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Murray KJ, Villalta PW, Griffin TJ, Balbo S. Discovery of Modified Metabolites, Secondary Metabolites, and Xenobiotics by Structure-Oriented LC-MS/MS. Chem Res Toxicol 2023; 36:1666-1682. [PMID: 37862059 DOI: 10.1021/acs.chemrestox.3c00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Exogenous compounds and metabolites derived from therapeutics, microbiota, or environmental exposures directly interact with endogenous metabolic pathways, influencing disease pathogenesis and modulating outcomes of clinical interventions. With few spectral library references, the identification of covalently modified biomolecules, secondary metabolites, and xenobiotics is a challenging task using global metabolomics profiling approaches. Numerous liquid chromatography-coupled mass spectrometry (LC-MS) small molecule analytical workflows have been developed to curate global profiling experiments for specific compound groups of interest. These workflows exploit shared structural moiety, functional groups, or elemental composition to discover novel and undescribed compounds through nontargeted small molecule discovery pipelines. This Review introduces the concept of structure-oriented LC-MS discovery methodology and aims to highlight common approaches employed for the detection and characterization of covalently modified biomolecules, secondary metabolites, and xenobiotics. These approaches represent a combination of instrument-dependent and computational techniques to rapidly curate global profiling experiments to detect putative ions of interest based on fragmentation patterns, predictable phase I or phase II metabolic transformations, or rare elemental composition. Application of these methods is explored for the detection and identification of novel and undescribed biomolecules relevant to the fields of toxicology, pharmacology, and drug discovery. Continued advances in these methods expand the capacity for selective compound discovery and characterization that promise remarkable insights into the molecular interactions of exogenous chemicals with host biochemical pathways.
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Affiliation(s)
- Kevin J Murray
- Department of Biochemistry, Molecular Biology, and Biophysics, College of Biological Science, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Peter W Villalta
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Timothy J Griffin
- Department of Biochemistry, Molecular Biology, and Biophysics, College of Biological Science, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Silvia Balbo
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, United States
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Fernández-García M, Ares-Arroyo M, Wedel E, Montero N, Barbas C, Rey-Stolle MF, González-Zorn B, García A. Multiplatform Metabolomics Characterization Reveals Novel Metabolites and Phospholipid Compositional Rules of Haemophilus influenzae Rd KW20. Int J Mol Sci 2023; 24:11150. [PMID: 37446331 DOI: 10.3390/ijms241311150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Haemophilus influenzae is a gram-negative bacterium of relevant clinical interest. H. influenzae Rd KW20 was the first organism to be sequenced and for which a genome-scale metabolic model (GEM) was developed. However, current H. influenzae GEMs are unable to capture several aspects of metabolome nature related to metabolite pools. To directly and comprehensively characterize the endometabolome of H. influenzae Rd KW20, we performed a multiplatform MS-based metabolomics approach combining LC-MS, GC-MS and CE-MS. We obtained direct evidence of 15-20% of the endometabolome present in current H. influenzae GEMs and showed that polar metabolite pools are interconnected through correlating metabolite islands. Notably, we obtained high-quality evidence of 18 metabolites not previously included in H. influenzae GEMs, including the antimicrobial metabolite cyclo(Leu-Pro). Additionally, we comprehensively characterized and evaluated the quantitative composition of the phospholipidome of H. influenzae, revealing that the fatty acyl chain composition is largely independent of the lipid class, as well as that the probability distribution of phospholipids is mostly related to the conditional probability distribution of individual acyl chains. This finding enabled us to provide a rationale for the observed phospholipid profiles and estimate the abundance of low-level species, permitting the expansion of the phospholipidome characterization through predictive probabilistic modelling.
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Affiliation(s)
- Miguel Fernández-García
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
- Departamento de Ciencias Médicas Básicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
| | - Manuel Ares-Arroyo
- Antimicrobial Resistance Unit (ARU), Departamento de Sanidad Animal and Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Complutense University of Madrid, 28040 Madrid, Spain
| | - Emilia Wedel
- Antimicrobial Resistance Unit (ARU), Departamento de Sanidad Animal and Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Complutense University of Madrid, 28040 Madrid, Spain
| | - Natalia Montero
- Antimicrobial Resistance Unit (ARU), Departamento de Sanidad Animal and Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Complutense University of Madrid, 28040 Madrid, Spain
| | - Coral Barbas
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
| | - Mª Fernanda Rey-Stolle
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
| | - Bruno González-Zorn
- Antimicrobial Resistance Unit (ARU), Departamento de Sanidad Animal and Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Complutense University of Madrid, 28040 Madrid, Spain
| | - Antonia García
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
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Noninvasive monitoring of evolving urinary metabolic patterns in neonatal encephalopathy. Pediatr Res 2022; 91:598-605. [PMID: 33953355 DOI: 10.1038/s41390-021-01553-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Infants with moderate and severe neonatal encephalopathy (NE) frequently suffer from long-term adverse outcomes. We hypothesize that the urinary metabolome of newborns with NE reflects the evolution of injury patterns observed with magnetic resonance imaging (MRI). METHODS Eligible patients were newborn infants with perinatal asphyxia evolving to NE and qualifying for therapeutic hypothermia (TH) included in the HYPOTOP trial. MRI was employed for characterizing brain injury. Urine samples of 55 infants were collected before, during, and after TH. Metabolic profiles of samples were recorded employing three complementary mass spectrometry-based assays, and the alteration of detected metabolic features between groups was assessed. RESULTS The longitudinal assessment revealed significant perturbations of the urinary metabolome. After 24 h of TH, a stable disease pattern evolved characterized by the alterations of 4-8% of metabolic features related to lipid metabolism, metabolism of cofactors and vitamins, glycan biosynthesis and metabolism, amino acid metabolism, and nucleotide metabolism. Characteristic metabolomic fingerprints were observed for different MRI injury patterns. CONCLUSIONS This study shows the potential of urinary metabolic profiles for the noninvasive monitoring of brain injury of infants with NE during TH. IMPACT A comprehensive approach for the study of the urinary metabolome was employed involving a semi-targeted capillary electrophoresis-time-of-flight mass spectrometry (TOFMS) assay, an untargeted ultra-performance liquid chromatography (UPLC)-quadrupole TOFMS assay, and a targeted UPLC-tandem MS-based method for the quantification of amino acids. The longitudinal study of the urinary metabolome identified dynamic metabolic changes between birth and until 96 h after the initiation of TH. The identification of altered metabolic pathways in newborns with pathologic MRI outcomes might offer the possibility of developing noninvasive monitoring approaches for personalized adjustment of the treatment and for supporting early outcome prediction.
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Fernández-Garcia M, Sanchez-Flores A, Gonzalez LM, Barbas C, Rey-Stolle MF, Sevilla E, García A, Montero E. Integration of Functional Genomic, Transcriptomic, and Metabolomic Data to Identify Key Features in Genomic Expression, Metabolites, and Metabolic Pathways of Babesia divergens. Methods Mol Biol 2021; 2369:217-249. [PMID: 34313992 DOI: 10.1007/978-1-0716-1681-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Upon invasion of red blood cells (RBCs), the Apicomplexa parasite Babesia divergens remains within the RBC for several hours and reproduces asexually, resulting in infective free merozoites that egress and destroy the host cell. Free merozoites rapidly seek and invade new uninfected RBCs. This repetitive cycle allows B. divergens to build a complex population of intraerythrocytic and extracellular stages in the bloodstream of humans and cattle, thus causing babesiosis. To compare biological aspects between B. divergens stages, including the different nature of their metabolism, could be key to our understanding of pathogenesis. Thus, we are currently assessing differences in the B. divergens metabolism of intra- and extracellular (free merozoites) life stages by the use of an integrative approach combining functional genomic, transcriptomic, differential expression, and metabolomic data acquired from sequencing and various analytical platforms. To our knowledge, this is the first effort to describe, in detail, the experimental procedures and integration of different omics to explore the regulation of the metabolism, invasion and proliferation mechanisms of B. divergens. This integrative approach can be used as a reference to study other Apicomplexa parasites.
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Affiliation(s)
- Miguel Fernández-Garcia
- CEMBIO (Center for Metabolomics and Bioanalysis), Facultad de Farmacia, Universidad San Pablo CEU, CEU Universities, Campus Monteprincipe, Boadilla del Monte, Madrid, Spain
| | - Alejandro Sanchez-Flores
- Unidad Universitaria de Secuenciación Masiva y Bioinformática, Instituto de Biotecnología, Cuernavaca, Mexico
| | - Luis Miguel Gonzalez
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, ISCIII Majadahonda, Madrid, Spain
| | - Coral Barbas
- CEMBIO (Center for Metabolomics and Bioanalysis), Facultad de Farmacia, Universidad San Pablo CEU, CEU Universities, Campus Monteprincipe, Boadilla del Monte, Madrid, Spain
| | - Mª Fernanda Rey-Stolle
- CEMBIO (Center for Metabolomics and Bioanalysis), Facultad de Farmacia, Universidad San Pablo CEU, CEU Universities, Campus Monteprincipe, Boadilla del Monte, Madrid, Spain
| | - Elena Sevilla
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, ISCIII Majadahonda, Madrid, Spain
| | - Antonia García
- CEMBIO (Center for Metabolomics and Bioanalysis), Facultad de Farmacia, Universidad San Pablo CEU, CEU Universities, Campus Monteprincipe, Boadilla del Monte, Madrid, Spain.
| | - Estrella Montero
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, ISCIII Majadahonda, Madrid, Spain.
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Gallart-Ayala H, Teav T, Ivanisevic J. Metabolomics meets lipidomics: Assessing the small molecule component of metabolism. Bioessays 2021; 42:e2000052. [PMID: 33230910 DOI: 10.1002/bies.202000052] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/11/2020] [Indexed: 12/16/2022]
Abstract
Metabolomics, including lipidomics, is emerging as a quantitative biology approach for the assessment of energy flow through metabolism and information flow through metabolic signaling; thus, providing novel insights into metabolism and its regulation, in health, healthy ageing and disease. In this forward-looking review we provide an overview on the origins of metabolomics, on its role in this postgenomic era of biochemistry and its application to investigate metabolite role and (bio)activity, from model systems to human population studies. We present the challenges inherent to this analytical science, and approaches and modes of analysis that are used to resolve, characterize and measure the infinite chemical diversity contained in the metabolome (including lipidome) of complex biological matrices. In the current outbreak of metabolic diseases such as cardiometabolic disorders, cancer and neurodegenerative diseases, metabolomics appears to be ideally situated for the investigation of disease pathophysiology from a metabolite perspective.
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Affiliation(s)
- Hector Gallart-Ayala
- Metabolomics Platform, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tony Teav
- Metabolomics Platform, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Julijana Ivanisevic
- Metabolomics Platform, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Olesti E, González-Ruiz V, Wilks MF, Boccard J, Rudaz S. Approaches in metabolomics for regulatory toxicology applications. Analyst 2021; 146:1820-1834. [PMID: 33605958 DOI: 10.1039/d0an02212h] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Innovative methodological approaches are needed to conduct human health and environmental risk assessments on a growing number of marketed chemicals. Metabolomics is progressively proving its value as an efficient strategy to perform toxicological evaluations of new and existing substances, and it will likely become a key tool to accelerate chemical risk assessments. However, additional guidance with widely accepted and harmonized procedures is needed before metabolomics can be routinely incorporated in decision-making for regulatory purposes. The aim of this review is to provide an overview of metabolomic strategies that have been successfully employed in toxicity assessment as well as the most promising workflows in a regulatory context. First, we provide a general view of the different steps of regulatory toxicology-oriented metabolomics. Emphasis is put on three key elements: robustness of experimental design, choice of analytical platform, and use of adapted data treatment tools. Then, examples in which metabolomics supported regulatory toxicology outputs in different scenarios are reviewed, including chemical grouping, elucidation of mechanisms of toxicity, and determination of points of departure. The overall intention is to provide insights into why and how to plan and conduct metabolomic studies for regulatory toxicology purposes.
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Affiliation(s)
- Eulalia Olesti
- School of Pharmaceutical Sciences, University of Geneva, Switzerland.
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7
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Njoku K, Sutton CJ, Whetton AD, Crosbie EJ. Metabolomic Biomarkers for Detection, Prognosis and Identifying Recurrence in Endometrial Cancer. Metabolites 2020; 10:E314. [PMID: 32751940 PMCID: PMC7463916 DOI: 10.3390/metabo10080314] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Abstract
Metabolic reprogramming is increasingly recognised as one of the defining hallmarks of tumorigenesis. There is compelling evidence to suggest that endometrial cancer develops and progresses in the context of profound metabolic dysfunction. Whilst the incidence of endometrial cancer continues to rise in parallel with the global epidemic of obesity, there are, as yet, no validated biomarkers that can aid risk prediction, early detection, prognostic evaluation or surveillance. Advances in high-throughput technologies have, in recent times, shown promise for biomarker discovery based on genomic, transcriptomic, proteomic and metabolomic platforms. Metabolomics, the large-scale study of metabolites, deals with the downstream products of the other omics technologies and thus best reflects the human phenotype. This review aims to provide a summary and critical synthesis of the existing literature with the ultimate goal of identifying the most promising metabolite biomarkers that can augment current endometrial cancer diagnostic, prognostic and recurrence surveillance strategies. Identified metabolites and their biochemical pathways are discussed in the context of what we know about endometrial carcinogenesis and their potential clinical utility is evaluated. Finally, we underscore the challenges inherent in metabolomic biomarker discovery and validation and provide fresh perspectives and directions for future endometrial cancer biomarker research.
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Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 5th Floor Research, St Mary’s Hospital, Oxford Road, Manchester M13 9WL, UK;
- Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Caroline J.J Sutton
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9WL, UK;
| | - Anthony D. Whetton
- Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Emma J. Crosbie
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 5th Floor Research, St Mary’s Hospital, Oxford Road, Manchester M13 9WL, UK;
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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8
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Petrov AP, Sherman LM, Camden JP, Dovichi NJ. Database of free solution mobilities for 276 metabolites. Talanta 2020; 209:120545. [PMID: 31892063 PMCID: PMC6956853 DOI: 10.1016/j.talanta.2019.120545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 11/23/2022]
Abstract
Although databases are available that provide mass spectra and chromatographic retention information for small-molecule metabolites, no publicly available database provides electrophoretic mobility for common metabolites. As a result, most compounds found in electrophoretic-based metabolic studies are unidentified and simply annotated as "features". To begin to address this issue, we analyzed 460 metabolites from a commercial library using capillary zone electrophoresis coupled with electrospray mass spectrometry. To speed analysis, a sequential injection method was used wherein six compounds were analyzed per run. An uncoated fused silica capillary was used for the analysis at 20 °C with a 0.5% (v/v) formic acid and 5% (v/v) methanol background electrolyte. A Prince autosampler was used for sample injection and the capillary was coupled to an ion trap mass spectrometer using an electrokinetically-pumped nanospray interface. We generated mobility values for 276 metabolites from the library (60% success rate) with an average standard deviation of 0.01 × 10-8 m2V-1s-1. As expected, cationic and anionic compounds were well resolved from neutral compounds. Neutral compounds co-migrated with electro-osmotic flow. Most of the compounds that were not detected were neutral and presumably suffered from adsorption to the capillary wall or poor ionization efficiency.
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Affiliation(s)
- Alexander P Petrov
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556-5670, USA
| | - Lindy M Sherman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556-5670, USA
| | - Jon P Camden
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556-5670, USA
| | - Norman J Dovichi
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556-5670, USA.
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Rodríguez-Coira J, Delgado-Dolset MI, Obeso D, Dolores-Hernández M, Quintás G, Angulo S, Barber D, Carrillo T, Escribese MM, Villaseñor A. Troubleshooting in Large-Scale LC-ToF-MS Metabolomics Analysis: Solving Complex Issues in Big Cohorts. Metabolites 2019; 9:metabo9110247. [PMID: 31652940 PMCID: PMC6918290 DOI: 10.3390/metabo9110247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 12/23/2022] Open
Abstract
Metabolomics, understood as the science that manages the study of compounds from the metabolism, is an essential tool for deciphering metabolic changes in disease. The experiments rely on the use of high-throughput analytical techniques such as liquid chromatography coupled to mass spectrometry (LC-ToF MS). This hyphenation has brought positive aspects such as higher sensitivity, specificity and the extension of the metabolome coverage in a single run. The analysis of a high number of samples in a single batch is currently not always feasible due to technical and practical issues (i.e., a drop of the MS signal) which result in the MS stopping during the experiment obtaining more than a single sample batch. In this situation, careful data treatment is required to enable an accurate joint analysis of multi-batch data sets. This paper summarizes the analytical strategies in large-scale metabolomic experiments; special attention has been given to QC preparation troubleshooting and data treatment. Moreover, labeled internal standards analysis and their aim in data treatment, and data normalization procedures (intra- and inter-batch) are described. These concepts are exemplified using a cohort of 165 patients from a study in asthma.
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Affiliation(s)
- Juan Rodríguez-Coira
- CEMBIO, Centro de Excelencia en Metabolómica y Bioanálisis, Facultad de Farmacia, Universidad San Pablo CEU, 28668 Madrid, Spain.
- IMMA, Instituto de Medicina Molecular Aplicada, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
| | - María I Delgado-Dolset
- CEMBIO, Centro de Excelencia en Metabolómica y Bioanálisis, Facultad de Farmacia, Universidad San Pablo CEU, 28668 Madrid, Spain.
- IMMA, Instituto de Medicina Molecular Aplicada, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
| | - David Obeso
- CEMBIO, Centro de Excelencia en Metabolómica y Bioanálisis, Facultad de Farmacia, Universidad San Pablo CEU, 28668 Madrid, Spain.
- IMMA, Instituto de Medicina Molecular Aplicada, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
| | - Mariana Dolores-Hernández
- CEMBIO, Centro de Excelencia en Metabolómica y Bioanálisis, Facultad de Farmacia, Universidad San Pablo CEU, 28668 Madrid, Spain.
- Laboratorio de Ensayos de Desarrollo Farmacéutico (LEDEFAR), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Estado de México CP.54714, Mexico.
| | - Guillermo Quintás
- Health and Biomedicine, Leitat Technological Center, 08028 Barcelona, Spain.
- Analytical Unit, Health Research Institute Hospital La Fe, 46026 Valencia, Spain.
| | - Santiago Angulo
- Departamento de Matemática Aplicada y Estadística, Universidad San Pablo CEU, 28668 Madrid, Spain.
| | - Domingo Barber
- IMMA, Instituto de Medicina Molecular Aplicada, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
| | - Teresa Carrillo
- Servicio de Alergia, "Hospital Universitario de Gran Canaria, Dr. Negrin", 35010 Las Palmas de G.C., Spain.
| | - María M Escribese
- IMMA, Instituto de Medicina Molecular Aplicada, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
- Departamento de Ciencias Médicas Básicas, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
| | - Alma Villaseñor
- IMMA, Instituto de Medicina Molecular Aplicada, Facultad de Medicina, Universidad San Pablo CEU, 28668 Madrid, Spain.
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