Exhaled Breath Condensate Of Patients Research Articles

Development of a nanocomposite hydrogel catalyzed H2O2/TMB system for determination of chlordiazepoxide in exhaled breath condensate.

In this study, an enzyme mimic catalyzed H2O2-tetramethylbenzidine system based on UiO-66/Au NPs-PVA nanocomposite hydrogel was employed as an optical probe for chlordiazepoxide sensing. An excellent detection limit of 0.0032 μg mL-1 with a linear range of 0.005-2.0 μg mL-1 was obtained for chlordiazepoxide in exhaled breath condensate samples under optimal conditions. The validated system showed good repeatability, simplicity, and stability toward chlordiazepoxide sensing in the exhaled breath condensate of patients receiving this drug.

Analysis of exhaled breath condensate in patients with asthma and recurrent wheezing

Wheezing is the most common clinical symptom of bronchial obstructive syndrome. The functions of pulmonary surfactant (PS) depend directly on the level of total phospholipids (TP). This can be used to assess the integrity of the cell membrane structure. Objective. To determine the level of total phospholipids and calcium in exhaled breath condensate in young children with recurrent wheezing and asthma. Materials and methods. The study included 77 patients divided into 3 groups. Group 1 included 30 patients (20 girls and 10 boys) with no more than 2 episodes of recurrent wheezing in their lifetime; Group 2 -10 patients (6 boys and 4 girls) with more than 3 episodes of recurrent wheezing, and 37 patients (15 girls, 22 boys) with asthma. The control group consisted of 20 conditionally healthy children (11 girls, 9 boys). All patients were aged from 3 months to 6 years. The determination of phospholipid levels and calcium (Ca) in the exhaled breath condensate was performed in dynamics - during the period of clinical manifestations and remission. Results. The level of phospholipids in the exhaled breath condensate was the highest in patients of all groups at the stage of clinical manifestations compared with the period of remission, while its lowest level was noted in the control group. During the peak of the disease, the level of Ca in the exhaled breath condensate was significantly lower compared to the period of remission. The control group had the highest level. Conclusions. The exhaled breath condensate's high level of phospholipids in the first days of the disease confirms cell damage in the presence of inflammation. Additionally, the exhaled breath condensate's Ca level is lowest during this period, possibly indicating its involvement in cell damage

Changes and clinical significance of multiple cytokines in exhaled breath condensate in patients with severe inhalation injury

To investigate the changes and clinical significance of multiple cytokine levels in exhaled breath condensate (EBC) in patients undergoing tracheotomy with severe inhalation injury. A prospective study was conducted. A total of 32 patients with severe burn combined with severe inhalation injury admitted to the department of burns and plastic surgery of Affiliated Suzhou Hospital of Nanjing Medical University from May 2021 to August 2022 were enrolled. Twenty healthy volunteers from the same period were served as controls. EBC of patients at 12 hours after burn and the samples of healthy controls were collected. The levels of 27 cytokines in EBC, including tumor necrosis factor-α (TNF-α) and interleukins (IL-1β, IL-6, IL-8, IL-10, and IL-17), were determined by liquid phase chip technology. Meanwhile, plasma of patients at 12 hours after burn and the plasma of volunteers were collected, and the levels of inflammatory cytokines were detected by liquid chip technology, and the differences between the levels in plasma and those in EBC were analyzed. Plasma and EBC of patients with aspiration injury were collected at 12 hours and 3, 7, 14 and 21 days after burn, and TNF-α levels were determined by enzyme-linked immunosorbent assay (ELISA). Finally, 32 patients were enrolled, and the total burned area was (40±16)% of total body surface area (TBSA). The time of admission was (4.2±2.3) hours after injury. (1) Twenty-seven cytokines in EBC: 18 kinds of cytokines including macrophage inflammatory protein-1β (MIP-1β), IL-6, IL-5, IL-2, IL-1β, IL-8, IL-10, IL-15, IL-9, interferon-γ (IFN-γ), IL-1 receptor antagonist (IL-1ra), TNF-α, chemotactic factor for eosinophil (Eotaxin), basic fibroblast growth factor (bFGF), platelet derived growth factor-BB (PDGF-BB), interferon-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), granulocyte colony-stimulating factor (G-CSF) were significantly increased in patients with severe aspiration injury compared with health controls. Eotaxin was not detected in EBC of healthy controls. Five cytokines, granulocyte-macrophage colony-stimulating factor (GM-CSF), chemokine ligand 5 (CCL5/RANTES), IL-13, IL-4 and MIP-1α, were not detected in EBC of severe inhalation injury patients and healthy controls. Vascular endothelial growth factor (VEGF) and IL-12 p70 in EBC of severe aspiration injury patients were slightly decreased as compared with healthy controls, while IL-7 and IL-17 were slightly increased, but the differences were not statistically significant. (2) Six inflammatory cytokines in plasma: the levels of IL-6 and IL-8 in the severe aspiration injury group were significantly increased as compared with healthy controls [IL-6 (ng/L): 18.51 (10.87, 26.21) vs. 0.22 (0.10, 0.36), IL-8 (ng/L): 10.75 (8.58, 18.79) vs. 1.06 (0.81, 2.14), both P < 0.01]. The plasma levels of TNF-α, IL-1β and IL-10 were slightly increased in patients with severe aspiration injury as compared with healthy controls, and IL-17 was slightly decreased, but the difference was not statistically significant. In the EBC collected during the same period, five inflammatory cytokines, including TNF-α, IL-1β, IL-6, IL-8 and IL-10, in patients with severe inhalation injury were significantly increased as compared with healthy controls [TNF-α (ng/L): 16.42 (12.57, 19.21) vs. 7.34 (6.11, 8.69), IL-1β (ng/L): 15.57 (10.53, 20.25) vs. 0.99 (0.67, 1.41), IL-6 (ng/L): 13.36 (9.76, 16.54) vs. 0.70 (0.42, 0.85), IL-8 (ng/L): 1 059.29 (906.91, 1 462.37) vs. 10.36 (8.40, 12.37), IL-10 (ng/L): 2.69 (1.54, 3.33) vs. 1.54 (1.18, 2.06), all P < 0.05]. (3) Dynamic changes of TNF-α in plasma and EBC: the level of TNF-α in EBC of patients with severe aspiration injury was lower than that in plasma. Plasma TNF-α level was increased gradually with the extension of time after injury, and was significantly higher than that of healthy controls on day 3 [ng/L: 30.38 (24.32, 39.19) vs. 22.94 (17.15, 30.74), P < 0.05], and reached the peak on day 14, then fell back. The level of TNF-α in EBC at 12 hours after injury was significantly higher than that in healthy controls [ng/L: 15.34 (11.75, 18.14) vs. 6.99 (6.53, 7.84), P < 0.01], and reached the peak on 3 days after injury, and then gradually decreased. There are changes in the expression of multiple cytokines in EBC of patients with severe inhalation injury, and the changes of many inflammatory cytokines including TNF-α are more sensitive than those in plasma, which can be used to monitor and evaluate the condition of patients with inhalation injury.

Analysis of Inflammation Biomarkers in Exhaled Breath Condensate in Patients with COPD Combined with Peripheral Arterial Disease

Analysis of Inflammation Biomarkers in Exhaled Breath Condensate in Patients with COPD Combined with Peripheral Arterial Disease

Biomarkers of nitrosative stress in exhaled breath condensate and serum among patients with cystic fibrosis

PurposeThe measurement of biomarkers in exhaled breath condensate (EBC) offers a non-invasive way to assess airway disease and can be easily done in a clinical setting among patients with cystic fibrosis (CF). The role of oxidative and nitrosative stress in the complex pathophysiology of CF is widely accepted and biomarkers of oxidative and nitrosative stress can be measured in the serum and EBC. To our knowledge, this is the first study to assess markers of nitrosative stress in EBC and serum, collected simultaneously from the CF patients. Patients and methodsPaired EBC and serum samples were collected from 36 stable patients with CF and 14 healthy controls. Markers of nitrosative stress ‒ 3-nitrotyrosine and nitrate/nitrite were measured in the EBC and serum using an enzyme-linked immunosorbent assay. ResultsWe found no differences in 3-nitrotyrosine and nitrate/nitrite in the EBC of patients with CF as compared to healthy controls (125.37 ​± ​3.29 vs. 126.24 ​± ​2.21 ​nmol/L, p ​= ​0.218; 12.66 ​± ​7.23 vs. 8.79 ​± ​4.83 ​μmol/L, p ​= ​0.133, respectively). Furthermore, 3-nitrotyrosine and nitrate/nitrite were significantly higher in the serum of patients with CF as compared to the healthy controls (0.13 ​± ​0.02 vs. 0.11 ​± ​0.01 ​nmol/mg protein, p ​= ​0.003; 70.78 ​± ​22.55 vs. 53.08 ​± ​8.5 ​μmol/L, p ​= ​0.009, respectively). No correlations were found between the markers determined in the EBC and serum. ConclusionsThe results of the EBC nitrosative stress biomarkers should be interpreted with caution, especially in patients with stable disease, as the EBC values may be independent on levels of circulating markers that are elevated in the serum of patients with stable CF.

Oxidative Stress and Inflammatory Mediators in Exhaled Breath Condensate of Patients with Pulmonary Tuberculosis. A Pilot Study with a Biomarker Perspective.

Tuberculosis (TB) is one of the highest infectious burdens worldwide. An excess of inflammation and inadequate antioxidant defense mechanisms are believed to lead to chronic inflammation and lung damage in tuberculosis (TB). However, circulating metabolites do not always replicate lung-associated biomarkers that define the pathobiology of the disease. The objective of this study was to determine the utility of exhaled breath condensate (EBC), a non-invasive and straightforward sample, to evaluate alveolar space-derived metabolites of redox state and inflammation. We assessed the levels of exhaled oxidant/antioxidant parameters (8-isoprostane, MDA, GSH), inflammatory markers, such as nucleosomes, cytokines (IL-2, IL-4, IL-6 and IL-8, IL-10, GM-CSF, TNF-α, and IFN-γ) and lipid mediators (PGE2, LTB4, RvD1, and Mar1), in patients with recently diagnosed pulmonary TB and healthy controls’ EBC and serum. The TB patients showed 36% lower GSH levels, and 2-, 1.4-, 1.1-, and 50-fold higher levels of 8-isoprostanes, nucleosomes, IL-6, and LTB4, respectively, in EBC. There was no correlation between EBC and serum, highlighting the importance of measuring local biomarkers. Quantitation of local inflammatory molecules and redox states in EBC would help find biomarkers useful for pharmacological and follow-up studies in pulmonary tuberculosis.

Inhaled corticosteroids’ effects on biomarkers in exhaled breath condensate and blood in patients newly diagnosed with asthma who smoke

Objective Exposure to cigarette smoke complicates the treatment and management of asthma through a variety of inflammatory effects. This study aimed to investigate the differences between newly diagnosed cases of asthma in smokers and nonsmokers in terms of localized and systemic biomarkers following treatment with inhaled corticosteroids (ICS) or ICS in combination with a long-acting β2 agonist (LABA). Methods Specimens of exhaled breath condensate (EBC) from newly diagnosed patients with asthma were used to quantify inflammation in the airways, while blood samples were used to assess systemic inflammation. In both samples, the levels of IL-6, LTB4, LTD4, and 8-isoprostane were measured and these were repeated after 3 months of treatment with ICS or ICS + LABA. Results Of the 20 patients, 10 (50%) were nonsmokers with asthma (NSA) and 10 (50%) smokers with asthma (SA). There was no statistically significant difference in the blood or EBC levels of IL-6, LTB4, LTD4, or 8-isoprostane between the groups prior to treatment. Only the decrease in 8-isoprostane level in the EBC samples was found to be significantly greater in the NSA group after treatment (for smokers, the change was 2.91 ± 23.22, while for nonsmokers it was −22.72 ± 33.12, p = 0.022). Post-treatment asthma control was significantly better in the NSA group (p = 0.033). Conclusion Monitoring the alterations in 8-isoprostane levels in EBC in patients with asthma who smoke may be helpful in deciding on therapeutic management and switching treatments. Asthma control was better in nonsmokers than in smokers.

Clinical value of serum and exhaled breath condensate inflammatory factor IL-11 levels in non-small cell lung cancer: Clinical value of IL-11 in non-small cell lung cancer.

Our study aimed to observe and evaluate the clinical value of interleukin (IL)-11 in the serum and exhaled breath condensate of patients with non-small cell lung cancer (NSCLC). A total of 91 patients with NSCLC and 72 healthy volunteers were included in this study. IL-11 concentration was determined by ELISA, and the relationship between IL-11 expression in serum and exhaled breath condensate specimens, and the clinicopathological characteristics of patients with NSCLC were analyzed. The relationship between serum IL-11 expression and traditional tumor markers and inflammation indicators of NSCLC was also analyzed. The correlation between serum IL-11 and exhaled breath condensate IL-11 level was determined. The receiver operating characteristic curve was used to evaluate the diagnostic value of IL-11 and carcinoembryonic antigen single and combined detection for NSCLC. The published data from online databases were used to analyze the relationship between the expression of IL-11 and the prognosis of NSCLC. IL-11 concentration in serum and exhaled breath condensate specimens of patients with NSCLC were significantly increased. IL-11 expression was positively correlated with lymph node metastasis, distant metastasis, tumor node metastasis stage, and tumor differentiation degree of NSCLC. The expression of IL-11 in serum was positively correlated with that in exhaled breath condensate specimens. IL-11 expression was closely related to that of neutrophil-to-lymphocyte ratio and carcinoembryonic antigen. The combination of serum IL-11 with exhaled breath condensate IL-11 and carcinoembryonic antigen showed significantly higher diagnostic value than any one marker alone. Besides, the high IL-11 expression was closely related to the poor prognosis of NSCLC. IL-11 can be used as a potential diagnostic and prognostic biomarker for NSCLC.

Extracellular vesicle-derived microbiome obtained from exhaled breath condensate in patients with asthma

Extracellular vesicle-derived microbiome obtained from exhaled breath condensate in patients with asthma

Long-chain fatty acids and short-chain fatty acids in exhaled breath condensate of patients with chronic obstructive pulmonary disease

In present study we performed gas-liquid chromatographic analysis of exhaled breath condensate to measure volatile fatty acids (C2 - acetic, C3 - propionic, C4 - butanoic, isoC4 - isobutyric, C5 - valerianic, C6 - caproic, C7 - heptanoic) and fatty acid with a long aliphatic chain (C14:0 - myristic, C15:0 - pentadecanoic, C16:0 - palmitic, C16:1 - palmitooleic, C17:0 - heptadecanoic, C17:1 - heptadecenoic, C18:0 - stearic, C18:1 - oleic, C18:2 - linolenic, C18:3ω3 - α-linolenic, C20:4ω6 - arachidonic) in patients suffering from moderate chronic obstructive pulmonary disease (2nd stage, GOLD). We revealed the increase of the total amount of short chain fatty acids (C2, C3, C4, C5) and polyunsaturated (C18:2, C20:4ω6) fatty acids, meanwhile the level of saturated fatty acids (C16:0, C17:0, C18:0) decreased.

Pulmonary Hypertension Clinical Trials and COVID-19: A Discussion With John Ryan and Roham Zamanian

Pulmonary Hypertension Clinical Trials and COVID-19: A Discussion With John Ryan and Roham Zamanian

The Healthy Airway Mycobiome in Individuals of Asian Descent

The Healthy Airway Mycobiome in Individuals of Asian Descent

MicroRNA Levels in Exhaled Breath Condensate of Patients with Esophageal Atresia.

MicroRNAs (miRNAs) are noncoding RNAs that play an important role in the regulation of inflammation and have not been evaluated in exhaled breath condensates (EBC) of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF). It is aimed to evaluate the levels of miRNA-21 and miRNA-24 in EBC of patients with EA-TEF. Patients who received surgery for EA-TEF (EA) were assessed for age, sex, types of anomaly, surgical treatments, and respiratory problems. A 500-1000 mL of EBC was obtained from each participant with EcoScreen. The levels of miRNA-21 and miRNA-24 in the EBC were analyzed by real-time polymerase chain reaction and compared between the EA group and the control group consisting of healthy children with no history of respiratory problems (n= 17). The levels of miRNAs in relation to respiratory problems and gastroesophageal reflux (GER) were also assessed. A total of 19 patients were enrolled in the EA group with a mean age of 7.8 ± 3.2 years and a male-to-female ratio of 10:9 EA cases had significantly lower levels of miRNA-21 (P< 0.05) compared to that in control group. The miRNA-24 levels did not differ between groups (P> 0.05). EA patients with positive pH testing for GER (n= 6) and fundoplication (n= 6) had higher levels of miRNA-21 than those with normal pH testing and without fundoplication, respectively (n= 13, P< 0.05). The levels of miRNA-21 and miRNA-24 did not differ between patients with and without proton pump inhibitor treatment (P> 0.05). The lower levels of miRNA-21 in the EBC of EA patients suggest a hyperreactive airway problem, which may be associated with GER and its surgical treatment.

Significance of vascular endothelium growth factor testing in exhaled breath condensate of patients with acute respiratory distress syndrome.

OBJECTIVE: We aimed to observe and investigate the clinical significance of vascular endothelium growth factor (VEGF) levels in exhaled breath condensate (EBC) from patients with acute respiratory distress syndrome (ARDS).METHODS: An improved EcoScreen condenser was used to collect EBC from 31 ARDS patients on mechanical ventilation and from 22 healthy subjects. Serum and EBC VEGF levels were analyzed with ELISA. VEGF levels in the EBC of patients with different grades of lung injuries were analyzed. The correlation between VEGF levels and clinical indicators was analyzed.RESULTS: Serum and EBC VEGF levels were linearly and positively correlated with a correlation coefficient of 0.694 ( 0.01). The VEGF level in the EBC of ARDS patients was significantly lower than that in the control group ( 0.01). The VEGF level in the EBC of the mild ARDS group was higher than that in the moderate-severe ARDS group ( 0.01). The VEGF level in the EBC of the survival group was higher than that in the mortality group. The VEGF level in the EBC of ARDS patients was positively correlated with PaO/FiO and PaO and was negatively correlated with lung injury score (LIS) and A-aDO/PaO.CONCLUSION: The changes in VEGF levels in the EBC of ARDS patients can Respiratory Medicine, reflect the severity of lung injury. Therefore, VEGF level in EBC can be used as an auxiliary index for judging the severity and prognosis of ARDS patients.

Assessment of ventilator-associated pneumonia by combining 8-isoprostane and nitric oxide levels in exhaled breath condensate with the clinical pulmonary infection score.

ObjectiveTo investigate the effectiveness of combining the 8-isoprostane and nitric oxide (NO) levels in exhaled breath condensate (EBC) with the clinical pulmonary infection score (CPIS) to assess ventilator-associated pneumonia (VAP) in patients on mechanical ventilation.MethodsThirty-two patients with VAP served as the observation group and 32 patients without VAP served as the control group. The correlations of 8-isoprostane and NO levels in EBC with CPIS, chest X-ray score, oxygenation index, and lung injury score (LIS) were analyzed. The area under the curve (AUC) was compared with experimental data using the receiver operating characteristic curve (ROC) to predict VAP.ResultsThe 8-isoprostane and NO levels in EBC of VAP patients on mechanical ventilation were positively correlated with CPIS, chest X-ray score, and LIS, but negatively correlated with oxygenation index. The AUC of simplified CPIS combined with 8-isoprostane and NO levels in EBC for predicting VAP was 0.914, which suggests that this is a highly effective for making a diagnosis.ConclusionsThe simplified CPIS combined with the 8-isoprostane and NO levels in EBC of patients on mechanical ventilation is effective for evaluating and diagnosing VAP. 8-Isoprostane and NO levels in EBC could be used as biomarkers to evaluate VAP.

Clinical Value of Serum and Exhaled Breath Condensate miR-186 and IL-1β Levels in Non-Small Cell Lung Cancer.

Objective:Our study aimed to investigate the expression level and clinical significance of serum and exhaled breath condensate miR-186 and IL-1β in non-small cell lung cancer patients.Methods:The serum and exhaled breath condensate specimens of 62 non-small cell lung cancer patients and 60 healthy controls were collected to detect miR-186 expression levels by real-time fluorescent quantitative PCR. Enzyme linked immunosorbent assay was applied to examine IL-1β concentration. Statistical analyses were used to evaluate the correlation between miR-186 and IL-1β in serum and clinicopathological features, traditional serum tumor markers, and inflammatory markers. The diagnostic efficacy of miR-186 and IL-1β for non-small cell lung cancer was evaluated by receiver operating characteristic curve analysis. The correlation between miR-186 and IL-1β was determined.Results:① The relative expression level of miR-186 was greatly reduced in the serum and EBC of patients with non-small cell lung cancer, and the miR-186 expression level was reduced in different TNM stages of non-small cell lung cancer, from the early to later stages. ② The IL-1β concentration in serum and exhaled breath condensate of patients with non-small cell lung cancer was increased. ③ Serum miR-186 and IL-1β levels were closely related to lymph node metastasis, and the low expression of serum miR-186 and the high concentration of IL-1β were associated with higher serum carcinoembryonic antigen, C-reactive protein, and erythrocyte sedimentation rate levels. ④ ROC curve analysis showed that exhaled breath condensate miR-186 had higher area under the curve than serum miR-186, and the combined detection showed higher diagnostic efficacy than the separate detection. In addition, the combined detection of IL-1β and miR-186 has a larger AUC than the separate detection of both. ⑤ The correlation between serum miR-186 and IL-1β was negative.Conclusion:miR-186 and IL-1β are expected to be potential diagnostic biomarkers for non-small cell lung cancer.

Clinical Pearls.

Many evidence-based practice (EBP) protocols are used in the care of critical care patients; however, the speed of translation of these protocols into practice can be long, potentially affecting the quality of that care. Although research has shown that specific nurse credentials improve patients’ outcomes, it is not known how these credentials are associated with the adoption of EBP.Gigli and colleagues conducted a survey to examine the relationship between nurses’ education level and certification status and their psychosocial beliefs, knowledge of EBP, and perceived value in EBP. They foundThe findings support the value of nurses with specialty credentialing. The authors recommend that institutions seeking adoption of EBP support nurse credentialing as a means to improve intensive care.See Article, pp e1–e12Sepsis remains a substantial health care challenge, with recent costs surpassing $23 million annually. Although the most common type of infection leading to sepsis is pneumonia, preventive efforts have focused primarily on ventilator-associated pneumonia (VAP). However, morbidity and mortality with nonventilator hospital-acquired pneumonia (NV-HAP) are significant.Giuliano and colleagues explored demographic and clinical characteristics of adult patients from a national inpatient dataset and found thatRecognition and treatment of NV-HAP has been underappreciated, thus increasing the risk for sepsis and other complications. The authors suggest additional research to turn successful VAP prevention into strategies for NV-HAP prevention.See Article, pp 9–14It has long been known that high tidal volumes and high airway pressures can damage the lungs of patients with acute respiratory disease. However, little study has addressed the effects of these mechanical ventilator settings on normal lungs.Ziaka and colleagues compared 2 ventilation strategies—low tidal volume (6 mL/kg) and high tidal volume (12 mL/kg)—on biomarkers of inflammation measured in exhaled breath condensate in patients with normal lungs. They found thatFindings indicate large tidal volume with mechanical ventilation may increase the risk for lung inflammation in patients without preexisting lung injury. Further study is warranted with more detailed mechanics of ventilation.See Article, pp 15–21Ethical conflicts occur for a number of reasons and can cause distress and anxiety for patients and families. Communication problems between the patient/family and health care providers on medical decision-making and treatment goals are a primary source of ethical conflicts in the intensive care unit. Unfortunately, little research has addressed the impact of team-based interventions for prevention of such conflicts.Pavlish and colleagues evaluated the use of a proactive, team-based intervention with 3 parts: (1) daily completion of early action protocol, (2) interactive case-based protocol orientation, and (3) an ethics application. They found the following:Using a routine, team-based intervention can improve communication between patients’ families and health care providers, resulting in improved goal clarification, care coordination, and identification of early action needs.See Article, pp 49–58

DOZ047.06: The MicroRNA levels in exhaled breath condensate of patients with esophageal atresia and tracheoesophageal fistula

Abstract Aim MicroRNAs (miRNAs) are noncoding RNAs that play a role in regulation of inflammation and cancer. It has been shown that miRNA-21 and 24 are downregulated in the exhaled breath condensate (EBC) of children with chronic inflammatory lung disease and asthma. A prospective study was performed to evaluate the miRNA-21 and 24 levels in the EBC of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF). Methods Patients operated for EA-TEF were evaluated for age, sex, type of anomaly, surgical treatment, and respiratory problems. 500–1000 μl of EBC was obtained from all patients with Ecoscreen. miRNA-21 and 24 levels in EBC were analyzed with ELISA. The results of the study group were compared with a control group (CG) consisting of healthy children with no history of respiratory problems and allergy (n = 17). miRNA levels were compared with respiratory problems and gastroesophageal reflux (GER). Results Nineteen patients with EA-TEF with a mean age of 7.8 ± 3.2 years were enrolled in the study. The male–female ratio was 10:9. The mean age of the CG was 9.1 ± 3.6 years (P &gt; 0.05). Distal fistula (78.9%) was the most common type of anomaly. 76.5% of cases required esophageal dilatations for strictures and 15.8% of them had fistula recurrence. Fifteen of the cases with EA were diagnosed as hyperreactive airway disease and require medical treatment. When miRNA levels were compared with CG (median = 0.68), EA cases had significantly decreased levels of miRNA-21 (median = 0.64, P &lt; 0.05). There was no difference between groups for miRNA-24 levels (P &gt; 0.05). The miRNA levels were also compared in patients with EA, according to positive pH testing for GER, use of proton pump inhibitor (PPI) treatment, and need for fundoplication. Patients with GER in pH test (median = 0.66) and fundoplication (median = 0.66) had increased levels of miRNA-21 than patients without reflux (median = 0.63) and surgical treatment (median = 0.64) (P &lt; 0.05). The levels of miRNA-21 and 24 did not show any significant difference in patients with and without PPI treatment (P &gt; 0.05). Conclusion The decreased levels of miRNA-21 in EBC suggest a hyperreactive airway problem in EA patients. Increased miRNA levels in EBC are associated with GER and its surgical treatment.

Matrix metalloproteinase 9 in exhaled breath condensate in patients with stable chronic obstructive pulmonary disease: an observational study.

Introduction Data on the measurement of matrix metalloproteinase 9 (MMP‑9) in exhaled breath condensate (EBC) from patients with chronic obstructive pulmonary disease (COPD) are scarce and inconsistent. Objectives We aimed to assess the usefulness of enzyme‑linked immunosorbent assay (ELISA) and immunoenzymatic assay (IEA) for the measurement of MMP‑9 in EBC, the agreement between the results of both methods, and the relationships between total and active MMP‑9 in EBC and clinical and functional COPD characteristics. Patients and methods Total (ELISA and IEA) and active (IEA) MMP‑9 levels were assessed in EBC from 70 patients with stable COPD and 21 controls and correlated with pulmonary function and COPD symptom severity. Results MMP‑9 levels did not reach the sensitivity threshold of the ELISA kit in any of the COPD patients and in 11 controls. Total and active MMP‑9 (IEA) levels did not differ between COPD patients and controls. In COPD patients, total MMP‑9 levels correlated positively with forced expiratory volume in 1 second (FEV1) and FEV1 to forced vital capacity ratio and inversely with residual volume to total lung capacity ratio. A weak positive correlation between active MMP‑9 concentrations and COPD Assessment Test (CAT) score was found (r = 0.31, P = 0.01). Conclusions The utility of ELISA in MMP‑9 assessment in EBC is limited in COPD patients, while MMP‑9 measurement in EBC by IEA is feasible. The positive correlation between active MMP‑9 and CAT score in our patients and the inverse relationship between total MMP‑9 concentration and the degree of airway obstruction reflect the complex role of MMP‑9 in COPD.

Phenotyping of Chronic Obstructive Pulmonary Disease Based on the Integration of Metabolomes and Clinical Characteristics.

Apart from the refined management-oriented clinical stratification of chronic obstructive pulmonary disease (COPD), the molecular pathologies behind this highly prevalent disease have remained obscure. The aim of this study was the characterization of patients with COPD, based on the metabolomic profiling of peripheral blood and exhaled breath condensate (EBC) within the context of defined clinical and demographic variables. Mass-spectrometry-based targeted analysis of serum metabolites (mainly amino acids and lipid species), untargeted profiles of serum and EBC of patients with COPD of different clinical characteristics (n = 25) and control individuals (n = 21) were performed. From the combined clinical/demographic and metabolomics data, associations between clinical/demographic and metabolic parameters were searched and a de novo phenotyping for COPD was attempted. Adjoining the clinical parameters, sphingomyelins were the best to differentiate COPD patients from controls. Unsaturated fatty acid-containing lipids, ornithine metabolism and plasma protein composition-associated signals from the untargeted analysis differentiated the Global Initiative for COPD (GOLD) categories. Hierarchical clustering did not reveal a clinical-metabolomic stratification superior to the strata set by the GOLD consensus. We conclude that while metabolomics approaches are good for finding biomarkers and clarifying the mechanism of the disease, there are no distinct co-variate independent clinical-metabolic phenotypes.