Dr Aarti Agarwal, Dr Puneet Goyal, Dr Abhishek Kumar, Dr Neeraj Sinha, Dr Sanjay Dhiraaj, Dr Afzal Azim


Introduction: COPD patients are exposed to endotracheal intubation and mechanical ventilation during general anaesthesia for various surgical interventions. In order to delineate the pathophysiology at molecular level, mini braonchoalveolar lavage (BAL) fluid was collected from these patients during mechanical ventilation and metabolomics profile of this was analyzed using nuclear magnetic resonance spectroscopy.

Methods: 20 adult COPD patients (GOLD stage II and III) were enrolled in this prospective observational pilot study, which is the first study in which mini BAL fluid was utilized for assessing metabolomics of COPD patients undergoing mechanical ventilation during general anaesthesia for various surgical procedures. During NMR spectroscopy, several 1D and 2D spectra such as 1H, COSY and HSQC were carried out to identify various metabolites.

Results: NMR spectra between 2 groups of samples (after intubation and before extubation) showed a slight difference on visual inspection in H1 D spectral analysis. There was slight increase in concentration of some metabolites (betaine, serine, aspartate, lysine/arginine and glucose) in “before extubation” samples. But 2D assignment techniques demonstrated no significant difference between 2 groups of samples.

Conclusion: No change in lung metabolomic profile of COPD patients could be detected after endotracheal intubation and mechanical ventilation during surgery of 3 to 5 hours duration. We can also infer that optimized COPD grade II and grade III patients do not undergo metabolomic change in lungs during 3 to 5 hours of mechanical ventilation.


Full Text:



Viswan A, Sharma RK, Azim A, and Sinha N. NMR-Based Metabolic Snapshot from Minibronchoalveolar Lavage Fluid: An Approach To Unfold Human Respiratory Metabolomics. J. Proteome Res., 2016, Jan 4;15(1);302–310. DOI: 10.1021/acs.jproteome.5b00919

Assfalg M, Bertini I, Colangiuli D, Luchinat, C, Schäfer, H, Schütz, B, Spraul, M. Evidence of different metabolic phenotypes in humans. Proc. Natl. Acad. Sci. U. S. A. 2008, 105, 1420−1424.

Lindon, J. C.; Nicholson, J. K.; Holmes, E.; Everett, J. R. Metabolomics: Metabolic processes studied by NMR spectroscopy of biofluids. Concepts Magn. Reson. 2000, 12, 289−320.

Goodacre, R.; Vaidyanathan, S.; Dunn, W. B.; Harrigan, G. G.;Kell, D. B. Metabolomic by numbers: acquiring and understanding global metabolite data. Trends Biotechnol. 2004, 22, 245−252

Bernini, P.; Bertini, I.; Luchinat, C.; Nepi, S.; Saccenti, E.;Schäfer, H.; Schütz, B.; Spraul, M.; Tenori, L. Individual Human Phenotypes in Metabolic Space and Time. J. Proteome Res. 2009, 8,4264−4271.

Nicholson, J. K.; Holmes, E.; Kinross, J. M.; Darzi, A. W.; Takats,Z.; Lindon, J. C. Metabolic phenotyping in clinical and surgical environments. Nature 2012, 491, 384−392.

Duarte, I. F.; Rocha, C. M.; Gil, A. M. Metabolic profiling ofbiofluids: potential in lung cancer screening and diagnosis. Expert Rev. Mol. Diagn. 2013, 13, 737−748

Park, Y.; Jones, D. P.; Ziegler, T. R.; Lee, K.; Kotha, K.; Yu, T.; Martin, G. S. Metabolic effects of albumin therapy in acute lung injury measured by proton nuclear magnetic resonance spectroscopy of plasma: A pilot study*. Crit. Care Med. 2011, 39, 2308−2313.

Nicholson, J. K.; Wilson, I. D. High resolution proton magnetic resonance spectroscopy of biological fluids. Prog. Nucl. Magn. Reson. Spectrosc. 1989, 21, 449−501.

Gebregiworgis T, Powers R. Application of NMR Metabolomics to Search for Human Disease Biomarkers. Comb. Chem. High Throughput Screening 2012 Sept; 15 (8): 595−610.

Khilnani G C, Arafath T K L, Hadda V, Kapil A., Sood S, Sharma SK. Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia. Indian Journal of Critical Care Medicine 2011; 15(1): 16–2

Nin et al Annual Update in Intensive Care and Emergency Medicine 2012 Volume 2012 of the series Annual Update in Intensive Care and Emergency Medicine pp 43-52.

Stojkovikj J, Zafirova-Ivanovska B, Kaeva B, et al. The Prevalence of Diabetes Mellitus in COPD Patients with Severe and Very Severe Stage of the Disease. Open Access Macedonian Journal of Medical Sciences. 2016;4(2):253-258. doi:10.3889/oamjms.2016.060.

Rai, R.; Azim, A.; Sinha, N.; Sahoo, J.; Singh, C.; Ahmed, A.;Saigal, S.; Baronia, A.; Gupta, D.; Gurjar, M.; Poddar, B.; Singh, R. Metabolic profiling in human lung injuries by high-resolution nuclear magnetic resonance spectroscopy of bronchoalveolar lavage fluid (BALF). Metabolomic 2013, 9, 667−676.

McClay JL, Adkins DE, Isern NG, O’Connell TM, Wooten JB, et al. (2010) (1)H nuclear magnetic resonance metabolomic analysis identifies novel urinary biomarkers for lung function. J Proteome Res 9: 3083–3090.

Saude, E. J.; Obiefuna, I. P.; Somorjai, R. L.; Ajamian, F.;Skappak, C.; Ahmad, T.; Dolenko, B. K.; Sykes, B. D.; Moqbel, R.;Adamko, D. J. Metabolomic Biomarkers in a Model of Asthma Exacerbation. Am. J. Respir. Crit. Care Med. 2009, 179, 25−34.

Bos, L. D. J.; Weda, H.; Wang, Y.; Knobel, H. H.; Nijsen, T. M.E.; Vink, T. J.; Zwinderman, A. H.; Sterk, P. J.; Schultz, M. J. Exhaled breath metabolomic as a noninvasive diagnostic tool for acute respiratory distress syndrome. Eur. Respir. J. 2014, 44, 188−197.

Singh, C.; Rai, R.; Azim, A.; Sinha, N.; Ahmed, A.; Singh, K.;Kayastha, A.; Baronia, A. K.; Gurjar, M.; Poddar, B.; Singh, R. Metabolic profiling of human lung injury by 1H high-resolution nuclear magnetic resonance spectroscopy of blood serum. Metabolomic 2015, 11, 166−174.

Beckonert, O., Keun, H. C., Ebbels, T. M., Bundy, J., Holmes, E., Lindon, J. C., et al. (2007). Metabolic profiling, metabolomic and metabolomic procedures for NMR spectroscopy of urine, plasma, serum and tissue extracts. Nature Protocols, 2(11),2692–2703.doi:10.1038/nprot.2007.376

de Laurentiis, G., Paris, D., Melck, D., Maniscalco, M., Marsico, S.,Corso, G., et al. (2008). Metabolomic analysis of exhaled breathcondensate in adults by nuclear magnetic resonance spectroscopy.European Respiratory Journal, 32, 1175–1183.

Adamko DJ, Nair P, Mayers, Tsuyuki RT, Regush S, Rowe BH.J Allergy Clin Metabolomic profiling of asthma and chronic obstructive pulmonary disease: A pilot study differentiating diseases. Immunol. 2015 Sep;136(3):571-580.e3. doi: 10.1016/j.jaci.2015.05.022. Epub 2015 Jul 4.


  • There are currently no refbacks.