spectrometry and selected ion flow tube-mass spectrometry with reported incidences of 30 and 8 studies, respectively. Key analytical techniques including Support Vector Machine, Principal Component Analysis, and Artificial Neural Networks were identified as the most prevalent, appearing in 22, 24, and 13 studies, respectively. While substantial improvements in detection accuracy and sensitivity are noted, significant challenges persist in sensor optimization, data integration, and adaptation into clinical settings. This comprehensive analysis bridges existing research gaps and lays a foundation for the development of non-invasive diagnostic devices. By refining detection technologies and advancing clinical applications, this work has the potential to transform cancer diagnostics, offering higher precision and reduced reliance on invasive procedures. Our aim is to provide a robust knowledge base for researchers at all experience levels, presenting insights on sensor capabilities, metrics, analytical methodologies, and the transformative impact of emerging electronic nose technologies in clinical practice.

Potential urinary volatile organic compounds as screening markers in cancer - a review

Early detection of cancer typically facilitates improved patient outcomes; however, many cancers are not easily diagnosed at an early stage. One potential route for developing new, non-invasive methods of cancer detection is by testing for cancer-related volatile organic compounds (VOCs) biomarkers in patients' urine. In this review, 44 studies covering the use and/or identification of cancer-related VOCs were examined, including studies which examined multiple types of cancer simultaneously, as well as diverse study designs. Among these studies the most studied cancers included prostate cancer (29% of papers), lung cancer (22%), breast cancer (20%), and bladder cancer (18%), with a smaller number of studies focused on colorectal cancer, cervical cancer, skin, liver cancer and others. Importantly, most studies which produced a VOC-based model of cancer detection observed a combined sensitivity and specificity above 150%, indicating that urine-based methods of cancer detection show considerable promise as a diagnostic tool. Mass spectrometry (MS) and electronic noses (eNose) were the most employed tools used in the detection of VOCs, while animal-based models were less common. In terms of VOCs of interest, 47 chemical species identified as correlated with various types of cancer in at least two unrelated papers, some of which were consistently up- or down-regulated in cancer patients, and which may represent useful targets for future studies investing urinary VOC biomarkers of cancer. Overall, it was concluded that research in this field has shown promising results, but more work may be needed before the widespread adoption of these techniques takes place.

Quantification of cancer biomarkers in urine using volatilomic approach

Urine analysis is an attractive approach for non-invasive cancer diagnostics. In this study, a procedure for the determination of volatile organic compounds (VOCs) in human urine (acetone, acetonitrile, dimethylsulfide, dimethyl disulfide, dimethyl trisulfide, hexane, benzene, toluene, 2-butanone, 2-pentanone, pentanal) has been described including sample preparation using preconcentration of analytes in sorbent tubes followed by gas chromatography with mass spectrometry (GC-MS). Fractional factorial design and constrained surfaces design were used to optimize preconcentration of VOCs in sorbent tubes. The procedure was validated by analysis of synthetic urine containing VOC standards in the concentration range of 1-5000 ng/mL. Optimized procedure was applied to analyze urine samples of 89 healthy volunteers and 85 patients with cancer of various localizations: 42 patients with lung cancer, 25 - colon, 3 - stomach, 2 - prostate, 2 - esophageal, 2 - pancreas, 2 - kidney, 1 - ovarian, 1 - cervical, 1 - skin, 1 - liver. Concentrations of 2-butanone, 2-pentanone, acetonitrile, and benzene were found different in urine of patients with cancer and healthy individuals. Influence of cancer localization and tumor, nodule, metastasis stage on urine VOC profile was considered. The approach of using ratios of VOCs to the main ones instead of concentrations was considered. A diagnostic model based on significantly different VOC ratios was created to classify healthy individuals and patients with cancer using artificial neural network (ANN). The model was validated during construction by means of 3-fold cross-validation. Average area under receiver operating characteristic (ROC) curve on test dataset was 0.886. Average sensitivity and specificity of the created model were 91 % and 82 %.

The human volatilome meets cancer diagnostics: past, present, and future of noninvasive applications

BACKGROUND

Cancer is a significant public health problem, causing dozens of millions of deaths annually. New cancer screening programs are urgently needed for early cancer detection, as this approach can improve treatment outcomes and increase patient survival. The search for affordable, noninvasive, and highly accurate cancer detection methods revealed a valuable source of tumor-derived metabolites in the human metabolome through the exploration of volatile organic compounds (VOCs) in noninvasive biofluids.

AIM OF REVIEW

This review discusses volatilomics-based approaches for cancer detection using noninvasive biomatrices (breath, saliva, skin secretions, urine, feces, and earwax). We presented the historical background, the latest approaches, and the required stages for clinical validation of volatilomics-based methods, which are still lacking in terms of making noninvasive methods available and widespread to the population. Furthermore, insights into the usefulness and challenges of volatilomics in clinical implementation steps for each biofluid are highlighted.

KEY SCIENTIFIC CONCEPTS OF REVIEW

We outline the methodologies for using noninvasive biomatrices with up-and-coming clinical applications in cancer diagnostics. Several challenges and advantages associated with the use of each biomatrix are discussed, aiming at encouraging the scientific community to strengthen efforts toward the necessary steps to speed up the clinical translation of volatile-based cancer detection methods, as well as discussing in favor of (i) hybrid applications (i.e., using more than one biomatrix) to describe metabolite modulations that can be "cancer volatile fingerprints" and (ii) in multi-omics approaches integrating genomics, transcriptomics, and proteomics into the volatilomic data, which might be a breakthrough for diagnostic purposes, onco-pathway assessment, and biomarker validations.

Exploiting volatile fingerprints for bladder cancer diagnosis: A scoping review of metabolomics and sensor-based approaches

Bladder cancer (BC) represents a significant global health concern, for which early detection is essential to improve patient outcomes. This review evaluates the potential of the urinary volatile organic compounds (VOCs) as biomarkers for detecting and staging BC. The methods used include gas chromatography-mass spectrometry (GC-MS)-based metabolomics and electronic-nose (e-nose) sensors. The GC-MS studies that have been published reveal diverse results in terms of diagnostic performance. The sensitivities range from 27 % to an impressive 97 %, while specificities vary between 43 % and 94 %. Furthermore, the accuracies reported in these studies range from 80 to 89 %. In the urine of BC patients, a total of 80 VOCs were discovered to be significantly altered when compared to controls. These VOCs encompassed a variety of chemical classes such as alcohols, aldehydes, alkanes, aromatic compounds, fatty acids, ketones, and terpenoids, among others. Conversely, e-nose-based studies displayed sensitivities from 60 to 100 %, specificities from 53 to 96 %, and accuracies from 65 to 97 %. Interestingly, conductive polymer-based sensors performed better, followed by metal oxide semiconductor and optical sensors. GC-MS studies have shown improved performance in detecting early stages and low-grade tumors, providing valuable insights into staging. Based on these findings, VOC-based diagnostic tools hold great promise for early BC detection and staging. Further studies are needed to validate biomarkers and their classification performance. In the future, advancements in VOC profiling technologies may significantly contribute to improving the overall survival and quality of life for BC patients.

Urinary VOCs as biomarkers of early stage lung tumour development in mice

BACKGROUND

Lung cancer is the primary cause of cancer-induced death. In addition to prevention and improved treatment, it has increasingly been established that early detection is critical to successful remission.

OBJECTIVE

The aim of this study was to identify volatile organic compounds (VOCs) in urine that could help diagnose mouse lung cancer at an early stage of its development.

METHODS

We analysed the VOC composition of urine in a genetically engineered lung adenocarcinoma mouse model with oncogenic EGFR doxycycline-inducible lung-specific expression. We compared the urinary VOCs of 10 cancerous mice and 10 healthy mice (controls) before and after doxycycline induction, every two weeks for 12 weeks, until full-blown carcinomas appeared. We used SPME fibres and gas chromatography - mass spectrometry to detect variations in cancer-related urinary VOCs over time.

RESULTS

This study allowed us to identify eight diagnostic biomarkers that help discriminate early stages of cancer tumour development (i.e., before MRI imaging techniques could identify it).

CONCLUSION

The analysis of mice urinary VOCs have shown that cancer can induce changes in odour profiles at an early stage of cancer development, opening a promising avenue for early diagnosis of lung cancer in other models.

Detection of tuberculosis-associated compounds from human skin by GCxGC-TOFMS

Tuberculosis (TB) remains a global health concern. This study aimed to investigate the potential of human skin volatile organic compounds (VOCs) as prospective biomarkers for TB diagnosis. It employed a non-invasive approach using a wearable silicone rubber band for VOC sampling, comprehensive gas chromatography - time of flight mass spectrometry (GCxGC-TOFMS), and chemometric techniques. Both targeted and untargeted biochemical screening was utilized to explore biochemical differences between healthy individuals and those with TB infection. Results confirmed a correlation between compounds found in this study, and those reported for TB from other biofluids. In a comparison to known TB-associated compounds from other biofluids our analysis established the presence of 27 of these compounds emanating from human skin. Additionally, 16 previously unreported compounds were found as potential biomarkers. The diagnostic ability of the VOCs selected by statistical methods was investigated using predictive modelling techniques. Artificial neural network multi-layered perceptron (ANN) yielded two compounds, 1H-indene, 2,3 dihydro-1,1,3-trimethyl-3-phenyl; and heptane-3-ethyl-2-methyl, as the most discriminatory, and could differentiate between TB-positive (n = 15) and TB-negative (n = 23) individuals with an area under the receiver operating characteristic curve (AUROC) of 92 %, a sensitivity of 100 % and a specificity of 94 % for six targeted features. For untargeted analysis, ANN assigned 3-methylhexane as the most discriminatory between TB-positive and TB- negative individuals. An AUROC of 98.5 %, a sensitivity of 83 %, and a specificity of 88 % were obtained for 16 untargeted features as chosen by high performance variable selection. The obtained values compare highly favourable to alternative diagnostic methods such as breath analysis and GeneXpert. Consequently, human skin VOCs hold considerable potential as a TB diagnostic screening test.

A PVDF-based colorimetric sensor array for noninvasive detection of multiple disease-related volatile organic compounds

Detection of human-generated volatile organic compounds (VOCs) is a new pathway for assessing health. Herein, a polyvinylidene fluoride (PVDF)-based colorimetric sensor array was designed for detecting disease-related VOCs (DVOCs) within 15 min, using a complex of Cu metal-organic framework, graphene aerogel, and dyes as response materials. Fingermaps derived from 28 DVOCs were obtained for further data processing. Pattern recognition was successfully employed in the correct discrimination of 28 DVOCs in low (10 μM), medium (100 μM), and high (300 μM) concentrations. Importantly, the sensor array also presented excellent discrimination ability and application potential when detecting VOCs produced by human cancer and normal cells. In general, VOC acquisition is noninvasive and harmless, and the PVDF-based sensor arrays are simple and visual. Such advantages expand their further application potential.

Detection of urological cancers by the signature of organic volatile compounds in urine, from dogs to electronic noses

PURPOSE OF REVIEW

Urine volatile organic compound (VOC) testing for early detection of urological cancers is a minimally invasive and promising method. The objective of this review was to present the results of recently published work on this subject.

RECENT FINDINGS

Organic volatile compounds are produced through oxidative stress and peroxidation of cell membranes, and they are eliminated through feces, urine, and sweat. Studies looking for VOCs in urine for the diagnosis of urological cancers have mostly focused on bladder and prostate cancers. However, the number of patients included in the studies was small. The electronic nose was the most widely used means of detecting VOCs in urine for the detection of urological cancers. MOS sensors and pattern recognition machine learning were more used for the composition of electronic noses. Early detection of urological cancers by detection of VOCs in urine is a method with encouraging results with sensitivities ranging from 27 to 100% and specificities ranging from 72 to 94%.

SUMMARY

The olfactory signature of urine from patients with urological cancers is a promising biomarker for the early diagnosis of urological cancers. The electronic nose with its ability to recognize complex odors is an excellent alterative to canine diagnosis and analytical techniques. Nevertheless, additional research improving the technology of Enoses and the methodology of the studies is necessary for its implementation in daily clinical practice.

Differences in the Volatilomic Urinary Biosignature of Prostate Cancer Patients as a Feasibility Study for the Detection of Potential Biomarkers

Prostate cancer (PCa) continues to be the second most common malignant tumour and the main cause of oncological death in men. Investigating endogenous volatile organic metabolites (VOMs) produced by various metabolic pathways is emerging as a novel, effective, and non-invasive source of information to establish the volatilomic biosignature of PCa. In this study, headspace solid-phase microextraction combined with gas chromatography-mass spectrometry (HS-SPME/GC-MS) was used to establish the urine volatilomic profile of PCa and identify VOMs that can discriminate between the two investigated groups. This non-invasive approach was applied to oncological patients (PCa group, n = 26) and cancer-free individuals (control group, n = 30), retrieving a total of 147 VOMs from various chemical families. This included terpenes, norisoprenoid, sesquiterpenes, phenolic, sulphur and furanic compounds, ketones, alcohols, esters, aldehydes, carboxylic acid, benzene and naphthalene derivatives, hydrocarbons, and heterocyclic hydrocarbons. The data matrix was subjected to multivariate analysis, namely partial least-squares discriminant analysis (PLS-DA). Accordingly, this analysis showed that the group under study presented different volatomic profiles and suggested potential PCa biomarkers. Nevertheless, a larger cohort of samples is required to boost the predictability and accuracy of the statistical models developed.

Production, Function, and Applications of the Sesquiterpenes Valencene and Nootkatone: a Comprehensive Review

Valencene and nootkatone, two sesquiterpenes, extracted from natural sources, have great market potential with diverse applications. This paper aims to comprehensively review the recent advances in valencene and nootkatone, including source, production, physicochemical and biological properties, safety and pharmacokinetics evaluation, potential uses, and their industrial applications as well as future research directions. Microbial biosynthesis offers a promising alternative approach for sustainable production of valencene and nootkatone. Both compounds exert various beneficial activities, including antimicrobial, insecticidal, antioxidant, anti-inflammatory, anticancer, cardioprotective, neuroprotective, hepatoprotective, and nephroprotective and other activities. However, most of the studies are performed in animals and in vitro, making it difficult to give a conclusive description about their health benefits and extend their application. Hence, more attention should be paid to in vivo and long-term clinical studies in the future. Moreover, valencene and nootkatone are considered safe for consumption and show great promise in the applications of food, cosmetic, pharmaceutical, chemical, and agricultural industries.

C. elegans as a Powerful Tool for Cancer Screening

Regular cancer screening is critical for early cancer detection. Cancer screening tends to be burdensome, invasive, and expensive, especially for a comprehensive multi-organ check. Improving the rate and effectiveness of routine cancer screenings remain a challenge in health care. Multi-cancer early detection (MCED) is an exciting concept and a potentially effective solution for addressing current issues with routine cancer screening. In recent years, several technologies have matured for MCED, such as identifying cell-free tumor DNA in blood or using organisms such as Caenorhabditis elegans as a tool for early cancer detection. In Japan, N-NOSE is a commercially available multi-cancer detection test based on the chemotaxis of C. elegans using a urine sample showing 87.5% sensitivity and 90.2% specificity. In this review, we focus on using C. elegans as a powerful biosensor for universal cancer screening. We review N-NOSE clinical research results, spotlighting it as an effective primary cancer screening test.