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Romano R, Cristescu SM, Risby TH, Marczin N. Lipid peroxidation in cardiac surgery: towards consensus on biomonitoring, diagnostic tools and therapeutic implementation. J Breath Res 2018; 12:027109. [PMID: 29104182 DOI: 10.1088/1752-7163/aa9856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review focuses on oxidative stress and more specifically lipid peroxidation in cardiac surgery, one of the fundamental theories of perioperative complications. We present the molecular pathways leading to lipid peroxidation and integrate analytical methods that allow detection of lipid peroxidation markers in the fluid phase with those focusing on volatile compounds in exhaled breath. In order to explore the accumulated data in the literature, we present a systematic review of quantitative analysis of malondialdehyde, a widely used lipid peroxidation product at various stages of cardiac surgery. This exploration reveals major limitations of existing studies in terms of variability of reported values and significant gaps due to discrete and variable sampling times during surgery. We also appraise methodologies that allow real-time and continuous monitoring of oxidative stress. Complimentary techniques highlight that beyond the widely acclaimed contribution of the cardiopulmonary bypass technology and myocardial reperfusion injury, the use of diathermy contributes significantly to intraoperative lipid peroxidation. We conclude that there is an urgent need to implement the theory of oxidative stress towards a paradigm change in the clinical practice. Firstly, we need to acquire definite and irrefutable information on the link between lipid peroxidation and post-operative complications by building international consensus on best analytical approaches towards generating qualitatively and quantitatively comparable datasets in coordinated multicentre studies. Secondly, we should move away from routine low-risk surgeries towards higher risk interventions where there is major unmet clinical need for improving patient journey and outcomes. There is also need for consensus on best therapeutic interventions which could be tested in convincing large scale clinical trials. As future directions, we propose combination of fluid phase platforms and 'metabography', an extended form of capnography-including real-time analysis of lipid peroxidation and volatile footprints of metabolism-for better patient phenotyping prior to and during high risk surgery towards molecular prediction, stratification and monitoring of the patient's journey.
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Affiliation(s)
- Rosalba Romano
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Schwarz EI, Engler A, Kohler M. Exhaled breath analysis in obstructive sleep apnea. Expert Rev Respir Med 2017; 11:631-639. [DOI: 10.1080/17476348.2017.1338950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Esther I Schwarz
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Anna Engler
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
- Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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Das S, Pal S, Mitra M. Significance of Exhaled Breath Test in Clinical Diagnosis: A Special Focus on the Detection of Diabetes Mellitus. J Med Biol Eng 2016; 36:605-624. [PMID: 27853412 PMCID: PMC5083779 DOI: 10.1007/s40846-016-0164-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
Abstract
Analysis of volatile organic compounds (VOCs) emanating from human exhaled breath can provide deep insight into the status of various biochemical processes in the human body. VOCs can serve as potential biomarkers of physiological and pathophysiological conditions related to several diseases. Breath VOC analysis, a noninvasive and quick biomonitoring approach, also has potential for the early detection and progress monitoring of several diseases. This paper gives an overview of the major VOCs present in human exhaled breath, possible biochemical pathways of breath VOC generation, diagnostic importance of their analysis, and analytical techniques used in the breath test. Breath analysis relating to diabetes mellitus and its characteristic breath biomarkers is focused on. Finally, some challenges and limitations of the breath test are discussed.
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Affiliation(s)
- Souvik Das
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal 741235 India
| | - Saurabh Pal
- Department of Applied Physics, University of Calcutta, Kolkata, West Bengal 700009 India
| | - Madhuchhanda Mitra
- Department of Applied Physics, University of Calcutta, Kolkata, West Bengal 700009 India
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Stenseth R, Nilsen T, Haaverstad R, Vitale N, Dale O. Frequent sampling allows detection of short and rapid surges of exhaled ethane during cardiac surgery. Perfusion 2016; 22:391-6. [DOI: 10.1177/0267659108089143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During cardiopulmonary bypass (CPB), hypoperfusion and reperfusion may cause oxidative stress and lipid peroxidation that generates ethane. The aim of this pilot study was to assess the feasibility of frequent sampling of exhaled ethane during cardiac surgery. After approval of the Research Ethics Committee, 10 patients undergoing combined aortic valve and coronary artery bypass surgery were enrolled. Breath samples were drawn in the perioperative period and analyzed by a rapid, sensitive and validated gas-chromatographic method. Increased exhaled ethane was regularly seen following sternotomy, after the start of CPB and after aortic clamp removal, whereas no change was seen after termination of bypass. In one patient, the maximum increase in exhaled ethane was 30-fold. Peak durations lasted only 2–4 min. This study demonstrates that frequent sampling of breath ethane is feasible in a clinical setting, allowing detection of rapid ethane surges of short duration.
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Affiliation(s)
- R Stenseth
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiothoracic Surgery, St Olav’s University Hospital, Trondheim, Norway
| | - T Nilsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - R Haaverstad
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiothoracic Surgery, St Olav’s University Hospital, Trondheim, Norway
| | - N Vitale
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiothoracic Surgery, St Olav’s University Hospital, Trondheim, Norway
| | - O Dale
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anesthesiology and Emergency Medicine, St Olav’s University Hospital, Trondheim, Norway
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Dolch ME, Choukèr A, Hornuss C, Frey L, Irlbeck M, Praun S, Leidlmair C, Villinger J, Schelling G. Quantification of propionaldehyde in breath of patients after lung transplantation. Free Radic Biol Med 2015; 85:157-64. [PMID: 25862413 DOI: 10.1016/j.freeradbiomed.2015.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/01/2015] [Indexed: 01/14/2023]
Abstract
Oxygen-derived free radicals (ROS) have been identified to contribute significantly to ischemia-reperfusion (I/R) injury by initiating chain reactions with polyunsaturated membrane lipids (lipid peroxidation, LPO) resulting in the generation of several aldehydes and ketones. Due to their volatile nature these LPO products can be measured noninvasively in breath. We hypothesized that one of these markers, namely propionaldehyde, will be increased in lung and heart-lung transplant patients where severe oxidative stress due to I/R injury with early graft dysfunction represents one of the major postoperative complications resulting in prolonged ventilation and increased in-hospital morbidity and mortality. Expiratory air measurements for acetone, isoprene, and propionaldehyde were performed in seven patients after lung (n = 5) or heart-lung (n = 2) transplantation, ventilated patients (n = 12), and healthy volunteers (n = 17) using online ion-molecule reaction mass spectrometry. Increased concentrations of acetone (transplanted: 3812 [2347-12498]; ventilated: 1255 [276-1959]; healthy: 631 [520-784] ppbv; P < .001) and propionaldehyde (transplanted: 270 [70-424]; ventilated: 82 [41.8-142]; healthy: 1.7 [0.1-11.8] ppbv; P < .001) were found in expiratory air of transplanted and ventilated patients. Propionaldehyde resulting from spontaneous fragmentation of peroxides due to free radical-induced LPO after I/R injury in patients after lung or heart-lung transplantation can be quantified in expired breath.
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Affiliation(s)
- M E Dolch
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians University, Munich, Germany.
| | - A Choukèr
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - C Hornuss
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - L Frey
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - M Irlbeck
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - S Praun
- VF Services GmbH, 6067 Absam, Austria
| | | | | | - G Schelling
- Department of Anaesthesiology, University Hospital Munich-Campus Großhadern, Ludwig-Maximilians University, Munich, Germany
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MEMS gas preconcentrator filled with CNT foam for exhaled VOC gas detection. BIOCHIP JOURNAL 2014. [DOI: 10.1007/s13206-014-9106-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cristescu SM, Kiss R, Hekkert STL, Dalby M, Harren FJM, Risby TH, Marczin N. Real-time monitoring of endogenous lipid peroxidation by exhaled ethylene in patients undergoing cardiac surgery. Am J Physiol Lung Cell Mol Physiol 2014; 307:L509-15. [PMID: 25128523 DOI: 10.1152/ajplung.00168.2014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (> 30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (> 10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene.
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Affiliation(s)
- Simona M Cristescu
- Department of Molecular and Laser Physics, Institute of Molecules and Materials, Radboud University, Nijmegen, the Netherlands
| | - Rudolf Kiss
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK; Section of Anaesthesia, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | | | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Frans J M Harren
- Department of Molecular and Laser Physics, Institute of Molecules and Materials, Radboud University, Nijmegen, the Netherlands
| | - Terence H Risby
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland; and
| | - Nandor Marczin
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK; Section of Anaesthesia, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
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Amann A, Costello BDL, Miekisch W, Schubert J, Buszewski B, Pleil J, Ratcliffe N, Risby T. The human volatilome: volatile organic compounds (VOCs) in exhaled breath, skin emanations, urine, feces and saliva. J Breath Res 2014; 8:034001. [PMID: 24946087 DOI: 10.1088/1752-7155/8/3/034001] [Citation(s) in RCA: 358] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breath analysis is a young field of research with its roots in antiquity. Antoine Lavoisier discovered carbon dioxide in exhaled breath during the period 1777-1783, Wilhelm (Vilém) Petters discovered acetone in breath in 1857 and Johannes Müller reported the first quantitative measurements of acetone in 1898. A recent review reported 1765 volatile compounds appearing in exhaled breath, skin emanations, urine, saliva, human breast milk, blood and feces. For a large number of compounds, real-time analysis of exhaled breath or skin emanations has been performed, e.g., during exertion of effort on a stationary bicycle or during sleep. Volatile compounds in exhaled breath, which record historical exposure, are called the 'exposome'. Changes in biogenic volatile organic compound concentrations can be used to mirror metabolic or (patho)physiological processes in the whole body or blood concentrations of drugs (e.g. propofol) in clinical settings-even during artificial ventilation or during surgery. Also compounds released by bacterial strains like Pseudomonas aeruginosa or Streptococcus pneumonia could be very interesting. Methyl methacrylate (CAS 80-62-6), for example, was observed in the headspace of Streptococcus pneumonia in concentrations up to 1420 ppb. Fecal volatiles have been implicated in differentiating certain infectious bowel diseases such as Clostridium difficile, Campylobacter, Salmonella and Cholera. They have also been used to differentiate other non-infectious conditions such as irritable bowel syndrome and inflammatory bowel disease. In addition, alterations in urine volatiles have been used to detect urinary tract infections, bladder, prostate and other cancers. Peroxidation of lipids and other biomolecules by reactive oxygen species produce volatile compounds like ethane and 1-pentane. Noninvasive detection and therapeutic monitoring of oxidative stress would be highly desirable in autoimmunological, neurological, inflammatory diseases and cancer, but also during surgery and in intensive care units. The investigation of cell cultures opens up new possibilities for elucidation of the biochemical background of volatile compounds. In future studies, combined investigations of a particular compound with regard to human matrices such as breath, urine, saliva and cell culture investigations will lead to novel scientific progress in the field.
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Affiliation(s)
- Anton Amann
- Univ-Clinic for Anesthesia and Intensive Care, Innsbruck Medical University, Anichstr, 35, A-6020 Innsbruck, Austria. Breath Research Institute of the University of Innsbruck, Rathausplatz 4, A-6850 Dornbirn, Austria
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Amann A, Miekisch W, Schubert J, Buszewski B, Ligor T, Jezierski T, Pleil J, Risby T. Analysis of exhaled breath for disease detection. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2014; 7:455-482. [PMID: 25014347 DOI: 10.1146/annurev-anchem-071213-020043] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Breath analysis is a young field of research with great clinical potential. As a result of this interest, researchers have developed new analytical techniques that permit real-time analysis of exhaled breath with breath-to-breath resolution in addition to the conventional central laboratory methods using gas chromatography-mass spectrometry. Breath tests are based on endogenously produced volatiles, metabolites of ingested precursors, metabolites produced by bacteria in the gut or the airways, or volatiles appearing after environmental exposure. The composition of exhaled breath may contain valuable information for patients presenting with asthma, renal and liver diseases, lung cancer, chronic obstructive pulmonary disease, inflammatory lung disease, or metabolic disorders. In addition, oxidative stress status may be monitored via volatile products of lipid peroxidation. Measurement of enzyme activity provides phenotypic information important in personalized medicine, whereas breath measurements provide insight into perturbations of the human exposome and can be interpreted as preclinical signals of adverse outcome pathways.
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Affiliation(s)
- Anton Amann
- Breath Research Institute of the University of Innsbruck, A-6850 Dornbirn, Austria;
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Effects of dietary nutrients on volatile breath metabolites. J Nutr Sci 2013; 2:e34. [PMID: 25191584 PMCID: PMC4153095 DOI: 10.1017/jns.2013.26] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
Breath analysis is becoming increasingly established as a means of assessing metabolic,
biochemical and physiological function in health and disease. The methods available for
these analyses exploit a variety of complex physicochemical principles, but are becoming
more easily utilised in the clinical setting. Whilst some of the factors accounting for
the biological variation in breath metabolite concentrations have been clarified, there
has been relatively little work on the dietary factors that may influence them. In
applying breath analysis to the clinical setting, it will be important to consider how
these factors may affect the interpretation of endogenous breath composition. Diet may
have complex effects on the generation of breath compounds. These effects may either be
due to a direct impact on metabolism, or because they alter the gastrointestinal flora.
Bacteria are a major source of compounds in breath, and their generation of H2,
hydrogen cyanide, aldehydes and alkanes may be an indicator of the health of their
host.
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Breath pentane as a potential biomarker for survival in hepatic ischemia and reperfusion injury--a pilot study. PLoS One 2012; 7:e44940. [PMID: 22984587 PMCID: PMC3439410 DOI: 10.1371/journal.pone.0044940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/15/2012] [Indexed: 01/18/2023] Open
Abstract
Background Exhaled pentane, which is produced as a consequence of reactive oxygen species-mediated lipid peroxidation, is a marker of oxidative stress. Propofol is widely used as a hypnotic agent in intensive care units and the operating room. Moreover, this agent has been reported to inhibit lipid peroxidation by directly scavenging reactive oxygen species. In this study, using a porcine liver ischemia-reperfusion injury model, we have evaluated the hypothesis that high concentrations of breath pentane are related to adverse outcome and that propofol could reduce breath pentane and improve liver injury and outcome in swine in this situation. Methodology/Principal Findings Twenty male swine were assigned to two groups: propofol (n = 10) and chloral hydrate groups (n = 10). Hepatic ischemia was induced by occluding the portal inflow vessels. Ischemia lasted for 30 min, followed by reperfusion for 360 min. Exhaled and blood pentane concentrations in the chloral hydrate group markedly increased 1 min after reperfusion and then decreased to baseline. Breath and blood pentane concentrations in the propofol group increased 1 min after reperfusion but were significantly lower than in the chloral hydrate group. A negative correlation was found between breath pentane levels and survival in the chloral hydrate group. The median overall survival was 251 min after reperfusion (range 150–360 min) in the chloral hydrate group. All of the swine were alive in the propofol group. Conclusions Monitoring of exhaled pentane may be useful for evaluating the severity of hepatic ischemia-reperfusion injury and aid in predicting the outcome; propofol may improve the outcome in this situation.
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Abstract
Reactive oxygen species are associated with tissue inflammation and injury. Our laboratory has demonstrated that ethane, a stable product of lipid peroxidation, in exhaled breath can be used to measure total body oxidative stress. Herein patients were studied who underwent outpatient surgery, laproscopic bilateral tubal ligation (BTL, n = 10) and anterior cruciate ligament (ACL, n = 10) repair of the knee. These surgical procedures were expected to involve mild degrees of ischemia and reperfusion. In each of these cases propofol, an intravenous anesthetic with antioxidant properties, was used. Breath ethane was measured as a biomarker of oxidative stress that occurred at reperfusion of ischemic tissue. Data were analyzed by one-way analysis of variance. Clinically relevant concentrations of propofol were unable to completely block the increase in oxidative stress following reperfusion in either of these minor surgeries. Breath ethane increased significantly after reperfusion in both the BTL (p = 0.03) and the ACL (p = 0.005) patients. Also, the increase in oxidative stress was related to the time of ischemia.
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Affiliation(s)
- Robert H Brown
- Department of Anesthesiology and Critical Care Medicine, Division of Pulmonary and Critical Care Medicine in the Department of Medicine, and Division of Physiology in the Department of Environmental Health Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
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Brown RH, Wagner EM, Cope KA, Risby TH. Propofol and in vivo oxidative stress: effects of preservative. J Breath Res 2009; 3:016003. [PMID: 21383451 DOI: 10.1088/1752-7155/3/1/016003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Reactive oxygen species are associated with tissue inflammation and injury. Our laboratory has demonstrated that ethane, a stable product of lipid peroxidation, in exhaled breath can be used to measure total body oxidative stress. An ischemia-reperfusion model of lung injury in sheep has been studied in which pulmonary and bronchial lung perfusion could be interrupted and restored. The goal of this study was to investigate whether two commercial formulations of propofol and the individual components of the commercial formulations attenuated the oxidative stress produced in this model. Breath ethane and breath carbon monoxide were measured as biomarkers of oxidative stress that occur at reperfusion of ischemic tissue. Data were analyzed by a standard least-squares-fit model. One of the formulations for propofol, which contained the preservative ethylenediaminetetraacetic acid (EDTA), was found to decrease the overall level of oxidative stress in sheep. Furthermore, while several models of severe lung injury demonstrate additional production of reactive oxygen species, our model of ischemia/reperfusion of lung tissue did not.
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Affiliation(s)
- Robert H Brown
- Department of Anesthesiology and Critical Care Medicine, Division of Pulmonary and Critical Care Medicine in the Department of Medicine, and Division of Physiology in the Department of Environmental Health Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
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Stevenson KS, Radhakrishnan K, Patterson CS, McMillan LC, Skeldon KD, Buist L, Padgett MJ, Shiels PG. Breath ethane peaks during a single haemodialysis session and is associated with time on dialysis. J Breath Res 2008; 2:026004. [DOI: 10.1088/1752-7155/2/2/026004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Thelen S, Miekisch W, Halmer D, Schubert J, Hering P, Mürtz M. Intercomparison of Infrared Cavity Leak-Out Spectroscopy and Gas Chromatography-Flame Ionization for Trace Analysis of Ethane. Anal Chem 2008; 80:2768-73. [DOI: 10.1021/ac702282q] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sven Thelen
- Institut für Lasermedizin, Universität Düsseldorf, Universitätstrasse 1, 40225 Düsseldorf, Germany, and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Wolfram Miekisch
- Institut für Lasermedizin, Universität Düsseldorf, Universitätstrasse 1, 40225 Düsseldorf, Germany, and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Daniel Halmer
- Institut für Lasermedizin, Universität Düsseldorf, Universitätstrasse 1, 40225 Düsseldorf, Germany, and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Jochen Schubert
- Institut für Lasermedizin, Universität Düsseldorf, Universitätstrasse 1, 40225 Düsseldorf, Germany, and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Peter Hering
- Institut für Lasermedizin, Universität Düsseldorf, Universitätstrasse 1, 40225 Düsseldorf, Germany, and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Manfred Mürtz
- Institut für Lasermedizin, Universität Düsseldorf, Universitätstrasse 1, 40225 Düsseldorf, Germany, and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Schillingallee 35, 18057 Rostock, Germany
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Patterson CS, McMillan LC, Stevenson K, Radhakrishnan K, Shiels PG, Padgett MJ, Skeldon KD. Dynamic study of oxidative stress in renal dialysis patients based on breath ethane measured by optical spectroscopy. J Breath Res 2007; 1:026005. [DOI: 10.1088/1752-7155/1/2/026005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Pabst F, Miekisch W, Fuchs P, Kischkel S, Schubert JK. Monitoring of oxidative and metabolic stress during cardiac surgery by means of breath biomarkers: an observational study. J Cardiothorac Surg 2007; 2:37. [PMID: 17877828 PMCID: PMC2100047 DOI: 10.1186/1749-8090-2-37] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 09/18/2007] [Indexed: 12/31/2022] Open
Abstract
Background Volatile breath biomarkers provide a non-invasive window to observe physiological and pathological processes in the body. This study was intended to assess the impact of heart surgery with extracorporeal circulation (ECC) onto breath biomarker profiles. Special attention was attributed to oxidative or metabolic stress during surgery and extracorporeal circulation, which can cause organ damage and poor outcome. Methods 24 patients undergoing cardiac surgery with extracorporeal circulation were enrolled into this observational study. Alveolar breath samples (10 mL) were taken after induction of anesthesia, after sternotomy, 5 min after end of ECC, and 30, 60, 90, 120 and 150 min after end of surgery. Alveolar gas samples were withdrawn from the circuit under visual control of expired CO2. Inspiratory samples were taken near the ventilator inlet. Volatile substances in breath were preconcentrated by means of solid phase micro extraction, separated by gas chromatography, detected and identified by mass spectrometry. Results Mean exhaled concentrations of acetone, pentane and isoprene determined in this study were in accordance with results from the literature. Exhaled substance concentrations showed considerable inter-individual variation, and inspired pentane concentrations sometimes had the same order of magnitude than expired values. This is the reason why, concentrations were normalized by the values measured 120 min after surgery. Exhaled acetone concentrations increased slightly after sternotomy and markedly after end of ECC. Exhaled acetone concentrations exhibited positive correlation to serum C-reactive protein concentrations and to serum troponine-T concentrations. Exhaled pentane concentrations increased markedly after sternotomy and dropped below initial values after ECC. Breath pentane concentrations showed correlations with serum creatinine (CK) levels. Patients with an elevated CK-MB (myocardial&brain)/CK ratio had also high concentrations of pentane in exhaled air. Exhaled isoprene concentrations raised significantly after sternotomy and decreased to initial levels at 30 min after end of ECC. Exhaled isoprene concentrations showed a correlation with cardiac output. Conclusion Oxidative and metabolic stress during cardiac surgery could be assessed continuously and non-invasively by means of breath analysis. Correlations between breath acetone profiles and clinical conditions underline the potential of breath biomarker monitoring for diagnostics and timely initiation of life saving therapy.
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Affiliation(s)
- Florian Pabst
- Department of Anesthesia and Intensive Care, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Wolfram Miekisch
- Department of Anesthesia and Intensive Care, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Patricia Fuchs
- Department of Anesthesia and Intensive Care, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Sabine Kischkel
- Department of Anesthesia and Intensive Care, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Jochen K Schubert
- Department of Anesthesia and Intensive Care, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
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Milei J, Forcada P, Fraga CG, Grana DR, Iannelli G, Chiariello M, Tritto I, Ambrosio G. Relationship between oxidative stress, lipid peroxidation, and ultrastructural damage in patients with coronary artery disease undergoing cardioplegic arrest/reperfusion. Cardiovasc Res 2007; 73:710-9. [PMID: 17224138 DOI: 10.1016/j.cardiores.2006.12.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 12/07/2006] [Accepted: 12/08/2006] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In animal models, formation of oxidants during postischemic reperfusion may exert deleterious effects ("oxidative stress"). Cardioplegic arrest/reperfusion during cardiac surgery might similarly induce oxidative stress. However, the phenomenon has not been precisely characterized in patients, and therefore the role of antioxidant therapy at cardiac surgery is a matter of debate. Thus, we wanted to ascertain whether the relationship between oxidant formation and development of myocardial injury also translates to the situation of patients subjected to cardioplegic arrest. METHODS In 24 patients undergoing coronary artery bypass, trans-cardiac blood samples and myocardial biopsies were taken before cardioplegic arrest and again following reperfusion. RESULTS Cardiac glutathione release (marker of oxidant production) was negligible at baseline (0.02+/-0.04 micromol/L), but it increased 15 min into reperfusion (1.10+/-0.40 micromol/L; p<0.05); concomitantly, myocardial concentration of the antioxidant ubiquinol decreased from 144.5+/-52.0 to 97.6+/-82.0 nmol/g (p<0.05). Although these changes document cardiac exposure to oxidants, they were not accompanied by evidence of injury. Neither coronary sinus blood nor cardiac biopsies showed increased lipid peroxide concentrations. Furthermore, electron microscopy showed no major ultrastructural alterations. Finally, full recovery of left ventricular systolic and diastolic function was observed. CONCLUSIONS Careful investigation reveals that while oxidant production does occur during cardiac surgery in patients with chronic ischemic heart disease, cardiac oxidative stress may not progress through membrane damage and irreversible injury.
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Affiliation(s)
- José Milei
- Instituto de Investigaciones Cardiológicas Alberto C. Taquini UBA-Conicet, Buenos Aires, Argentina
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Nose K, Nunome Y, Kondo T, Araki S, Tsuda T. Identification of gas emanated from human skin: methane, ethylene, and ethane. ANAL SCI 2006; 21:625-8. [PMID: 15984195 DOI: 10.2116/analsci.21.625] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We investigated whether methane, ethylene and ethane gas can be detected in gas emanating from human skin, which is called skin gas. Skin gas was collected with a homemade stainless-steel trap system, which was cooled with liquid nitrogen, and analyzed with a gas chromatograph fitted with a flame ionization detector (FID). Skin-gas samples were obtained by covering a hand for 30 min with a polyfluorovinyl bag in which pure helium gas was introduced. The bag, the trap system and GC were set up online to avoid any contamination by air. Methane, ethylene and ethane in skin gas were successfully collected at an average amount emanated for 30 min (from ten subjects) of 150 +/- 63, 20 +/- 11 and 17 +/- 8 [mean +/- SD] pg/cm2, respectively.
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Affiliation(s)
- Kazutoshi Nose
- Department of Materials Science & Engineering, Graduate School of Engineering, Nagoya Institute of Technology, Gokiso, Showa, Nagoya 466-8555, Japan.
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20
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Skeldon KD, Patterson C, Wyse CA, Gibson GM, Padgett MJ, Longbottom C, McMillan LC. The potential offered by real-time, high-sensitivity monitoring of ethane in breath and some pilot studies using optical spectroscopy. ACTA ACUST UNITED AC 2005. [DOI: 10.1088/1464-4258/7/6/019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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21
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Miekisch W, Schubert JK, Noeldge-Schomburg GFE. Diagnostic potential of breath analysis--focus on volatile organic compounds. Clin Chim Acta 2004; 347:25-39. [PMID: 15313139 DOI: 10.1016/j.cccn.2004.04.023] [Citation(s) in RCA: 591] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Revised: 01/30/2004] [Accepted: 04/16/2004] [Indexed: 01/03/2023]
Abstract
Breath analysis has attracted a considerable amount of scientific and clinical interest during the last decade. In contrast to NO, which is predominantly generated in the bronchial system, volatile organic compounds (VOCs) are mainly blood borne and therefore enable monitoring of different processes in the body. Exhaled ethane and pentane concentrations were elevated in inflammatory diseases. Acetone was linked to dextrose metabolism and lipolysis. Exhaled isoprene concentrations showed correlations with cholesterol biosynthesis. Exhaled levels of sulphur-containing compounds were elevated in liver failure and allograft rejection. Looking at a set of volatile markers may enable recognition and diagnosis of complex diseases such as lung or breast cancer. Due to technical problems of sampling and analysis and a lack of normalization and standardization, huge variations exist between results of different studies. This is among the main reasons why breath analysis could not yet been introduced into clinical practice. This review addresses the basic principles of breath analysis and the diagnostic potential of different volatile breath markers. Analytical procedures, issues concerning biochemistry and exhalation mechanisms of volatile substances, and future developments will be discussed.
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Affiliation(s)
- Wolfram Miekisch
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany.
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Schubert JK, Miekisch W, Geiger K, Nöldge-Schomburg GFE. Breath analysis in critically ill patients: potential and limitations. Expert Rev Mol Diagn 2004; 4:619-29. [PMID: 15347256 DOI: 10.1586/14737159.4.5.619] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breath tests are attractive since they are noninvasive and can be repeated frequently in the dynamically changing state of critically ill patients. Volatile organic compounds can be produced anywhere in the body and are transported via the bloodstream and exhaled through the lung. They can reflect physiologic or pathologic biochemical processes such as lipid peroxidation, liver disease, renal failure, allograft rejection, and dextrose or cholesterol metabolism. This review describes the diagnostic potential of endogenous organic volatile substances in the breath of critically ill patients. Since many of these patients require ventilatory support, aspects of breath analysis under mechanical ventilation will be addressed. Analytical procedures, problems concerning the physiologic meaning of breath markers and future developments will be discussed.
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Affiliation(s)
- Jochen K Schubert
- Department of Anaesthesiology and Intensive Care, University of Rostock, Schillingallee 35, 18057 Rostock, Germany.
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23
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Scholpp J, Schubert JK, Miekisch W, Noeldge-Schomburg GFE. Lipid Peroxidation Early after Brain Injury. J Neurotrauma 2004; 21:667-77. [PMID: 15253795 DOI: 10.1089/0897715041269632] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The role of lipid peroxidation after brain injury is still not completely understood, and results of different studies have been equivocal. In this study, three proposed peroxidation markers were determined in patients early after isolated head injury and results compared to healthy controls. Malondialdehyde (MDA) and thiobarbituric acid-reactive substances (TBARS) were measured in plasma, and n-pentane was determined in patients' exhaled air. For MDA and TBARS no significant differences could be shown (0.267 vs. 0.358 ng/mL, and 0.896 vs. 0.814 ng/mL in patients vs. healthy volunteers, respectively). n-Pentane, however, was significantly increased in the expired air of patients (0.471 vs. 0.118 nmol/L in healthy volunteers). Similar results for n-pentane were obtained when only male patients and volunteers were considered (0.510 vs. 0.113 nmol/L). Stratification according to clinical outcome showed significantly higher values for n-pentane in male patients with poor outcome (0.656 nmol/L) in comparison with healthy male volunteers (0.113 nmol/L). No difference was found when patients were stratified according to the presence or absence of subarachnoid hemorrhage. It is concluded that, only in a sub-population of patients with brain injury, lipid-peroxidation is a crucial mechanism. n-Pentane seems to be a valuable marker to detect lipid peroxidation early after brain trauma. Malondialdehyde may be of value only later in the course of the disease. TBARS are not a specific marker and should therefore not be used.
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Affiliation(s)
- Joachim Scholpp
- Department of Anesthesia, University Hospital of Freiburg, Freiburg i. Brsg., Germany.
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24
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Halliwell B, Whiteman M. Measuring reactive species and oxidative damage in vivo and in cell culture: how should you do it and what do the results mean? Br J Pharmacol 2004; 142:231-55. [PMID: 15155533 PMCID: PMC1574951 DOI: 10.1038/sj.bjp.0705776] [Citation(s) in RCA: 1499] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 03/08/2004] [Accepted: 03/08/2004] [Indexed: 02/06/2023] Open
Abstract
Free radicals and other reactive species (RS) are thought to play an important role in many human diseases. Establishing their precise role requires the ability to measure them and the oxidative damage that they cause. This article first reviews what is meant by the terms free radical, RS, antioxidant, oxidative damage and oxidative stress. It then critically examines methods used to trap RS, including spin trapping and aromatic hydroxylation, with a particular emphasis on those methods applicable to human studies. Methods used to measure oxidative damage to DNA, lipids and proteins and methods used to detect RS in cell culture, especially the various fluorescent "probes" of RS, are also critically reviewed. The emphasis throughout is on the caution that is needed in applying these methods in view of possible errors and artifacts in interpreting the results.
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Affiliation(s)
- Barry Halliwell
- Department of Biochemistry, Faculty of Medicine, National University of Singapore, MD 7 #03-08, 8 Medical Drive, Singapore 117597, Singapore.
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Dale O, Bergum H, Lund T, Nilsen T, Aadahl P, Stenseth R. A validated method for rapid analysis of ethane in breath and its application in kinetic studies in human volunteers. Free Radic Res 2004; 37:815-21. [PMID: 14567440 DOI: 10.1080/1071576031000107353] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oxidative stress may initiate lipid peroxidation that generates ethane. Ethane, at low concentrations, is eliminated by pulmonary exhalation. Previous methods have not allowed frequent sampling, thus ethane kinetics has not been studied in man. A validated method over the range 3.8-100,000 ppb with a limit of quantitation of 3.8 ppb (CV 9.3%) based on cryofocusing technique of a 60 ml breath sample allowed frequent sampling. Due to a rapid analytical procedure batches of more than 100 samples may be analyzed. In human volunteers (24-55 years) uptake was studied for up to 23 min (n = 9), elimination was studied for 210 min (n = 9). Ethane was inhaled (concentrations varied from 16 to 29 ppm (parts per million)) through a non-rebreathing system; sampling was performed with short intervals from the expiratory limb. Samples were also drawn from the inhalatory limb. Ninety-five percent of steady state (inspired) concentration was reached within 1.75 min. Five percent of the initially inhaled concentrations was found in exhaled air 1.5 min after termination of inhalation. A terminal mean half life of 31 min for ethane was also observed. The data indicate that frequent sampling will be necessary to capture relevant changes in breath ethane.
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Affiliation(s)
- Ola Dale
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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26
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Wyse CA, Preston T, Yam PS, Sutton DGM, Christley RM, Hotchkiss JW, Mills CA, Glidle A, Cumming DRS, Cooper JM, Love S. Current and future uses of breath analysis as a diagnostic tool. Vet Rec 2004; 154:353-60. [PMID: 15074325 DOI: 10.1136/vr.154.12.353] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The analysis of exhaled breath is a potentially useful method for application in veterinary diagnostics. Breath samples can be easily collected from animals by means of a face mask or collection chamber with minimal disturbance to the animal. After the administration of a 13C-labelled compound the recovery of 13C in breath can be used to investigate gastrointestinal and digestive functions. Exhaled hydrogen can be used to assess orocaecal transit time and malabsorption, and exhaled nitric oxide, carbon monoxide and pentane can be used to assess oxidative stress and inflammation. The analysis of compounds dissolved in the aqueous phase of breath (the exhaled breath condensate) can be used to assess airway inflammation. This review summarises the current status of breath analysis in veterinary medicine, and analyses its potential for assessing animal health and disease.
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Affiliation(s)
- C A Wyse
- Institute of Comparative Medicine, University of Glasgow Veterinary School, Bearsden, Glasgow G61 1QH
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von Basum G, Dahnke H, Halmer D, Hering P, Mürtz M. Online recording of ethane traces in human breath via infrared laser spectroscopy. J Appl Physiol (1985) 2003; 95:2583-90. [PMID: 12897034 DOI: 10.1152/japplphysiol.00542.2003] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A method is described for rapidly measuring the ethane concentration in exhaled human breath. Ethane is considered a volatile marker for lipid peroxidation. The breath samples are analyzed in real time during single exhalations by means of infrared cavity leak-out spectroscopy. This is an ultrasensitive laser-based method for the analysis of trace gases on the sub-parts per billion level. We demonstrate that this technique is capable of online quantifying of ethane traces in exhaled human breath down to 500 parts per trillion with a time resolution of better than 800 ms. This study includes what we believe to be the first measured expirograms for trace fractions of ethane. The expirograms were recorded after a controlled inhalation exposure to 1 part per million of ethane. The normalized slope of the alveolar plateau was determined, which shows a linear increase over the first breathing cycles and ends in a mean value between 0.21 and 0.39 liter-1. The washout process was observed for a time period of 30 min and was modelled by a threefold exponential decay function, with decay times ranging from 12 to 24, 341 to 481, and 370 to 1770 s. Our analyzer provides a promising noninvasive tool for online monitoring of the oxidative stress status.
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Affiliation(s)
- Golo von Basum
- Institut für Lasermedizin, Universität Düsseldorf, Universitätsstrabetae 1, D-40225 Düsseldorf, Germany
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Lindstrom AB, Pleil JD. A review of the USEPA's single breath canister (SBC) method for exhaled volatile organic biomarkers. Biomarkers 2002; 7:189-208. [PMID: 12141064 DOI: 10.1080/13547500110119750] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Exhaled alveolar breath can provide a great deal of information about an individual's health and previous exposure to potentially harmful xenobiotic materials. Because breath can be obtained non-invasively and its constituents directly reflect concentrations in the blood, its use has many potential applications in the field of biomarker research. This paper reviews the utility and application of the single breath canister (SBC) method of alveolar breath collection and analysis first developed by the US Environmental Protection Agency (USEPA) in the 1990s. This review covers the development of the SBC technique in the laboratory and its application in a range of field studies. Together these studies specifically show how the SBC method (and exhaled breath analysis in general) can be used to clearly demonstrate recent exposure to volatile organic compounds, to link particular activities to specific exposures, to determine compound-specific uptake and elimination kinetics, and to assess the relative importance of various routes of exposure (i.e. dermal, ingestion, inhalation) in multi-pathway scenarios. Specific investigations covered in this overview include an assessment of exposures related to the residential use of contaminated groundwater, exposures to gasoline and fuel additives at self-service gas stations, swimmers' exposures to trihalomethanes, and occupational exposures to jet fuel.
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Affiliation(s)
- Andrew B Lindstrom
- National Exposure Research Laboratory, US Environmental Protection Agency, MD-44, Research Triangle Park, NC 27711, USA.
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Studer SM, Orens JB, Rosas I, Krishnan JA, Cope KA, Yang S, Conte JV, Becker PB, Risby TH. Patterns and significance of exhaled-breath biomarkers in lung transplant recipients with acute allograft rejection. J Heart Lung Transplant 2001; 20:1158-66. [PMID: 11704475 DOI: 10.1016/s1053-2498(01)00343-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obliterative bronchiolitis (OB) remains one of the leading causes of death in lung transplant recipients after 2 years, and acute rejection (AR) of lung allograft is a major risk factor for OB. Treatment of AR may reduce the incidence of OB, although diagnosis of AR often requires bronchoscopic lung biopsy. In this study, we evaluated the utility of exhaled-breath biomarkers for the non-invasive diagnosis of AR. METHODS We obtained breath samples from 44 consecutive lung transplant recipients who attended ambulatory follow-up visits for the Johns Hopkins Lung Transplant Program. Bronchoscopy within 7 days of their breath samples showed histopathology in 21 of these patients, and we included them in our analysis. We measured hydrocarbon markers of pro-oxidant events (ethane and 1-pentane), isoprene, acetone, and sulfur-containing compounds (hydrogen sulfide and carbonyl sulfide) in exhaled breath and compared their levels to the lung histopathology, graded as stable (non-rejection) or AR. None of the study subjects were diagnosed with OB or infection at the time of the clinical bronchoscopy. RESULTS We found no significant difference in exhaled levels of hydrocarbons, acetone, or hydrogen sulfide between the stable and AR groups. However, we did find significant increase in exhaled carbonyl sulfide (COS) levels in AR subjects compared with stable subjects. We also observed a trend in 7 of 8 patients who had serial sets of breath and histopathology data that supported a role for COS as a breath biomarker of AR. CONCLUSIONS This study demonstrated elevations in exhaled COS levels in subjects with AR compared with stable subjects, suggesting a diagnostic role for this non-invasive biomarker. Further exploration of breath analysis in lung transplant recipients is warranted to complement fiberoptic bronchoscopy and obviate the need for this procedure in some patients.
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Affiliation(s)
- S M Studer
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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30
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Affiliation(s)
- S A Kharitonov
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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31
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Abstract
Isolation and quantification of volatile breath biomarkers indicative of relevant alterations in clinical status has required development of new techniques and applications of existing analytical chemical methods. The most significant obstacles to successful application of this type of sample have been reduction in required sample volume permitting replicate analysis (an absolute requirement for all clinical studies), separation of the analyte(s) of interest from background molecules, water vapor and other molecules with similar physical properties, introduction of automation in analysis and the use of selective detection systems (electron impact mass spectrometry, flame photometric, thermionic detectors), and automated sample collection from the human subject. Advances in adsorption technology and trace gas analysis have permitted rapid progress in this area of clinical chemistry.
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Affiliation(s)
- T H Risby
- Department of Environmental Health Sciences, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA
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