There is accumulating evidence in support of the significant improvement in survival rates and clinical outcomes when pulmonary arterial hypertension (PAH) is diagnosed at early stages. Nevertheless, it remains a major clinical challenge and the outcomes are dependent on invasive right heart catheterisation.
Resulting from pathophysiological processes and detectable in exhaled breath, volatile organic compounds (VOCs) have been proposed as noninvasive biomarkers for PAH. Studies have confirmed significant alterations of the exhaled VOCs among PAH patients when compared to controls and/or patients with other respiratory diseases. This suggests exhaled breath analysis as a potential noninvasive medical application in the field of PAH.
In this article, we review and discuss the progress made so far in the field of exhaled volatolomics (the omics of VOCs) as a potential noninvasive diagnostics of PAH. In addition, we propose a model including possible biochemical pathways on the level of the remodelled artery, in which specific VOCs could be detectable in exhaled breath during the early phases of PAH. We debate the different analytical approaches used and recommend a diagram including a “bottom–top” strategy, from basic to translational studies, required for promoting the field.
Volatile organic compounds: exhaled volatolomics analysis for noninvasive early diagnosis of PAH http://ow.ly/4R6Q306A0zJ
Support statement: M.K. Nakhleh acknowledges the International Associated Laboratory Inserm-Technion and the European Respiratory Society Long-Term PAH for the post-doctoral grants and support.
The authors thank Assistance Publique – Hôpitaux de Paris (AP-HP, Contrat Local d'Interface 2014 to S. Cohen-Kaminsky) and Département Hospitalo-Universitaire Thorax Innovation (DHU TORINO) for financial support.
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
- Received September 27, 2016.
- Accepted November 15, 2016.
- Copyright ©ERS 2017