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Respiratory Research
Published in: Respiratory Research 1/2020

Open Access 01-12-2020 | Chronic Obstructive Lung Disease | Research

Identification of lipid biomarker from serum in patients with chronic obstructive pulmonary disease

Authors: Ding Liu, Maureen Meister, Shiying Zhang, Chi-In Vong, Shuaishuai Wang, Ruixie Fang, Lei Li, Peng George Wang, Pierre Massion, Xiangming Ji

Published in: Respiratory Research | Issue 1/2020

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Abstract

Background

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States with no effective treatment. The current diagnostic method, spirometry, does not accurately reflect the severity of COPD disease status. Therefore, there is a pressing unmet medical need to develop noninvasive methods and reliable biomarkers to detect early stages of COPD. Lipids are the fundamental components of cell membranes, and dysregulation of lipids was proven to be associated with COPD. Lipidomics is a comprehensive approach to all the pathways and networks of cellular lipids in biological systems. It is widely used for disease diagnosis, biomarker identification, and pathology disorders detection relating to lipid metabolism.

Methods

In the current study, a total of 25 serum samples were collected from 5 normal control subjects and 20 patients with different stages of COPD according to the global initiative for chronic obstructive lung disease (GOLD) (GOLD stages I ~ IV, 5 patients per group). After metabolite extraction, lipidomic analysis was performed using electrospray ionization mass spectrometry (ESI-MS) to detect the serum lipid species. Later, the comparisons of individual lipids were performed between controls and patients with COPD. Orthogonal projections to latent structures discriminant analysis (OPLS-DA) and receiver operating characteristic (ROC) analysis were utilized to test the potential biomarkers. Finally, correlations between the validated lipidomic biomarkers and disease stages, age, FEV1% pack years and BMI were evaluated.

Results

Our results indicate that a panel of 50 lipid metabolites including phospholipids, sphingolipids, glycerolipids, and cholesterol esters can be used to differentiate the presence of COPD. Among them, 10 individual lipid species showed significance (p < 0.05) with a two-fold change. In addition, lipid ratios between every two lipid species were also evaluated as potential biomarkers. Further multivariate data analysis and receiver operating characteristic (ROC: 0.83 ~ 0.99) analysis suggest that four lipid species (AUC:0.86 ~ 0.95) and ten lipid ratios could be potential biomarkers for COPD (AUC:0.94 ~ 1) with higher sensitivity and specificity. Further correlation analyses indicate these potential biomarkers were not affected age, BMI, stages and FEV1%, but were associated with smoking pack years.

Conclusion

Using lipidomics and statistical methods, we identified unique lipid signatures as potential biomarkers for diagnosis of COPD. Further validation studies of these potential biomarkers with large population may elucidate their roles in the development of COPD.
Appendix
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Literature
1.
2.
Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, Dellavalle R, Danaei G, Ezzati M, Fahimi A, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608.PubMedCrossRef
3.
Mannino DM, Martinez FJ. Lifetime risk of COPD: what will the future bring? Lancet. 2011;378(9795):964–5.PubMedCrossRef
4.
Jeffery PK. Remodeling and inflammation of bronchi in asthma and chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(3):176–83.PubMedCrossRef
5.
Salvi S. Tobacco smoking and environmental risk factors for chronic obstructive pulmonary disease. Clin Chest Med. 2014;35(1):17–27.PubMedCrossRef
6.
Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195(5):557–82.PubMedCrossRef
7.
Brutsche MH, Downs SH, Schindler C, Gerbase MW, Schwartz J, Frey M, Russi EW, Ackermann-Liebrich U, Leuenberger P, Team S. Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA cohort study. Thorax. 2006;61(8):671–7.PubMedPubMedCentralCrossRef
8.
Csikesz NG, Gartman EJ. New developments in the assessment of COPD: early diagnosis is key. Int J Chron Obstruct Pulmon Dis. 2014;9:277–86.PubMedPubMedCentral
9.
Chen H, Li Z, Dong L, Wu Y, Shen H, Chen Z. Lipid metabolism in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2019;14:1009–18.PubMedPubMedCentralCrossRef
10.
Petrache I, Natarajan V, Zhen L, Medler TR, Richter AT, Cho C, Hubbard WC, Berdyshev EV, Tuder RM. Ceramide upregulation causes pulmonary cell apoptosis and emphysema-like disease in mice. Nat Med. 2005;11(5):491–8.PubMedPubMedCentralCrossRef
11.
Lambert AA, Putcha N, Drummond MB, Boriek AM, Hanania NA, Kim V, Kinney GL, McDonald MN, Brigham EP, Wise RA, et al. Obesity is associated with increased morbidity in moderate to severe COPD. Chest. 2017;151(1):68–77.PubMedCrossRef
12.
Cao C, Wu Y, Xu Z, Lv D, Zhang C, Lai T, Li W, Shen H. The effect of statins on chronic obstructive pulmonary disease exacerbation and mortality: a systematic review and meta-analysis of observational research. Sci Rep. 2015;5:16461.PubMedPubMedCentralCrossRef
13.
14.
Lusuardi M, Capelli A, Carli S, Tacconi MT, Salmona M, Donner CF. Role of surfactant in chronic obstructive pulmonary disease: therapeutic implications. Respiration. 1992;59(Suppl 1):28–32.PubMedCrossRef
15.
Telenga ED, Hoffmann RF, Ruben TK, Hoonhorst SJ, Willemse BW, van Oosterhout AJ, Heijink IH, van den Berge M, Jorge L, Sandra P, et al. Untargeted lipidomic analysis in chronic obstructive pulmonary disease. Uncovering sphingolipids. Am J Respir Crit Care Med. 2014;190(2):155–64.PubMedCrossRef
16.
Zemski Berry KA, Murphy RC, Kosmider B, Mason RJ. Lipidomic characterization and localization of phospholipids in the human lung. J Lipid Res. 2017;58(5):926–33.PubMedPubMedCentralCrossRef
17.
Navarrete A, Ruperez FJ, Mendes TO, Perez-Rial S, Giron-Martinez A, Terron-Exposito R, Diaz-Gil JJ, Peces-Barba G, Barbas C, Garcia A. A metabolomic approach shows sphingosine 1-phosphate and lysophospholipids as mediators of the therapeutic effect of liver growth factor in emphysema. J Pharm Biomed Anal. 2017;139:238–46.PubMedCrossRef
18.
Barnawi J, Tran HB, Roscioli E, Hodge G, Jersmann H, Haberberger R, Hodge S. Pro-phagocytic effects of Thymoquinone on cigarette smoke-exposed macrophages occur by modulation of the Sphingosine-1-phosphate Signalling system. COPD. 2016;13(5):653–61.PubMedCrossRef
19.
Bowler RP, Jacobson S, Cruickshank C, Hughes GJ, Siska C, Ory DS, Petrache I, Schaffer JE, Reisdorph N, Kechris K. Plasma sphingolipids associated with chronic obstructive pulmonary disease phenotypes. Am J Respir Crit Care Med. 2015;191(3):275–84.PubMedPubMedCentralCrossRef
20.
Hannun YA, Obeid LM. Principles of bioactive lipid signalling: lessons from sphingolipids. Nat Rev Mol Cell Biol. 2008;9(2):139–50.PubMedCrossRef
21.
Lee JY, Sohn KH, Rhee SH, Hwang D. Saturated fatty acids, but not unsaturated fatty acids, induce the expression of cyclooxygenase-2 mediated through toll-like receptor 4. J Biol Chem. 2001;276(20):16683–9.PubMedCrossRef
22.
23.
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–55.PubMedCrossRef
24.
Zhou X, Mao J, Ai J, Deng Y, Roth MR, Pound C, Henegar J, Welti R, Bigler SA. Identification of plasma lipid biomarkers for prostate cancer by lipidomics and bioinformatics. PLoS One. 2012;7(11):e48889.PubMedPubMedCentralCrossRef
25.
Comfurius P, Zwaal RF. The enzymatic synthesis of phosphatidylserine and purification by CM-cellulose column chromatography. Biochim Biophys Acta. 1977;488(1):36–42.PubMedCrossRef
26.
Devaiah SP, Roth MR, Baughman E, Li M, Tamura P, Jeannotte R, Welti R, Wang X. Quantitative profiling of polar glycerolipid species from organs of wild-type Arabidopsis and a phospholipase Dalpha1 knockout mutant. Phytochemistry. 2006;67(17):1907–24.PubMedCrossRef
27.
Welti R, Li W, Li M, Sang Y, Biesiada H, Zhou HE, Rajashekar CB, Williams TD, Wang X. Profiling membrane lipids in plant stress responses. Role of phospholipase D alpha in freezing-induced lipid changes in Arabidopsis. J Biol Chem. 2002;277(35):31994–2002.PubMedCrossRef
28.
29.
Zhou Z, Marepally SR, Nune DS, Pallakollu P, Ragan G, Roth MR, Wang L, Lushington GH, Visvanathan M, Welti R. LipidomeDB data calculation environment: online processing of direct-infusion mass spectral data for lipid profiles. Lipids. 2011;46(9):879–84.PubMedPubMedCentralCrossRef
30.
Anton G, Wilson R, Yu ZH, Prehn C, Zukunft S, Adamski J, Heier M, Meisinger C, Romisch-Margl W, Wang-Sattler R, et al. Pre-analytical sample quality: metabolite ratios as an intrinsic marker for prolonged room temperature exposure of serum samples. PLoS One. 2015;10(3):e0121495.PubMedPubMedCentralCrossRef
31.
Mundra PA, Barlow CK, Nestel PJ, Barnes EH, Kirby A, Thompson P, Sullivan DR, Alshehry ZH, Mellett NA, Huynh K, et al. Large-scale plasma lipidomic profiling identifies lipids that predict cardiovascular events in secondary prevention. JCI Insight. 2018;3(17):e121326.
32.
Uehara T, Kikuchi H, Miyazaki S, Iino I, Setoguchi T, Hiramatsu Y, Ohta M, Kamiya K, Morita Y, Tanaka H, et al. Overexpression of Lysophosphatidylcholine Acyltransferase 1 and concomitant lipid alterations in gastric Cancer. Ann Surg Oncol. 2016;23(Suppl 2):S206–13.PubMedCrossRef
33.
Zafirova-Ivanovska B, Stojkovikj J, Dokikj D, Anastasova S, Debresliovska A, Zejnel S, Stojkovikj D. The level of cholesterol in COPD patients with severe and very severe stage of the disease. Open Access Maced J Med Sci. 2016;4(2):277–82.PubMedPubMedCentralCrossRef
34.
Burkart KM, Manichaikul A, Wilk JB, Ahmed FS, Burke GL, Enright P, Hansel NN, Haynes D, Heckbert SR, Hoffman EA, et al. APOM and high-density lipoprotein cholesterol are associated with lung function and per cent emphysema. Eur Respir J. 2014;43(4):1003–17.PubMedCrossRef
35.
Li H, Liu Y, Wang L, Shen T, Du W, Liu Z, Chen R, Hu M. High apolipoprotein M serum levels correlate with chronic obstructive pulmonary disease. Lipids Health Dis. 2016;15:59.PubMedPubMedCentralCrossRef
36.
Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ. 1989;298(6676):784–8.PubMedPubMedCentralCrossRef
37.
38.
Eriksson L, Antti H, Gottfries J, Holmes E, Johansson E, Lindgren F, Long I, Lundstedt T, Trygg J, Wold S. Using chemometrics for navigating in the large data sets of genomics, proteomics, and metabonomics (gpm). Anal Bioanal Chem. 2004;380(3):419–29.PubMedCrossRef
39.
Blasco H, Blaszczynski J, Billaut JC, Nadal-Desbarats L, Pradat PF, Devos D, Moreau C, Andres CR, Emond P, Corcia P, et al. Comparative analysis of targeted metabolomics: dominance-based rough set approach versus orthogonal partial least square-discriminant analysis. J Biomed Inform. 2015;53:291–9.PubMedCrossRef
40.
Linden A. Measuring diagnostic and predictive accuracy in disease management: an introduction to receiver operating characteristic (ROC) analysis. J Eval Clin Pract. 2006;12(2):132–9.PubMedCrossRef
41.
van Bragt J, Vijverberg SJH, Weersink EJM, Richards LB, Neerincx AH, Sterk PJ, Bel EHD, Maitland-van der Zee AH. Blood biomarkers in chronic airways diseases and their role in diagnosis and management. Expert Rev Respir Med. 2018;12(5):361–74.PubMedCrossRef
42.
Roche N, Chapman KR, Vogelmeier CF, Herth FJF, Thach C, Fogel R, Olsson P, Patalano F, Banerji D, Wedzicha JA. Blood Eosinophils and response to maintenance chronic obstructive pulmonary disease treatment. Data from the FLAME trial. Am J Respir Crit Care Med. 2017;195(9):1189–97.PubMedCrossRef
43.
Bafadhel M, McKenna S, Terry S, Mistry V, Pancholi M, Venge P, Lomas DA, Barer MR, Johnston SL, Pavord ID, et al. Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. Am J Respir Crit Care Med. 2012;186(1):48–55.PubMedPubMedCentralCrossRef
44.
Bafadhel M, McKenna S, Terry S, Mistry V, Reid C, Haldar P, McCormick M, Haldar K, Kebadze T, Duvoix A, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med. 2011;184(6):662–71.PubMedCrossRef
45.
Pignatti P, Visca D, Cherubino F, Zampogna E, Lucini E, Saderi L, Sotgiu G, Spanevello A. Do blood eosinophils strictly reflect airway inflammation in COPD? Comparison with asthmatic patients. Respir Res. 2019;20(1):145.PubMedPubMedCentralCrossRef
46.
Kolsum U, Donaldson GC, Singh R, Barker BL, Gupta V, George L, Webb AJ, Thurston S, Brookes AJ, McHugh TD, et al. Blood and sputum eosinophils in COPD; relationship with bacterial load. Respir Res. 2017;18(1):88.PubMedPubMedCentralCrossRef
47.
Dickens JA, Miller BE, Edwards LD, Silverman EK, Lomas DA, Tal-Singer R, Evaluation of CLtISEsi. COPD association and repeatability of blood biomarkers in the ECLIPSE cohort. Respir Res. 2011;12:146.PubMedPubMedCentralCrossRef
48.
Cecere LM, Littman AJ, Slatore CG, Udris EM, Bryson CL, Boyko EJ, Pierson DJ, Au DH. Obesity and COPD: associated symptoms, health-related quality of life, and medication use. COPD. 2011;8(4):275–84.PubMedCrossRef
49.
Artha I, Bhargah A, Dharmawan NK, Pande UW, Triyana KA, Mahariski PA, Yuwono J, Bhargah V, Prabawa IPY, Manuaba I, et al. High level of individual lipid profile and lipid ratio as a predictive marker of poor glycemic control in type-2 diabetes mellitus. Vasc Health Risk Manag. 2019;15:149–57.PubMedPubMedCentralCrossRef
50.
Sato Y, Suzuki I, Nakamura T, Bernier F, Aoshima K, Oda Y. Identification of a new plasma biomarker of Alzheimer's disease using metabolomics technology. J Lipid Res. 2012;53(3):567–76.PubMedPubMedCentralCrossRef
51.
Anroedh S, Hilvo M, Akkerhuis KM, Kauhanen D, Koistinen K, Oemrawsingh R, Serruys P, van Geuns RJ, Boersma E, Laaksonen R, et al. Plasma concentrations of molecular lipid species predict long-term clinical outcome in coronary artery disease patients. J Lipid Res. 2018;59(9):1729–37.PubMedPubMedCentralCrossRef
52.
Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315–6.PubMedCrossRef
53.
Hohlfeld J, Fabel H, Hamm H. The role of pulmonary surfactant in obstructive airways disease. Eur Respir J. 1997;10(2):482–91.PubMedCrossRef
54.
Mercado N, Ito K, Barnes PJ. Accelerated ageing of the lung in COPD: new concepts. Thorax. 2015;70(5):482–9.PubMedCrossRef
55.
Perez-Gil J, Keough KM. Interfacial properties of surfactant proteins. Biochim Biophys Acta. 1998;1408(2–3):203–17.PubMedCrossRef
56.
Kahn MC, Anderson GJ, Anyan WR, Hall SB. Phosphatidylcholine molecular species of calf lung surfactant. Am J Phys. 1995;269(5 Pt 1):L567–73.
57.
Joppa P, Petrasova D, Stancak B, Dorkova Z, Tkacova R. Oxidative stress in patients with COPD and pulmonary hypertension. Wien Klin Wochenschr. 2007;119(13–14):428–34.PubMedCrossRef
58.
Titz B, Luettich K, Leroy P, Boue S, Vuillaume G, Vihervaara T, Ekroos K, Martin F, Peitsch MC, Hoeng J. Alterations in Serum Polyunsaturated Fatty Acids and Eicosanoids in Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease (COPD). Int J Mol Sci. 2016;17(9):1583.
59.
Lentz BR. Exposure of platelet membrane phosphatidylserine regulates blood coagulation. Prog Lipid Res. 2003;42(5):423–38.PubMedCrossRef
60.
Petrache I, Petrusca DN, Bowler RP, Kamocki K. Involvement of ceramide in cell death responses in the pulmonary circulation. Proc Am Thorac Soc. 2011;8(6):492–6.PubMedPubMedCentralCrossRef
61.
Scarpa MC, Baraldo S, Marian E, Turato G, Calabrese F, Saetta M, Maestrelli P. Ceramide expression and cell homeostasis in chronic obstructive pulmonary disease. Respiration. 2013;85(4):342–9.PubMedCrossRef
62.
Petrusca DN, Van Demark M, Gu Y, Justice MJ, Rogozea A, Hubbard WC, Petrache I. Smoking exposure induces human lung endothelial cell adaptation to apoptotic stress. Am J Respir Cell Mol Biol. 2014;50(3):513–25.PubMedPubMedCentralCrossRef
63.
Petrusca DN, Gu Y, Adamowicz JJ, Rush NI, Hubbard WC, Smith PA, Berdyshev EV, Birukov KG, Lee CH, Tuder RM, et al. Sphingolipid-mediated inhibition of apoptotic cell clearance by alveolar macrophages. J Biol Chem. 2010;285(51):40322–32.PubMedPubMedCentralCrossRef
64.
Lea SR, Metcalfe HJ, Plumb J, Beerli C, Poll C, Singh D, Abbott-Banner KH. Neutral sphingomyelinase-2, acid sphingomyelinase, and ceramide levels in COPD patients compared to controls. Int J Chron Obstruct Pulmon Dis. 2016;11:2139–47.PubMedPubMedCentralCrossRef
65.
Jonas A, Kezdy KE, Williams MI, Rye KA. Lipid transfers between reconstituted high density lipoprotein complexes and low density lipoproteins: effects of plasma protein factors. J Lipid Res. 1988;29(10):1349–57.PubMed
66.
67.
Thacker SG, Rousset X, Esmail S, Zarzour A, Jin X, Collins HL, Sampson M, Stonik J, Demosky S, Malide DA, et al. Increased plasma cholesterol esterification by LCAT reduces diet-induced atherosclerosis in SR-BI knockout mice. J Lipid Res. 2015;56(7):1282–95.PubMedPubMedCentralCrossRef
68.
Savel J, Lafitte M, Pucheu Y, Pradeau V, Tabarin A, Couffinhal T. Very low levels of HDL cholesterol and atherosclerosis, a variable relationship--a review of LCAT deficiency. Vasc Health Risk Manag. 2012;8:357–61.PubMedPubMedCentral
69.
Reed RM, Iacono A, DeFilippis A, Eberlein M, Girgis RE, Jones S. Advanced chronic obstructive pulmonary disease is associated with high levels of high-density lipoprotein cholesterol. J Heart Lung Transplant. 2011;30(6):674–8.PubMedCrossRef
70.
Stamler CJ, Breznan D, Neville TA, Viau FJ, Camlioglu E, Sparks DL. Phosphatidylinositol promotes cholesterol transport in vivo. J Lipid Res. 2000;41(8):1214–21.PubMed
71.
To Y, Ito K, Kizawa Y, Failla M, Ito M, Kusama T, Elliott WM, Hogg JC, Adcock IM, Barnes PJ. Targeting phosphoinositide-3-kinase-delta with theophylline reverses corticosteroid insensitivity in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;182(7):897–904.PubMedPubMedCentralCrossRef
Metadata
Title
Identification of lipid biomarker from serum in patients with chronic obstructive pulmonary disease
Authors
Ding Liu
Maureen Meister
Shiying Zhang
Chi-In Vong
Shuaishuai Wang
Ruixie Fang
Lei Li
Peng George Wang
Pierre Massion
Xiangming Ji
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2020
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-020-01507-9

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