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BMC Medicine
Published in: BMC Medicine 1/2016

Open Access 01-12-2016 | Research article

Urine metabolome profiling of immune-mediated inflammatory diseases

Authors: Arnald Alonso, Antonio Julià, Maria Vinaixa, Eugeni Domènech, Antonio Fernández-Nebro, Juan D. Cañete, Carlos Ferrándiz, Jesús Tornero, Javier P. Gisbert, Pilar Nos, Ana Gutiérrez Casbas, Lluís Puig, Isidoro González-Álvaro, José A. Pinto-Tasende, Ricardo Blanco, Miguel A. Rodríguez, Antoni Beltran, Xavier Correig, Sara Marsal, for the IMID Consortium

Published in: BMC Medicine | Issue 1/2016

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Abstract

Background

Immune-mediated inflammatory diseases (IMIDs) are a group of complex and prevalent diseases where disease diagnostic and activity monitoring is highly challenging. The determination of the metabolite profiles of biological samples is becoming a powerful approach to identify new biomarkers of clinical utility. In order to identify new metabolite biomarkers of diagnosis and disease activity, we have performed the first large-scale profiling of the urine metabolome of the six most prevalent IMIDs: rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn’s disease, and ulcerative colitis.

Methods

Using nuclear magnetic resonance, we analyzed the urine metabolome in a discovery cohort of 1210 patients and 100 controls. Within each IMID, two patient subgroups were recruited representing extreme disease activity (very high vs. very low). Metabolite association analysis with disease diagnosis and disease activity was performed using multivariate linear regression in order to control for the effects of clinical, epidemiological, or technical variability. After multiple test correction, the most significant metabolite biomarkers were validated in an independent cohort of 1200 patients and 200 controls.

Results

In the discovery cohort, we identified 28 significant associations between urine metabolite levels and disease diagnosis and three significant metabolite associations with disease activity (PFDR < 0.05). Using the validation cohort, we validated 26 of the diagnostic associations and all three metabolite associations with disease activity (PFDR < 0.05). Combining all diagnostic biomarkers using multivariate classifiers we obtained a good disease prediction accuracy in all IMIDs and particularly high in inflammatory bowel diseases. Several of the associated metabolites were found to be commonly altered in multiple IMIDs, some of which can be considered as hub biomarkers. The analysis of the metabolic reactions connecting the IMID-associated metabolites showed an over-representation of citric acid cycle, phenylalanine, and glycine-serine metabolism pathways.

Conclusions

This study shows that urine is a source of biomarkers of clinical utility in IMIDs. We have found that IMIDs show similar metabolic changes, particularly between clinically similar diseases and we have found, for the first time, the presence of hub metabolites. These findings represent an important step in the development of more efficient and less invasive diagnostic and disease monitoring methods in IMIDs.
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Metadata
Title
Urine metabolome profiling of immune-mediated inflammatory diseases
Authors
Arnald Alonso
Antonio Julià
Maria Vinaixa
Eugeni Domènech
Antonio Fernández-Nebro
Juan D. Cañete
Carlos Ferrándiz
Jesús Tornero
Javier P. Gisbert
Pilar Nos
Ana Gutiérrez Casbas
Lluís Puig
Isidoro González-Álvaro
José A. Pinto-Tasende
Ricardo Blanco
Miguel A. Rodríguez
Antoni Beltran
Xavier Correig
Sara Marsal
for the IMID Consortium
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2016
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-016-0681-8

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