1
|
Chen J, Ji Y, Liu Y, Cen Z, Chen Y, Zhang Y, Li X, Li X. Exhaled volatolomics profiling facilitates personalized screening for gastric cancer. Cancer Lett 2024; 590:216881. [PMID: 38614384 DOI: 10.1016/j.canlet.2024.216881] [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] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024]
Abstract
Gastric cancer (GC) is one of the most fatal cancers, characterized by non-specific early symptoms and difficulty in detection. However, there are no valid non-invasive screening tools available for GC. Here we establish a non-invasive method that employs exhaled volatolomics and ensemble learning to detect GC. We developed a comprehensive mass spectrometry-based procedure and determined of a wide range of volatolomics from 314 breath samples. The discovery, identification and verification research screened a biomarker panel to distinguish GC from controls. This panel has achieved 0.90 (0.87-0.94, 95%CI) accuracy, with an area under curve (AUC) of 0.92 (0.89-0.94, 95%CI) in discovery cohort and 0.88 (0.83-0.91, 95%CI) accuracy with an AUC of 0.91 (0.87-0.93, 95%CI) in replication cohort, which outperformed traditional serum markers. Single-cell sequencing and gene set enrichment analysis revealed that these exhaled markers originated from aldehyde oxidation and pyruvate metabolism. Our approach advances the design of exhaled analysis for GC detection and holds promise as a non-invasive method to the clinic.
Collapse
Affiliation(s)
- Jian Chen
- Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, PR China
| | - Yongyan Ji
- Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, PR China
| | - Yongqian Liu
- Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, PR China
| | - Zhengnan Cen
- Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, PR China
| | - Yuanwen Chen
- Department of Gastroenterology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, PR China
| | - Yixuan Zhang
- Department of Gastroenterology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, PR China
| | - Xiaowen Li
- Department of Gastroenterology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, PR China.
| | - Xiang Li
- Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, PR China.
| |
Collapse
|
2
|
Herth J, Schmidt F, Basler S, Sievi NA, Kohler M. Exhaled breath analysis in patients with potentially curative lung cancer undergoing surgery: a longitudinal study. J Breath Res 2024; 18:036003. [PMID: 38718786 DOI: 10.1088/1752-7163/ad48a9] [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] [Received: 02/04/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Exhaled breath analysis has emerged as a non-invasive and promising method for early detection of lung cancer, offering a novel approach for diagnosis through the identification of specific biomarkers present in a patient's breath. For this longitudinal study, 29 treatment-naive patients with lung cancer were evaluated before and after surgery. Secondary electrospray ionization high-resolution mass spectrometry was used for exhaled breath analysis. Volatile organic compounds with absolute log2fold change ⩾1 andq-values ⩾ 0.71 were selected as potentially relevant. Exhaled breath analysis resulted in a total of 3482 features. 515 features showed a substantial difference before and after surgery. The small sample size generated a false positive rate of 0.71, therefore, around 154 of these 515 features were expected to be true changes. Biological identification of the features with the highest consistency (m/z-242.18428 andm/z-117.0539) revealed to potentially be 3-Oxotetradecanoic acid and Indole, respectively. Principal component analysis revealed a primary cluster of patients with a recurrent lung cancer, which remained undetected in the initial diagnostic and surgical procedures. The change of exhaled breath patterns after surgery in lung cancer emphasizes the potential for lung cancer screening and detection.
Collapse
Affiliation(s)
- Jonas Herth
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix Schmidt
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sarah Basler
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Malcolm Kohler
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
3
|
Torbicki A, Kurzyna M. The Diagnostic Approach to Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:728-737. [PMID: 37487526 DOI: 10.1055/s-0043-1770116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
The clinical presentation of pulmonary hypertension (PH) is nonspecific, resulting in significant delays in its detection. In the majority of cases, PH is a marker of the severity of other cardiopulmonary diseases. Differential diagnosis aimed at the early identification of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) who do require specific and complex therapies is as important as PH detection itself. Despite all efforts aimed at the noninvasive assessment of pulmonary arterial pressure, the formal confirmation of PH still requires catheterization of the right heart and pulmonary artery. The current document will give an overview of strategies aimed at the early diagnosis of PAH and CTEPH, while avoiding their overdiagnosis. It is not intended to be a replica of the recently published European Society of Cardiology (ESC) and European Respiratory Society (ERS) Guidelines on Diagnosis and Treatment of Pulmonary Hypertension, freely available at the Web sites of both societies. While promoting guidelines' recommendations, including those on new definitions of PH, we will try to bring them closer to everyday clinical practice, benefiting from our personal experience in managing patients with suspected PH.
Collapse
Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre for Postgraduate Medical Education at ECZ-Otwock, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre for Postgraduate Medical Education at ECZ-Otwock, Otwock, Poland
| |
Collapse
|
4
|
Walters R, Vasilaki E, Aman J, Chen CN, Wu Y, Liang OD, Ashek A, Dubois O, Zhao L, Sabrin F, Cebola I, Ferrer J, Morrell NW, Klinger JR, Wilkins MR, Zhao L, Rhodes CJ. SOX17 Enhancer Variants Disrupt Transcription Factor Binding And Enhancer Inactivity Drives Pulmonary Hypertension. Circulation 2023; 147:1606-1621. [PMID: 37066790 PMCID: PMC7614572 DOI: 10.1161/circulationaha.122.061940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a rare disease characterized by remodeling of the pulmonary arteries, increased vascular resistance, and right-sided heart failure. Genome-wide association studies of idiopathic/heritable PAH established novel genetic risk variants, including conserved enhancers upstream of transcription factor (TF) SOX17 containing 2 independent signals. SOX17 is an important TF in embryonic development and in the homeostasis of pulmonary artery endothelial cells (hPAEC) in the adult. Rare pathogenic mutations in SOX17 cause heritable PAH. We hypothesized that PAH risk alleles in an enhancer region impair TF-binding upstream of SOX17, which in turn reduces SOX17 expression and contributes to disturbed endothelial cell function and PAH development. METHODS CRISPR manipulation and siRNA were used to modulate SOX17 expression. Electromobility shift assays were used to confirm in silico-predicted TF differential binding to the SOX17 variants. Functional assays in hPAECs were used to establish the biological consequences of SOX17 loss. In silico analysis with the connectivity map was used to predict compounds that rescue disturbed SOX17 signaling. Mice with deletion of the SOX17-signal 1 enhancer region (SOX17-4593/enhKO) were phenotyped in response to chronic hypoxia and SU5416/hypoxia. RESULTS CRISPR inhibition of SOX17-signal 2 and deletion of SOX17-signal 1 specifically decreased SOX17 expression. Electromobility shift assays demonstrated differential binding of hPAEC nuclear proteins to the risk and nonrisk alleles from both SOX17 signals. Candidate TFs HOXA5 and ROR-α were identified through in silico analysis and antibody electromobility shift assays. Analysis of the hPAEC transcriptomes revealed alteration of PAH-relevant pathways on SOX17 silencing, including extracellular matrix regulation. SOX17 silencing in hPAECs resulted in increased apoptosis, proliferation, and disturbance of barrier function. With the use of the connectivity map, compounds were identified that reversed the SOX17-dysfunction transcriptomic signatures in hPAECs. SOX17 enhancer knockout in mice reduced lung SOX17 expression, resulting in more severe pulmonary vascular leak and hypoxia or SU5416/hypoxia-induced pulmonary hypertension. CONCLUSIONS Common PAH risk variants upstream of the SOX17 promoter reduce endothelial SOX17 expression, at least in part, through differential binding of HOXA5 and ROR-α. Reduced SOX17 expression results in disturbed hPAEC function and PAH. Existing drug compounds can reverse the disturbed SOX17 pulmonary endothelial transcriptomic signature.
Collapse
Affiliation(s)
- Rachel Walters
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Eleni Vasilaki
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Jurjan Aman
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
- Department of Pulmonary Medicine, Amsterdam University Medical Center, The Netherlands (J.A.)
| | - Chien-Nien Chen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Yukyee Wu
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Olin D Liang
- Division of Hematology/Oncology, Department of Medicine (O.D.L.), Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence
| | - Ali Ashek
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Olivier Dubois
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Lin Zhao
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Farah Sabrin
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Inês Cebola
- Section of Genetics & Genomics, Department of Metabolism, Digestion & Reproduction, Hammersmith Hospital, Imperial College, London, United Kingdom (I.C., J.F.)
| | - Jorge Ferrer
- Section of Genetics & Genomics, Department of Metabolism, Digestion & Reproduction, Hammersmith Hospital, Imperial College, London, United Kingdom (I.C., J.F.)
- Computational Biology and Health Genomics Programme, Centre for Genomic Regulation, Barcelona Institute of Science and Technology, Spain (J.F.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain (J.F.)
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, United Kingdom (N.W.M.)
- NIHR BioResource for Translational Research, University of Cambridge, United Kingdom (N.W.M.)
- On Behalf of the British Heart Foundation/Medical Research Council UK PAH Cohort Consortium (N.W.M., M.R.W., C.J.R.)
| | - James R Klinger
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine (J.R.K.), Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence
| | - Martin R Wilkins
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
- On Behalf of the British Heart Foundation/Medical Research Council UK PAH Cohort Consortium (N.W.M., M.R.W., C.J.R.)
| | - Lan Zhao
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
| | - Christopher J Rhodes
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College, London, United Kingdom (R.W., E.V., J.A., C.-N.C., Y.W., A.A., O.D., L.Z., F.S., M.R.W., L.Z., C.J.R.)
- On Behalf of the British Heart Foundation/Medical Research Council UK PAH Cohort Consortium (N.W.M., M.R.W., C.J.R.)
| |
Collapse
|
5
|
Alzoman H, Alssum L, Helmi M, Alsaleh L. Relationship between Hormonal Changes and Self-Perceived Halitosis in Females: A Cross-Sectional Study. Healthcare (Basel) 2022; 11:healthcare11010043. [PMID: 36611503 PMCID: PMC9818922 DOI: 10.3390/healthcare11010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Halitosis is a growing concern for patients seeking dental treatment. Women experience hormonal changes throughout different phases of their life. These changes may affect volatile organic compound (VOC) production and can be linked to halitosis. The aim of this study was to evaluate the effect of hormonal changes on self-perceived halitosis in a sample of females using a self-administered questionnaire. This study used a cross-sectional observational design. The questionnaire was distributed electronically through Google forms. A total of 1089 participants completed the questionnaire. Almost 50% of participants were below the age of 25; and 12% were of menopausal age (defined as 45 years and older). Most participants reported having regular menstrual cycles (63.5%) while only 20% reported having hormonal disturbances. Almost 62% of the sample reported that they notice halitosis on themselves with 27.6% indicating their perception of halitosis occurred at different times of the month. Around 12% of the sample thought that a relationship between halitosis and their menstrual cycle existed with 4.6% reporting halitosis during menstruation. The present study found that regularity of menstrual cycle and hormonal disturbances can affect females' self-perceived halitosis and the prevalence of oral health symptoms.
Collapse
Affiliation(s)
- Hamad Alzoman
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
| | - Lamees Alssum
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
- Correspondence: ; Tel.: +966-506975695
| | - Mohammad Helmi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
| | - Lama Alsaleh
- College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| |
Collapse
|
6
|
Wasilewski T, Brito NF, Szulczyński B, Wojciechowski M, Buda N, Melo ACA, Kamysz W, Gębicki J. Olfactory Receptor-based Biosensors as Potential Future Tools in Medical Diagnosis. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2022.116599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Salman D, Ibrahim W, Kanabar A, Joyce A, Zhao B, Singapuri A, Wilde M, Cordell RL, McNally T, Ruszkiewicz D, Hadjithekli A, Free R, Greening N, Gaillard EA, Beardsmore C, Monks P, Brightling C, Siddiqui S, Thomas CLP. The variability of volatile organic compounds in the indoor air of clinical environments. J Breath Res 2021; 16. [PMID: 34724656 DOI: 10.1088/1752-7163/ac3565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022]
Abstract
The development of clinical breath-analysis is confounded by the variability of background volatile organic compounds (VOCs). Reliable interpretation of clinical breath-analysis at individual, and cohort levels requires characterisation of clinical-VOC levels and exposures. Active-sampling with thermal-desorption/gas chromatography-mass spectrometry recorded and evaluated VOC concentrations in 245 samples of indoor air from three sites in a large National Health Service (NHS) provider trust in the UK over 27 months. Data deconvolution, alignment and clustering isolated 7344 features attributable to VOC and described the variability (composition and concentration) of respirable clinical VOC. 328 VOC were observed in more than 5% of the samples and 68 VOC appeared in more than 30% of samples. Common VOC were associated with exogenous and endogenous sources and 17 VOC were identified as seasonal differentiators. The presence of metabolites from the anaesthetic sevoflurane, and putative-disease biomarkers in room air, indicated that exhaled VOC were a source of background-pollution in clinical breath-testing activity. With the exception of solvents, and waxes associated with personal protective equipment (PPE), exhaled VOC concentrations above 3µg m-3are unlikely to arise from room air contamination, and in the absence of extensive survey-data, this level could be applied as a threshold for inclusion in studies, removing a potential environmental confounding-factor in developing breath-based diagnostics.
Collapse
Affiliation(s)
- Dahlia Salman
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - Wadah Ibrahim
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Amisha Kanabar
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - Abigail Joyce
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - Bo Zhao
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Amisha Singapuri
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Michael Wilde
- Department of Chemistry, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom
| | - Rebecca L Cordell
- Department of Chemistry, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom
| | - Teresa McNally
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom
| | - Dorota Ruszkiewicz
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - Andria Hadjithekli
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - Robert Free
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Neil Greening
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Erol A Gaillard
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom
| | - Caroline Beardsmore
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom
| | - Paul Monks
- Department of Chemistry, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom
| | - Chris Brightling
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Salman Siddiqui
- College of Life Sciences, Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom.,Leicester NIHR Biomedical Research Centre (Respiratory theme), Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - C L Paul Thomas
- Department of Chemistry, Loughborough University, Loughborough LE11 3TU, United Kingdom
| |
Collapse
|
8
|
Zhang J, Tian Y, Luo Z, Qian C, Li W, Duan Y. Breath volatile organic compound analysis: an emerging method for gastric cancer detection. J Breath Res 2021; 15. [PMID: 34610588 DOI: 10.1088/1752-7163/ac2cde] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/05/2021] [Indexed: 12/14/2022]
Abstract
Gastric cancer is a common malignancy, being the fifth most frequently diagnosed cancer and the fourth leading cause of cancer-related deaths worldwide. Diagnosis of gastric cancer at the early stage is critical to effectively improve the survival rate. However, a substantial proportion of patients with gastric cancer in the early stages lack specific symptoms or are asymptomatic. Moreover, the imaging techniques currently used for gastric cancer screening, such as computed tomography and barium examination, are usually radioactive and have low sensitivity and specificity. Even though endoscopy has high accuracy for gastric cancer screening, its application is limited by the invasiveness of the technique. Breath analysis is an economic, effective, easy to perform, non-invasive detection method, and has no undesirable side effects on subjects. Extensive worldwide research has been conducted on breath volatile organic compounds (VOCs), which reveals its prospect as a potential method for gastric cancer detection. Many interesting results have been obtained and innovative methods have been introduced in this subject; hence, an extensive review would be beneficial. By providing a comprehensive list of breath VOCs identified by gastric cancer would promote further research in this field. This review summarizes the commonly used technologies for exhaled breath analysis, focusing on the application of analytical instruments in the detection of breath VOCs in gastric cancers, and the alterations in the profile of breath biomarkers in gastric cancer patients are discussed as well.
Collapse
Affiliation(s)
- Jing Zhang
- Research Center of Analytical Instrumentation, Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an 710069, People's Republic of China
| | - Yonghui Tian
- Research Center of Analytical Instrumentation, Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an 710069, People's Republic of China
| | - Zewei Luo
- Research Center of Analytical Instrumentation, Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an 710069, People's Republic of China
| | - Cheng Qian
- Shaanxi Key Laboratory of Earth Surface System and Environmental Carrying Capacity, College of Urban and Environmental Sciences, Northwest University, Xi'an 710127, People's Republic of China
| | - Wenwen Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Yixiang Duan
- Research Center of Analytical Instrumentation, Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry & Materials Science, Northwest University, Xi'an 710069, People's Republic of China
| |
Collapse
|
9
|
Milyutin Y, Abud-Hawa M, Kloper-Weidenfeld V, Mansour E, Broza YY, Shani G, Haick H. Fabricating and printing chemiresistors based on monolayer-capped metal nanoparticles. Nat Protoc 2021; 16:2968-2990. [PMID: 34012107 DOI: 10.1038/s41596-021-00528-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
Chemiresistors that are based on monolayer-capped metal nanoparticles (MCNPs) have been used in a wide variety of innovative sensing applications, including detection and monitoring of diagnostic markers in body fluids, explosive materials, environmental contaminations and food quality control. The sensing mechanism is based on reversible swelling or aggregation and/or changes in dielectric constant of the MCNPs. In this protocol, we describe a procedure for producing MCNP-based chemiresistive sensors that is reproducible from device to device and from batch to batch. The approach relies on three main steps: (i) controlled synthesis of gold MCNPs, (ii) fabrication of electrodes that are surrounded with a microbarrier ring to confine the deposited MCNP solution and (iii) a tailor-made drying process to enable evaporation of solvent residues from the MCNP sensing layer to prevent a coffee-ring effect. Application of this approach has been shown to produce devices with ±1.5% variance-a value consistent with the criterion for commercial sensors-as well as long shelf life and stability. Fabrication of chemical sensors based on dodecanethiol- or 2-ethylhexanethiol-capped MCNPs with this approach provides high sensitivity and accuracy in the detection of volatile organic compounds (e.g., octane and decane), toxic gaseous species (e.g., HCl and NH3) in air and simulated mixtures of lung and gastric cancer from exhaled breath.
Collapse
Affiliation(s)
- Yana Milyutin
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Manal Abud-Hawa
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Viki Kloper-Weidenfeld
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elias Mansour
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoav Y Broza
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gidi Shani
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hossam Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
10
|
Sukul P, Schubert JK, Zanaty K, Trefz P, Sinha A, Kamysek S, Miekisch W. Exhaled breath compositions under varying respiratory rhythms reflects ventilatory variations: translating breathomics towards respiratory medicine. Sci Rep 2020; 10:14109. [PMID: 32839494 PMCID: PMC7445240 DOI: 10.1038/s41598-020-70993-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022] Open
Abstract
Control of breathing is automatic and its regulation is keen to autonomic functions. Therefore, involuntary and voluntary nervous regulation of breathing affects ventilatory variations, which has profound potential to address expanding challenges in contemporary pulmonology. Nonetheless, the fundamental attributes of the aforementioned phenomena are rarely understood and/or investigated. Implementation of unconventional approach like breathomics may leads to a better comprehension of those complexities in respiratory medicine. We applied breath-resolved spirometry and capnometry, non-invasive hemodynamic monitoring along with continuous trace analysis of exhaled VOCs (volatile organic compounds) by means of real-time mass-spectrometry in 25 young and healthy adult humans to investigate any possible mirroring of instant ventilatory variations by exhaled breath composition, under varying respiratory rhythms. Hemodynamics remained unaffected. Immediate changes in measured breath compositions and corresponding variations occurred when respiratory rhythms were switched between spontaneous (involuntary/unsynchronised) and/or paced (voluntary/synchronised) breathing. Such changes in most abundant, endogenous and bloodborne VOCs were closely related to the minute ventilation and end-tidal CO2 exhalation. Unprecedentedly, while preceded by a paced rhythm, spontaneous rhythms in both independent setups became reproducible with significantly (P-value ≤ 0.005) low intra- and inter-individual variation in measured parameters. We modelled breath-resolved ventilatory variations via alveolar isoprene exhalation, which were independently validated with unequivocal precision. Reproducibility i.e. attained via our method would be reliable for human breath sampling, concerning biomarker research. Thus, we may realize the actual metabolic and pathophysiological expressions beyond the everlasting in vivo physiological noise. Consequently, less pronounced changes are often misinterpreted as disease biomarker in cross-sectional studies. We have also provided novel information beyond conventional spirometry and capnometry. Upon clinical translations, our findings will have immense impact on pulmonology and breathomics as they have revealed a reproducible pattern of ventilatory variations and respiratory homeostasis in endogenous VOC exhalations.
Collapse
Affiliation(s)
- Pritam Sukul
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | - Jochen K Schubert
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Karim Zanaty
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Phillip Trefz
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Anupam Sinha
- Institute for Clinical Chemistry and Laboratory Medicine, University Clinic Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Svend Kamysek
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Wolfram Miekisch
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
| |
Collapse
|
11
|
Harbaum L, Rhodes CJ, Otero-Núñez P, Wharton J, Wilkins MR. The application of 'omics' to pulmonary arterial hypertension. Br J Pharmacol 2020; 178:108-120. [PMID: 32201940 DOI: 10.1111/bph.15056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/03/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Recent genome-wide analyses of rare and common sequence variations have brought greater clarity to the genetic architecture of pulmonary arterial hypertension and implicated novel genes in disease development. Transcriptional signatures have been reported in whole lung tissue, pulmonary vascular cells and peripheral circulating cells. High-throughput platforms for plasma proteomics and metabolomics have identified novel biomarkers associated with clinical outcomes and provided molecular instruments for risk assessment. There are methodological challenges to integrating these datasets, coupled to statistical power limitations inherent to the study of a rare disease, but the expectation is that this approach will reveal novel druggable targets and biomarkers that will open the way to personalized medicine. Here, we review the current state-of-the-art and future promise of 'omics' in the field of translational medicine in pulmonary arterial hypertension. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.1/issuetoc.
Collapse
Affiliation(s)
- Lars Harbaum
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Pablo Otero-Núñez
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John Wharton
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
12
|
Abstract
Pulmonary arterial hypertension (PAH) is rare and, if untreated, has a median survival of 2-3 years. Pulmonary arterial hypertension may be idiopathic (IPAH) but is frequently associated with other conditions. Despite increased awareness, therapeutic advances, and improved outcomes, the time from symptom onset to diagnosis remains unchanged. The commonest symptoms of PAH (breathlessness and fatigue) are non-specific and clinical signs are usually subtle, frequently preventing early diagnosis where therapies may be more effective. The failure to improve the time to diagnosis largely reflects an inability to identify patients at increased risk of PAH using current approaches. To date, strategies to improve the time to diagnosis have focused on screening patients with a high prevalence [systemic sclerosis (10%), patients with portal hypertension assessed for liver transplantation (2-6%), carriers of mutations of the gene encoding bone morphogenetic protein receptor type II, and first-degree relatives of patients with heritable PAH]. In systemic sclerosis, screening algorithms have demonstrated that patients can be identified earlier, however, current approaches are resource intensive. Until, recently, it has not been considered possible to screen populations for rare conditions such as IPAH (prevalence 5-15/million/year). However, there is interest in the use of artificial intelligence approaches in medicine and the application of diagnostic algorithms to large healthcare data sets, to identify patients at risk of rare conditions. In this article, we review current approaches and challenges in screening for PAH and explore novel population-based approaches to improve detection.
Collapse
Affiliation(s)
- David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
- Insigneo Institute for in silico Medicine, Sheffield, S1 3JD, UK
| | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
- Insigneo Institute for in silico Medicine, Sheffield, S1 3JD, UK
| | - Marc Humbert
- Univ. Paris–Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
- AP-HP, Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| |
Collapse
|
13
|
Broza YY, Zhou X, Yuan M, Qu D, Zheng Y, Vishinkin R, Khatib M, Wu W, Haick H. Disease Detection with Molecular Biomarkers: From Chemistry of Body Fluids to Nature-Inspired Chemical Sensors. Chem Rev 2019; 119:11761-11817. [DOI: 10.1021/acs.chemrev.9b00437] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Yoav Y. Broza
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Xi Zhou
- School of Natural and Applied Sciences, Northwestern Polytechnical University, Xi’an 710072, P.R. China
| | - Miaomiao Yuan
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, P.R. China
| | - Danyao Qu
- School of Advanced Materials and Nanotechnology, Interdisciplinary Research Center of Smart Sensors, Xidian University, Shaanxi 710126, P.R. China
| | - Youbing Zheng
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Rotem Vishinkin
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Muhammad Khatib
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Weiwei Wu
- School of Advanced Materials and Nanotechnology, Interdisciplinary Research Center of Smart Sensors, Xidian University, Shaanxi 710126, P.R. China
| | - Hossam Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
- School of Advanced Materials and Nanotechnology, Interdisciplinary Research Center of Smart Sensors, Xidian University, Shaanxi 710126, P.R. China
| |
Collapse
|
14
|
Trefz P, Obermeier J, Lehbrink R, Schubert JK, Miekisch W, Fischer DC. Exhaled volatile substances in children suffering from type 1 diabetes mellitus: results from a cross-sectional study. Sci Rep 2019; 9:15707. [PMID: 31673076 PMCID: PMC6823423 DOI: 10.1038/s41598-019-52165-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
Monitoring metabolic adaptation to type 1 diabetes mellitus in children is challenging. Analysis of volatile organic compounds (VOCs) in exhaled breath is non-invasive and appears as a promising tool. However, data on breath VOC profiles in pediatric patients are limited. We conducted a cross-sectional study and applied quantitative analysis of exhaled VOCs in children suffering from type 1 diabetes mellitus (T1DM) (n = 53) and healthy controls (n = 60). Both groups were matched for sex and age. For breath gas analysis, a very sensitive direct mass spectrometric technique (PTR-TOF) was applied. The duration of disease, the mode of insulin application (continuous subcutaneous insulin infusion vs. multiple daily insulin injection) and long-term metabolic control were considered as classifiers in patients. The concentration of exhaled VOCs differed between T1DM patients and healthy children. In particular, T1DM patients exhaled significantly higher amounts of ethanol, isopropanol, dimethylsulfid, isoprene and pentanal compared to healthy controls (171, 1223, 19.6, 112 and 13.5 ppbV vs. 82.4, 784, 11.3, 49.6, and 5.30 ppbV). The most remarkable differences in concentrations were found in patients with poor metabolic control, i.e. those with a mean HbA1c above 8%. In conclusion, non-invasive breath testing may support the discovery of basic metabolic mechanisms and adaptation early in the progress of T1DM.
Collapse
Affiliation(s)
- Phillip Trefz
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany.
| | - Juliane Obermeier
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Ruth Lehbrink
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Jochen K Schubert
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Wolfram Miekisch
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | | |
Collapse
|
15
|
Elia D, Caminati A, Zompatori M, Cassandro R, Lonati C, Luisi F, Pelosi G, Provencher S, Harari S. Pulmonary hypertension and chronic lung disease: where are we headed? Eur Respir Rev 2019; 28:28/153/190065. [DOI: 10.1183/16000617.0065-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/22/2019] [Indexed: 12/26/2022] Open
Abstract
Pulmonary hypertension related to chronic lung disease, mainly represented by COPD and idiopathic pulmonary fibrosis, is associated with a worse outcome when compared with patients only affected by parenchymal lung disease. At present, no therapies are available to reverse or slow down the pathological process of this condition and most of the clinical trials conducted to date have had no clinically significant impact. Nevertheless, the importance of chronic lung diseases is always more widely recognised and, along with its increasing incidence, associated pulmonary hypertension is also expected to be growing in frequency and as a health burden worldwide. Therefore, it is desirable to develop useful and reliable tools to obtain an early diagnosis and to monitor and follow-up this condition, while new insights in the therapeutic approach are explored.
Collapse
|
16
|
Abstract
Pulmonary hypertension (PH) is a common finding that can result from many different pathological conditions. Depending on the etiology, treatment may be quite different, but early diagnosis and correct classification of PH is difficult. With an aging population and recently suggested decreased pulmonary arterial pressure threshold defining PH, we are facing even more diagnostic uncertainties. A new approach to patients' phenotyping is needed. Here we present available data and future perspectives on employing an in-depth analysis of the omics cascade to allow an earlier and more reliable diagnosis and classification of PH. Indeed, with the help of super-fast computing, it became possible to simultaneously consider the levels of thousands of potential biomarkers to find patterns specific for clinically suspected disease. The omics cascade is an invaluable source of information. However, while the genome can be perceived as providing possibilities, transcriptome-as carving them this is metabolome that may tell us 'what is really going on' in an individual living organism. Metabolomics research requires blinded search for characteristic patterns of discreet changes in the levels of detectable metabolites. Since as many as 40,000 various substances are produced as a 'side effect of staying alive', metabolite profiling can be compared to fishing up for organized signals in a universe of chaos. Although difficult, such search for metabolic patterns that might lead to replacing the term biomarker by metabolic fingerprinting in the area of pulmonary circulation has already begun.
Collapse
|
17
|
Greaves RF, Bernardini S, Ferrari M, Fortina P, Gouget B, Gruson D, Lang T, Loh TP, Morris HA, Park JY, Roessler M, Yin P, Kricka LJ. Key questions about the future of laboratory medicine in the next decade of the 21st century: A report from the IFCC-Emerging Technologies Division. Clin Chim Acta 2019; 495:570-589. [DOI: 10.1016/j.cca.2019.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
|
18
|
Einoch Amor R, Nakhleh MK, Barash O, Haick H. Breath analysis of cancer in the present and the future. Eur Respir Rev 2019; 28:28/152/190002. [DOI: 10.1183/16000617.0002-2019] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/19/2019] [Indexed: 12/11/2022] Open
Abstract
Most of the currently used diagnostics for cancerous diseases have yet to meet the standards of screening, as they are insufficiently accurate and/or invasive and risky. In this review, we describe the rationale, the progress made to date, and the potential of analysing the exhaled volatile organic compounds as a pathway for enabling early diagnosis of cancer and, therefore, for achieving better clinical prognosis and survival rates. The review highlights the major advancements made in this field, from fundamentals, up to translational phases and clinical trials, with a special emphasis on sensing platforms based on nanomaterials. The prospects for breath analysis in early cancerous disease are presented and discussed.
Collapse
|
19
|
Hashoul D, Haick H. Sensors for detecting pulmonary diseases from exhaled breath. Eur Respir Rev 2019; 28:28/152/190011. [PMID: 31243097 PMCID: PMC9489036 DOI: 10.1183/16000617.0011-2019] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/13/2019] [Indexed: 01/09/2023] Open
Abstract
This review presents and discusses a new frontier for fast, risk-free and potentially inexpensive diagnostics of respiratory diseases by detecting volatile organic compounds (VOCs) present in exhaled breath. One part of the review is a didactic presentation of the overlaying concept and the chemistry of exhaled breath. The other part discusses diverse sensors that have been developed and used for the detection of respiratory diseases (e.g. chronic obstructive pulmonary disease, asthma, lung cancer, pulmonary arterial hypertension, tuberculosis, cystic fibrosis, obstructive sleep apnoea syndrome and pneumoconiosis) by analysis of VOCs in exhaled breath. The strengths and pitfalls are discussed and criticised, particularly in the perspective in disseminating information regarding these advances. Ideas regarding the improvement of sensors, sensor arrays, sensing devices and the further planning of workflow are also discussed. Detection of volatile organic compounds from exhaled breath by nanomaterial-based sensors is a new diagnostics frontier in the screening of pulmonary diseases.http://bit.ly/2JoBKXn
Collapse
Affiliation(s)
- Dina Hashoul
- Dept of Chemical Engineering, Russell Berrie Nanotechnology Institute, and the Technion Integrated Cancer Center, Haifa, Israel
| | - Hossam Haick
- Dept of Chemical Engineering, Russell Berrie Nanotechnology Institute, and the Technion Integrated Cancer Center, Haifa, Israel
| |
Collapse
|
20
|
Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A, Oudiz R, Satoh T, Torres F, Torbicki A. Diagnosis of pulmonary hypertension. Eur Respir J 2019; 53:1801904. [PMID: 30545972 PMCID: PMC6351333 DOI: 10.1183/13993003.01904-2018] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 12/20/2022]
Abstract
A revised diagnostic algorithm provides guidelines for the diagnosis of patients with suspected pulmonary hypertension, both prior to and following referral to expert centres, and includes recommendations for expedited referral of high-risk or complicated patients and patients with confounding comorbidities. New recommendations for screening high-risk groups are given, and current diagnostic tools and emerging diagnostic technologies are reviewed.
Collapse
Affiliation(s)
- Adaani Frost
- Dept of Medicine, Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - David Badesch
- Divisions of Pulmonary Sciences and Critical Care Medicine, and Cardiology, University of Colorado, Denver, CO, USA
| | - J. Simon R. Gibbs
- National Heart and Lung Institute, Imperial College of London, London, UK
| | - Deepa Gopalan
- Dept of Radiology, Imperial College Healthcare NHS Trust and Imperial College London, Hammersmith Hospital, London, UK
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Alessandra Manes
- Cardio-Thoracic and Vascular Dept, Sant'Orsola University Hospital, Bologna, Italy
| | - Ronald Oudiz
- LA Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Toru Satoh
- Division of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Fernando Torres
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Adam Torbicki
- Dept of Pulmonary Circulation and Cardidology, Medical Center for Postgraduate Education, ECZ-Otwock, Otwock, Poland
| |
Collapse
|
21
|
Giannoukos S, Agapiou A, Brkić B, Taylor S. Volatolomics: A broad area of experimentation. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1105:136-147. [PMID: 30584978 DOI: 10.1016/j.jchromb.2018.12.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/19/2018] [Accepted: 12/13/2018] [Indexed: 01/06/2023]
Abstract
Chemical analysis (detection and monitoring) of compounds associated with the metabolic activities of an organism is at the cutting edge of science. Volatile metabolomics (volatolomics) are applied in a broad range of applications including: biomedical research (e.g. disease diagnostic tools, personalized healthcare and nutrition, etc.), toxicological analysis (e.g. exposure tool to environmental pollutants, toxic and hazardous chemical environments, industrial accidents, etc.), molecular communications, forensics, safety and security (e.g. search and rescue operations). In the present review paper, an overview of recent advances and applications of volatolomics will be given. The main focus will be on volatile organic compounds (VOCs) originating from biological secretions of various organisms (e.g. microorganisms, insects, plants, humans) and resulting fusion of chemical information. Bench-top and portable or field-deployable technologies-systems will also be presented and discussed.
Collapse
Affiliation(s)
- S Giannoukos
- Laboratory of Atmospheric Chemistry, Paul Scherrer Institute (PSI), 5232 Villigen, Switzerland; University of Liverpool, Department of Electrical Engineering and Electronics, Liverpool L69 3GJ, UK
| | - A Agapiou
- University of Cyprus, Department of Chemistry, P.O. Box 20357, 1678 Nicosia, Cyprus.
| | - B Brkić
- BioSense Institute, University of Novi Sad, Dr Zorana Đinđića 1, 21 101 Novi Sad, Serbia
| | - S Taylor
- University of Liverpool, Department of Electrical Engineering and Electronics, Liverpool L69 3GJ, UK; Q Technologies Ltd, 100 Childwall Road, Liverpool L15 6UX, UK.
| |
Collapse
|
22
|
Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A, Oudiz R, Satoh T, Torres F, Torbicki A. Diagnosis of pulmonary hypertension. Eur Respir J 2018. [PMID: 30545972 DOI: 10.1183/13993003.01904‐2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A revised diagnostic algorithm provides guidelines for the diagnosis of patients with suspected pulmonary hypertension, both prior to and following referral to expert centres, and includes recommendations for expedited referral of high-risk or complicated patients and patients with confounding comorbidities. New recommendations for screening high-risk groups are given, and current diagnostic tools and emerging diagnostic technologies are reviewed.
Collapse
Affiliation(s)
- Adaani Frost
- Dept of Medicine, Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - David Badesch
- Divisions of Pulmonary Sciences and Critical Care Medicine, and Cardiology, University of Colorado, Denver, CO, USA
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College of London, London, UK
| | - Deepa Gopalan
- Dept of Radiology, Imperial College Healthcare NHS Trust and Imperial College London, Hammersmith Hospital, London, UK
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Alessandra Manes
- Cardio-Thoracic and Vascular Dept, Sant'Orsola University Hospital, Bologna, Italy
| | - Ronald Oudiz
- LA Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Toru Satoh
- Division of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Fernando Torres
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Adam Torbicki
- Dept of Pulmonary Circulation and Cardidology, Medical Center for Postgraduate Education, ECZ-Otwock, Otwock, Poland
| |
Collapse
|
23
|
Natural menstrual rhythm and oral contraception diversely affect exhaled breath compositions. Sci Rep 2018; 8:10838. [PMID: 30022081 PMCID: PMC6052073 DOI: 10.1038/s41598-018-29221-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/09/2018] [Indexed: 12/17/2022] Open
Abstract
Natural menstrual cycle and/or oral contraception diversely affect women metabolites. Longitudinal metabolic profiling under constant experimental conditions is thereby realistic to understand such effects. Thus, we investigated volatile organic compounds (VOCs) exhalation throughout menstrual cycles in 24 young and healthy women with- and without oral contraception. Exhaled VOCs were identified and quantified in trace concentrations via high-resolution real-time mass-spectrometry, starting from a menstruation and then repeated follow-up with six intervals including the next bleeding. Repeated measurements within biologically comparable groups were employed under optimized measurement setup. We observed pronounced and substance specific changes in exhaled VOC concentrations throughout all cycles with low intra-individual variations. Certain blood-borne volatiles changed significantly during follicular and luteal phases. Most prominent changes in endogenous VOCs were observed at the ovulation phase with respect to initial menstruation. Here, the absolute median abundances of alveolar ammonia, acetone, isoprene and dimethyl sulphide changed significantly (P-value ≤ 0.005) by 18.22↓, 13.41↓, 18.02↑ and 9.40↓%, respectively. These VOCs behaved in contrast under the presence of combined oral contraception; e.g. isoprene decreased significantly by 30.25↓%. All changes returned to initial range once the second bleeding phase was repeated. Changes in exogenous benzene, isopropanol, limonene etc. and smoking related furan, acetonitrile and orally originated hydrogen sulphide were rather nonspecific and mainly exposure dependent. Our observations could apprehend a number of known/pre-investigated metabolic effects induced by monthly endocrine regulations. Potential in vivo origins (e.g. metabolic processes) of VOCs are crucial to realize such effects. Despite ubiquitous confounders, we demonstrated the true strength of volatolomics for metabolic monitoring of menstrual cycle and contraceptives. These outcomes may warrant further studies in this direction to enhance our fundamental and clinical understanding on menstrual metabolomics and endocrinology. Counter-effects of contraception can be deployed for future noninvasive assessment of birth control pills. Our findings could be translated toward metabolomics of pregnancy, menopause and post-menopausal complications via breath analysis.
Collapse
|
24
|
Broza YY, Vishinkin R, Barash O, Nakhleh MK, Haick H. Synergy between nanomaterials and volatile organic compounds for non-invasive medical evaluation. Chem Soc Rev 2018; 47:4781-4859. [PMID: 29888356 DOI: 10.1039/c8cs00317c] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article is an overview of the present and ongoing developments in the field of nanomaterial-based sensors for enabling fast, relatively inexpensive and minimally (or non-) invasive diagnostics of health conditions with follow-up by detecting volatile organic compounds (VOCs) excreted from one or combination of human body fluids and tissues (e.g., blood, urine, breath, skin). Part of the review provides a didactic examination of the concepts and approaches related to emerging sensing materials and transduction techniques linked with the VOC-based non-invasive medical evaluations. We also present and discuss diverse characteristics of these innovative sensors, such as their mode of operation, sensitivity, selectivity and response time, as well as the major approaches proposed for enhancing their ability as hybrid sensors to afford multidimensional sensing and information-based sensing. The other parts of the review give an updated compilation of the past and currently available VOC-based sensors for disease diagnostics. This compilation summarizes all VOCs identified in relation to sickness and sampling origin that links these data with advanced nanomaterial-based sensing technologies. Both strength and pitfalls are discussed and criticized, particularly from the perspective of the information and communication era. Further ideas regarding improvement of sensors, sensor arrays, sensing devices and the proposed workflow are also included.
Collapse
Affiliation(s)
- Yoav Y Broza
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion - Israel Institute of Technology, Haifa 3200003, Israel.
| | | | | | | | | |
Collapse
|
25
|
Savale L, Guignabert C, Weatherald J, Humbert M. Precision medicine and personalising therapy in pulmonary hypertension: seeing the light from the dawn of a new era. Eur Respir Rev 2018; 27:27/148/180004. [PMID: 29653948 PMCID: PMC9488842 DOI: 10.1183/16000617.0004-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/21/2018] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) include different cardiopulmonary disorders in which the interaction of multiple genes with environmental and behavioural factors modulates the onset and the progression of these severe conditions. Although the development of therapeutic agents that modulate abnormalities in three major pathobiological pathways for PAH has revolutionised our approach to the treatment of PAH, the long-term survival rate remains unsatisfactory. Accumulating evidence has underlined that clinical outcomes and responses to therapy in PAH are modified by multiple factors, including genetic variations, which will be different for each individual. Since precision medicine, also known as stratified medicine or personalised medicine, aims to better target intervention to the individual while maximising benefit and minimising harm, it has significant potential advantages. This article aims to assemble and discuss the different initiatives that are currently underway in the PH/PAH fields together with the opportunities and prospects for their use in the near future. Development of precision medicine strategies will be the next frontier in the evolution of PAH treatmenthttp://ow.ly/8T8730j7e36
Collapse
|
26
|
Keppler F, Fischer J, Sattler T, Polag D, Jaeger N, Schöler HF, Greule M. Chloromethane emissions in human breath. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 605-606:405-410. [PMID: 28672229 DOI: 10.1016/j.scitotenv.2017.06.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
Chloromethane (CH3Cl), currently the most abundant chlorinated organic compound in the atmosphere at around ~550 parts per trillion by volume (pptv), is considered responsible for approximately 16% of halogen-catalyzed stratospheric ozone destruction. Although emissions of CH3Cl are known to occur from animals such as cattle, formation and release of CH3Cl from humans has not yet been reported. In this study a pre-concentration unit coupled with a gas chromatograph directly linked to a mass spectrometer was used to precisely measure concentrations of CH3Cl at the pptv level in exhaled breath from 31 human subjects with ages ranging from 3 to 87years. We provide analytical evidence that all subjects exhaled CH3Cl in the range of 2.5 to 33 parts per billion by volume, levels which significantly exceed those of inhaled air by a factor of up to 60. If the mean of these emissions was typical for the world's population, then the global source of atmospheric CH3Cl from humans would be around 0.66Ggyr-1 (0.33 to 1.48Ggyr-1), which is less than 0.03% of the total annual global atmospheric source strength. The observed endogenous formation of a chlorinated methyl group in humans might be of interest to biochemists and medical scientists as CH3Cl is also known to be a potent methylating agent and thus, could be an important target compound in future medical research diagnostic programs.
Collapse
Affiliation(s)
- Frank Keppler
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany; Heidelberg Center for the Environment (HCE), Heidelberg University, D-69120 Heidelberg, Germany.
| | - Jan Fischer
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany
| | - Tobias Sattler
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany
| | - Daniela Polag
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany
| | - Nicole Jaeger
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany
| | - Heinz Friedrich Schöler
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany
| | - Markus Greule
- Institute of Earth Sciences, Heidelberg University, Im Neuenheimer Feld 234-236, 69120 Heidelberg, Germany
| |
Collapse
|
27
|
Broza YY, Har-Shai L, Jeries R, Cancilla JC, Glass-Marmor L, Lejbkowicz I, Torrecilla JS, Yao X, Feng X, Narita A, Müllen K, Miller A, Haick H. Exhaled Breath Markers for Nonimaging and Noninvasive Measures for Detection of Multiple Sclerosis. ACS Chem Neurosci 2017; 8:2402-2413. [PMID: 28768105 DOI: 10.1021/acschemneuro.7b00181] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Multiple sclerosis (MS) is the most common chronic neurological disease affecting young adults. MS diagnosis is based on clinical characteristics and confirmed by examination of the cerebrospinal fluids (CSF) or by magnetic resonance imaging (MRI) of the brain or spinal cord or both. However, neither of the current diagnostic procedures are adequate as a routine tool to determine disease state. Thus, diagnostic biomarkers are needed. In the current study, a novel approach that could meet these expectations is presented. The approach is based on noninvasive analysis of volatile organic compounds (VOCs) in breath. Exhaled breath was collected from 204 participants, 146 MS and 58 healthy control individuals. Analysis was performed by gas-chromatography mass-spectrometry (GC-MS) and nanomaterial-based sensor array. Predictive models were derived from the sensors, using artificial neural networks (ANNs). GC-MS analysis revealed significant differences in VOC abundance between MS patients and controls. Sensor data analysis on training sets was able to discriminate in binary comparisons between MS patients and controls with accuracies up to 90%. Blinded sets showed 95% positive predictive value (PPV) between MS-remission and control, 100% sensitivity with 100% negative predictive value (NPV) between MS not-treated (NT) and control, and 86% NPV between relapse and control. Possible links between VOC biomarkers and the MS pathogenesis were established. Preliminary results suggest the applicability of a new nanotechnology-based method for MS diagnostics.
Collapse
Affiliation(s)
- Yoav Y. Broza
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 32000003, Israel
| | - Lior Har-Shai
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center, Haifa 34362, Israel
- Rappaport Faculty of Medicine & Research Institute, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - Raneen Jeries
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 32000003, Israel
| | - John C. Cancilla
- Departamento de
Ingeniería Química,
Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Lea Glass-Marmor
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center, Haifa 34362, Israel
- Rappaport Faculty of Medicine & Research Institute, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - Izabella Lejbkowicz
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center, Haifa 34362, Israel
- Rappaport Faculty of Medicine & Research Institute, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - José S. Torrecilla
- Departamento de
Ingeniería Química,
Facultad de Ciencias Químicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Xuelin Yao
- Max Planck Institute for Polymer Research, Ackermannweg 10, D-55128 Mainz, Germany
| | - Xinliang Feng
- Max Planck Institute for Polymer Research, Ackermannweg 10, D-55128 Mainz, Germany
| | - Akimitsu Narita
- Max Planck Institute for Polymer Research, Ackermannweg 10, D-55128 Mainz, Germany
| | - Klaus Müllen
- Max Planck Institute for Polymer Research, Ackermannweg 10, D-55128 Mainz, Germany
| | - Ariel Miller
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center, Haifa 34362, Israel
- Rappaport Faculty of Medicine & Research Institute, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - Hossam Haick
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 32000003, Israel
| |
Collapse
|
28
|
Sukul P, Schubert JK, Kamysek S, Trefz P, Miekisch W. Applied upper-airway resistance instantly affects breath components: a unique insight into pulmonary medicine. J Breath Res 2017; 11:047108. [PMID: 28925377 DOI: 10.1088/1752-7163/aa8d86] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Respiratory parameters such as flow or rate have complex effects on the exhalation of volatile substances and can hamper clinical interpretation of breath biomarkers. We have investigated the effects of progressively applied upper-airway resistances on the exhalation of volatile organic compounds (VOCs) in healthy humans. We performed real-time mass-spectrometric determination of breath volatiles in 50 subjects with parallel, non-invasive hemodynamic monitoring, breath-resolved spirometry and capnometry during controlled tidal breathing (12 breaths/min). Airway resistance was increased by changing the mouthpiece diameters from 2.5 cm to 1.0 cm and to 0.5 cm. At the smallest diameter, oxygen uptake increased (35%↑). Cardiac output decreased (6%↓) but end-tidal PCO2 (8%↑) and exhalation of blood-borne isoprene (19%↑) increased. Carbon dioxide production remained constant. Furan, hydrogen sulphide mirrored isoprene. Despite lowered minute ventilation (4%↓) acetone concentrations decreased (3%↓). Exogenous acetonitrile, propionic acid, isopropanol, limonene mimicked acetone. VOC concentration changes could be modelled through substance volatility. Airway resistance-induced changes in hemodynamics, and ventilation can affect VOC exhalation and thereby interfere with breath biomarker interpretation. The effects of collateral ventilation, intra-alveolar pressure gradients and respiratory mechanics had to be considered to explain the exhalation kinetics of CO2 and VOCs. Conventional breath sampling via smaller mouthpiece diameters (≤1.0 cm, e.g. via straw in Tedlar bags or canisters, etc) will immediately affect VOC exhalation and thereby mislead the analysis of the obtained results. Endogenous isoprene may probe respiratory muscle workload under obstructive conditions. Breath-gas analysis might enhance our understanding of diagnosis and management of obstructive lung diseases in the future.
Collapse
Affiliation(s)
- Pritam Sukul
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Dept. of Anaesthesiology and Intensive Care, University Medicine Rostock, Schillingallee 35, D-18057 Rostock, Germany
| | | | | | | | | |
Collapse
|
29
|
Nakhleh MK, Quatredeniers M, Haick H. Detection of halitosis in breath: Between the past, present, and future. Oral Dis 2017. [DOI: 10.1111/odi.12699] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- MK Nakhleh
- Univ Paris-Sud; Faculté de Médecine; Université Paris-Saclay; Le Kremlin Bicêtre France
- AP-HP; DHU TORINO; Service de Pneumologie; Hôpital Bicêtre; Le Kremlin Bicêtre France
- Inserm UMR_S 999; LabExLERMIT; Hôpital Marie Lannelongue; Le Plessis Robinson France
| | - M Quatredeniers
- Univ Paris-Sud; Faculté de Médecine; Université Paris-Saclay; Le Kremlin Bicêtre France
- AP-HP; DHU TORINO; Service de Pneumologie; Hôpital Bicêtre; Le Kremlin Bicêtre France
- Inserm UMR_S 999; LabExLERMIT; Hôpital Marie Lannelongue; Le Plessis Robinson France
| | - H Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute; Technion-Israel Institute of Technology; Haifa Israel
| |
Collapse
|