ABSTRACT
Necrotizing otitis externa (NOE) is an aggressive and fast-evolving infection of the external auditory canal. Late diagnoses and untreated cases can lead to severe, even fatal consequences and so early diagnosis and treatment are paramount. NOE is a notoriously challenging diagnosis to make. It is therefore important to understand what diagnostic modalities are available and how otolaryngologists can use them to accurately treat such an aggressive disease. This review aims to evaluate the different diagnostic options available in NOE and discuss their advantages and limitations, thus, providing an up-to-date picture of the multimodal approach required in the diagnosis of this disease.
ABSTRACT
RATIONALE: Traditionally, hydrogen/deuterium exchange (HDX) reactions are done in the solution phase. This usually involves incubating the protein with a suitable deuterating agent then acidifying the solution to quench the reaction. A more efficient method may be to conduct the reaction within the ion source of a mass spectrometer and subsequently analyze the products. METHODS: Using the two electrospray emitters equipped on the Waters Synapt G1 mass spectrometer, HDX reactions were conducted within the ion source region in a controlled fashion ('dual-spray'). Peptide and protein solutions were electrosprayed through one emitter and the deuterating agent D2 O through the secondary electrospray emitter. For the relatively small peptides, Phe-Leu-Glu-Glu-Leu and oxytocin, the yield of products was calculated using deconvolution functions. Electrospray ionization (ESI) charge-state distributions and average number of deuterium exchanges were used to probe secondary and tertiary structures of ubiquitin, lysozyme, and cytochrome c in their native and unfolded states. RESULTS: Clear shifts in isotope distributions indicated HDX occurring within the ion source. By ion mobility, simultaneous deuterium exchange for two isobaric species, the oxytocin monomer and dimer, was observed. For denatured ubiquitin, the 12+ and 13+ charge states have a lower average number of exchanges relative to the lower charge states which indicates that these charge states have segments which restrict the access of D2 O. Lysozyme has a linear relationship between the charge state and the average number of exchanges, indicating that lysozyme becomes increasingly unfolded as the charge state increases. The dual-spray HDX method was paired to high-performance liquid chromatography (HPLC) to demonstrate the applicability of the technique for probing gas-phase structures in protein mixtures. CONCLUSIONS: ESI droplets formed from a secondary emitter penetrate primary ESI droplets and change the solvent composition. Dual-spray HDX is demonstrated to be a more efficient method for probing the structure of proteins than solution-phase HDX since the acid quenching step can be surpassed. Copyright © 2016 John Wiley & Sons, Ltd.
