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Ferrandino G, De Palo G, Murgia A, Birch O, Tawfike A, Smith R, Debiram-Beecham I, Gandelman O, Kibble G, Lydon AM, Groves A, Smolinska A, Allsworth M, Boyle B, van der Schee MP, Allison M, Fitzgerald RC, Hoare M, Snowdon VK. Breath Biopsy ® to Identify Exhaled Volatile Organic Compounds Biomarkers for Liver Cirrhosis Detection. J Clin Transl Hepatol 2023; 11:638-648. [PMID: 36969895 PMCID: PMC10037526 DOI: 10.14218/jcth.2022.00309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 11/01/2022] [Indexed: 03/29/2023] Open
Abstract
Background and Aims The prevalence of chronic liver disease in adults exceeds 30% in some countries and there is significant interest in developing tests and treatments to help control disease progression and reduce healthcare burden. Breath is a rich sampling matrix that offers non-invasive solutions suitable for early-stage detection and disease monitoring. Having previously investigated targeted analysis of a single biomarker, here we investigated a multiparametric approach to breath testing that would provide more robust and reliable results for clinical use. Methods To identify candidate biomarkers we compared 46 breath samples from cirrhosis patients and 42 from controls. Collection and analysis used Breath Biopsy OMNI™, maximizing signal and contrast to background to provide high confidence biomarker detection based upon gas chromatography mass spectrometry (GC-MS). Blank samples were also analyzed to provide detailed information on background volatile organic compounds (VOCs) levels. Results A set of 29 breath VOCs differed significantly between cirrhosis and controls. A classification model based on these VOCs had an area under the curve (AUC) of 0.95±0.04 in cross-validated test sets. The seven best performing VOCs were sufficient to maximize classification performance. A subset of 11 VOCs was correlated with blood metrics of liver function (bilirubin, albumin, prothrombin time) and separated patients by cirrhosis severity using principal component analysis. Conclusions A set of seven VOCs consisting of previously reported and novel candidates show promise as a panel for liver disease detection and monitoring, showing correlation to disease severity and serum biomarkers at late stage.
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Affiliation(s)
| | | | | | | | | | | | - Irene Debiram-Beecham
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | | | - Graham Kibble
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | - Anne Marie Lydon
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | - Alice Groves
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, UK
| | - Agnieszka Smolinska
- Owlstone Medical, Cambridge, UK
- Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, the Netherlands
| | | | | | | | - Michael Allison
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
- Addenbrookes Hepatology and Liver Transplantation Unit, Addenbrookes Hospital, Cambridge, UK
| | - Rebecca C. Fitzgerald
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Matthew Hoare
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
- Addenbrookes Hepatology and Liver Transplantation Unit, Addenbrookes Hospital, Cambridge, UK
- CRUK Cambridge Institute, Cambridge, UK
| | - Victoria K. Snowdon
- Addenbrookes Hepatology and Liver Transplantation Unit, Addenbrookes Hospital, Cambridge, UK
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Ferrandino G, Orf I, Smith R, Calcagno M, Thind AK, Debiram-Beecham I, Williams M, Gandelman O, de Saedeleer A, Kibble G, Lydon AM, Mayhew CA, Allsworth M, Boyle B, van der Schee MP, Allison M, Hoare M, Snowdon VK. Breath Biopsy Assessment of Liver Disease Using an Exogenous Volatile Organic Compound-Toward Improved Detection of Liver Impairment. Clin Transl Gastroenterol 2020; 11:e00239. [PMID: 33094960 PMCID: PMC7498135 DOI: 10.14309/ctg.0000000000000239] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Liver cirrhosis and its complication - hepatocellular carcinoma (HCC) - have been associated with increased exhaled limonene. It is currently unclear whether this increase is more strongly associated with the presence of HCC or with the severity of liver dysfunction. METHODS We compared the exhaled breath of 40 controls, 32 cirrhotic patients, and 12 cirrhotic patients with HCC using the Breath Biopsy platform. Breath samples were analyzed by thermal desorption-gas chromatography-mass spectrometry. Limonene levels were compared between the groups and correlated to bilirubin, albumin, prothrombin time international normalized ratio, and alanine aminotransferase. RESULTS Breath limonene concentration was significantly elevated in subjects with cirrhosis-induced HCC (M: 82.1 ng/L, interquartile range [IQR]: 16.33-199.32 ng/L) and cirrhosis (M: 32.6 ng/L, IQR: 6.55-123.07 ng/L) compared with controls (M: 6.2 ng/L, IQR: 2.62-9.57 ng/L) (P value = 0.0005 and 0.0001, respectively) with no significant difference between 2 diseased groups (P value = 0.37). Levels of exhaled limonene correlated with serum bilirubin (R = 0.25, P value = 0.0016, r = 0.51), albumin (R = 0.58, P value = 5.3e-8, r = -0.76), and international normalized ratio (R = 0.29, P value = 0.0003, r = 0.51), but not with alanine aminotransferase (R = 0.01, P value = 0.36, r = 0.19). DISCUSSION Exhaled limonene levels are primarily affected by the presence of cirrhosis through reduced liver functional capacity, as indicated by limonene correlation with blood metrics of impaired hepatic clearance and protein synthesis capacity, without further alterations observed in subjects with HCC. This suggests that exhaled limonene is a potential non-invasive marker of liver metabolic capacity (see Visual abstract, Supplementary Digital Content 1, http://links.lww.com/CTG/A388).
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Affiliation(s)
| | - Isabel Orf
- Owlstone Medical, Cambridge, UK
- Current affiliation: Human Metabolome Technologies, Leiden, the Netherlands
| | | | | | | | - Irene Debiram-Beecham
- Department of Oncology, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | | | | | | | - Graham Kibble
- Department of Oncology, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Anne Marie Lydon
- Department of Oncology, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Chris A. Mayhew
- Institute for Breath Research, Leopold-Franzens-Universität Innsbruck, Dornbirn, Austria
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham, Birmingham, UK
| | | | | | | | - Michael Allison
- Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Addenbrooke's Hepatology and Liver Transplantation Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Matthew Hoare
- Addenbrooke's Hepatology and Liver Transplantation Unit, Addenbrooke's Hospital, Cambridge, UK
- CRUK Cambridge Institute, Cambridge, UK
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Victoria K. Snowdon
- Addenbrooke's Hepatology and Liver Transplantation Unit, Addenbrooke's Hospital, Cambridge, UK
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Gouda BB, Lydon AM, Badhe A, Shorten GD. A comparison of the effects of ranitidine and omeprazole on volume and pH of gastric contents in elective surgical patients. Eur J Anaesthesiol 2004; 21:260-4. [PMID: 15109187 DOI: 10.1017/s0265021504004028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE In cases of aspiration of gastric contents the risk of pneumonitis is dependent on the pH and volume of the gastric contents. Omeprazole and rantidine each decrease gastric volume and increase gastric pH. We evaluated the efficacy of preoperative administration of omeprazole (60 mg) or ranitidine (150 mg) in the prophylaxis of aspiration pneumonitis. METHODS Data were obtained from 75 elective female surgical patients randomly allocated to one of three groups, who received either omeprazole 60 mg orally, or ranitidine 150 mg orally, or neither, on the evening prior to, and on the morning of, surgery. Gastric volume and pH was measured using blind aspiration. RESULTS Both pH < 2.5 and volume > 25 mL were present in none of the patients in either the ranitidine or omeprazole groups, compared to 15 of 25 control patients (P < 0.0001). CONCLUSIONS Preoperative oral administration of omeprazole (60 mg) or ranitidine (150 mg) reduced residual gastric content volume and increased pH > 2.5, possibly reducing the effects of pulmonary aspiration of gastric contents.
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Affiliation(s)
- B B Gouda
- Jawaharlal Institute of Postgraduate Medical Education and Research, Department of Anesthesiology, Pondicherry, India
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Abstract
Patient-ventilator interactions may be coordinated (synchronous) or uncoordinated (dyssynchronous). Ventilator-patient dyssynchrony increases the work of breathing by imposing a respiratory muscle workload. Respiratory centre output responds to feedback from respiratory muscle loading. Mismatching of respiratory centre output and mechanical assistance results in dyssynchrony. We describe a case of severe patient-ventilator dyssynchrony and hypothesize that dyssynchrony was induced by a change in mode of ventilation from pressure-cycled to volume-cycled ventilation, due to both ventilator settings and by the patient's own respiratory centre adaptation to mechanical ventilation. The causes, management and clinical implications of dyssynchrony are discussed.
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Affiliation(s)
- A M Lydon
- Department of Anaesthesia and Intensive Care Medicine, Adelaide and Meath Hospital, National Children's Hospital, Tallaght, Dublin, Ireland
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Lydon AM, Cooke T, Duggan F, Shorten GD. Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine. Can J Anaesth 1999; 46:544-9. [PMID: 10391601 DOI: 10.1007/bf03013544] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE A decrease in the rate of gastric emptying can delay resumption of enteral feeding, alter bioavailability of orally administered drugs, and result in larger residual gastric volumes, increasing the risk of nausea and vomiting. We compared the effects of 1) intrathecal bupivacaine (17.5 mg) and 2) the combination of intrathecal morphine (0.6 mg) and intrathecal bupivacaine (17.5 mg) on the rate of gastric emptying in patients undergoing elective hip arthroplasty. METHODS Twenty four fasting ASA 1-3 patients were randomly assigned, in a double blind manner, to receive intrathecal hyperbaric bupivacaine (17.5 mg), either alone (group 1), or followed by intrathecal morphine (0.6 mg) (group 2). Gastric emptying was measured (using an acetaminophen absorption technique), twice in each patient; preoperatively, and approximately one hour postoperatively. Gastric emptying parameters are: AUC (area under the plasma acetaminophen concentration time curve), maximum plasma acetaminophen concentration (Cmax), and time to Cmax (tCmax), analyzed using paired Student's t tests. RESULTS Gastric emptying rates were reduced in both group 1 (AUC = 14.98 (3.8) and 11.05 (4.6) pre- and postoperatively, respectively) and group 2 (AUC = 13.93 (3.59) and 6.4 (3.42) pre- and postoperatively, respectively); the magnitude of the reduction was greater in group 2 [AUC (P = 0.04), Cmax (P = 0.05), tCmax (P = 0.13)]. CONCLUSION The combination of intrathecal morphine (0.6 mg) and intrathecal bupivacaine (17.5 mg) delays gastric emptying postoperatively.
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Affiliation(s)
- A M Lydon
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland
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Affiliation(s)
- A M Lydon
- Department of Anaesthesia and Intensive Care, St. Vincent's Hospital, Dublin, Ireland
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