SIFT-MS Analysis of Nose-Exhaled Breath; Mouth Contamination and the Influence of Exercise

Recent developments and applications of selected ion flow tube mass spectrometry (SIFT-MS)

Selected ion flow tube mass spectrometry (SIFT-MS) is now recognized as the most versatile analytical technique for the identification and quantification of trace gases down to the parts-per-trillion by volume, pptv, range. This statement is supported by the wide reach of its applications, from real-time analysis, obviating sample collection of very humid exhaled breath, to its adoption in industrial scenarios for air quality monitoring. This review touches on the recent extensions to the underpinning ion chemistry kinetics library and the alternative challenge of using nitrogen carrier gas instead of helium. The addition of reagent anions in the Voice200 series of SIFT-MS instruments has enhanced the analytical capability, thus allowing analyses of volatile trace compounds in humid air that cannot be analyzed using reagent cations alone, as clarified by outlining the anion chemistry involved. Case studies are reviewed of breath analysis and bacterial culture volatile organic compound (VOC), emissions, environmental applications such as air, water, and soil analysis, workplace safety such as transport container fumigants, airborne contamination in semiconductor fabrication, food flavor and spoilage, drugs contamination and VOC emissions from packaging to demonstrate the stated qualities and uniqueness of the new generation SIFT-MS instrumentation. Finally, some advancements that can be made to improve the analytical capability and reach of SIFT-MS are mentioned.

Real-Time Monitoring of Metabolism during Exercise by Exhaled Breath

Continuous monitoring of metabolites in exhaled breath has recently been introduced as an advanced method to allow non-invasive real-time monitoring of metabolite shifts during rest and acute exercise bouts. The purpose of this study was to continuously measure metabolites in exhaled breath samples during a graded cycle ergometry cardiopulmonary exercise test (CPET), using secondary electrospray high resolution mass spectrometry (SESI-HRMS). We also sought to advance the research area of exercise metabolomics by comparing metabolite shifts in exhaled breath samples with recently published data on plasma metabolite shifts during CPET. We measured exhaled metabolites using SESI-HRMS during spiroergometry (ramp protocol) on a bicycle ergometer. Real-time monitoring through gas analysis enabled us to collect high-resolution data on metabolite shifts from rest to voluntary exhaustion. Thirteen subjects participated in this study (7 female). Median age was 30 years and median peak oxygen uptake (VO₂max) was 50 mL·/min/kg. Significant changes in metabolites (n = 33) from several metabolic pathways occurred during the incremental exercise bout. Decreases in exhaled breath metabolites were measured in glyoxylate and dicarboxylate, tricarboxylic acid cycle (TCA), and tryptophan metabolic pathways during graded exercise. This exploratory study showed that selected metabolite shifts could be monitored continuously and non-invasively through exhaled breath, using SESI-HRMS. Future studies should focus on the best types of metabolites to monitor from exhaled breath during exercise and related sources and underlying mechanisms.

Sensitivity of secondary electrospray ionization mass spectrometry to a range of volatile organic compounds: Ligand switching ion chemistry and the influence of Zspray™ guiding electric fields

RATIONALE

Secondary electrospray ionization (SESI) is currently only semi-quantitative. In the Zspray™ arrangement of SESI-MS, the transfer of ions from near atmospheric pressure to a triple quadrupole is achieved by guiding electric fields that partially desolvate both reagent and analyte ions which must be understood. Also, to make SESI-MS more quantitative, the mechanisms and the kinetics of the reaction processes, especially ligand switching reactions of hydrated hydronium reagent ions, H₃ O⁺ (H₂ O)_n , with volatile organic compound (VOC) molecules, need to be understood.

METHODS

A modified Zspray™ ESI ion source operating at sub-atmospheric pressure with analyte sample gas introduced via an inlet coaxial with the spray was used. Variation of the ion-guiding electric fields was used to reveal the degree of desolvation of both reagent and analyte ions. The instrument sensitivity was determined for several classes of VOCs by introducing bag samples of suitably varying concentrations as quantified on-line using selected ion flow tube MS.

RESULTS

Electric field desolvation resulted in largely protonated VOCs, MH⁺ , and their monohydrates, MH⁺ H₂ O, and for some VOCs proton-bound dimer ions, MH⁺ M, were formed. There was a highly linear response of the ion signal to the measured VOC sample concentration, which provided the instrument sensitivities, S, for 25 VOCs. The startling results show very wide variations in S from near 0 to 1 for hydrocarbons, and up to 100, on a relative scale, for polar compounds such as monoketones and unsaturated aldehydes.

CONCLUSIONS

The complex ion chemistry occurring in the SESI ion source, largely involving gas-phase ligand switching, results in widely variable sensitivities for different classes of VOCs. The sensitivity is observed to depend on the dipole moment and proton affinity of the analyte VOC molecule, M, and to decrease with the observed fraction of MH⁺ H₂ O, but other yet unrecognized factors must play a significant role.

An exploratory study on online quantification of isoprene in human breath using cavity ringdown spectroscopy in the ultraviolet

Breath analysis offers a promising method of noninvasive analyses of volatile metabolites and xenobiotics present in human body. Isoprene is one of the highest abundant volatile organic compounds (VOCs) present in human exhaled breath. Breath isoprene (50-200 part per billion by volume (ppbv) or higher) can be analyzed by using mass spectroscopy-based methods, yet laser absorption spectral detection of breath isoprene has not been much reported, partially due to its ultraviolet (UV) absorption wavelength and the spectral overlap with other breath VOCs such as acetone in the same wavelength region. These facts make it challenging to develop a spectroscopy-based breath isoprene analyzer for a potential portable instrument. Here we report on the development of a cavity ringdown spectroscopy (CRDS) system for detection of breath isoprene in the UV region near 226 nm. First, we investigated spectral absorption interferences near 226 nm and selected an optimal detection wavelength at 226.56 nm with minimum to no spectral interference. We then measured absorption cross-sections of isoprene at 225.5-227.4 nm under controlled cavity pressures, and the measured absorption cross-section 1.93 × 10^-17 cm²/molecule at 226.56 nm was used to quantify isoprene in different cases including human breath gas samples. Finally, we validated the CRDS system by measuring breath gas samples from 19 human subjects using proton transfer reaction mass spectrometry (PTR-MS). The CRDS system shows good linear response (R² = 0.999), high stability (0.2%), and high accuracy (R² = 0.906 with PTR-MS). The limit of detection of the system was 0.47 ppbv, with average over 100 ringdown events (equivalent to 5 s). This work represents the first exploratory study of the detection of breath isoprene using CRDS. The results demonstrate the potential of developing a CRDS-based breath analyzer for online, near-real time, sensitive analysis of breath isoprene for further research that would help to elucidate its physiological and clinical significance.

Selected ion flow tube mass spectrometry analyses of isobaric compounds methanol and hydrazine in humid air

RATIONALE

The volatile compounds generated by the electrochemical reduction of atmospheric carbon dioxide and nitrogen include isobaric methanol (CH₃ OH) and, potentially, hydrazine (N₂ H₄ ). To achieve quantification of hydrazine molecules by selected ion flow tube mass spectrometry (SIFT-MS), its reactions with H₃ O⁺ , NO⁺ and O₂ ⁺ reagent ions must be understood.

METHODS

A SIFT study (using a SIFT-MS instrument) was carried out to obtain rate coefficients and product ions for the reactions of H₃ O⁺ , NO⁺ and O₂ ⁺ reagent ions with N₂ H₄ and CH₃ OH molecules present in the humid headspace of their aqueous solutions. Using the kinetics data obtained, solution headspace concentrations were determined for both compounds as a function of their liquid-phase concentrations at 10, 20 and 35°C.

RESULTS

Both compounds react with H₃ O⁺ ions via rapid proton transfer to produce CH₃ OH₂ ⁺ and H₅ N₂ ⁺ ions with the common m/z value of 33. It is revealed that NO⁺ rapidly transfers charge to N₂ H₄ (rate coefficient k = 2.3 × 10^-9 cm³ s^-1 ) but only slowly associates with CH₃ OH (k_2eff  = 7.1 × 10^-11 cm³ s^-1 ). Thus, selective analysis can be achieved using both H₃ O⁺ and NO⁺ reagent ions. The headspace methanol vapour concentration was found to increase with increasing solution temperature, but that of hydrazine decreased with an associated increase of ammonia (NH₃ ) as measured with O₂ ⁺ reagent ions.

CONCLUSIONS

The isobaric compounds methanol and hydrazine can be separately analysed in real time by SIFT-MS using H₃ O⁺ and NO⁺ reagent ions, even when they co-occur in humid air. The evolution of hydrazine from aqueous solutions can be quantitatively monitored together with its decomposition at elevated temperatures.

On-line monitoring human breath acetone during exercise and diet by proton transfer reaction mass spectrometry

Aim: This study aims to develop a method for monitoring fat loss by detection of breath acetone. Methods: A new method combining direct breath sampling system and proton transfer reaction MS (PTR-MS) was developed for on-line detection of breath acetone. The breath acetone of 272 volunteers was detected respectively when exercise or diet. Results: Exercises perennially can make the breath acetone increase by 40–130%. Dinner fasting for 1 week can make it increase by 140%. Conclusion: Exercise and diet are two useful methods to lose fat. Determination of breath acetone concentration using the direct breath sampling system-proton transfer reaction MS can help design scheme of exercise and diet for losing weight.

What is the real utility of breath ammonia concentration measurements in medicine and physiology?

Much effort continues to be devoted to the development of devices to analyse breath ammonia with the anticipation that breath ammonia analyses will be useful in clinical practice. In this perspective we refer to the analytical techniques that have been used to measure breath ammonia, focusing on selected ion flow tube mass spectrometry, SIFT-MS, of which we have special knowledge and understanding. From the collected data obtained using the different techniques, we exam the origins of mouth- and nose-exhaled ammonia and conclude that mouth-exhaled ammonia is always elevated above a concentration that would be equilibrated with blood ammonia and is largely produced by the action of enzymes on salivary urea. Support to this conclusion is given by the reasonable correlation between blood urea concentration and mouth-exhaled ammonia concentration. Further, it is discussed that nose-exhaled ammonia largely originates at the alveolar interface and so its concentration more closely relates to the expected alveolar blood ammonia concentration. Ingestion of proteins results in increased blood/saliva urea and ultimately mouth-exhaled ammonia as does the generation of urease by H. pylori infection. It is also concluded that when mouth-exhaled ammonia is elevated then it may be due to either abnormally high blood urea, a high pH of the saliva/mouth/airways mucosa, poor oral hygiene or a combinations of these.

Direct detection and quantification of malondialdehyde vapour in humid air using selected ion flow tube mass spectrometry supported by gas chromatography/mass spectrometry

RATIONALE

It has been proposed that malondialdehyde (MDA) reflects free oxygen-radical lipid peroxidation and can be useful as a biomarker to track this process. For the analysis of MDA molecules in humid air by selected ion flow tube mass spectrometry (SIFT-MS), the rate coefficients and the ion product distributions for the reactions of the SIFT-MS reagent ions with volatile MDA in the presence of water vapour are required.

METHODS

The SIFT technique has been used to determine the rate coefficients and ion product distributions for the reactions of H3O(+), NO(+) and O2 (+•) with gas-phase MDA. In support of the SIFT-MS analysis of MDA, solid-phase microextraction, SPME, coupled with gas chromatography/mass spectrometry, GC/MS, has been used to confirm the identification of MDA.

RESULTS

The primary product ions have been identified for the reactions of H3O(+), NO(+) and O2 (+•) with MDA and the formation of their hydrates formed in humid samples is described. The following combinations of reagent and the analyte ions (given as m/z values) have been adopted for SIFT-MS analyses of MDA in the gas phase: H3O(+): 109; NO(+): 89, 102; O2 (+•): 72, 90, 108, 126. The detection and quantification of MDA released by a cell culture by SIFT-MS are demonstrated.

CONCLUSIONS

This detailed study has provided the kinetics data required for the SIFT-MS analysis of MDA in humid air, including exhaled breath and the headspace of liquid-phase biogenic media. The detection and quantification by SIFT-MS of MDA released by a cell culture are demonstrated.

Breath ammonia and ethanol increase in response to a high protein challenge

Quantifying changes in ammonia and ethanol in blood and body fluid assays in response to food is cumbersome. We used breath analysis of ammonia, ethanol, hydrogen (an accepted standard of gut transit) and acetone to investigate gastrointestinal physiology. In 30 healthy participants, we measured each metabolite serially over 6 h in control and high protein trials. Two-way repeated measures ANOVA compared treatment (control versus intervention), change from baseline to maximum and interaction of treatment and time change. Interaction was significant for ammonia (p < 0.0001) and hydrogen (p < 0.0001). We describe the dynamic measurement of multiple metabolites in response to an oral challenge.

Pitfalls in the analysis of volatile breath biomarkers: suggested solutions and SIFT-MS quantification of single metabolites

The experimental challenges presented by the analysis of trace volatile organic compounds (VOCs) in exhaled breath with the objective of identifying reliable biomarkers are brought into focus. It is stressed that positive identification and accurate quantification of the VOCs are imperative if they are to be considered as discreet biomarkers. Breath sampling procedures are discussed and it is suggested that for accurate quantification on-line real time sampling and analysis is desirable. Whilst recognizing such real time analysis is not always possible and sample collection is often required, objective recognition of the pitfalls involved in this is essential. It is also emphasized that mouth-exhaled breath is always contaminated to some degree by orally generated compounds and so, when possible, analysis of nose-exhaled breath should be performed. Some difficulties in breath analysis are mitigated by the choice of analytical instrumentation used, but no single instrument can provide solutions to all the analytical challenges. Analysis and interpretation of breath analysis data, however acquired, needs to be treated circumspectly. In particular, the excessive use of statistics to treat imperfect mass spectrometry/mobility spectra should be avoided, since it can result in unjustifiable conclusions. It is should be understood that recognition of combinations of VOCs in breath that, for example, apparently describe particular cancer states, will not be taken seriously until they are replicated in other laboratories and clinics. Finally, the inhibiting notion that single biomarkers of infection and disease will not be identified and utilized clinically should be dispelled by the exemplary and widely used single biomarkers NO and H2 and now, as indicated by recent selected ion flow tube mass spectroscopy (SIFT-MS) results, triatomic hydrogen cyanide and perhaps pentane and acetic acid. Hopefully, these discoveries will provide encouragement to research workers to be more open-minded on this important and desirable issue.

SIFT-MS and FA-MS methods for ambient gas phase analysis: developments and applications in the UK

The origins of SIFT created to study interstellar chemistry and SIFT-MS developed for ambient gas and exhaled breath analysis and the UK centres in which these techniques are being exploited.

Changes in the concentration of breath ammonia in response to exercise: a preliminary investigation

Breath ammonia has proven to be a difficult compound to measure accurately. The goal of this study was to evaluate the effects that the physiological intervention, exercise, had on the levels of breath ammonia. The effects of vigorous exercise (4000 m indoor row) in 13 participants were studied and increases in breath ammonia were observed in all participants. Mean pre-exercise concentrations of ammonia were 670 pmol ml(-1) CO2 (SD, 446) and these concentrations increased to post-exercise maxima of 1499 pmol ml(-1) CO2 (SD, 730), p < 0.0001. The mean increase in ammonia concentrations from pre-exercise to maximum achieved in conditioned (1362 pmol ml(-1) CO2) versus non-conditioned rowers (591 pmol ml(-1) CO2) were found to be statistically different, p = 0.029. Taken together, these results demonstrate our ability to repeatedly measure the influence of exercise on the concentration of breath ammonia.

Breath analysis in disease diagnosis: methodological considerations and applications

Breath analysis is a promising field with great potential for non-invasive diagnosis of a number of disease states. Analysis of the concentrations of volatile organic compounds (VOCs) in breath with an acceptable accuracy are assessed by means of using analytical techniques with high sensitivity, accuracy, precision, low response time, and low detection limit, which are desirable characteristics for the detection of VOCs in human breath. "Breath fingerprinting", indicative of a specific clinical status, relies on the use of multivariate statistics methods with powerful in-built algorithms. The need for standardisation of sample collection and analysis is the main issue concerning breath analysis, blocking the introduction of breath tests into clinical practice. This review describes recent scientific developments in basic research and clinical applications, namely issues concerning sampling and biochemistry, highlighting the diagnostic potential of breath analysis for disease diagnosis. Several considerations that need to be taken into account in breath analysis are documented here, including the growing need for metabolomics to deal with breath profiles.

Breath analysis of ammonia, volatile organic compounds and deuterated water vapor in chronic kidney disease and during dialysis

The volatile metabolites present in trace amounts in exhaled breath of healthy individuals and patients, for example those with advanced chronic kidney disease (CKD), can now be detected and quantified by sensitive analytical techniques. In this review, special attention is given to the major retention metabolites resulting from dialysis-dependent CKD stage 5 and especially ammonia, as a potential estimator of the severity of uremia. However, other biomarkers are important, including the hydrocarbons isoprene, ethane and pentane, in that they are likely to indicate tissue injury associated with the dialysis treatment itself. Evaluation of over-hydration, a serious complication of CKD stage5 can be improved by analysis of deuterium in exhaled water vapor after ingestion of a known amount of deuterated water, so providing total body water measurements at the bedside to support clinical management of volume status.

On the features, successes and challenges of selected ion flow tube mass spectrometry

The major features of the selected ion flow tube mass spectrometry (SIFT-MS) analytical method that was conceived and designed for the analysis, in real time, of air obviating sample collections into bags or extraction by pre-concentration of trace compounds onto surfaces are reviewed. The unique analytical capabilities of SIFT-MS for ambient analysis are stressed that allow quantification of volatile organic and inorganic compounds directly from the measurement of physical parameters without the need for regular instrumental calibration using internal or external standards. Then, emphasis is placed on the challenging real-time accurate analysis of single exhalations of humid breath, which is now achieved and readily facilitates wider applications of SIFT-MS in other fields where trace gas analysis has value. The quality of the data obtained by SIFT-MS is illustrated by the quantification of some exhaled breath metabolites that are of immediate relevance to physiology and medicine, including that of hydrogen cyanide in the breath of patients with cystic fibrosis. The current status of SIFT-MS is revealed by a form of a strengths, weakness, opportunities and threats (SWOT) analysis intended to present an objective view of this analytical technique and the likely way forward towards its further development and application.