Rapid “Breath-Print” of Liver Cirrhosis by Proton Transfer Reaction Time-of-Flight Mass Spectrometry. A Pilot Study.

Morisco, Filomena; Aprea, Eugenio; Lembo, Vincenzo; Fogliano, Vincenzo; Vitaglione, Paola; Mazzone, G.; Cappellin, Luca; Gasperi, F.; Masone, Stefania; Palma, Giovanni Domenico De; Marmo, Riccardo; Caporaso, N.; Biasioli, Franco

doi:10.1371/journal.pone.0059658

Cited by 73 publications

(117 citation statements)

References 33 publications

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“…The methodology has been previously reported [50, 51]. Limonene has also been shown to be elevated in the breath of patients with liver disease in other studies [10, 13]. …”

Section: Resultsmentioning

confidence: 95%

Limonene in exhaled breath is elevated in hepatic encephalopathy

O’Hara

Río

Holt³

et al. 2016

J. Breath Res.

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Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol−1 in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol−1, respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10–44) and 42 (32–58) nmol mol−1.

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“…The methodology has been previously reported [50, 51]. Limonene has also been shown to be elevated in the breath of patients with liver disease in other studies [10, 13]. …”

Section: Resultsmentioning

confidence: 95%

Limonene in exhaled breath is elevated in hepatic encephalopathy

O’Hara

Río

Holt³

et al. 2016

J. Breath Res.

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“…It holds promise towards noninvasive clinical diagnosis as well as therapeutic and physiological monitoring12345678910. In early years, researchers were mainly focused on the discovery of trace (~ppbV to ~pptV ranges) gases in human breath as unique biomarkers for diseases.…”

mentioning

confidence: 99%

FEV manoeuvre induced changes in breath VOC compositions: an unconventional view on lung function tests

Sukul

Schubert

Oertel

et al. 2016

Sci Rep

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Breath volatile organic compound (VOC) analysis can open a non-invasive window onto pathological and metabolic processes in the body. Decades of clinical breath-gas analysis have revealed that changes in exhaled VOC concentrations are important rather than disease specific biomarkers. As physiological parameters, such as respiratory rate or cardiac output, have profound effects on exhaled VOCs, here we investigated VOC exhalation under respiratory manoeuvres. Breath VOCs were monitored by means of real-time mass-spectrometry during conventional FEV manoeuvres in 50 healthy humans. Simultaneously, we measured respiratory and hemodynamic parameters noninvasively. Tidal volume and minute ventilation increased by 292 and 171% during the manoeuvre. FEV manoeuvre induced substance specific changes in VOC concentrations. pET-CO2 and alveolar isoprene increased by 6 and 21% during maximum exhalation. Then they decreased by 18 and 37% at forced expiration mirroring cardiac output. Acetone concentrations rose by 4.5% despite increasing minute ventilation. Blood-borne furan and dimethyl-sulphide mimicked isoprene profile. Exogenous acetonitrile, sulphides, and most aliphatic and aromatic VOCs changed minimally. Reliable breath tests must avoid forced breathing. As isoprene exhalations mirrored FEV performances, endogenous VOCs might assure quality of lung function tests. Analysis of exhaled VOC concentrations can provide additional information on physiology of respiration and gas exchange.

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“…As an aid for diagnosis, a PTR-TOF-MS was used in the investigation of liver cirrhosis and the severity of the disease was assessed by direct analysis of exhaled breath [88]. Kohl et al examined the breath of 96 patients shortly before and after kidney transplantation using PTR-MS.…”

Section: Medicalmentioning

confidence: 99%

Direct Analysis Mass Spectrometry

McEwan

2015

Ion/Molecule Attachment Reactions: Mass Spectrometry

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Rapid “Breath-Print” of Liver Cirrhosis by Proton Transfer Reaction Time-of-Flight Mass Spectrometry. A Pilot Study.

Cited by 73 publications

References 33 publications

Limonene in exhaled breath is elevated in hepatic encephalopathy

Limonene in exhaled breath is elevated in hepatic encephalopathy

FEV manoeuvre induced changes in breath VOC compositions: an unconventional view on lung function tests

Direct Analysis Mass Spectrometry

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