Potential and Challenges for Mid-Infrared Sensors in Breath Diagnostics Seong-Soo Kim, Christina Young, Brani Vidakovic, Sheryl G
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IEEE SENSORS JOURNAL, VOL. 10, NO. 1, JANUARY 2010 145 Potential and Challenges for Mid-Infrared Sensors in Breath Diagnostics Seong-Soo Kim, Christina Young, Brani Vidakovic, Sheryl G. A. Gabram-Mendola, Charlene W. Bayer, and Boris Mizaikoff Abstract—Exhaled breath contains more than 1000 con- I. INTRODUCTION stituents at trace level concentrations, with a wide variety of these compounds potentially serving as biomarkers for specific T is well established that exhaled breath (EB) from pa- diseases, physiologic status, or therapeutic progress. Some of the I tients suffering specific diseases contains distinctive scents, compounds in exhaled breath (EB) are well studied, and their as documented for a long time in both eastern and western cul- relationship with disease pathologies is well established. However, ture. The analysis of breath is among the oldest diagnostic tech- molecularly specific analysis of such biomarkers in EB at clinically niques in medical practice characterizing diseases by specific relevant levels remains an analytical and practical challenge due to the low levels of such biomarkers frequently below the ppb (v/v) odors [1]. For ages it was believed that expired breath from pa- range in EB. In this contribution, mid-infrared (MIR) spectro- tients may contain chemicals related to specific diseases without scopic sensing techniques are reviewed for potential application in validation of this hypothesis. In 1971, Linus Pauling pioneered breath diagnostics. While the spectral regime from 3–20 m has the analytical assessment of breath components by gas chro- already been utilized for fundamental studies on breath analysis, matographic (GC) analysis of exhaled air, and identified a wide significant further improvements are in demand for substantiating range of bloodborne volatile organic compounds (VOCs) ex- MIR spectroscopy and sensing techniques as a suitable candidate for clinically deployable breath analyzers. Several advantageous haled after passing the blood/air interface within the lungs [2]. features including inherent molecular selectivity, real-time mon- Also to the benefit of disease diagnostics, the scientific itoring capability, comparable ease of operation, potentially low and technological achievements during the 20th century have costs, and a compact device footprint promise reliable optical brought numerous analytical diagnostic instruments to matu- diagnostics in the MIR. Hence, while the application of MIR rity and have facilitated their implementation in the medical spectroscopy and sensing systems to breath analysis yet appear sciences. Advanced diagnostic instruments such as electro- in their infancy, recent progress on advanced MIR light sources, waveguides, and device concepts forecasts next-generation optical cardiography (ECG), 3-D functional tomography (CT), and sensing platforms suitable for addressing the challenges of in situ similar technologies provide more accurate vital information to breath diagnostics. medical doctors for precise diagnostic judgments on a patient’s Index Terms—Absorption spectroscopy, breast cancer, chem- condition. Modern biomedical analytical instruments have ical sensor, exhaled breath (EB), exhaled breath condensate changed and matured with the medical sciences from empirical (EBC), exposure monitoring, hollow waveguide, infrared sensor, to analytical strategies, and have assisted in broadening our mid-infrared (MIR), optical sensor, planar waveguide, quantum understanding on physiological processes from the molecular cascade laser. level to cells, cell ensembles, and entire living organisms. Consequently, it is of paramount importance to monitor phys- iological processes associated with the human body for the diagnosis of diseases or for assessing the health status. Unique panels of molecular constituents may accompany certain physi- Manuscript received September 09, 2009; revised September 27, 2009; ac- ological processes or disease pathologies as mediators, markers, cepted September 27, 2009. Current version published December 16, 2009. The or metabolic by- or end-products, etc. Hence, characteristic associate editor coordinating the review of this paper and approving it for pub- lication was Prof. Cristina Davis. biomarkers addressable with appropriate analytical techniques S.-S. Kim is with the School of Electrical and Computer Engineering, Georgia have the potential for elucidating the corresponding physio- Institute of Technology, Atlanta, GA 30332 USA (e-mail: [email protected]. logical processes, pathogenic pathways, or pharmacological edu). C. Young is with the School of Chemistry and Biochemistry, Georgia Institute responses. However, usually such biomarkers are found only at of Technology, Atlanta, GA 30332-0400 USA (e-mail: christina.young@chem- trace level concentrations within the human body. istry.gatech.edu). Recent advances on the identification of disease biomarkers B. Vidakovic is with The Wallace H. Coulter Department of Biomedical have attracted considerable scientific and clinical interest in the Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0535 USA (e-mail: [email protected]). analysis of EB (vapor or condensate) providing a noninvasive S. G. A. Gabram-Mendola is with Emory University, Winship Cancer Insti- diagnostic window for diagnostic purposes. It is evident that tute and the AVON Comprehensive Breast Center, Grady, Atlanta, GA 30322 the composition of EB provides a complex image of the cor- USA (e-mail: [email protected]). C. W. Bayer is with the Georgia Tech Research Institute, Atlanta, GA 30332- responding biochemical processes occurring within the body, 0841 USA (e-mail: [email protected]). which may be correlated to the physiological status of a patient. B. Mizaikoff is with Institute of Analytical and Bioanalytical Chemistry, Uni- Hence, quantitative compositional analysis of breath may pro- versity of Ulm, Ulm, Germany (e-mail: [email protected]). Color versions of one or more of the figures in this paper are available online vide an attractive noninvasive diagnostic strategy for the recog- at http://ieeexplore.ieee.org. nition, diagnosis, and status monitoring of complex diseases Digital Object Identifier 10.1109/JSEN.2009.2033940 and treatment strategies including but not limited to, e.g., breast 1530-437X/$26.00 © 2009 IEEE 146 IEEE SENSORS JOURNAL, VOL. 10, NO. 1, JANUARY 2010 cancer, lung cancer, and pulmonary diseases. However, quan- in or characteristic for specific reactions. While the majority titative analysis of breath metabolites present at nanomolar to of such biomarkers remain located inside the human body pro- picomolar ( ) concentration levels in real viding access only via invasive sampling of blood or biopsies, time remains a significant analytical challenge. to a certain extent the pathophysiological condition should also Nonetheless, it is evident that bodily secretions such as be reflected in the composition of excreted bodily fluids such urine or EB contain at least subsets or breakdown products of as urine, perspiration, saliva, etc., and breath as well as breath biomarkers present within human body. In consequence, it is condensate. Hence, it is not surprising that some of constituents highly desirable to establish sensing schemes with sufficient initially present with the human body may be determined sensitivity and molecular selectivity for addressing these con- either natively or after metabolitic transformation within such stituents noninvasively at trace levels. Gas chromatography excretions. Each of these constituents may be considered a in combination with mass spectrometry (GC-MS) may be potential biomarker providing valuable information on the considered the current golden standard method for analyzing physiological status of the respective biological system, or the constituents relevant to breath diagnostics [3]. Despite excellent progression of a disease and/or therapeutic treatment thereof. sensitivity, GC-MS usually requires preprocessing of breath However, given the complexity of such processes it has to be samples and separation for addressing target analytes, which anticipated that rather than individual biomarkers – which do renders this method less suitable for analyzing samples in real exist but are rarely sufficient for characterizing a physiological time. While there are efforts in progress on miniaturizing GC condition – entire panels of biomarkers will be up- and/or and MS components, to date this technology remains for most down-regulated during disease or treatment, yet above and applications confined to laboratory applications. In contrast, beyond any naturally occurring patient-to-patient variation. mid-infrared (MIR) spectroscopy has proven an excellent Among these excretions, EB is considered a projection image alternative methodology for trace level chemical detection – particularly of the volatile – chemical constituent profile of with high sensitivity and molecular selectivity. Compared blood. While the alveolar membrane represents the interface to GC-MS, MIR spectroscopy is appears more amenable to between blood and air, where the exchange of and miniaturization and integration, therefore promising close to takes place. However, any other molecular component perme- real-time analysis evaluating highly discriminative vibrational ating through this membrane barrier may finally be excreted and rotational molecular signatures, which are critical merits via EB, therefore serving as potential biomarkers. In addition, for clinical applications