Exhaled Breath Volatiles Research Articles

Stability of selected exhaled breath volatiles stored in Tenax® TA adsorbent tubes at −80 °C

Preservation of the breath sample integrity during storage and transport is one of the biggest challenges in off-line exhaled breath gas analysis. In this context, adsorbent tubes are frequently used as storage containers for use with analytical methods employing gas chromatography with mass spectrometric detection. The key objective of this short communication is to provide data on the recovery of selected breath volatiles from Tenax® TA adsorbent tubes that were stored at −80 °C for up to 90 d. For this purpose, an Owlstone Medical’s ReCIVA® Breath Sampler was used for exhaled breath collection. The following fifteen compounds, selected to cover a range of chemical properties, were monitored for their stability: isoprene, n-heptane, n-nonane, toluene, p-cymene, allyl methyl sulfide, 1-(methylthio)-propane, 1-(methylthio)-1-propene, α-pinene, DL-limonene, β-pinene, γ-terpinene, 2-pentanone, acetoin and 2,3 butanedione. All compounds, but one (acetoin), were found to be stable during the first 4 weeks of storage (recovery within ± 2 × RSD). Furthermore, n-nonane was stable during the whole of the investigated period.

Analyses of lung cancer-derived volatiles in exhaled breath and in vitro models.

Lung cancer is one of the leading causes of cancer incidence and cancer-related deaths in the world. Early diagnosis of pulmonary tumors results in improved survival compared to diagnosis with more advanced disease, yet early disease is not reliably indicated by symptoms. Despite of the improved testing and monitoring techniques for lung cancer in the past decades, most diagnostic tests, such as sputum cytology or tissue biopsies, are invasive and risky, rendering them unfeasible for large population screening. The non-invasive analysis of exhaled breath has gained attentions as an innovative screening method to measure chemical alterations within the human volatilome profile as a result of oncogenesis. More importantly, volatile organic compounds (VOCs) have been correlated to the pathophysiology of disease since the source of volatile compounds relies mostly on endogenous metabolic processes that are altered as a result of disease onset. Therefore, studying VOCs emitted from human breath may assist lung cancer diagnosis, treatment monitoring, and other surveillance of this devastating disease. In this mini review, we evaluated recent human studies that have attempted to identify lung cancer-derived volatiles in exhaled breath of patients. We also examined reported volatiles in cell cultures of lung cancer to better understand the origins of cancer-associated VOCs. We highlight the metabolic processes of lung cancer that could be responsible for the endogenous synthesis of these VOCs and pinpoint the protein-encoding genes involved in these pathways. Finally, we highlight the potential value of a breath test in lung cancer and propose prominent areas for future research required for the incorporation of VOCs-based testing into clinical settings.

Analyses of short-chain fatty acids and exhaled breath volatiles in dietary intervention trials for metabolic diseases

As an alternative to pharmacological treatment to diseases, lifestyle interventions, such as dietary changes and physical activities, can help maintain healthy metabolic conditions. Recently, the emerging analyses of volatile organic compounds (VOCs) from breath and short-chain fatty acids (SCFAs) from plasma/feces have been considered as useful tools for the diagnosis and mechanistic understanding of metabolic diseases. Furthermore, diet-induced changes of SCFAs in individuals with diagnosed metabolic abnormalities have been correlated with the composition changes of the gut microbiome. More interestingly, the analysis of exhaled breath (breathomics) has gained attention as a useful technique to measure the human VOC profile altered as a result of dietary interventions. In this mini-review, we examined recent clinical trials that performed promising dietary interventions, SCFAs analysis in plasma/feces, and VOC profile analysis in exhaling breath to understand the relationship between dietary intervention and metabolic health.

Electronic Nose Analysis of Exhaled Breath Volatiles to Identify Lung Cancer Cases: A Systematic Review.

The purpose of our review was to analyze evidence of the validity of electronic noses to discriminate persons with lung cancer from healthy control subjects and to advance implications for this technology in the care of people living with HIV. A computerized database search of the literature (published 1946-2018) was conducted to identify studies that used electronic nose-generated smellprints to discriminate persons with lung cancer from healthy control subjects. Fifteen articles met the sampling criteria. In 14 studies, mean sensitivity and specificity values from a single training sample were 84.1% and 80.9%, respectively. Five studies applied the prediction model obtained from the training sample to a separate validation sample; mean sensitivity was 88.2%, and mean specificity was 70.2%. Findings suggest that breath smellprints are valid markers of lung cancer and may be useful screening measures for cancer. No studies included people living with HIV; additional studies are needed to assess generalizability to this population.

Compendium of the Reactions of H3O+ With Selected Ketones of Relevance to Breath Analysis Using Proton Transfer Reaction Mass Spectrometry.

Soft chemical ionization mass spectrometric techniques, such as proton transfer reaction mass spectrometry (PTR-MS), are often used in breath analysis, being particularly powerful for real-time measurements. To ascertain the type and concentration of volatiles in exhaled breath clearly assignable product ions resulting from these volatiles need to be determined. This is difficult for compounds where isomers are common, and one important class of breath volatiles where this occurs are ketones. Here we present a series of extensive measurements on the reactions of H3O+ with a selection of ketones using PTR-MS. Of particular interest is to determine if ketone isomers can be distinguished without the need for pre-separation by manipulating the ion chemistry through changes in the reduced electric field. An additional issue for breath analysis is that the product ion distributions for these breath volatiles are usually determined from direct PTR-MS measurements of the compounds under the normal operating conditions of the instruments. Generally, no account is made for the effects on the ion-molecule reactions by the introduction of humid air samples or increased CO2 concentrations into the drift tubes of these analytical devices resulting from breath. Therefore, another motivation of this study is to determine the effects, if any, on the product ion distributions under the humid conditions associated with breath sampling. However, the ultimate objective for this study is to provide a valuable database of use to other researchers in the field of breath analysis to aid in analysis and quantification of trace amounts of ketones in human breath. Here we present a comprehensive compendium of the product ion distributions as a function of the reduced electric field for the reactions of H3O+. (H2O)n (n = 0 and 1) with nineteen ketones under normal and humid (100% relative humidity for 37 °C) PTR-MS conditions. The ketones selected for inclusion in this compendium are (in order of increasing molecular weight): 2-butanone; 2-pentanone; 3-pentanone; 2-hexanone; 3-hexanone; 2-heptanone; 3-heptanone; 4-heptanone; 3-octanone; 2-nonanone; 3-nonanone; 2-decanone; 3-decanone; cyclohexanone; 3-methyl-2-butanone; 3-methyl-2-pentanone; 2-methyl-3-pentanone; 2-methyl-3-hexanone; and 2-methyl-3-heptanone.

MEMS sensor array-based electronic nose for breath analysis—a simulation study

The paper presents a simulation study of breath analysis based on theoretical models of microelectromechanical structure (MEMS) cantilever sensor array. The purpose of this study is to suggest a methodology for the development of MEMS electronic nose (e-nose) for monitoring disease-specific volatiles in exhaled breath. Oxidative stress and diabetes are taken as case studies for the assessment of e-nose designs. The detection of ethane for general oxidative stress, isoprene for hypoxia, and acetone for diabetes are considered for targeted detection. A number of volatiles concurrently present in the exhaled breath are taken as interferents. The MEMS cantilevers are coated with volatile-selective polymers and are analyzed in both the static and dynamic modes. The sensor array is defined by polymer selections based on three data mining methods: principal component analysis (PCA), fuzzy c-means clustering (FCM), and fuzzy subtractive clustering (FSC). This utilizes vapor/polymer partition coefficients as a database. Analyses are carried out to find optimal combinations of the polymer selection method and cantilever sensing mode. Virtual breath analysis experiments are analyzed by PCA for target discrimination. It is found that no single combination works best in all conditions. The acetone (diabetes) detection is best in both sensing modes with the polymers selected by FSC; the isoprene (hypoxia) is detectable only in static sensing mode with polymers selected by FCM clustering; and the ethane (oxidative stress) detection is possible by all sensing modes and polymer selections, provided the breath samples are preconcentrated. This study suggests that it is difficult to realize a single general-purpose MEMS breath analyzer. The dedicated analyzers for specific disease indications can however be made with an optimal combination of sensing mode and polymer coatings.

Diurnal variation in expired breath volatiles in malaria-infected and healthy volunteers

We previously showed that thioether levels in the exhaled breath volatiles of volunteers undergoing controlled human malaria infection (CHMI) with P. falciparum increase as infection progresses. In this study, we show that thioethers have diurnal cyclical increasing patterns and their levels are significantly higher in P. falciparum CHMI volunteers compared to those of healthy volunteers. The synchronized cycle and elevation of thioethers were not present in P. vivax-infection, therefore it is likely that the thioethers are associated with unique factors in the pathology of P. falciparum. Moreover, we found that time-of-day of breath collection is important to accurately predict (98%) P. falciparum-infection. Critically, this was achieved when the disease was asymptomatic and parasitemia was below the level detectable by microscopy. Although these findings are encouraging, they show limitations because of the limited and logistically difficult diagnostic window and its utility to P. falciparum malaria only. We looked for new biomarkers in the breath of P. vivax CHMI volunteers and found that a set of terpenes increase significantly over the course of the malaria infection. The accuracy of predicting P. vivax using breath terpenes was up to 91%. Moreover, some of the terpenes were also found in the breath of P. falciparum CHMI volunteers (accuracy up to 93.5%). The results suggest that terpenes might represent better biomarkers than thioethers to predict malaria as they were not subject to malaria pathogens diurnal changes.

Exhaled breath profiling using broadband quantum cascade laser-based spectroscopy in healthy children and children with asthma and cystic fibrosis

Exhaled breath analysis is a potential non-invasive tool for diagnosing and monitoring airway diseases. Gas chromatography–mass spectrometry and electrochemical sensor arrays are the main techniques to detect volatile organic compounds (VOC) in exhaled breath. We developed a broadband quantum cascade laser spectroscopy technique for VOC detection and identification.The objective of this study was to assess the repeatability of exhaled breath profiling with broadband quantum cascade laser-based spectroscopy and to explore the clinical applicability by comparing exhaled breath samples from healthy children with those from children with asthma or cystic fibrosis (CF).Healthy children and children with stable asthma or stable CF, aged 6–18 years, were included. Two to four exhaled breath samples were collected in Tedlar bags and analyzed by quantum cascade laser spectroscopy to detect VOCs with an absorption profile in the wavenumber region between 832 and 1262.55 cm−1.We included 35 healthy children, 39 children with asthma and 15 with CF. Exhaled breath VOC profiles showed poor repeatability (Spearman’s rho = 0.36 to 0.46) and agreement of the complete profiles. However, we were able to discriminate healthy children from children with stable asthma or stable CF and identified VOCs that were responsible for this discrimination.Broadband quantum cascade laser-based spectroscopy detected differences in VOC profiles in exhaled breath samples between healthy children and children with asthma or CF. The combination of a relatively easy and fast method and the possibility of molecule identification makes broadband quantum cascade laser-based spectroscopy attractive to investigate the diagnostic and prognostic potential of volatiles in exhaled breath.

Fiber content of diet affects exhaled breath volatiles in fasting and postprandial state in a pilot crossover study

Our pilot study examined the potential of exhaled breath analysis in studying the metabolic effects of dietary fiber (DF). We hypothesized that a high-fiber diet (HFD) containing whole grain rye changes volatile organic compound (VOC) levels in exhaled breath and that consuming a single meal affects these levels. Seven healthy men followed a week-long low-fiber diet (17 g/d) and HFD (44 g/d) in a randomized crossover design. A test meal containing 50 g of the available carbohydrates from wheat bread was served as breakfast after each week. Alveolar exhaled breath samples were analyzed at fasting state and 30, 60, and 120 minutes after this meal parallel to plasma glucose, insulin, and serum lipids. We used solid-phase microextraction and gas chromatography–mass spectrometry for detecting changes in 15 VOCs. These VOCs were acetone, ethanol, 1-propanol, 2-propanol, 1-butanol, acetic acid, propionic acid, butyric acid, valeric acid, isovaleric acid, 2-methylbutyric acid, hexanoic acid, acetoin, diacetyl, and phenol. Exhaled breath 2-methylbutyric acid in the fasting state and 1-propanol at 120 minutes decreased (P = .091 for both) after an HFD. Ingestion of the test meal increased ethanol, 1-propanol, acetoin, propionic acid, and butyric acid levels while reducing acetone, 1-butanol, diacetyl, and phenol levels. Both DF diet content and having a single meal affected breathVOCs. Exploring exhaled breath further could help to develop tools for monitoring the metabolic effects of DF.

Exhaled Breath Biomonitoring Using Laser Spectroscopy

Biological monitoring usually relies on the collection of blood and urine samples. Although being non-invasive and providing an inextinguishable sampling pool, the analysis of exhaled breath is not well established. A gas phase measurement is, however, inherently simpler than the analysis of complex biological fluids, and modern methods have identified hundreds of volatile compounds in the breath of persons exposed to normal environmental concentrations. The most commonly deployed analytical techniques in breath analysis are gas chromatography combined with mass spectrometry (GC/MS) and other MS-based methods. Lately, also laser-based optical methods, such as cavity ring-down spectroscopy (CRDS), have emerged in the field. With such instruments, it is possible to accurately quantify the concentrations of volatiles in exhaled breath down to below part-per-billion (ppb) levels with sub-second time resolution. Laser spectroscopy thereby enables real-time investigations during and after exposure to exogenous chemicals. In general, depending on the sampling approach used, the measured levels of the breath compounds may vary significantly. It is therefore of importance to systematically study and account for the phenomena affecting the recorded concentrations, and subsequently select an appropriate sampling and measurement strategy. In Helsinki, we have used CRDS to study the background levels of hydrogen cyanide (HCN), ammonia (NH3) and acetylene (C2H2) in the exhaled breath of healthy volunteers. Different sampling techniques have been employed in an effort to standardize the breath sampling event. The realtime elimination kinetics of breath C2H2 after smoking has also been studied. Keywords: Acetylene, ammonia, biomonitoring, breath analysis, cavity ring-down spectroscopy, hydrogen cyanide, laser spectroscopy, toxicokinetics

Exercise changes volatiles in exhaled breath assessed by an electronic nose

Exercise-caused metabolic changes can be followed by monitoring exhaled volatiles; however it has not been previously reported if a spectrum of exhaled gases is modified after physical challenge. We have hypothesized that changes in volatile molecules assessed by an electronic nose may be the reason for the alkalization of the exhaled breath condensate (EBC) fluid following physical exercise.Ten healthy young subjects performed a 6-minute running test. Exhaled breath samples pre-exercise and post-exercise (0 min, 15 min, 30 min and 60 min) were collected for volatile pattern ("smellprint") determination and pH measurements (at 5.33 kPa CO2), respectively. Exhaled breath smellprints were analyzed using principal component analysis and were related to EBC pH.Smellprints (p=0.04) and EBC pH (p=0.01) were altered during exercise challenge. Compared to pre-exercise values, smellprints and pH differed at 15 min, 30 min and 60 min following exercise (p<0.05), while no difference was found at 0 min post-exercise. In addition, a significant correlation was found between volatile pattern of exhaled breath and EBC pH (p=0.01, r=-0.34).Physical exercise changes the pattern of exhaled volatiles together with an increase in pH of breath. Changes in volatiles may be responsible for increase in EBC pH.

Effect of the influenza A (H1N1) live attenuated intranasal vaccine on nitric oxide (FENO) and other volatiles in exhaled breath

For the 2009 influenza A (H1N1) pandemic, vaccination and infection control were the main modes of prevention. A live attenuated H1N1 vaccine mimics natural infection and works by evoking a host immune response, but currently there are no easy methods to measure such a response. To determine if an immune response could be measured in exhaled breath, exhaled nitric oxide (FENO) and other exhaled breath volatiles using selected ion flow tube mass spectrometry (SIFT-MS) were measured before and daily for seven days after administering the H1N1 2009 monovalent live intranasal vaccine (FluMist®, MedImmune LLC) in nine healthy healthcare workers (age 35 ± 7 years; five females). On day 3 after H1N1 FluMist® administration there were increases in FENO (MEAN±SEM: day 0 15 ± 3 ppb, day 3 19 ± 3 ppb; p < 0.001) and breath isoprene (MEAN±SEM: day 0 59 ± 15 ppb, day 3 99 ± 17 ppb; p = 0.02). MS analysis identified the greatest number of changes in exhaled breath on day 3 with 137 product ion masses that changed from baseline. The exhaled breath changes on day 3 after H1N1 vaccination may reflect the underlying host immune response. However, further work to elucidate the sources of the exhaled breath changes is necessary.

Inhaled today, not gone tomorrow: pharmacokinetics and environmental exposure of volatiles in exhaled breath

The chemical analysis of exhaled breath gas to assess state of health or identify disease biomarkers has gained growing interest in recent years, with advances in new technologies providing scientists and physicians with a powerful analytical arsenal with which to tackle pertinent issues. The application of these methods for pharmacokinetic studies, however, has received less attention despite its enormous potential in this field. For instance, breath gas analysis may be employed to characterize uptake and distribution within the body of exogenous volatile compounds, either from a pharmaceutical point of view, or in relation to environmental inhalation exposure. Both of these topics can benefit greatly from utilizing breath gas complementarily or as a surrogate to blood as an analytical medium, since breath sampling is non-invasive, inexhaustible, and is achievable with a frequency far exceeding that which is feasible for blood. However, because of the efficiency with which certain exogenous compounds are reflected in breath, this can also often be a significant source of confounding variables that require consideration in routine breath gas analyses. This paper provides an overview of the possibilities of breath gas analysis for pharmacokinetics and environmental exposure investigations and discusses the presence of exogenous compounds in standard breath analyses and their repercussions in terms of erroneous data interpretation.