Chemical sensors for breath gas analysis: the latest developments at the Breath Analysis Summit 2013.

Profiling the body chemistry by means of volatile organic compounds (VOCs) in the breath opens exciting new avenues in medical diagnostics. Gas sensors could provide ideal platforms for realizing portable, hand-held breath testing devices in the near future. This review summarizes the latest developments and applications in the field of chemical sensors for diagnostic breath testing that were presented at the Breath Analysis Summit 2013 in Wallerfangen, Germany. Considerable progress has been made towards clinically applicable breath testing devices, especially by utilizing chemo-sensitive nanomaterials. Examples of several specialized breath testing applications are presented that are either based on stand-alone nanomaterial-based sensors being highly sensitive and specific to individual breath compounds over others, or on combinations of several highly specific sensors, or on experimental nanomaterial-based sensors arrays. Other interesting approaches include the adaption of a commercially available MOx-based sensor array to indirect breath testing applications, using a sample pre-concentration method, and the development of compact integrated GC-sensor systems. The recent trend towards device integration has led to the development of fully integrated prototypes of point-of-care devices. We describe and compare the performance of several prototypes that are based on different sensing technologies and evaluate their potential as low-cost and readily available next-generation medical devices.

Impact of hemodialysis on exhaled volatile organic compounds in end-stage renal disease: a pilot study.

AIM: To demonstrate the feasibility of nanomaterial-based sensors for identifying patterns of exhaled volatile organic compound of end-stage renal disease (ESRD) and study the impact of hemodialysis (HD) on these patterns. PATIENTS & METHODS: Exhaled breath samples were collected from a group of 37 volunteers (26 ESRD HD patients; 11 healthy controls); a third of the samples were randomly blinded for determining the sensitivity/specificity of the method. Discriminant function analysis was used to build a model for discriminating ESRD patients and healthy controls (classification accuracy for blind samples: 80%), based on the signals of the nanomaterial sensors. RESULTS & CONCLUSION: The breath pattern of the ESRD patients approached the healthy pattern during the HD treatment, without reaching it completely. Gas chromatography/mass spectrometry identified four volatile organic compounds as potential ESRD biomarkers. Although this pilot study has yielded encouraging results, additional large-scale clinical studies are required to develop a fast, noninvasive breath test for monitoring HD adequacy in real time.

Geographical variation in the exhaled volatile organic compounds.

Breath-gas analysis has demonstrated that concentration profiles of volatile organic compounds (VOCs) could be used for detecting a variety of diseases, among them gastric cancer (GC) and peptic ulcer disease (PUD). Here, we explore how geographical variation affects the disease-specific changes in the chemical composition of breath samples, as compared to control states (less severe gastric conditions). Alveolar exhaled breath samples from 260 patients were collected at two remotely different geographic locations (China and Latvia), following similar breath-collection protocols. Each cohort included 130 patients that were matched in terms of diagnosis (37 GC/32 PUD/61 controls), average age, gender ratio and smoking habits. Helicobacter Pylori infection, which is a major cause for GC and PUD, was found in part of the patients, as well as in part of the controls, at both locations. The breath samples were analyzed by gas chromatography/mass spectrometry, using the same equipment and protocol-of-experiment. We observed similar characteristic differences in the chemical composition of the breath samples between the study groups at the two locations, even though the exact composition of the breath samples differed. Both in China and Latvia, the GC patients and controls could be distinguished by differences in the average levels of 6-methyl-5-hepten-2-one; PUD patients were distinguished from controls by the levels of aromatic compounds and alcohols; GC and PUD patients could not be distinguished at either site. This pilot study indicates the limitations of chemical breath-gas analysis alone for identifying gastric diseases based on the concentration profiles of separate VOCs in international patient cohorts. We assume that these limitations would apply to other diseases as well. The presented data could potentially be useful for developing an alternative, universally applicable diagnostic method that relies on the detection of changes in the collective patterns of the disease-specific classes of exhaled VOCs.

Detection of volatile organic compounds in Brucella abortus-seropositive bison.

Brucellosis is of great public health and economic importance worldwide. Detection of brucellosis currently relies on serologic testing of an antibody response to Brucella infection, which suffers from cross-sensitivities to other antibody responses. Here we present a new method for identifying Brucella exposure that is based on profiling volatile organic compounds (VOCs) in exhaled breath. Breath samples from Brucella-seropositive bison and controls were chemically analyzed and demonstrated statistically significant differences in the concentration profiles of five VOCs. A point-of-care device incorporating an array of nanomaterial-based sensors could identify VOC patterns indicative of Brucella exposure with excellent discriminative power, using a statistical algorithm. We show that the patterns were not affected by the animals' environment and that the discriminative power of the approach was stable over time. The Brucella-indicative VOCs and collective patterns that were identified in this pilot study could lead to the development of a novel diagnostic screening test for quickly detecting infected animals chute-side, pen-side, or even remotely in populations of free-ranging ungulates. The promising preliminary results presented encourage subsequent larger scale trials in order to further evaluate the proposed method.

Volatile fingerprints of cancer specific genetic mutations.

We report on a new concept for profiling genetic mutations of (lung) cancer cells, based on the detection of patterns of volatile organic compounds (VOCs) emitted from cell membranes, using an array of nanomaterial-based sensors. In this in-vitro pilot study we have derived a volatile fingerprint assay for representative genetic mutations in cancer cells that are known to be associated with targeted cancer therapy. Five VOCs were associated with the studied oncogenes, using complementary chemical analysis, and were discussed in terms of possible metabolic pathways. The reported approach could lead to the development of novel methods for guiding treatments, so that patients could benefit from safer, more timely and effective interventions that improve survival and quality of life while avoiding unnecessary invasive procedures. Studying clinical samples (tissue/blood/breath) will be required as next step in order to determine whether this cell-line study can be translated into a clinically useful tool. FROM THE CLINICAL EDITOR: In this novel study, a new concept for profiling genetic mutations of (lung) cancer cells is described, based on the detection of patterns of volatile organic compounds emitted from cell membranes, using an array of nano-gold based sensors.

A nanomaterial-based breath test for short-term follow-up after lung tumor resection.

In this case study, we demonstrate the feasibility of nanomaterial-based sensors for identifying the breath-print of early-stage lung cancer (LC) and for short-term follow-up after LC-resection. Breath samples were collected from a small patient cohort prior to and after lung resection. Gas-chromatography/mass-spectrometry showed that five volatile organic compounds were significantly reduced after LC surgery. A nanomaterial-based sensor-array distinguished between pre-surgery and post-surgery LC states, as well as between pre-surgery LC and benign states. In contrast, the same sensor-array could neither distinguish between pre-surgery and post-surgery benign states, nor between LC and benign states after surgery. This indicates that the observed pattern is associated with the presence of malignant lung tumors. The proof-of-concept presented here has initiated a large-scale clinical study for post-surgery follow-up of LC patients. FROM THE CLINICAL EDITOR: Monitoring for tumor recurrence remains very challenging due to post-surgical and radiation therapy induced changes in target organs, which often renders standard radiological identification of recurrent malignancies inaccurate. In this paper a novel nanotechnology-based sensor array is used for identification of volatile organic compounds in exhaled air that enable identification of benign vs. malignant states.

Detection of Alzheimer's and Parkinson's disease from exhaled breath using nanomaterial-based sensors.

AIM: To study the feasibility of a novel method in nanomedicine that is based on breath testing for identifying Alzheimer's disease (AD) and Parkinson's disease (PD), as representative examples of neurodegenerative conditions. PATIENTS & METHODS: Alveolar breath was collected from 57 volunteers (AD patients, PD patients and healthy controls) and analyzed using combinations of nanomaterial-based sensors (organically functionalized carbon nanotubes and gold nanoparticles). Discriminant factor analysis was applied to detect statistically significant differences between study groups and classification success was estimated using cross-validation. The pattern identification was supported by chemical analysis of the breath samples using gas chromatography combined with mass spectrometry. RESULTS: The combinations of sensors could clearly distinguish AD from healthy states, PD from healthy states, and AD from PD states, with a classification accuracy of 85, 78 and 84%, respectively. Gas chromatography combined with mass spectrometry analysis showed statistically significant differences in the average abundance of several volatile organic compounds in the breath of AD, PD and healthy subjects, thus supporting the breath prints observed with the sensors. CONCLUSION: The breath prints that were identified with combinations of nanomaterial-based sensors have future potential as cost-effective, fast and reliable biomarkers for AD and PD.

Detection of asymptomatic nigrostriatal dopaminergic lesion in rats by exhaled air analysis using carbon nanotube sensors.

The ante-mortem diagnosis of Parkinson's disease (PD) still relies on clinical symptoms. Biomarkers could in principle be used for the early detection of PD-related neuronal damage, but no validated, inexpensive, and simple biomarkers are available yet. Here we report on the breath-print of presymptomatic PD in rats, using a model with 50% lesion of dopaminergic neurons in substantia nigra. Exhaled breath was collected from 19 rats (10 lesioned and 9 sham operated) and analyzed using organically functionalized carbon nanotube sensors. Discriminant factor analysis detected statistically significant differences between the study groups and a classification accuracy of 90% was achieved using leave-one-out cross-validation. The sensors' breath-print was supported by determining statistically significant differences of several volatile organic compounds in the breath of the lesioned rats and the sham operated rats, using gas chromatography combined with mass spectrometry. The observed breath-print shows potential for cost-effective, fast, and reliable early PD detection.

The scent fingerprint of hepatocarcinoma: in-vitro metastasis prediction with volatile organic compounds (VOCs).

BACKGROUND: Hepatocellular carcinoma (HCC) is a common and aggressive form of cancer. Due to a high rate of postoperative recurrence, the prognosis for HCC is poor. Subclinical metastasis is the major cause of tumor recurrence and patient mortality. Currently, there is no reliable prognostic method of invasion. AIM: To investigate the feasibility of fingerprints of volatile organic compounds (VOCs) for the in-vitro prediction of metastasis. METHODS: Headspace gases were collected from 36 cell cultures (HCC with high and low metastatic potential and normal cells) and analyzed using nanomaterial-based sensors. Predictive models were built by employing discriminant factor analysis pattern recognition, and the classification success was determined using leave-one-out cross-validation. The chemical composition of each headspace sample was studied using gas chromatography coupled with mass spectrometry (GC-MS). RESULTS: Excellent discrimination was achieved using the nanomaterial-based sensors between (i) all HCC and normal controls; (ii) low metastatic HCC and normal controls; (iii) high metastatic HCC and normal controls; and (iv) high and low HCC. Several HCC-related VOCs that could be associated with biochemical cellular processes were identified through GC-MS analysis. CONCLUSION: The presented results constitute a proof-of-concept for the in-vitro prediction of the metastatic potential of HCC from VOC fingerprints using nanotechnology. Further studies on a larger number of more diverse cell cultures are needed to evaluate the robustness of the VOC patterns. These findings could benefit the development of a fast and potentially inexpensive laboratory test for subclinical HCC metastasis.

Gold nanoparticle sensors for detecting chronic kidney disease and disease progression.

AIM: To study the feasibility of a novel nanomedical method that utilizes breath testing for identifying chronic kidney disease (CKD) and disease progression. MATERIALS & METHODS: Exhaled breath samples were collected from 62 volunteers. The breath samples were analyzed using sensors based on organically functionalized gold nanoparticles, combined with support vector machine analysis. Sensitivity and specificity with reference to CKD patient classification according to estimated glomerular filtration rate were determined using cross-validation. The chemical composition of the breath samples was studied using gas chromatography linked with mass spectrometry. RESULTS: A combination of two to three gold nanoparticles sensors provided good distinction between early-stage CKD and healthy states (accuracy of 79%) and between stage 4 and 5 CKD states (accuracy of 85%). A single sensor provided a distinction between early and advanced CKD (accuracy of 76%). Several substances in the breath were identified and could be associated with CKD-related biochemical processes or with the accumulation of toxins through kidney function loss. CONCLUSION: Breath testing using gold nanoparticle sensors holds future potential as a cost-effective, fast and reliable diagnostic test for early detection of CKD and monitoring of disease progression.

Molecular gating of silicon nanowire field-effect transistors with nonpolar analytes.

Silicon nanowire field-effect transistors (Si NW FETs) have been used as powerful sensors for chemical and biological species. The detection of polar species has been attributed to variations in the electric field at the conduction channel due to molecular gating with polar molecules. However, the detection of nonpolar analytes with Si NW FETs has not been well understood to date. In this paper, we experimentally study the detection of nonpolar species and model the detection process based on changes in the carrier mobility, voltage threshold, off-current, off-voltage, and subthreshold swing of the Si NW FET. We attribute the detection of the nonpolar species to molecular gating, due to two indirect effects: (i) a change in the dielectric medium close to the Si NW surface and (ii) a change in the charged surface states at the functionality of the Si NW surface. The contribution of these two effects to the overall measured sensing signal is determined and discussed. The results provide a launching pad for real-world sensing applications, such as environmental monitoring, homeland security, food quality control, and medicine.

Classification of lung cancer histology by gold nanoparticle sensors.

We propose a nanomedical device for the classification of lung cancer (LC) histology. The device profiles volatile organic compounds (VOCs) in the headspace of (subtypes of) LC cells, using gold nanoparticle (GNP) sensors that are suitable for detecting LC-specific patterns of VOC profiles, as determined by gas chromatography-mass spectrometry analysis. Analyzing the GNP sensing signals by support vector machine allowed significant discrimination between (i) LC and healthy cells; (ii) small cell LC and non-small cell LC; and between (iii) two subtypes of non-small cell LC: adenocarcinoma and squamous cell carcinoma. The discriminative power of the GNP sensors was then linked with the chemical nature and composition of the headspace VOCs of each LC state. These proof-of-concept findings could totally revolutionize LC screening and diagnosis, and might eventually allow early and differential diagnosis of LC subtypes with detectable or unreachable lung nodules. FROM THE CLINICAL EDITOR: In this study, a nanomedical device that profiles volatile organic compounds (VOCs) in lung cancer cells is investigated, using a matrix of gold nanoparticle (GNP) sensors that are suitable for detecting lung cancer (LC) specific patterns of VOC profiles. This device might eventually allow early differential diagnosis of LC subtypes including unreachable lung nodules.

Classification of breast cancer precursors through exhaled breath.

Certain benign breast diseases are considered to be precursors of invasive breast cancer. Currently available techniques for diagnosing benign breast conditions lack accuracy. The purpose of this study was to deliver a proof-of-concept for a novel method that is based on breath testing to identify breast cancer precursors. Within this context, the authors explored the possibility of using exhaled alveolar breath to identify and distinguish between benign breast conditions, malignant lesions, and healthy states, using a small-scale, case-controlled, cross-sectional clinical trial. Breath samples were collected from 36 volunteers and were analyzed using a tailor-made nanoscale artificial NOSE (NA-NOSE). The NA-NOSE signals were analyzed using two independent methods: (i) principal component analysis, ANOVA and Student's t-test and (ii) support vector machine analysis to detect statistically significant differences between the sub-populations. The NA-NOSE could distinguish between all studied test populations. Breath testing with a NA-NOSE holds future potential as a cost-effective, fast, and reliable diagnostic test for breast cancer risk factors and precursors, with possible future potential as screening method.

Diagnosing lung cancer in exhaled breath using gold nanoparticles.

Conventional diagnostic methods for lung cancer are unsuitable for widespread screening because they are expensive and occasionally miss tumours. Gas chromatography/mass spectrometry studies have shown that several volatile organic compounds, which normally appear at levels of 1-20 ppb in healthy human breath, are elevated to levels between 10 and 100 ppb in lung cancer patients. Here we show that an array of sensors based on gold nanoparticles can rapidly distinguish the breath of lung cancer patients from the breath of healthy individuals in an atmosphere of high humidity. In combination with solid-phase microextraction, gas chromatography/mass spectrometry was used to identify 42 volatile organic compounds that represent lung cancer biomarkers. Four of these were used to train and optimize the sensors, demonstrating good agreement between patient and simulated breath samples. Our results show that sensors based on gold nanoparticles could form the basis of an inexpensive and non-invasive diagnostic tool for lung cancer.

Spongelike structures of hexa-peri-hexabenzocoronene derivatives enhance the sensitivity of chemiresistive carbon nanotubes to nonpolar volatile organic compounds of cancer.

Cancer is a leading health hazard, and lung cancer is its most common form. Breath testing is a fast, noninvasive diagnostic method which links specific volatile organic compounds (VOCs) in exhaled breath to medical conditions. Arrays of sensors based on carbon nanotubes (CNTs) could in principle detect cancer by differentiating between the VOCs found in the breath of healthy and sick persons, but the notoriously low sensitivity of CNT sensors to nonpolar VOCs limits their accuracy. In this study, we have achieved a marked improvement of the sensitivity and selectivity of random networks (RNs) of CNT chemiresistors to nonpolar VOCs by functionalizing them with self-assembled, spongelike structures of discotic hexa-peri-hexabenzocoronene (HBC) derivatives. We observed swelling of the organic film by monitoring the changes of organic film thickness during exposure and propose that the expansion of the spongelike organic overlayer creates scattering centers in the underlying RN-CNTs by physically distancing the CNTs at their intersections. The results presented here could lead to the development of robust sensors for nonpolar VOCs of cancer breath, which have hitherto been difficult to trace.

Detection of nonpolar molecules by means of carrier scattering in random networks of carbon nanotubes: toward diagnosis of diseases via breath samples.

Field effect transistors (FETs) based on random networks (RNs) of single-wall carbon nanotubes (CNTs) have several technological advantages. However, the low sensitivity (or no sensitivity) of RN-CNT sensors to nonpolar molecules is a problematic, negative feature that limits their applications in the detection of a wide variety of diseases via breath samples. In this paper, we show experimental evidence for the detection of both individual nonpolar molecules and patterns of nonpolar molecules, even in the presence of polar molecules in the same environment. We do so by preparing RN-CNT FETs and functionalizing them with organic films that exhibit distinctive electrical and physical (or mechanical) characteristics. Exposing the functionalized RN-CNTs to representative nonpolar breath biomarkers, and, for comparison, to polar molecules in the gas phase, and monitoring the changes in conductance, work function, and organic film thickness show sensitivity toward nonpolar molecules. We explain this observation by carrier scattering as a result of swelling of the organic film upon exposure to (nonpolar) chemical agents. Hence, the sensitivity towards nonpolar molecules can be tailored, even in the presence of polar molecules, by controlling the scattering of charge carrier through deliberate functionalization of CNTs. As examples for the technological impact of our findings, we describe ways to detect lung cancer and kidney disease using specially designed RN-CNT sensor arrays.

Annealing-induced interfacial toughening using a molecular nanolayer.

Self-assembled molecular nanolayers (MNLs) composed of short organic chains and terminated with desired functional groups are attractive for modifying surface properties for a variety of applications. For example, organosilane MNLs are used as lubricants, in nanolithography, for corrosion protection and in the crystallization of biominerals. Recent work has explored uses of MNLs at thin-film interfaces, both as active components in molecular devices, and as passive layers, inhibiting interfacial diffusion, promoting adhesion and toughening brittle nanoporous structures. The relatively low stability of MNLs on surfaces at temperatures above 350-400 degrees C (refs 12, 13), as a result of desorption or degradation, limits the use of surface MNLs in high-temperature applications. Here we harness MNLs at thin-film interfaces at temperatures higher than the MNL desorption temperature to fortify copper-dielectric interfaces relevant to wiring in micro- and nano-electronic devices. Annealing Cu/MNL/SiO2 structures at 400-700 degrees C results in interfaces that are five times tougher than pristine Cu/SiO2 structures, yielding values exceeding approximately 20 J m(-2). Previously, similarly high toughness values have only been obtained using micrometre-thick interfacial layers. Electron spectroscopy of fracture surfaces and density functional theory modelling of molecular stretching and fracture show that toughening arises from thermally activated interfacial siloxane bridging that enables the MNL to be strongly linked to both the adjacent layers at the interface, and suppresses MNL desorption. We anticipate that our findings will open up opportunities for molecular-level tailoring of a variety of interfacial properties, at processing temperatures higher than previously envisaged, for applications where microlayers are not a viable option-such as in nanodevices or in thermally resistant molecular-inorganic hybrid devices.