Abstract
Background
Measured exhaled volatile organic compounds (VOCs) in breath also referred to as exhaled volatilome have been long claimed as a potential source of non-invasive and clinically applicable biomarkers. However, the feasibility of using exhaled volatilome in clinical practice remains to be demonstrated, particularly in pediatrics where the need for improved non-invasive diagnostic and monitoring methods is most urgent. This work presents the first formal evidence-based judgment of the clinical potential of breath volatilome in the pediatric population.
Methods
A rigorous systematic review across Web of Science, SCOPUS, and PubMed databases following the PRISMA statement guidelines. A narrative synthesis of the evidence was conducted and QUADAS-2 was used to assess the quality of selected studies.
Results
Two independent reviewers deemed 22 out of the 229 records initially found to satisfy inclusion criteria. A summary of breath VOCs found to be relevant for several respiratory, infectious, and metabolic pathologies was conducted. In addition, we assessed their associated metabolism coverage through a functional characterization analysis.
Conclusion
Our results indicate that current research remains stagnant in a preclinical exploratory setting. Designing exploratory experiments in compliance with metabolomics practice should drive forward the clinical translation of VOCs breath analysis.
Impact
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What is the key message of your article?
Metabolomics practice could help to achieve the clinical utility of exhaled volatilome analysis.
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What does it add to the existing literature?
This work is the first systematic review focused on disease status discrimination using analysis of exhaled breath in the pediatric population. A summary of the reported exhaled volatile organic compounds is conducted together with a functional characterization analysis.
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What is the impact?
Having noted challenges preventing the clinical translation, we summary metabolomics practices and the experimental designs that are closer to clinical practice to create a framework to guide future trials.
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Acknowledgements
Rosa A. Sola Martínez acknowledges her fellowship from the Spanish Ministry of Science, Innovation, and Universities (FPU18/00545). This work was supported by grants from the Instituto de Salud Carlos III through the project “PIE15/00051” (Co-funded by European Regional Development Fund/European Social Fund “A way to make Europe”/“Investing in your future”), the Ministry of Science, Innovation, and Universities (MCIU), the State Research Agency (AEI) and the European Regional Development Fund (FEDER), RTI2018-094393-B-C21-MCIU/AEI/FEDER, UE, and the Seneca Foundation CARM, 20786/PI/18.
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R.A.S.M.: Conceptualization and design, methodology, acquisition of data, data curation, formal analysis, and writing-original draft. J.M.P.H.: Conceptualization and design, methodology, acquisition of data, and writing-review. Ó.Y.T.: Data curation, formal analysis, writing-review, and editing. M.C.D.: Writing-review and editing, project administration, and funding acquisition. T.d.D.P.: Conceptualization and design, methodology, data curation, formal analysis, writing-review and editing, supervision, project administration, and funding acquisition. M.V.C.: Conceptualization and design, methodology, data curation, formal analysis, writing-review, and editing. All authors read and approved the final.
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Sola Martínez, R.A., Pastor Hernández, J.M., Yanes Torrado, Ó. et al. Exhaled volatile organic compounds analysis in clinical pediatrics: a systematic review. Pediatr Res 89, 1352–1363 (2021). https://doi.org/10.1038/s41390-020-01116-8
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DOI: https://doi.org/10.1038/s41390-020-01116-8
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