Establishing breath as a biomarker platform—take home messages from the Breath Biopsy Conference 2023

Abstract

The annual Breath Biopsy Conference hosted by Owlstone Medical gathers together the leading experts, early career researchers, and physicians working with breath as a biomarker platform for clinical purposes. The current topics in breath research are discussed and presented, and an overarching topical theme is identified and discussed as part of an expert panel to close the conference. The profiling of normal breath composition and the establishment of standards for analyzing breath compared to background signal were two important topics that were major focuses of this conference, as well as important innovative progress that has been made since last year, including the development of a non-invasive breath test for lung cancer and liver disease. This meeting report offers an overview of the key take-home messages from the various presentations, posters, and discussions from the conference.

Progress and challenges of developing volatile metabolites from exhaled breath as a biomarker platform

“…This approach has been used during the development of the VOC Atlas, an ongoing project to develop a reference range of VOCs present in the breath that are able to be distinguished from background based on tiers of quantitative metrics (Hatch et al, n.d.). Due to how important this is to advance breath research, many groups both academic and industrial are also developing reference databases of normal human breath (Chou et al, 2024b ; Human Breath Atlas, 2024 ). Several reference databases from multiple sources and groups across the world and global collaboration in these efforts will allow for comparison between databases for even greater confidence in what the normal ranges of VOCs in the breath are.…”

“…Improving confidence in chemical identification has been a focal point for standardization in breath research, as highlighted by experts during previous breath conferences (Beauchamp et al, 2016 ; Chou et al, 2024a , 2024b ; Schmidt et al, 2021 ). Untargeted breath biomarker discovery workflows make up most breath VOC studies and often result in a list of tentatively identified VOCs through comparison to publicly available standard libraries, such as those provided by the National Institute of Standards and Technology (NIST).…”

“…Confidently knowing the IDs of VOCs in the breath can significantly help with biological interpretation as to why certain VOCs may be increased or decreased in abundance, which then may help link the findings to specific pathways that may be involved in pathophysiology. Along similar lines, establishing a list of VOCs from healthy individuals is a key step in differentiating between disease states, and is a major pursuit of many breath researchers (Chou et al, 2024b ; Human Breath Atlas, 2024 ; Sasiene et al, 2024 ). This will notably contribute to a better understanding of the mechanistic origins of breath VOCs in the body, improving the standardization in the field through a quantitative baseline for comparison and benchmarking, and forming the foundation for accelerated breath biomarker discovery studies to the translation into clinical settings.…”

“…To identify biomarkers and put them to clinical use, untargeted analysis is more suited to gain oversight of the entire VOC profile change between different disease cohorts. Alongside reliable breath VOC reference databases, this could substantially fast-track the discovery, narrowing down, and validation of candidate biomarkers (Chou et al, 2024b ; Hatch et al, 2023 ).…”