Metabolic effects of albumin therapy in acute lung injury measured by proton nuclear magnetic resonance spectroscopy of plasma: A pilot study*

Abstract

Objectives Improved means to monitor and guide interventions could be useful in the intensive care unit (ICU). Metabolomic analysis with bioinformatics is used to understand mechanisms and identify biomarkers of disease development and progression. This pilot study evaluated plasma 1H-NMR spectroscopy as a means to monitor metabolism following albumin administration in acute lung injury (ALI) patients. Design This study was conducted on plasma samples from 6 albumin-treated and 6 saline-treated patients from a larger double-blind trial. The albumin group was administered 25 g of 25% human albumin in 0.9% saline every 8 h for a total of 9 doses over 72 h. 0.9% saline was used as placebo. Blood samples were collected immediately prior to, 1 h after and 4 h after the albumin/saline administration for the 1st, 4th, and 7th doses (first dose of each day for 3 days). Samples were analyzed by 1H-NMR spectroscopy, and spectra were analyzed by principal component analysis and biostatistical methods. Measurements and Main Results After 1 day of albumin therapy, changes in small molecules, including amino acids and plasma lipids, were evident with Principal Component Analysis (PCA). Differences remained 3 days after the last albumin administration. Analysis of data along with spectra from healthy controls showed that patients receiving albumin had a trajectory toward the spectra observed in healthy individuals while placebo controls did not. Conclusions The data suggest that metabolic changes detected by 1H-NMR spectroscopy and bioinformatics tool may be useful approach to clinical research especially in acute lung injury.

Bioinformatics insights into acute lung injury/acute respiratory distress syndrome

“…This study showed that blood albumin levels normalized and oxygenation improved with albumin treatment compared to saline treatment. In this study, 1 H-NMR spectroscopy was introduced to characterize systemic metabolic responses and identify patients’ unique response to pharmacologic therapy and appealed to play a potential role in the guiding treatment and reducing healthcare cost [68]. …”

“…Although the amplification of quantitative metabolomics in clinic bioinformaticsis in its infancy, it has been increasingly used recently. It is a unique tool of discovery because it identifies multiple endogenous markers, and it changes over time which can be predictive of clinical outcome and therapeutic response [67,68]. The ability of magnetic resonance imaging (MRI) and metabolic NMR were investigated to detect and quantify inflammationmediated lung injury [69].…”

“…albumin levels normalized and oxygenation improved with albumin treatment compared to saline treatment. In this study, 1 H-NMR spectroscopy was introduced to characterize systemic metabolic responses and identify patients' unique response to pharmacologic therapy and appealed to play a potential role in the guiding treatment and reducing healthcare cost [68]. In summary, ALI/ARDS is a complex disease which can be initiated by a diverse array of precipitating factors and involving the interplay of both the environment and genetic factors.…”

Pharmacometabolomics by NMR in Oncology: A Systematic Review

“…Furthermore, most of the studies relied on using sodium trimethylsilyl [2,2,3,3- 2 H 4 ] propionate (TSP) as an internal standard, whereas 2,2,3,3-d 4 -3-(trimethylsilyl) propionic acid (TMSP) or 4,4-dimethyl-4-silapentane-1-sulfonic acid (DSS) were only used in a few studies. Other chemical compounds, such as tetramethylsilane (TMS) or calcium formate, were rarely used [ 38 , 39 ].…”

Nutritional Metabolomics: Progress in Addressing Complexity in Diet and Health

“…Importantly, gene co-expression in circulating leukocytes was dependent upon plasma metabolites, showing networks linkage with lipoproteins, lipids and amino acids. Stringer et al (86) showed that quantitative metabolomics was potentially useful in sepsis-induced acute lung injury, and Park et al (70) showed a progressive trajectory of the principal component analysis (PCA) of plasma metabolites in albumin-treated patients toward a normal healthy metabolic profile. The most discriminatory regions by PCA consisted of parts of the spectra in which amino acids, glucose and other metabolites are present, suggesting utility to evaluate nutritional imbalance of critical illness and to assess recovery from critical illness (70).…”