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Metabolomics for Medical Science Dr. Metabolo by Dr. Megumi KIBI Masaru Yoshida M.D., Ph.D. Division of Metabolomics Research, Gastroenterology, The Integrated Center for Mass Spectrometry, Kobe University Graduate School of Medicine Today’s Contents 1. Background and Present State of Metabolomics 2. Methods to Measure Metabolites 3. Study for Biomarker Discovery 4. Study for Drug (metabolites) Discovery Omics Studies DNA: Genomics (23,000) The large-scale study of genome Genome wide association study Protein: Proteomics (1,000,000) The large-scale study of proteins Metabolite: Metabolomics (4,000) The systematic study of metabolites (possible by recent progress of mass spec. & analysis software) Why Metabolomics? ✓Smaller numbers compared to genome, RNA, and proteome Human genome = about 23,000 Human functional RNA = about 100,000 Human proteome = about 1,000,000 Human metabolome = about 3,000-4,000 (enzyme related gene, less than 1,100) ✓Metabolites have been examined by traditional assays Traditionally, metabolites have been well investigated in biochemical fields. ✓Close to phenotype Alterations in genome and proteome do not always change the phenotype due to homeostasis. ✓No species-specificity Analytical methods are available to samples from different species. Global Movement of Metabolomics 2020 visions (nature, 2010) ・Search Engines ・Ecology ・Microbiome ・Metabolomics ・Lasers Multi-platform System for Widely Targeted Profiling Metabolites ・・・・a great variety of physicochemical properties Polarity small hydrophobic Organic acid Amino acid Amine Sugar Fatty acid MW Multi-platform system is required. hydrophilic Sugar alcohole large Sugar phosphate CoA Nucleotide Lipid Peptide LC/MS GC/MS and Ion-paring LC/MS 代謝物カテゴリー Derivatizat Method Ionization ion Mobile phase GC/MS EI Essential Gas LC-MS ESI No need Liquid Amino acid Sugar, Sugar alcohol ○ ○ ◎ × × × × ◎ ◎ × △ △ × × ◎ ◎ × Fatty acid Lipid Organic Sugar phosphate, Amine acid Co A, Nucleotide △ × ○ × Reverse phase ◎ ◎ × Ion pair method × × PFPP column × × by Nishiumi S, Izumi Y, Matsubara A et al. Metabolomics Analysis by GC/MS Capilary column for metabolites separation in the colum oven Each metabolite is fragmented by 70 eV thermoelectron. Fragmentation 70eV thermoelectron 73.2 Metabolite X 155.0 Mass (m/z) Metabolites are efficiently separated at their own specific boiling points. Observed EI spectrum Column oven temp. 100ºC~ ~320ºC Database spectrum 316.8 TIC chromatograms obtained by GC/MS of serum Pancreatic cancer patient Healthy volunteer Superposition of TIC chromatograms Some metabolites are changed in patients. (Nishiumi S et al. Metabolomics 2010) Metabolites Database for Identification by GC/MS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Boric acid Trichloroacetic acid Phenol Lactic acid 2-Hydroxyisobutyric acid Caproic acid Glycolic acid L-Alanine L-Glycine Glyoxylic acid Oxalic acid 2-Hydroxybutyric acid 2-Furoic acid Sarcosine 3-Hydroxypropionic acid Pyruvic acid Valproic acid 4-Cresol 3-Hydroxybutyric acid 3-Hydroxyisobutyric acid 2-Hydroxyisovaleric acid alpha-Aminobutyric acid 2-Methyl-3-hydroxybutyric acid Malonic acid beta-Aminoisobutyric acid 3-Hydroxyisovaleric acid 2-Keto-isovaleric acid Methylmalonic acid L-Valine Ethylhydracrylic acid Urea 4-Hydroxybutyric acid 2-Hydroxyisocaproic acid 3-Hydroxyvaleric acid D,L-Norvaline Acetoacetic acid 2-Hydroxy-3-Methylvaleric acid Benzoic acid Acetoacetic acid Octanoic acid Cyclohexanediol 2-Methyl-3-hydroxyvaleric acid 2-Propyl hydroxyglutaric acid L-Leucine Glycerol Acetylglycine Phosphoric acid Ethylmalonic acid 2-Ketoisocaproic acid L-Isoluecine 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 allo-Isoleucine Phenylacetic acid Maleic acid L-Proline 2-Octenoic acid Succinic acid Methylsuccinic acid Glyceric acid Fumaric acid Uracil Citraconic acid Propionylglycine L-Serine Acetylglycine Mevalonic lactone Isobutyrylglycine 2-propyl-3-hydroxy-pentanoic acid L-Threonine Mesaconic acid Glutaric acid Thymine 3-Methylglutaconic acid 3-Methylglutaric acid Propionylglycine Isobutyrylglycine 2-Deoxytetronic acid 3-Methylglutaconic acid(E) Glutaconic acid Succinylacetone Decanoic acid 3-Methylglutaconic acid(Z) 2-Propyl-5-hydroxy-pentanoic acid Citramalic acid Mandelic acid Isovalerylglycine Malic acid Adipic acid Phenyllactic acid p-Nitrophenol Isovalerylglycine 2-Hexenedioic acid Aspartic acid L-Methionine 5-Oxoproline Thiodiglycolic acid 4-Hydroxyproline 3-Methyladipic acid Acetylsalicylic acid 7-Hydroxyoctanoic acid 2-Propyl-glutaric acid 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 Cinnamic acid 5-Hydroxy-2-furoic acid Tiglylglycine 3-Methylcrotonylglycine Tiglylglycine 3-Hydroxybenzoic acid 3-Methylcrotonylglycine 2-Hydroxyphenylacetic acid 2-Hydroxyglutaric acid Pimelic acid 3-Hydroxy-3-methylglutaric acid 3-Hydroxyphenylacetic acid L-Glutamic acid 4-Hydroxybenzoic acid 2-Ketoglutaric acid L-Phenylalanine 4-Hydroxyphenylacetic acid Lauric acid Tartaric acid Hexanoylglycine 2-Ketoglutaric acid N-Acetylaspartic acid Glutaconic acid N-Acetylaspartic acid Asparagine 2-Hydroxyadipic acid Octenedioic acid 3-Hydroxyadipic acid Suberic acid Lysine 2-Keto-adipic alpha-Aminoadipic acid Tricarballylic acid Glutaconic acid Aconitic acid Orotic acid 3-Methoxy-4-hydroxybenzoic acid Homovanillic acid L-Glutamine Azelaic acid Hippuric acid Isocitric acid Citric acid Glucuronoic lactone Hippuric acid Homogentisic acid Myristic acid Glucuronoic lactone Methylcitric acid 3-(3-Hydroxyphenyl)-3-hydroxypropionic acid 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 Caffeine Hydroxylysine (2 isomers) Methylcitric acid Vanilmandelic acid Sebacic acid Decadienedioic acid 4-Hydroxyphenyllactic acid Theophylline L-Histidine 3,4-Dihydroxymandelic acid L-Tyrosine Indole-3-acetic acid Palmitoleic acid Palmitic acid 2-Hydroxysebacic acid 3-Hydroxysebacic acid 2-Hydroxyhippuric acid Dodecanedioic acid Naproxen N-Acetyltyrosine Uric acid Margaric acid 3,6-Epoxydodecanedioic acid Indolelactic acid Stearic acid L-Tryptophan 3-hydroxydodecanedioic acid Chloramphenicol Amino acids Other organic acids Other organic acids(Fatty Acids) Alcohols Ketones Nucleosides Carbohydrates Heterocyclic molecules Inorganic compounds Anionic Metabolites Profiling by Ion-Paring-LC/MS/MS Central metabolism Most of intermediates metabolites are water-soluble anionic metabolites. Glycolysis Pentose phosphate pathway 【Anionic metabolites】 Sugar phosphates Citrate cycle Organic acids Nucleotides + Coenzyme etc. Cofactors (Acetyl-CoA, NAD(P)H, etc.) Anionic Metabolites Profiling by Ion-Paring-LC/MS/MS 【ODS C18 column + Ion-pair reagent】 Tributylamine (TBA) Cationic ion-paring reagent NH+ Hydrophobicity of each polar-anionic metabolites is increased! Retention and separation UHPLC Nexera + LCMS-8040 (Shimadzu Co.) Ion paring cannot be retained on the ODS column. ODS C18 particle G6P highly polar anionic metabolite <HPLC condition> Column: Unison UK-C18 column, 3 m, 2.0 X 150 mm (Imtakt Corp.) Column Temp.: 35.0oC Injection: 5 L Solvent A: 10 mM TBA/15 mM acetic acid in water B: MeOH Flow rate: 0.3 mL・min-1 Serum Lipidomics by LC/MS/MS Lipidomics Large-scale lipids profiling (one of the metabolomics) Lipid metabolism related enzyme stimulate inhibit Cancer onset ・ malignant Lipids may be associated with the each process of diseases. Candidates of biomarkers Target lipids Lipids variety: Theoretical → over 30,000 species; Actual → over 1,000 species ・Free fatty acid (FFA): approximately 50 metabolites Basic structure of lipids O Simple lipids (neutral lipids: C, H, O) ・Lipids O ・Diacylglycerol (DG) → R2, R3:acyl chains R2 ・Triacylglycerol (TG) → R1, R2, R3:acyl chains C O O C O R3 R1 CH H2C Complex lipids (C, H, O + P, N, S, Sugars) Glycerol Phospholipids Glycerophospholipids H2C O R3: P O X OH ・lyso-Phosphatidylcholine (LPC) ・lyso-Phosphatidylethanolamine (LPE) ・Phosphatidylcholine (PC) ・Phosphatidylethanolamine (PE) ・Phosphatidic acid (PA) ・Phosphatidylglycerol (PG) ・Phosphatidylinositol (PI)・Phosphatidylserine (PS) Sphingophospholipids ・Sphingomyelin (SM) Glycolipids Glyceroglycolipids ・Monogalactosyldiacylglycerol (MGDG) Sphingoglycolipids ・Cerebroside (CB) Glycerophospholipids metabolic pathway NADH ATP NAD+ ADP H2 O Dihydroxyacetonephosphate (DHAP) Glycerol Glycerol‐3‐phosphate (G3P) Phosphatidylglycerophosphate Acyl‐CoA CoA‐SH CDP‐DAG Pi CMP Phosphatidylglycerol (PG) Cardiolipin (CL), Diphosphatidylglycerol CMP myo‐inositol G3P CMP PPi CTP sn-1-acyl-G3P CDP‐DAG Acyl‐CoA Phosphatidylinositol (PI) ATP CoA‐SH ADP Choline ATP ATP ADP ADP Ethanolamine ATP ATP ADP ADP O‐Phosphocholine CTP ADP H2 O PPi ATP Pi O‐Phosphoethanolamine PI4P ATP PI5P ADP ADP PPi PI3,4P2 PI4,5P2 ATP PI3,5P2 ADP CMP CMP Diacylglycerol (DAG) CO2 Serine ATP ADP Choline PI3,4,5P3 Serine Ethanolamine Phosphatidylcholine (PC) H2 O Ceramide Fatty acid Lysophosphatidylcholine (LPC) Phosphatidylserine (PS) Phosphatidylethanolamine (PE) H2 O Fatty acid DAG Sphingomyelin (SM) Lysophosphatidylethanolamine (LPE) ATP ADP CTP CDP‐ethanolamine CDP‐choline ATP PI3P Phosphatidic acid (PA) + Free fatty acid (FFA) MRM settings for multi-targeted lipid profiling Identification of lipids using various samples by exact m/z (Mouse liver, intestine, brain, and blood plasma, and Human serum) Condition of UHPLC Chromatography for Structural Isomers Separation Precursor-ion scan Neutral loss scan Positive mode Phosphoryl choline Common fragment of m/z 184.1 Choice of Precursor Ions Fatty acid Negative mode Determination of Fatty Acids Product-ion scan Fatty acid LC/MS/MS(triple-quqdrupole) A total of 200 MRM transitions settings with posi・nega switching • Free fatty acid (FFA) ・・・ 35 MRM transitions (Negative) • Phosphatidylcholine (PC) ・・・・ 59 MRM transitions (Positive) • Lysophosphatidylcholine (LPC) ・・・ 21 MRM transitions (Positive) • Phosphatidylethanolamine (PE) ・・・・ 67 MRM transitions (Positive) • Lysophosphatidylethanolamine (LPE) ・・・18 MRM transitions (Positive) Each Cancer Mortality Rate People / 100 thousand people Gastric cancer Pancreatic cancer Breast cancer Ovarian cancer Leukemia Male Liver cancer Lung cancer Uterine cancer Prostate cancer Colorectal cancer Female Source: ‘‘vital statistics’’ by Ministry of Health, Labour and Welfare (MHLW) in Japan The number of colorectal cancer patients has been increased with a Western-style food. Colorectal Cancer (CRC) Early CRC • Occult blood test → Resistance toward stool collection → False negative • Conventional tumor makers → Lower sensitivity at the early stage Advanced CRC • Imaging methods (CT etc.) →Not applicable to very early screening Complete remission rate: almost 100% • Colonoscopy → Invasive procedure When CRC is first diagnosed, 40-60% are advanced. Omics Research using Blood for Diagnosis Number of targets Analysis Health condition Genomics (gene) Proteomics (protein) ≈ 23,000 ≈ 100,000 ≈ 4,000 Difficult Easy Laborious Metabolomics (metabolite) Not reflect Difficult to reflect Easy to reflect Serum Metabolomics by GC/MS Training set N Male Female Age Average Median Range BMI Stage • • • 0 1 2 3 4 Colorectal cancer patients 60 39 21 Healthy volunteers 60 39 21 67.7 70 36-88 21.9 64.5 68 39-88 22.1 12 12 12 12 12 P value N.S. N.S. (N.S., Not significant) The cancer staging was determined base on the International Union Against Center (UICC) TNM classification Diagnosis of colorectal cancer patients were performed at Kobe University Hospital or Hyogo Cancer Center. Healthy volunteers were selected based upon the results of consultations at Kobe University Hospital or those of health examination at another institutions. Serum Metabolomics by GC/MS Training set A total of 131 metabolites was identified in 50 L of serum. First Screening Confirmation of the metabolites • • • • not-derived from serum stability through the analysis intra and inter- day variations Increased or decreased in CRC patients 27 candidates (Nishiumi S et al. PLos One 2012) GC/MS血清メタボロミクス Metabolites selected by first screening Lactitol (an artificial sweetener) meso-Erythritol (an artificial sweetener) Kynurenine 2-Hydroxy-butyrate Glutamic acid p-Hydroxybenzoic acid Arabinose Aspartic acid Exclusion of metabolites from foods Cysteine+Cystine Cysteamine+Cystamine Selection of Top 10 metabolites Pyruvate+Oxalacetic acid Isoleucine Xylitol Pyroglutamic acid -Alanine Palmitoleate(C16:1) Second Screening Ornithine Stepwise selection Inositol Phosphate Asparagine Glucuronate_1 Citrulline Glucosamine_2 Construction of Logistic Regression Model O-Phosphoethanolamine Creatinine Ribulose Nonanoic acid(C9) (Nishiumi S et al. PLos One 2012) Stepwise-Multivariate Logistic Regression (MLR) Model Stepwise selection Methods that select metabolites objectively from candidates. Multivariate Logistic Regression (MLR) model Multivariate linear regression model;prediction of Y using variables. Y = aX1+ bX2 + cX3 + dX4…..+ intercept How can we predict “diagnosis” using variables? Set dummy; healthy = 0, diseased = 1 “Output” of the prediction model needs to be converged within 0 and 1. P 1 1 e ( aX 1 + bX 2 + cX 3 + dX 4 .... + intercept ) Multivariate Logistic Regression (MLR) Model Appropriate P value (cut off value) is determined by ROC analysis. Serum Metabolomics by GC/MS Coefficient (a, b…) Prediction model 1 e (Intercept + ax1 + bx 2 + cx 3 + dx 4 ................ ) 286.59 33.87 1634.96 78.78 Intercept -8.32 ROC analysis AUC= 0.9097 (95% CI: 0.8438-0.9495) Cut-off value=0.4945 True positive Sensitivity P 1 2-Hydroxy-butyrate Aspartic acid Kynurenine Cystamine Sensitivity: 85.0% Specificity: 85.0% Accuracy: 85.0% Specificity False positive (Nishiumi S et al. PLos One 2012) Serum Metabolomics by GC/MS Validation N Male Female Age Average Median Range BMI Stage 0 1 2 3 4 Colorectal cancer patients 59 30 29 Healthy volunteers 63 32 31 64.8 66 31-84 22.5 62.8 63 47-73 22.2 P value N.S. N.S. 15 11 3 11 19 (N.S., Not significant) Serum Metabolomics by GC/MS Comparison with Tumor Markers Training set CEA CA19-9 stage stage stage stage stage stage 0-4 0-2 3-4 0-4 0-2 3-4 Predictive model stage stage stage 0-4 0-2 3-4 Sensitivity 35.0% 30.6% 37.5% 16.7% 5.6% 29.2% 100% Specificity 96.7% 58.3% Accuracy 65.8% 85.0% 83.3% 87.5% 85.0% 85.0% Validation set CEA CA19-9 stage stage stage stage stage stage 0-4 0-2 3-4 0-4 0-2 3-4 Predictive model stage stage stage 0-4 0-2 3-4 Sensitivity 33.9% 6.9% 60.0% 13.6% 100% Specificity 96.8% 58.2% Accuracy 66.4% 0% 26.7% 83.1% 82.8% 83.3% 81.0% 82.0% (Nishiumi S et al. PLos One 2012) Serum Metabolomics by GC/MS Summary • Construction of stepwise MLR model based on the results of training set between healthy and CRC patients • The calculated prediction model with training set had good performance (sensitivity, 85.0%: specificity, 85.0% and accuracy, 85.0%). • When applied to the validation set, the predictive ability was maintained (sensitivity, 83.1%: specificity, 81.0% and specificity, 79.6%). Metabolites selected in the prediction model 2-Hydroxy-butyrate(2-HB) Aspartic acid(Asp) Kynurenine(Kyn) Cystamine(Cyst) p= 1 1 + e-{-8.32+286.59(2-HB)+33.87(Asp)+1634.96(Kyn)+78.78(Cyst)} Serum Metabolomics for Early Detection of Pancreatic Cancer Metabolites for Formula Xylitol (Xly) 1,5-Anhydro-D-glucitol(1,5AD) Histidine(His) Inositol(Ino) p= 1 1 + e-{5.48+167.57(Xly)-15.21(1,5AD)-282.34(His)+60.99(Ino)} Kobayashi et al. Cancer Epidemiol Biomarkers Prev. 2013 Development for Clinical Medicine Pretreatment GCMS analysis Identification and Quantification P Extraction and Derivatization blood automation Meaduament by Conventional Methods Diagnosis of Multiple Diseases Diagnosis P 1 1 e (Intercept + ax1 + bx 2 + cx 3 + dx 4 ................ ) Diagnosis Kits for Specific Disease 1 1 e (Intercept + ax1 + bx 2 + cx 3 + dx 4 ................ ) Background for Inflammatory Bowel Disease Inflammatory bowel disease… is characterized by chronic and relapsing inflammation of the gastrointestinal tract Aim Inflammatory bowel disease Genetic Factors Environmental Factors ? Immune Abnormalities Intestinal Inflammation HIbi T, et al. J Gastroenterol. 2006 Utilized metabolomics to examine the pathogenesis of IBD DSS-induced Colitis Model Oral administration of dextran sulphate sodium (DSS) causes similar clinical features to human UC. (Okayasu et al., 1990; Cooper et al., 1993) Sacrifice 0 day 5 day 3.0% DSS C57BL/6J Water 7 day 10 day Water DSS: dextran sulphate sodium DSS (day 7) DSS (day 10) Day 7: The degree of colitis was severe (x40) Day 10: The degree of colitis was almost improved (x200) Shiomi et al., Inflamm Bowel Dis. 20111 Methods in Metabolomics Serum (Start volume: 50 l) / Tissue (20 mg) Extraction (CH3OH:CHCl3:H2O=2.5:1:1) Soluble Fraction Lyophilization Lyophilized Product Oximation & Derivatization Liquid Solution Measurement by GCMS Metabolite Data Gas Chromatograph Mass Spectrometer (GC/MS) Results ・ In serum, 77 metabolites were detected. 23 Amino acids 42 Organic acids 6 Fatty acids 6 Others ・ In colon tissue, 92 metabolites were detected. 24 Amino acids 56 Organic acids 6 Fatty acids 6 Others Look for the decreased metabolite at day 7 Results ~PLS-DA scores plots~ Partial Least Square Discriminant Analysis (PLS-DA) : one of Multiple Classification Analysis 3D of the first three principal components control DSS (day10) PLS-DA scores plots showed distinct clustering and clear separation of the groups according to the degree of colitis. DSS (day7) 2D-PLS-DA scores plots 10 DSS (day7) 5 DSS (day10) control control 5 DSS (day10) 0 -5 -10 -10 -5 0 t[1] 0 -5 DSS (day10) 5 10 t[3] control t[3] t[2] 5 DSS (day7) -10 -5 0 t[1] 0 -5 5 10 -10 DSS (day7) -5 0 t[2] 5 10 Results DSS (day7) 5 DSS (day10) control -5 DSS (day10) -10 -5 0 5 -10 10 -5 0 -0.10 -0.20 0.20 T48 T22 T67 T82 T45 T58 T16 T20 T73 T33 T17 T66 T5 T34 T19 T30 T31 T52 T77 T21 T40 T62 T46 T53 T35T89 T81T90 T9 T54T56 T39 T88 T2 T10 T49 T32 T12 T72 T68 T1 T4 T65 T28 T44 T41 T60 T38 T18 T6 T37 T59 T84 T42 T23T27 T43 T3 T70 T61 T47 T51 T25 T83 T87 T50 T29 T86 T26 T7T24 T80 T91 T92 T71 T55 T63 T69 T13 T78 T14 T79 T15T85 T57T36 T74 T75 T64 T76 -0.20 -0.10 -0.00 w*c[1] 0.10 T41 T71 T57 -0.00 -0.10 -0.20 -0.30 T25 -0.00 w*c[1] 0 5 10 T71 T25 T57 T64 T41 T36 T69 T50 T89 0.10 T46 T83 T65T9 T38 T77 T76T75 T35 T55 T43T32T21T17 T33 T8 T63 T26T61 T91 T84 T42 -0.00 T27 T59 T28 T60 T70 T88 T34 T74T7 T24 T86 T29 T72 T54T52 T6T56 T23 T14 T12 T13 T79 T5 T80T51 T78 T90T31 T37 T66 -0.10 T85 T92 T47 T16T45 T3 T68T53 T22 T40 T81 T4 T67T48 T1 T10 T49 T2 T73 T15 T62 T82 T18 T19 -0.20 T39 T30 T20 T87 T44 0.20 T64 -0.10 -5 t[2] T36 T50 T38 T77 T75 T76 T35 T55 T43 T33 T26 T63 T91 T21T32 T17 T8 T84 T61 T7 T34T42 T59T70 T28 T27 T60 T88 T24 T74 T72 T86 T29 T54T56 T6 T52 T23 T79 T12 T5 T51 T80 T90 T78 T37 T66 T47 T31 T53 T16 T3T14 T22 T13 T45 T68 T85T92 T40 T67 T81 T4 T1 T49 T10 T15 T48 T2 T73 T62 T82 T18 T19 T39 T20 T30 T87 T44 T11 T58 -0.20 DSS (day7) -10 10 T69 0.10 T46T65T89 T9T83 T8 w*c[3] w*c[2] -0.00 5 t[1] T11 0.20 -5 DSS (day7) t[1] 0.10 0 control -5 -10 0 DSS (day10) control t[3] t[3] t[2] 5 0 5 0.10 w*c[3] 10 ~PLS-DA scores plots and loadings plots~ -0.30 T11 T58 -0.20 -0.10 -0.00 0.10 0.20 w*c[2] The dereased or increased meatbolits will be found easily. Shiomi et al., Inflamm Bowel Dis. 20111 Results Decreased Metabolites at day 7 in colon tissue 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Succinic acid Cont. DSS DSS 7day 10day L-Glutamic acid 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Cont. 1.4 1.2 1 0.8 0.6 0.4 0.2 0 DSS DSS 7day 10day L-Glutamine Cont. DSS DSS 7day 10day Indol-3-acetic acid 1.2 1 0.8 0.6 0.4 0.2 0 Cont. DSS DSS 7day 10day (Avg±SE, n=6) Shiomi et al., Inflamm Bowel Dis. 20111 Supplementation of Glutamine in DSS-induced Colitis Sacrifice C57BL/6J DSS 7 day 5 day 3.0% DSS Gln or Water Gln: Glutamine DSS DSS + 2.0 g/dl Gln + 4.0 g/dl Gln (x40) Histological score 0 day * 10 * 5 0 DSS (x200) Administration of glutamine could attenuate DSS-induced colitis in mice. DSS DSS + + 2.0 g/dl 4.0 g/dl Gln Gln (Mean±SE, n=5) Supplementation of Glutamine in DSS-induced Colitis Glutamine: ◆ The primary source of amino acids in the intestinal mucosa ◆ The main respiratory substrate for enterocytes Serum The glutamine level The glutamine level 1.2 1 0.8 0.6 0.4 0.2 0 Colon tissue 1.2 1 0.8 0.6 0.4 0.2 W W W + + 2G 4G D D D + + 2G 4G 0 W W W + + 2G 4G D D D + + 2G 4G D: DSS G: glutamine (Avg±SE, n=5) Inflamm Bowel Dis, 2011 DSS-induced colitis animal model • The pathogenesis of colitis led to the alterations of some metabolites in the colon tissue. • Supplementation of the metabolite in the body; i.e., glutamine, recover rapidly. Patient Information Ulcerative colitis (UC) patients N (male/female) Age (median/range) Years with disease (median/range) Inflammation (Proctitis/Left Side/Pan Colitis) Rachmilewitz index (CAI) (remission/active) Sampling location (normal/lesion) Matt's classification (median/range) Daily medication 5-aminosalicylates Prednisolone 6-mercaptopurine Azathioprine Tacrolimus 22 (12/10) 43.9/14-85 8.4/1-30 3/7/12 16/6 16/22 3/1-5 21 (2250-4000 mg/day) 2 (5-10 mg/day) 0 0 2 (4-8 mg/day) Tissue Metabolomics Colon tissue of UC patient Non-inflamed site colon cecum anus rectum Inflamed site Liquid-liquid extraction from each tissue site GC/MS measurement Target: Amino acids and TCA-cycle related metabolites GCMS-QP2010plus Result: Comparison of Detected Metabolites Amino acids (19) Fold induction (lesion/normal) N-Acetylaspartic acid 0.66 Alanine 0.58 Aspartic acid 0.94 Asparagine 0.47 Glutamic acid 0.73 Glutamine 0.25 Glycine 0.73 Isoleucine 0.67 Leucine 0.74 Lysine 0.59 Methionine 0.70 5-Oxoproline 0.89 Phenylalanine 0.70 Proline 0.59 Serine 0.67 Threonine 0.70 Tryptophan 0.75 Tyrosine 0.70 Valine 0.70 TCA related metabolites (6) Fold induction P value 0.0028a <0.0001a 0.39 <0.0001a 0.044a <0.0001a 0.0021a 0.00067a 0.0050a 0.031a 0.0016a 0.30 0.0016a <0.0001a 0.00049a 0.0030a 0.051 0.0011a 0.0023a Citric acid Fumaric acid Isocitric acid Malic acid Pyruvic acid Succinic acid (lesion/normal) 0.61 0.56 0.58 0.50 1.03 0.63 P value 0.011a 0.00031a 0.0031a 0.00060a 0.41 <0.0001a (Red color: Significantly decreased metabolites) The levels of 16 amino acids and 5 TCA-clcle related metabolites were significantly decreased in the lesional site compared with the normal tissue. (Ooi et al., Inflamm Res, 2011) Serum Metabolomics Method Serum metabolomics Blood collection Liquid-liquid extraction from blood GC/MS measurement Target: Amino acids and • UC patients • Healthy volunteers TCA-cycle related metabolites GCMS-QP2010plus Patient Information Ulcerative colitis (UC) patients N (male/female) 13 (7/6) Age (median/range) 39/26-57 Years with disease (median/range) 5.8/1.5-12 (All patients were followed up, and their pathology of UC showed clinical remission.) Healthy volunteers N (male/female) Age (median/range) 17 (12/5) 38.9/25-67 Result: Comparison of Detected Metabolites Amino acids (20) Fold induction UC/H Alanine 0.99 Aspartic acid 1.46 0.80 Asparagine Glutamic acid 0.73 0.51 Glutamine Glycine 1.74 0.38 Histidine 4-Hydroxyproline 1.30 Isoleucine 1.12 Leucine 0.97 Lysine 1.14 Methionine 1.08 5-Oxoproline 1.01 Phenylalanine 0.99 Proline 0.96 Serine 1.08 Threonine 1.10 0.63 Tryptophan Tyrosine 0.94 Valine 0.99 TCA related metabolites (6) P value UC vs H 0.983 0.025a 0.0032a 0.075 <0.0001a <0.0001a <0.0001a 0.305 0.174 0.983 0.187 0.754 0.818 0.691 0.601 0.464 0.950 0.00010a 0.161 0.884 Aconitic acid Citric acid Fumaric acid Isocitric acid Malic acid Pyruvic acid Succinic acid Fold induction P value UC/H UC vs H 1.20 0.069 0.98 0.544 1.33 0.013a 0.96 0.490 1.18 0.117 1.03 0.851 0.99 0.722 UC, Ulcerative colitis patients H, Healthy volunteers (Ooi et al., Inflamm Res, 2011) The levels of 4 metabolites including asparagine, glutamine, histidine, and tryptophan were significantly decreased in both the lesional tissue and the UC patients serum (P < 0.05). Summary Human inflammatory bowel disease • • The levels of many metabolites were significantly decreased in the inflamed site. The serum levels of some of amino acids were also significantly downregulated in the UC patients. ✓ The potential of nutritional therapy The potential of Personalized Medicine Metabolic profiling ~Metabolomics~ Identification of the specific changing metabolites in individual patient Personalized medicine Therapy with in vivo targeted metabolite • Supplementation of the insufficient metabolites in the body • Normalization of the metabolites which present excessively in vivo Improvement in pathological conditions Conclusion Metabolomics is capable of providing the greatly useful information in the medical field. ✓The discovery of disease biomarkers ✓The finding of novel therapeutic agents ✓Examination of pathogenetic mechanisms behind various diseases