血浆尿素循环代谢物可能是嗜酸性粒细胞性食管炎患儿有用的生物标志物。

Plasma Urea Cycle Metabolites May Be Useful Biomarkers in Children With Eosinophilic Esophagitis.

作者信息

Moye Lindsay M, Liu Yuying, Coarfa Cristian, Putluri Nagireddy, Rhoads Jon Marc

机构信息

Department of Pediatric Gastroenterology, University of Texas McGovern Medical School, Houston, TX, United States.

Department of Molecular and Cellular Biology, Advanced Technology Core, Baylor College of Medicine, Houston, TX, United States.

出版信息

Front Pediatr. 2019 Jan 10;6:423. doi: 10.3389/fped.2018.00423. eCollection 2018.

Abstract

Eosinophilic esophagitis (EoE) is a disorder of the esophagus that has become increasingly recognized in children. Because these children undergo multiple endoscopies, discovering a non-invasive biomarker of disease activity is highly desirable. The aim of this study was to use targeted plasma metabolomics to identify potential biomarker candidates for EoE in a discovery phase. A prospective, single-center clinical trial was performed on 24 children ages 2-18 years with and without EoE undergoing upper endoscopy for any indication. Blood samples were collected for metabolomics profiling using the subclasses: amino acids, tricarboxylic acid cycle, acetylation, and methylation. Using mass spectrometry and systematic bioinformatics analysis, 48 metabolites were measured and compared between children with active EoE (+EoE) and controls (-EoE). To investigate the effect of proton pump inhibitor (PPI) use on metabolites, patients were also stratified based on PPI use (+PPI, -PPI). Seven children had active EoE at the time of endoscopy. Eleven children were on PPI (4 with EoE). Of the 48 metabolites measured, 8 plasma metabolites showed statistically significant differences ( < 0.05) comparing +EoE -PPI to -EoE -PPI, a few of which were upregulated metabolites involved in the urea cycle. There were 14 significant differences comparing +EoE +PPI to +EoE -PPI. This demonstrated that in EoE patients, PPI use upregulated metabolites involved in the urea cycle, while it downregulated metabolites involved in methylation. Comparison among all four groups, +EoE +PPI, +EoE -PPI, -EoE +PPI, and -EoE -PPI, revealed 27 significantly different metabolites. +EoE +PPI had downregulated methionine and N-acetyl methionine, while both +EoE groups and -EoE +PPI had upregulated homocysteine, N-acetylputrescine, N-acetylornithine, arginine, and ornithine. The present study revealed key plasma metabolite differences in children with EoE compared to unaffected controls. Notable candidate biomarkers include dimethylarginine, putrescine, and N-acetylputrescine. PPI use was shown to influence these urea cycle metabolites, regardless of EoE presence. Therefore, future studies should distinguish patients based on PPI use or determine metabolites while not on treatment. These findings will be confirmed in a larger validation phase, as this may represent a significant discovery in the search for a non-invasive biomarker for EoE. This clinical trial was registered with ClinicalTrials.gov, identifier: NCT 03107819.

摘要

嗜酸性粒细胞性食管炎(EoE)是一种食管疾病,在儿童中越来越受到关注。由于这些儿童需要接受多次内镜检查,因此非常希望找到一种疾病活动的非侵入性生物标志物。本研究的目的是在探索阶段使用靶向血浆代谢组学来识别EoE潜在的生物标志物候选物。对24名年龄在2至18岁之间、有或没有EoE且因任何指征接受上消化道内镜检查的儿童进行了一项前瞻性、单中心临床试验。采集血样用于代谢组学分析,分析类别包括:氨基酸、三羧酸循环、乙酰化和甲基化。使用质谱和系统生物信息学分析,测量并比较了活动性EoE儿童(+EoE)和对照组(-EoE)之间的48种代谢物。为了研究质子泵抑制剂(PPI)使用对代谢物的影响,患者还根据PPI使用情况进行分层(+PPI,-PPI)。7名儿童在接受内镜检查时患有活动性EoE。11名儿童正在使用PPI(4名患有EoE)。在测量的48种代谢物中,8种血浆代谢物在比较+EoE -PPI与-EoE -PPI时显示出统计学上的显著差异(<0.05),其中一些是参与尿素循环的上调代谢物。在比较+EoE +PPI与+EoE -PPI时,有14个显著差异。这表明在EoE患者中,PPI的使用上调了参与尿素循环的代谢物,同时下调了参与甲基化的代谢物。对+EoE +PPI、+EoE -PPI、-EoE +PPI和-EoE -PPI这四组进行比较,发现有27种代谢物存在显著差异。+EoE +PPI组的蛋氨酸和N-乙酰蛋氨酸下调,而+EoE组和-EoE +PPI组的同型半胱氨酸、N-乙酰腐胺、N-乙酰鸟氨酸、精氨酸和鸟氨酸均上调。本研究揭示了EoE儿童与未受影响的对照组相比关键的血浆代谢物差异。值得注意的候选生物标志物包括二甲基精氨酸、腐胺和N-乙酰腐胺。无论是否存在EoE,PPI的使用均显示会影响这些尿素循环代谢物。因此,未来的研究应根据PPI使用情况区分患者,或在未进行治疗时确定代谢物。这些发现将在更大规模的验证阶段得到证实,因为这可能代表了在寻找EoE非侵入性生物标志物方面的一项重大发现。该临床试验已在ClinicalTrials.gov注册,标识符:NCT 03107819。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1e1/6335364/7752274b4fe1/fped-06-00423-g0001.jpg

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