WO2009039152A1 - Detection of h. pylori utilizing unlabeled urea - Google Patents

Detection of h. pylori utilizing unlabeled urea Download PDF

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Publication number
WO2009039152A1
WO2009039152A1 PCT/US2008/076631 US2008076631W WO2009039152A1 WO 2009039152 A1 WO2009039152 A1 WO 2009039152A1 US 2008076631 W US2008076631 W US 2008076631W WO 2009039152 A1 WO2009039152 A1 WO 2009039152A1
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Prior art keywords
detection
breath
pylori
ammonia
patient
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PCT/US2008/076631
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French (fr)
Inventor
Basil Rigas
Anastasia Rigas
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The Research Foundation Of State University Of New York
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Application filed by The Research Foundation Of State University Of New York filed Critical The Research Foundation Of State University Of New York
Priority to EP08832402.5A priority Critical patent/EP2203563A4/en
Priority to US12/678,654 priority patent/US9289155B2/en
Publication of WO2009039152A1 publication Critical patent/WO2009039152A1/en
Priority to US14/247,107 priority patent/US20140221863A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/082—Evaluation by breath analysis, e.g. determination of the chemical composition of exhaled breath
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/02—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving viable microorganisms
    • C12Q1/04—Determining presence or kind of microorganism; Use of selective media for testing antibiotics or bacteriocides; Compositions containing a chemical indicator therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/097—Devices for facilitating collection of breath or for directing breath into or through measuring devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7282—Event detection, e.g. detecting unique waveforms indicative of a medical condition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient ; user input means
    • A61B5/742—Details of notification to user or communication with user or patient ; user input means using visual displays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K49/00—Preparations for testing in vivo
    • A61K49/0004—Screening or testing of compounds for diagnosis of disorders, assessment of conditions, e.g. renal clearance, gastric emptying, testing for diabetes, allergy, rheuma, pancreas functions
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/483—Physical analysis of biological material
    • G01N33/497—Physical analysis of biological material of gaseous biological material, e.g. breath
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N27/00—Investigating or analysing materials by the use of electric, electrochemical, or magnetic means
    • G01N27/02—Investigating or analysing materials by the use of electric, electrochemical, or magnetic means by investigating impedance
    • G01N27/04—Investigating or analysing materials by the use of electric, electrochemical, or magnetic means by investigating impedance by investigating resistance
    • G01N27/06—Investigating or analysing materials by the use of electric, electrochemical, or magnetic means by investigating impedance by investigating resistance of a liquid
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/0004—Gaseous mixtures, e.g. polluted air
    • G01N33/0009—General constructional details of gas analysers, e.g. portable test equipment
    • G01N33/0011—Sample conditioning
    • G01N33/0014—Sample conditioning by eliminating a gas
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/0004—Gaseous mixtures, e.g. polluted air
    • G01N33/0009—General constructional details of gas analysers, e.g. portable test equipment
    • G01N33/0027—General constructional details of gas analysers, e.g. portable test equipment concerning the detector
    • G01N33/0036—General constructional details of gas analysers, e.g. portable test equipment concerning the detector specially adapted to detect a particular component
    • G01N33/0054—Ammonia
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/20—Air quality improvement or preservation, e.g. vehicle emission control or emission reduction by using catalytic converters

Definitions

  • the present invention relates generally to a medical device and protocols to facilitate diagnosis of Helicobacter pylori (H. pylori) based on administration of unlabelled urea.
  • Exhaled breath has long been known to enable non-invasive disease detection.
  • Exhaled gases such as ammonia, nitric oxide, aldehydes and ketones have been associated with kidney and liver malfunction, asthma, diabetes, cancer, and ulcers.
  • Other exhaled compounds like ethane, butane, pentane, and carbon disulfide have been connected to abnormal neurological conditions.
  • body fluids blood, sputum, urine
  • human breath analysis methodologies that exploit the non-invasive nature of such diagnoses are still under-developed and conventional technologies lack specificity, are excessively expensive or lack portability.
  • pylori include a) serologic testing to detect anti-H. pylori antibodies in blood, b) upper gastrointestinal endoscopy with mucosal biopsies, c) H. pylori culture, including antimicrobial susceptibility testing, and d) detection of H. pylori antigens in stool.
  • Serologic testing cannot distinguish current from old infection.
  • Upper gastrointestinal endoscopic biopsies are submitted for rapid urease testing or histological examination, and this approach has the drawbacks of the invasive nature of endoscopy and the suboptimal performance of histopathology.
  • H. Pylori culture is invasive and cumbersome and detection of H. pylori antigens in stool is limited by the low acceptance of stool testing and suboptimal specificity/sensitivity.
  • H. Pylori produces large amounts of urease which often comprises about five percent of its total protein.
  • Urease activity is assessed in two general ways: Biopsy- based rapid urease testing and various urea breath tests. Biopsy-based rapid urease tests require endoscopy for sample acquisition. Biopsy samples are placed in an agar gel or paper strip containing a pH indicator. In addition to requiring an invasive endoscopy, biopsy-based rapid urease tests provide a less-than-optimal test due to the time required for the diagnosis, which is 3-24 hours, a less than 90% specificity, and reduced sensitivity in children. Moreover, conventional devices, particularly point-of-care devices, are expensive, particularly to assess H. pylori, which discontinuously colonizes the gastroduodenal mucosa.
  • Urea Breath Testing for the diagnosis of H. pylori infection, there are two versions of the UBT, based upon the type of urea being used as a substrate: 13 C labeled urea and 14 C labeled urea. 14 C is a radioactive isotope of carbon. 13 C is a stable, non-radioactive isotope, encountered in nature.
  • the FDA has approved both 13 C- and l4 C-based UBTs for the diagnosis of H. pylori, though the 14 C-based assay is rarely used.
  • the 14 C-based UBT is associated with exposure to radioactivity, which albeit small for an otherwise healthy adult, is nevertheless present and patients should not be exposed to it in the absence of safe alternatives. It is because of the risk associated with the radioactivity of the 14 C -urea that the 14 C-based UBT is contraindicated in pregnant women and children. See, Using Breath Tests Wisely in a Gastroenterology Practice: An Evidence-Based Review of Indications and Pitfalls in Interpretation. Romagnuolo, et al., Am J Gastroenterology 97:1113-1126 (2002).
  • a further difficulty arising with the UBT is the high cost of l3 C-urea, as well as the cost and operational expenses of instruments to detect exhaled l3 C ⁇ 2 .
  • the present invention departs from detection of 13 CO 2 by using unlabeled urea as a substrate, detecting ammonia in breath instead of CO 2 .
  • the present invention provides an ammonia-specific nanosensor and provides a simple, inexpensive hand-held device for the detection of breath NH 3 . Accordingly, the present invention provides a highly accurate, economical, easy to operate, portable and sufficiently sensitive medical device for diagnosis of H. Pylori.
  • the present invention departs from detection of 13 CO 2 and provides a simplified assay that uses lower cost unlabeled urea as a substrate.
  • the present invention substantially solves the above shortcomings and provides at least the following advantages.
  • a medical device is provided to sample breath emitted from a patient's mouth, to analyze ammonia content and the composition of a gaseous sample via contact with sensing electrodes, particularly gold substrates arranged on a TO8 substrate.
  • Another embodiment of the present invention provides a method for using the medical device of the present invention to analyze a patient's breath sample to diagnose the presence of a medical condition, by obtaining a breath sample from a patient; analyzing volatile components of the patient sample to provide a breath profile that includes both qualitative and quantitative data; comparing the patient's breath profile to a database of breath profiles, with each database profile being characteristic of at least one medical condition, to provide information pertinent to diagnosis of the presence or absence of a medical condition.
  • a single sample is used for an independent or multiple tests, which may be combined to produce a template or pattern representative of a patient's condition or representative of the presence of a particular compound or set of compounds.
  • high sensitivity nanomorphs of metal oxides prepared by sol-gel practices are used for a more selective and quantitatively precise analysis.
  • the invention utilizes arrays of biocomposite and bio-doped films to provide a low cost, portable analyzer for detection of chemical products of biochemical reactions, such as ammonia and NO, in a real-time manner.
  • Figure 1 is a schematic representation of an embodiment of a test device for the present invention
  • Figures 2a and 2b show heater and sensing electrodes utilized in Fig. 1; Figures 3a and 3b show sensor response of the test device of Fig. 1; Figures 4a and 4b show NH 3 sensing and sensor response when exposed only to CO 2 ;
  • Figure 5 shows NH 3 sensing with a CO 2 filter
  • Figure 6 provides a block diagram of an apparatus of an embodiment of the present invention.
  • the senor is tuned to detect NH3 levels lower than 50 parts per billion ( ⁇ 50 ppb) and as high as 500 ppm, thereby covering all NH 3 levels encountered in humans, and in particular in patients undergoing UBT.
  • Quantitative analyzers preferably include a sensing substrate surrounded by a gold substrate surrounded by a TO8 substrate.
  • the medical device of the present invention is preferably qualitatively used to test exhaled gas.
  • Qualitative tests performed by the test device usable with the present invention may test carbon dioxide content, alcohol content, lipid degradation products, aromatic compounds, thio compounds, ammonia and amines or halogenated compounds.
  • multiple different tests performed on a single sample may be independent, or may be the result of several tests combined to produce a template or pattern representative of a patient's condition or representative of the presence of a particular compound or set of compounds.
  • the high sensitivity of the nanomorphs of metal oxides prepared by sol-gel practices used in the medical device of the present invention are both more selective and more quantitatively precise than similar information obtained by currently available electronic nose technology. As a result, correlating the data pattern or changes in the data pattern over time identifies a wider range of conditions or compounds.
  • the present invention departs from detection of 13 CO 2 and provides a simplified assay that uses unlabeled urea as a substrate and detects ammonia in breath instead Of CO 2 utilizing Equation (1): CO(NH 2 ) 2 + HOH — urease ⁇ CO 2 + 2NH 3 (1)
  • a nanosensor is provided to detect breath ammonia and a simple, portable, inexpensive hand-held device is thereby provided to detect breath NH 3 .
  • the nanosensor is tuned according to the method described below for other breath gases, and the nanosensor is in a preferred embodiment provided as a plug-in component.
  • the sensor is constructed of a metal oxide that is not crystalline, raising sensitivity to ammonia and other gases.
  • a gas sample i.e. breath or skin emission, accesses analyzer 110 via entry and exit orifices 102 and 104.
  • a stainless steel chamber preferably connects the orifices to avoid absorption/distortion.
  • Sensing electrode 122 and heater electrode 124 are positioned within the analyzer 110.
  • the sensing electrode 122 includes a sensor 130 having gold substrate 132, sensing substrate 134 and TO8 substrate 136. Heater and sensing electrodes 122 and 124 of an embodiment of the present invention are shown in Figures 2a and 2b. Those of skill in the art recognize use of the TO8 substrate. Hirata et al. in U.S. Patent No. 5,252,292, the contents of which are incorporated by reference herein, disclose a type of ammonia sensor.
  • the sensing electrode 124 is selectively tuned by spin or drop coating of sensing substrates generating a film of MoO 3 .
  • a gel-sol synthesis was employed to produce three-dimensional (3-D) networks of nanoparticles, with the sol-gel processing preparing a sol, gelating the sol and removing the solvent.
  • Molybdenum trioxide (MoO3) was prepared by an alkoxide reaction with alcohol according to Equation (2): Molydenum (VI) Isopropoxide + 1 -Butanol -> Precursor ⁇ .1 M) (2) The prepared sol was spin coated and drop coated onto sensing substrates generating thin films of MOO 3 .
  • the sensing substrates (3mm x 3mm) were made OfAbO 3 and were patterned with interdigitated Pt electrodes. Pt heater electrodes were embedded on the rear of the sensor. The amorphous films were then calcined at higher temperatures generating polymorphic form. Differential scanning calorimetry confirmed the phase transformation.
  • Figure 3a shows sensor response to NH 3 , with the sensor generating a clear and measurable response to two NH3 concentrations, 50 and 100 ppb. The measured amounts of ppb, i.e. parts per billion, are much lower than amounts typically expected in human breath, allowing for more accurate and expedited measurement and results.
  • Figure 3b shows sensor response to various breath gases, and the specificity regarding same. Shown in Figure 3b are NH 3 , NO 2 , NO, C3H6 and H 2 , gases that potentially interfere with NH 3 determination.
  • Figure 4a shows NH3 sensing without a CO 2 filter, as gas-sensing properties of the nanosensor.
  • Figs. 4a-b when the sensor was exposed to various concentrations of NH3 gas in a background mixture OfN 2 and O 2 simulating ambient air, NH 3 was detected easily, down to 50 ppb, and even lower concentrations.
  • CO 2 and NH3, each at 1 ppm produce similar responses to gas pulses, shown as vertical lines in Figure 4a.
  • Sensor response when exposed only to CO 2 gas, in the presence of the CO 2 filter is shown in Figure 4b.
  • the CO 2 filter completely eliminates CO 2 from the gas stream, abrogating the sensor response to it.
  • Sensor specificity in regard to sensing of NH3, was evaluated by exposing the sensor to various gases typically encountered in human breath, including NO 2 , NO, C3H6, and H 2 , each up to 490 ppm. Conductivity changes were measured in dry N 2 with 10% O 2 . At 440° C the film was very sensitive to NH 3 , with 490 ppm increasing the conductivity by approximately a factor of 70, approximately 17 times greater than the response to the other gases. The NH3 response, however, was relatively unaffected by 100 ppm OfNO 2 , NO, C 3 H 6 , and H 2 . X-ray photoelectron spectroscopy (XPS) showed that the increased conductivity in the presence of NH 3 was accompanied by a partial reduction of the surface MoO 3 . The resistance of the films increased after extended time at elevated temperatures.
  • gases typically encountered in human breath including NO 2 , NO, C3H6, and H 2 , each up to 490 ppm. Conductivity changes were measured in dry N 2 with 10% O 2
  • CO 2 is an important component of human breath, with its concentration in expired breath reaching up to 5%. Under test conditions, CO 2 interfered with NH 3 sensing.
  • a commercially available CO 2 filter NaOH premixed with Vermiculite (V-lite) used in a 10:1 ratio; Decarbite absorption tube, PW Perkins and Co
  • Decarbite reacts only with highly acidic gases such as CO 2 , H 2 S, thus excluding the possibility of cross adsorption; and the latter was verified.
  • Exposing the sensor to various concentrations of NH 3 and CO 2 in the presence of N 2 and O 2 , indicated that the presence of CO 2 did not affect NH 3 sensing. This was found to be true even when the two gases were at equal concentrations ranging between 0.5 and 10 ppm.
  • Figs. 4a-b are from experiments with a low CO 2 concentration (1 ppm).
  • the NaOH Decarbite traps CO 2 more efficiently at high CO 2 concentrations.
  • Figure 5 shows NH 3 sensing with a CO 2 filter.
  • the sensor is exposed to NH 3 in the presence of the filter, with no interference of the measurement.
  • Fig. 6 shows a prototype for sensing breath, having a sensor, acquisition module, memory/computation module and displays.
  • the apparatus of the present invention is preferably based on sensor response modifying electrical resistance. That is, the MoO 3 sensor is prepared with properties required for its intended use, with lower limits of detection for NH3 well below the NH3 concentrations typically found in human breath and, of course, below the increased NH3 levels of a positive UBT.
  • Lithium ion batteries are vital for advancing the field of portable electronics. They operate by reversibly inserting Li+ ions from the electrolyte into the electrodes and for generating electricity. Reversible intercalation of Li+ ions into the host matrix is crucial for battery operation and can be accomplished by having electrode materials that have relatively open crystal structures. Thermodynamically stable crystal structures are typically close-packed, whereas metastable oxide phases have open lattices that promote very high diffusion rates for intercalating ions.
  • One-dimensional nanomaterials with high aspect ratio such as nanowires are used to construct miniaturized power units and to increase the surface area of the electrodes in order to increase energy density.
  • Building 3-dimensional architectures of micro-/nano electrodes allows for a reduced footprint area for the battery, while at the same time the high aspect ratio of the nanowires serves to increase the energy density tremendously.
  • Nanowires of h-WO 3 are fabricated by hydrolysis and subsequent annealing of a sub- stoichiometric metal alkoxide precursor (tungsten (V) isopropoxide-W (i Pr)5) in air at a maximum temperature limit of 515°C.
  • tungsten (V) isopropoxide-W (i Pr)5 in air at a maximum temperature limit of 515°C.
  • the sol-gel reaction occurring with the metal alkoxide precursor is outlined in Equation (3): W (iPr)5 + H -OH ⁇ W (OH)5 + R-OH (1) (3)
  • the hydrolysis and subsequent condensation occur by alcoxolation, i.e. by removal of water.
  • the isopropoxide functional group is removed as isopropanol, which then dries out.
  • the precursor for the hexagonal lattice requires an additive for stabilizing the framework.
  • the substoichiometric isopropoxide precursor on reaction with atmospheric moisture results in the formation of H0.24 WO 3 that is known to transform to h-W0 3 on oxidation in air.
  • the metal alkoxide is sub-stoichiometric and removal of two molecules of water from the W(0H)5 in Equation (3) results in a lone hydrogen atom that can be accommodated in the interstitial spaces of WO 3 framework.
  • Advantages of this embodiment include single step synthesis of a novel metastable phase of WO3; unique crystal structure of the material enables reversible intercalation of Li ions for rechargeable batteries; higher thermal stability; high aspect ratio nanostructures such as nanowires, nanocubes and nanosheets for high surface area to volume ratio applications.

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Abstract

Disclosed is a method and device for detection of H. Pylori in breath emissions utilizing an unlabelled urea, in which a patient ingests a safe quantity of unlabelled urea. After ingestion, expired breath of the patient is analyzed for ammonia, with a detection based on levels of ammonia lower than 50 parts per billion to 500 ppm to detect helicobacter pylori.

Description

DETECTION OF H. PYLORI UTILIZING UNLABELED UREA
PRIORITY
This application claims priority to U.S. Patent application serial number 60/973,066, filed September 17, 2007, the contents of which are incorporated herein by reference. BACKGROUND
1. Field of the Invention
The present invention relates generally to a medical device and protocols to facilitate diagnosis of Helicobacter pylori (H. pylori) based on administration of unlabelled urea.
2. Background of the Invention Exhaled breath has long been known to enable non-invasive disease detection. Exhaled gases, such as ammonia, nitric oxide, aldehydes and ketones have been associated with kidney and liver malfunction, asthma, diabetes, cancer, and ulcers. Other exhaled compounds like ethane, butane, pentane, and carbon disulfide have been connected to abnormal neurological conditions. However, though analysis of body fluids (blood, sputum, urine) for disease diagnoses and monitoring is routine clinical practice, human breath analysis methodologies that exploit the non-invasive nature of such diagnoses are still under-developed and conventional technologies lack specificity, are excessively expensive or lack portability.
Sensors have been produced to measure gases in a variety of settings, including automotive and biological applications. See U.S. Patent No. 7,017,389 to Gouma, the contents of which are incorporated by reference, regarding detection OfNox emissions in the automotive field. Technologies for monitoring exhaled breath require complex and expensive apparatuses that are difficult to calibrate and are often not sufficiently sensitive to provide a high degree of certainty in regard to medical condition diagnosis. Such biological systems pose challenges that include sensitivity to extremely low levels of gases, presence of reducing and oxidizing gases, organic vapors (VOCs), etc. See U.S. Patent No. 7,220,387 to Flaherty et al., the contents of which are incorporated by reference, regarding disposable sensors to measure gaseous sample analytes.
A conventional apparatus disclosed by Kearney, D, et al., Breath Ammonia Measurement in Helicobacter pylori Infection. Digestive Diseases and Sciences, Vol. 47, No. 11, pp. 2523- 2530 (2002), provides a fiber optic device placed in the stream of expelled breath that is connected to an optical sensor for detecting whether a patient has H. pylori by measuring for ammonia excreted by the lungs, utilizing a hydrophobic TFE-based membrane to avoid affect of dissolved ions such as ammonia. Also see, WO 03/041565 A2 of Hubbard et al., the contents of which are incorporated by reference, H. pylori detection. Diagnostic tests for H. pylori include a) serologic testing to detect anti-H. pylori antibodies in blood, b) upper gastrointestinal endoscopy with mucosal biopsies, c) H. pylori culture, including antimicrobial susceptibility testing, and d) detection of H. pylori antigens in stool. Serologic testing, however, cannot distinguish current from old infection. Upper gastrointestinal endoscopic biopsies are submitted for rapid urease testing or histological examination, and this approach has the drawbacks of the invasive nature of endoscopy and the suboptimal performance of histopathology. H. Pylori culture is invasive and cumbersome and detection of H. pylori antigens in stool is limited by the low acceptance of stool testing and suboptimal specificity/sensitivity.
Several diagnostic tests are based on the ability of H. pylori to convert urea to CO2 and NH3 using its enzyme urease. H. Pylori produces large amounts of urease which often comprises about five percent of its total protein. Urease activity is assessed in two general ways: Biopsy- based rapid urease testing and various urea breath tests. Biopsy-based rapid urease tests require endoscopy for sample acquisition. Biopsy samples are placed in an agar gel or paper strip containing a pH indicator. In addition to requiring an invasive endoscopy, biopsy-based rapid urease tests provide a less-than-optimal test due to the time required for the diagnosis, which is 3-24 hours, a less than 90% specificity, and reduced sensitivity in children. Moreover, conventional devices, particularly point-of-care devices, are expensive, particularly to assess H. pylori, which discontinuously colonizes the gastroduodenal mucosa.
Conventional testing is performed utilizing instrumentation that ranges from variations of mass spectrometers to IR detectors that are costly and require a trained operator. Breath sample transportation is also an issue with most conventional devices. The limited availability of instruments operable by patients and available at the point of care requires samples to be shipped to central testing facilities, adding cost and inconvenience. In regard to Urea Breath Testing (UBT) for the diagnosis of H. pylori infection, there are two versions of the UBT, based upon the type of urea being used as a substrate: 13C labeled urea and 14C labeled urea. 14C is a radioactive isotope of carbon. 13C is a stable, non-radioactive isotope, encountered in nature. The FDA has approved both 13C- and l4C-based UBTs for the diagnosis of H. pylori, though the 14C-based assay is rarely used. The 14C-based UBT is associated with exposure to radioactivity, which albeit small for an otherwise healthy adult, is nevertheless present and patients should not be exposed to it in the absence of safe alternatives. It is because of the risk associated with the radioactivity of the 14C -urea that the 14C-based UBT is contraindicated in pregnant women and children. See, Using Breath Tests Wisely in a Gastroenterology Practice: An Evidence-Based Review of Indications and Pitfalls in Interpretation. Romagnuolo, et al., Am J Gastroenterology 97:1113-1126 (2002).
A further difficulty arising with the UBT is the high cost of l3C-urea, as well as the cost and operational expenses of instruments to detect exhaled l3Cθ2.
To solve this shortcoming, the present invention departs from detection of 13CO2 by using unlabeled urea as a substrate, detecting ammonia in breath instead of CO2. The present invention provides an ammonia-specific nanosensor and provides a simple, inexpensive hand-held device for the detection of breath NH3. Accordingly, the present invention provides a highly accurate, economical, easy to operate, portable and sufficiently sensitive medical device for diagnosis of H. Pylori. The present invention departs from detection of 13CO2 and provides a simplified assay that uses lower cost unlabeled urea as a substrate.
SUMMARY QF THE INVENTION The present invention substantially solves the above shortcomings and provides at least the following advantages.
The present invention obviates the need for serologic testing, for upper gastrointestinal endoscopy with mucosal biopsies for the detection of H. pylori, which is invasive and cumbersome, and for detection of H. pylori antigens in stool. In a preferred embodiment, a medical device is provided to sample breath emitted from a patient's mouth, to analyze ammonia content and the composition of a gaseous sample via contact with sensing electrodes, particularly gold substrates arranged on a TO8 substrate.
Another embodiment of the present invention provides a method for using the medical device of the present invention to analyze a patient's breath sample to diagnose the presence of a medical condition, by obtaining a breath sample from a patient; analyzing volatile components of the patient sample to provide a breath profile that includes both qualitative and quantitative data; comparing the patient's breath profile to a database of breath profiles, with each database profile being characteristic of at least one medical condition, to provide information pertinent to diagnosis of the presence or absence of a medical condition.
In a preferred embodiment, a single sample is used for an independent or multiple tests, which may be combined to produce a template or pattern representative of a patient's condition or representative of the presence of a particular compound or set of compounds. In a preferred embodiment high sensitivity nanomorphs of metal oxides prepared by sol-gel practices are used for a more selective and quantitatively precise analysis.
In a preferred embodiment, the invention utilizes arrays of biocomposite and bio-doped films to provide a low cost, portable analyzer for detection of chemical products of biochemical reactions, such as ammonia and NO, in a real-time manner.
DETAILED DESCRIPTION OF THE FIGURES
The above and other objects, features and advantages of certain exemplary embodiments of the present invention will be more apparent from the following detailed description taken in conjunction with the accompanying drawings, in which:
Figure 1 is a schematic representation of an embodiment of a test device for the present invention;
Figures 2a and 2b show heater and sensing electrodes utilized in Fig. 1; Figures 3a and 3b show sensor response of the test device of Fig. 1; Figures 4a and 4b show NH3 sensing and sensor response when exposed only to CO2;
Figure 5 shows NH3 sensing with a CO2 filter; and
Figure 6 provides a block diagram of an apparatus of an embodiment of the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS The below description of detailed construction of preferred embodiments provides a comprehensive understanding of exemplary embodiments of the invention. Accordingly, those of ordinary skill in the art will recognize that various changes and modifications of the embodiments described herein can be made without departing from the scope and spirit of the invention. Descriptions of well-known functions and constructions are omitted for clarity and conciseness. Analysis of breath and skin emission samples for diagnostic purposes has the advantage that the sample to be analyzed is collected from the patient in a non-invasive manner with a minimum of discomfort or inconvenience. Basic components of the medical device used for analysis in accordance with a preferred embodiment of the present invention are shown in Figure 1. In preferred embodiments of the invention, breath samples are quantitatively and qualitatively processed. Notably, the sensor is tuned to detect NH3 levels lower than 50 parts per billion (<50 ppb) and as high as 500 ppm, thereby covering all NH3 levels encountered in humans, and in particular in patients undergoing UBT. Quantitative analyzers preferably include a sensing substrate surrounded by a gold substrate surrounded by a TO8 substrate. The medical device of the present invention is preferably qualitatively used to test exhaled gas. Qualitative tests performed by the test device usable with the present invention may test carbon dioxide content, alcohol content, lipid degradation products, aromatic compounds, thio compounds, ammonia and amines or halogenated compounds.
In a preferred embodiment, multiple different tests performed on a single sample may be independent, or may be the result of several tests combined to produce a template or pattern representative of a patient's condition or representative of the presence of a particular compound or set of compounds. The high sensitivity of the nanomorphs of metal oxides prepared by sol-gel practices used in the medical device of the present invention are both more selective and more quantitatively precise than similar information obtained by currently available electronic nose technology. As a result, correlating the data pattern or changes in the data pattern over time identifies a wider range of conditions or compounds.
The present invention departs from detection of 13CO2 and provides a simplified assay that uses unlabeled urea as a substrate and detects ammonia in breath instead Of CO2 utilizing Equation (1): CO(NH2)2 + HOH — urease→ CO2 + 2NH3 (1)
In an embodiment of the present invention, a nanosensor is provided to detect breath ammonia and a simple, portable, inexpensive hand-held device is thereby provided to detect breath NH3. The nanosensor is tuned according to the method described below for other breath gases, and the nanosensor is in a preferred embodiment provided as a plug-in component. The sensor is constructed of a metal oxide that is not crystalline, raising sensitivity to ammonia and other gases. In Figure 1, a gas sample, i.e. breath or skin emission, accesses analyzer 110 via entry and exit orifices 102 and 104. A stainless steel chamber preferably connects the orifices to avoid absorption/distortion. Sensing electrode 122 and heater electrode 124 are positioned within the analyzer 110. The sensing electrode 122 includes a sensor 130 having gold substrate 132, sensing substrate 134 and TO8 substrate 136. Heater and sensing electrodes 122 and 124 of an embodiment of the present invention are shown in Figures 2a and 2b. Those of skill in the art recognize use of the TO8 substrate. Hirata et al. in U.S. Patent No. 5,252,292, the contents of which are incorporated by reference herein, disclose a type of ammonia sensor.
In the present invention, the sensing electrode 124 is selectively tuned by spin or drop coating of sensing substrates generating a film of MoO3. In a preferred embodiment, a gel-sol synthesis was employed to produce three-dimensional (3-D) networks of nanoparticles, with the sol-gel processing preparing a sol, gelating the sol and removing the solvent. Molybdenum trioxide (MoO3) was prepared by an alkoxide reaction with alcohol according to Equation (2): Molydenum (VI) Isopropoxide + 1 -Butanol -> Precursor^.1 M) (2) The prepared sol was spin coated and drop coated onto sensing substrates generating thin films of MOO3. The sensing substrates (3mm x 3mm) were made OfAbO3 and were patterned with interdigitated Pt electrodes. Pt heater electrodes were embedded on the rear of the sensor. The amorphous films were then calcined at higher temperatures generating polymorphic form. Differential scanning calorimetry confirmed the phase transformation. Figure 3a shows sensor response to NH3, with the sensor generating a clear and measurable response to two NH3 concentrations, 50 and 100 ppb. The measured amounts of ppb, i.e. parts per billion, are much lower than amounts typically expected in human breath, allowing for more accurate and expedited measurement and results. Figure 3b shows sensor response to various breath gases, and the specificity regarding same. Shown in Figure 3b are NH3, NO2, NO, C3H6 and H2, gases that potentially interfere with NH3 determination.
Figure 4a shows NH3 sensing without a CO2 filter, as gas-sensing properties of the nanosensor. As shown in Figs. 4a-b, when the sensor was exposed to various concentrations of NH3 gas in a background mixture OfN2 and O2 simulating ambient air, NH3 was detected easily, down to 50 ppb, and even lower concentrations. In Figure 4a, CO2 and NH3, each at 1 ppm, produce similar responses to gas pulses, shown as vertical lines in Figure 4a. Sensor response when exposed only to CO2 gas, in the presence of the CO2 filter, is shown in Figure 4b. The CO2 filter completely eliminates CO2 from the gas stream, abrogating the sensor response to it.
Sensor specificity, in regard to sensing of NH3, was evaluated by exposing the sensor to various gases typically encountered in human breath, including NO2, NO, C3H6, and H2, each up to 490 ppm. Conductivity changes were measured in dry N2 with 10% O2. At 440° C the film was very sensitive to NH3, with 490 ppm increasing the conductivity by approximately a factor of 70, approximately 17 times greater than the response to the other gases. The NH3 response, however, was relatively unaffected by 100 ppm OfNO2, NO, C3H6, and H2. X-ray photoelectron spectroscopy (XPS) showed that the increased conductivity in the presence of NH3 was accompanied by a partial reduction of the surface MoO3. The resistance of the films increased after extended time at elevated temperatures.
CO2 is an important component of human breath, with its concentration in expired breath reaching up to 5%. Under test conditions, CO2 interfered with NH3 sensing. To overcome this limitation, a commercially available CO2 filter (NaOH premixed with Vermiculite (V-lite) used in a 10:1 ratio; Decarbite absorption tube, PW Perkins and Co) was used. Decarbite reacts only with highly acidic gases such as CO2, H2S, thus excluding the possibility of cross adsorption; and the latter was verified. Exposing the sensor to various concentrations of NH3 and CO2, in the presence of N2 and O2, indicated that the presence of CO2 did not affect NH3 sensing. This was found to be true even when the two gases were at equal concentrations ranging between 0.5 and 10 ppm.
The data shown in Figs. 4a-b are from experiments with a low CO2 concentration (1 ppm). In the present invention, the NaOH Decarbite traps CO2 more efficiently at high CO2 concentrations.
Figure 5 shows NH3 sensing with a CO2 filter. In Figure 5, the sensor is exposed to NH3 in the presence of the filter, with no interference of the measurement. Fig. 6 shows a prototype for sensing breath, having a sensor, acquisition module, memory/computation module and displays.
Combining NH3 and CO2 generated similar results, with the filter eliminating the experimental 1 ppm of CO2 in the gas stream. Even at low concentrations, interference by CO2 is eliminated. Operation of the apparatus of the present invention is preferably based on sensor response modifying electrical resistance. That is, the MoO3 sensor is prepared with properties required for its intended use, with lower limits of detection for NH3 well below the NH3 concentrations typically found in human breath and, of course, below the increased NH3 levels of a positive UBT.
Another embodiment includes colloidal synthesis of hexagonal WO3 nanowire and sheets. Lithium ion batteries are vital for advancing the field of portable electronics. They operate by reversibly inserting Li+ ions from the electrolyte into the electrodes and for generating electricity. Reversible intercalation of Li+ ions into the host matrix is crucial for battery operation and can be accomplished by having electrode materials that have relatively open crystal structures. Thermodynamically stable crystal structures are typically close-packed, whereas metastable oxide phases have open lattices that promote very high diffusion rates for intercalating ions.
Building smaller and more efficient batteries is imperative for advancing nanoelectronics. The synthesis of novel materials with reduced dimensionalities for battery electrodes is the key factor in improving battery performance. One-dimensional nanomaterials with high aspect ratio such as nanowires are used to construct miniaturized power units and to increase the surface area of the electrodes in order to increase energy density. Building 3-dimensional architectures of micro-/nano electrodes allows for a reduced footprint area for the battery, while at the same time the high aspect ratio of the nanowires serves to increase the energy density tremendously.
In the area of resistive gas sensing, the attraction of hexagonal WO3 lies in the structural similarity it shares with the orthorhombic form of M0O3. Both these crystal structures have layered oxygen octahedra, in other words an open lattice structure, that provides long paths for small, diffusing gas molecules and facilitates easy removal of oxygen ions from the lattice. The present invention utilizes the key role played by the crystal structure in determining selectivity of the sensing matrix. Orthorhombic M0O3 has been shown to be selective to ammonia in the presence of other gases. MOO3 with its low sublimation temperature is not a suitable candidate for prolonged use at elevated temperatures. WO3 on the other hand has higher structural integrity than MOO3 and hence ideal for high temperature sensor applications. Also the high aspect ratio of the nanowires will serve to improve the energy density of the batteries without increasing the effective volume of the battery. Also, metal oxides with lower dimensionalities have been the focus of intense research activity for applications requiring high surface-area to volume ratio such as gas sensing. Nanowires of h-WO3 are fabricated by hydrolysis and subsequent annealing of a sub- stoichiometric metal alkoxide precursor (tungsten (V) isopropoxide-W (i Pr)5) in air at a maximum temperature limit of 515°C. The sol-gel reaction occurring with the metal alkoxide precursor is outlined in Equation (3): W (iPr)5 + H -OH → W (OH)5 + R-OH (1) (3)
The hydrolysis and subsequent condensation occur by alcoxolation, i.e. by removal of water. The isopropoxide functional group is removed as isopropanol, which then dries out. The precursor for the hexagonal lattice requires an additive for stabilizing the framework. The substoichiometric isopropoxide precursor on reaction with atmospheric moisture results in the formation of H0.24 WO3 that is known to transform to h-W03 on oxidation in air. The metal alkoxide is sub-stoichiometric and removal of two molecules of water from the W(0H)5 in Equation (3) results in a lone hydrogen atom that can be accommodated in the interstitial spaces of WO3 framework.
Advantages of this embodiment include single step synthesis of a novel metastable phase of WO3; unique crystal structure of the material enables reversible intercalation of Li ions for rechargeable batteries; higher thermal stability; high aspect ratio nanostructures such as nanowires, nanocubes and nanosheets for high surface area to volume ratio applications. While this invention has been particularly shown and described with reference to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.

Claims

WHAT IS CLAIMED IS:
1. A method for detection of Helicobacter pylori, the method comprising: ingesting by a patient a safe quantity of unlabelled urea; and analyzing, after the ingestion, expired breath of the patient for ammonia, wherein the analysis is based on levels of ammonia lower than 50 parts per billion to 500 ppm to detect helicobacter pylori.
2. The method of claim 1, wherein the detection is not based on 13CO2 levels.
3. The method of claim 1 , wherein the analysis is based on an equation:
CO(NH2)2 + HOH — urease→ CO2 + 2NH3 .
4. The method of claim 1 , wherein a sensor is utilized for the detection of ammonia.
5. The method of claim 4, wherein the sensor is constructed of a metal oxide.
6. The method of claim 1 , further including removal by a CO2 trap of CO2 in the sample.
7. The method of claim 6, wherein the CO2 trap is a NaOH Decarbite trap.
8. The method of claim 1, wherein the patient is a pediatric patient.
PCT/US2008/076631 2007-09-17 2008-09-17 Detection of h. pylori utilizing unlabeled urea WO2009039152A1 (en)

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EP2203563A4 (en) 2013-07-24

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