Article
Reference
Human urinary biomarkers of dioxin exposure: Analysis by metabolomics and biologically driven data dimensionality reduction
JEANNERET, Fabienne, et al.
Abstract
Untargeted metabolomic approaches offer new opportunities for a deeper understanding of the molecular events related to toxic exposure. This study proposes a metabolomic investigation of biochemical alterations occurring in urine as a result of dioxin toxicity. Urine samples were collected from Czech chemical workers submitted to severe dioxin occupational exposure in a herbicide production plant in the late 1960s. Experiments were carried out with ultra-high pressure liquid chromatography (UHPLC) coupled to high-resolution quadrupole time-of-flight (QTOF) mass spectrometry. A chemistry-driven feature selection was applied to focus on steroid-related metabolites. Supervised multivariate data analysis allowed biomarkers, mainly related to bile acids, to be highlighted. These results supported the hypothesis of liver damage and oxidative stress for long-term dioxin toxicity. As a second step of data analysis, the information gained from the urine analysis of Victor Yushchenko after his poisoning was examined. A subset of relevant urinary markers of acute dioxin toxicity from this extreme phenotype, including glucuro- and [...]
JEANNERET, Fabienne, et al . Human urinary biomarkers of dioxin exposure: Analysis by metabolomics and biologically driven data dimensionality reduction. Toxicology Letters , 2013, vol. 230, no. 2, p. 234-243
PMID : 24201000
DOI : 10.1016/j.toxlet.2013.10.031
Available at:
http://archive-ouverte.unige.ch/unige:33236
Disclaimer: layout of this document may differ from the published version.
ToxicologyLettersxxx (2013) xxx–xxx
ContentslistsavailableatScienceDirect
Toxicology Letters
j o ur na l h o me p a g e : w w w . e l s e v i e r . c o m / l o c a t e / t o x l e t
Human urinary biomarkers of dioxin exposure: Analysis by
metabolomics and biologically driven data dimensionality reduction
Fabienne Jeanneret
a,b,c,1, Julien Boccard
d,1, Flavia Badoud
c, Olivier Sorg
a,c, David Tonoli
a, Daniela Pelclova
e, Stepanka Vlckova
e, Douglas N. Rutledge
d, Caroline F. Samer
c,f,
Denis Hochstrasser
a,g, Jean-Hilaire Saurat
c, Serge Rudaz
b,c,∗aDepartmentofHumanProteinSciences,FacultyofMedicine,UniversityofGeneva,Geneva,Switzerland
bSchoolofPharmaceuticalSciences,UniversityofGeneva,UniversityofLausanne,Geneva,Switzerland
cSwissCentreforAppliedHumanToxicology,UniversityofGeneva,Geneva,Switzerland
dAgroParisTechUMR1145,LaboratoiredeChimieAnalytique,Paris,France
eCharlesUniversityPrague,DepartmentofOccupationalMedicineoftheFirstFacultyofMedicineandGeneralUniversityHospital,Prague,CzechRepublic
fClinicalPharmacologyandToxicology,GenevaUniversityHospitals,Geneva,Switzerland
gDepartmentofGeneticandLaboratoryMedicine,GenevaUniversityHospitals,Geneva,Switzerland
h i g h l i g h t s
•Highlight of biomarkers of dioxin exposurebymetabolomics.
•Datadimensionalityreductiondone by chemical and biological knowl- edge.
•Steroidandbileacidpatternaremod- ifiedbydioxinexposure.
g r a p h i c a l a b s t r a c t
a r t i c l e i n f o
Articlehistory:
Available online xxx Keywords:
Steroidomics Extremephenotype Dimensionalityreduction Dioxin
Toxicity Biomarkers
a b s t r a c t
Untargetedmetabolomicapproachesoffernewopportunitiesforadeeperunderstandingofthemolec- ulareventsrelatedtotoxicexposure.Thisstudyproposesametabolomicinvestigationofbiochemical alterationsoccurringinurineasaresultofdioxintoxicity.UrinesampleswerecollectedfromCzech chemicalworkerssubmittedtoseveredioxinoccupationalexposureinaherbicideproductionplantin thelate1960s.Experimentswerecarriedoutwithultra-highpressureliquidchromatography(UHPLC) coupledtohigh-resolutionquadrupoletime-of-flight(QTOF)massspectrometry.Achemistry-drivenfea- tureselectionwasappliedtofocusonsteroid-relatedmetabolites.Supervisedmultivariatedataanalysis allowedbiomarkers,mainlyrelatedtobileacids,tobehighlighted.Theseresultssupportedthehypoth- esisofliverdamageandoxidativestressforlong-termdioxintoxicity.Asasecondstepofdataanalysis, theinformationgainedfromtheurineanalysisofVictorYushchenkoafterhispoisoningwasexamined.
Asubsetofrelevanturinarymarkersofacutedioxintoxicityfromthisextremephenotype,including glucuro-andsulfo-conjugatedendogenoussteroidmetabolitesandbileacids,wasassessedforitsability todetectlong-termeffectsofexposure.Themetabolomicstrategypresentedinthisworkallowedthe determinationofmetabolicpatternsrelatedtodioxineffectsinhumanandthediscoveryofhighlypre- dictivesubsetsofbiologicallymeaningfulandclinicallyrelevantcompounds.Theseresultsareexpected
∗Correspondingauthorat:SchoolofPharmaceuticalSciences,UniversityofGeneva,20Bdd’Yvoy,1211Geneva4,Switzerland.
Tel.:+41223796572;fax:+41223796808.
E-mailaddress:serge.rudaz@unige.ch(S.Rudaz).
1 Bothauthorscontributedequallytothiswork.
0378-4274/$–seefrontmatter© 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.toxlet.2013.10.031
2 F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx
toprovidevaluableinformationforadeeperunderstandingofthemoleculareventsrelatedtodioxin toxicity.Furthermore,itpresentsanoriginalmethodologyofdatadimensionalityreductionbyusing extremephenotypeasaguidetoselectrelevantfeaturespriortodatamodeling(biologicallydrivendata reduction).
© 2013 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
Dioxinsaretoxicandextremelypersistentandastheydegrade veryslowlyandaccumulatethroughthefoodchain,manypeople mayberepeatedlyexposedtolowamountsofdioxin-likecom- pounds,makingthisaquestionofpublichealthconcern(Giesetal., 2007;Steenland etal., 2001).Theirinfluenceon humanhealth atlow levelsremainspoorly understood.Theeffects of2,3,7,8- tetrachlorodibenzo-p-dioxin (TCDD) are mainlymediated byits bindingtothearylhydrocarbonreceptor(AhR)(BockandKohle, 2009).Hepaticdamages,neurologicaleffects,diabetes,atheroscle- rosisandhypertensionwereassociatedwithhumanacutedioxins exposure.TCDDhasbeenclassifiedasahumancarcinogenbythe WorldHealthOrganisationandtheUSNationalToxicologicalPro- gram(IARC,1997).Thisfactiscontroversial,becauseallevidences forarelationshipbetweenTCDDandhumancarcinogenesisare indirect.TCDDhasaverylongbiologicalhalf-lifeandisnotmuta- genic,andnostudycoulddemonstratethatTCDDisacarcinogen inhumans(Boffettaetal.,2011).
Themostseverehumanintoxicationsoccurredafterindustrial accidentsduetouncontrolledformationofTCDD,e.g.Seveso(Italy) in1976(Bertazzietal.,2001),Neratovice(CentralBohemiainthe formerCzechoslovakia)in1965–1968(Pelclovaetal.,2001)and Ludwigshafen(Germany)in1953(Zoberetal.,1997).Themassive spreadingofAgentOrange,aTCDD-contaminatedherbicide,during theVietnamWaralsoledtosevereintoxications(Gochfeld,2001).
Additional TCDD exposure cases were reported, including two womenexposedinVienna(Austria)inatextileresearchinstitute in1997–1998(Geusauetal.,2001)andthedeliberatepoisoning ofUkrainianpresidentVictorYushchenko(VY)inSeptember2004 (Sauratetal.,2012;Sorgetal.,2009).AllthesecasesofacuteTCDD intoxicationsresultedinchloracne.Thisskinlesionplaystherole ofasentinelsignfordioxinordioxin-likecompoundsexposure, asthereiscurrentlynootherreliablehumanbiomarkerofsuch intoxication.Theconfirmationisusuallydonebydirectdioxinmea- surementinblood,aprotocolwhichisnotroutinelyimplemented inmosthospitallaboratories.
Relevantandsensitivebiomarkersarethereforehighlydesir- abletodetecttheonsetofdioxintoxicitybeforetheappearanceof clinicalmanifestationsandmetabolomicsconstitutesapromising approachforthatpurpose.Metabolomicsisablossomingresearch fieldwhichhasbeendemonstratedasavaluableapproachtomon- itorthe chemical diversity of complex biological systems from aholisticangle(Goodacreet al.,2004).It aimsatdepictingthe moleculareventsassociatedwithbiologicalprocessescharacter- izinglivingsystems,atthetissue,theorganorthewholeorganism level.Thisdescriptioncanberelatedtophysiologicalconditionsor tothereactiontopathological,environmentalordevelopmental perturbations(NicholsonandLindon,2008).Thankstoitsability tomonitoralterationsofendogenousmetaboliteslevels,butalso xenobioticsandtheirbiotransformationproducts,metabolomics wasquicklypromotedasarelevanttoolforassessingbiochemical phenotypesrelatedtotoxicity(Lindonetal.,2003).
Duetotheever-increasingsensitivityandresolutionofmod- ernanalyticalplatformscommonlyusedinmetabolomics,suchas massspectrometry(MS),akeychallengewhenachievinguntar- getedanalysesistreatingtheveryhighnumberofrecordedsignals (Boccardetal.,2010).Biologicallyrelevanthypothesesareharder tofindwhenhandlingthesemassivelymultivariatedata.Variable
selectionintendstoreducethesizeofthedatabyselectingsubsets ofrelevantvariables,i.e.biomarkersabletorepresentthesalient characteristicsofthephenomenonunderstudy.Knowledge-based dimensionalityreductionisveryusefultoreducethesizeofthe hypothesisspaceandprovidemoreparsimonioussolutionstobio- logicalproblems(Mitchell,1997).
TodateonlyfewmetabolomicstudiesassessingTCDDtoxicity basedoncelllinesorrodentmodelswerereported.Mostresults highlightedchangesrelatedtoaminoacidsandlipidmetabolism includingfattyacidsorbileacids(Forgacsetal.,2012;Linetal., 2011a,b;Ruiz-Aracamaetal.,2011).Ametabolomicinvestigation ofserumsamplesfromworkersexposedtoTCDDwasachieved recentlybutnomajoralterationcouldbedetected(SaberiHosnijeh etal.,2013).
Findingaclinicallyrelevantmetabolicpatternofdioxintoxicity inhumansconstitutesakeyissueintheperspectiveofdiagnos- ticandprognosticproceduresandlong-termexposureisprobably themostrelevantsituationinthecontextofhumanhealthcare.
Theobjectiveofthisworkwastoinvestigatelong-termeffectsof dioxintoxicity relatedtooccupational exposuretoTCDD.Urine samples from a cohort of Czech workers were analyzed on a platformhyphenatingultra-highpressureliquidchromatography (UHPLC) to quadrupole time-of-flight (QTOF) mass spectrome- try. Since dioxins have been regularly described as perturbing thesteroidprofile,avalidatedmethoddedicatedtotheanalysis ofglucuro-and sulfo-conjugatedformsof someandrogens was applied(Badoudetal.,2011).AstheQTOFtechnologyallowsthe untargeted screening of metabolites, it could help findingnew biomarkers,asreportedrecentlyfortestosteroneintakeinthecon- textofanti-doping(Boccardetal.,2011).Anoriginaldatatreatment strategyusingbiologicalknowledgeaswellasstatisticaltoolswas implementedtoobtainasmallsubsetofbiomarkersabletochar- acterizecasesofTCDDintoxication.Forthispurpose,anextreme phenotypecasewasusedasareference.Phenotypicextremesare expectedtoprovidecharacteristicpatternsoftoxicityforthedetec- tionofreliablebiomarkers.Themostcontributingfeaturesdetected duringtheinvestigationofacaseofacuteintoxication(extreme phenotype) wereselected for furtheranalysisof thelong-term effects ofdioxin exposure. Therefore,thedata analysisstrategy integratedchemicalandphenotypicinformationforthedetection ofrelevanttoxicitybiomarkers.
2. Experimental
2.1. Chemicalsandreagents
5␣-Androstan-3␣-ol-17-one sulfate sodium salt (androsterone sulfate),4- androsten-17-ol-3-onesulfatesodiumsalt(testosteronesulfate),4-androsten- 17␣-ol-3-one sulfate sodium salt (epitestosterone sulfate), 5-androstan-3␣- ol-17-one sulfate sodium salt (etiocholanolone sulfate), 5-androsten-3-ol- 17-one sulfate sodium salt (dehydroepiandrosterone sulfate), 4-androsten- 17-ol-3-oneglucosiduronate(testosteroneglucuronide),4-androsten-17␣-ol-3- oneglucosiduronate(epitestosterone glucuronide),5-androstan-3␣-ol-17-one glucosiduronate (etiocholanolone glucuronide), 5-androsten-3-ol-17-one glu- cosiduronate(dehydroepiandrosteroneglucuronide)and5␣-androstan-17-ol-3- oneglucosiduronate(dihydrotestosteroneglucuronide)werepurchasedfromSter- aloids(Newport,RI,USA).4-Androsten-17␣-ol-3-onesulfate(epitestosteronesul- fate),5␣-androstan-3␣-ol-17-one-3␣-d-glucuronide(androsteroneglucuronide), [16,16,17␣-2H3]androst-4-en-17␣-ol-3-onesulfate triethylammonium salt (TS- d3), [16,16,17-2H3] androst-4-en-17-ol-3-one sulfate (ES-d3), [2,2,3,4,4-
2H5]5-androstan-3␣-ol-17-onesulfate(EtioS-d5),[2,2,4,4-2H4]5␣-androstan-3␣- ol-17-onesulfate(AS-d4),[16,16,17␣-2H3]androst-4-en-17-ol-3-oneglucuronide (TG-d3), [16,16,17␣-2H3]androst-4-en-17␣-ol-3-one glucuronide (EG-d3), and
F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx 3
[2,2,4,4-2H4]5␣-androstan-3␣-ol-17-one glucuronide (AG-d4) were purchased from LGC Standard GmbH (Wesel, Germany). Water, acetonitrile (ACN) and methanol (MeOH) were ULC–MS quality and were obtained from Biosolve (Valkenswaald,TheNetherlands).Formicacid(FA)andammoniumhydroxidewere purchased,respectively,fromMerck(Darmstadt,Germany)andfromSigma–Aldrich (Buchs,Switzerland).
2.2. Urinesamples 2.2.1. Czechcohort
Anuncontrolleddecompositionreactionoccurredduringtheproductionofthe herbicidetrichlorophenolaceticacidinaCzechplantduringtheyearsbetween 1965and1968.ItleadedtotheformationofTCDD.TheTCDDbloodlevelsof80 workerswereestimatedtoabout5000pg/gbloodlipidatthetimeofexposure (Pelclovaetal.,2001).Amongthesepatients,11arestillmedicallyfollowedbythe CharlesUniversityofPragueinCzechRepublic(Pelclovaetal.,2002,2006,2007, 2009,2011;Urbanetal.,2007).24hurinesampleswerecollectedin2011andkept at−80◦C.These11workerswerebornbetween1940and1946andwereexposed todioxinforperiodsfrom10daysto23months(Pelclovaetal.,2009).Samples fromhealthyvolunteersmatchedforage(65–70yearsold)werealsocollectedto constitutethecontrolgroup(CTRL65group,n=11).Thesesampleswereprovidedby theGenevaUniversityHospital(anonymousurineswithnon-pathologicalresults, protocolnumberCE11-111approvedbytheethicalcommission).
2.2.2. VictorYushchenko
VYwaspoisonedthe6thSeptember2004.HisTCDDbloodlevelwasabout 108,000pg/gfatfourmonthsafterintoxication(Sorgetal.,2009).Variousurine sampleswerecollectedinUkraineorinSwitzerlandthemonthsandyearsfollow- ingthepoisoning(Sauratetal.,2012).Thesesampleswerethenkeptat−80◦C inGeneva.Elevensampleswereavailableforanalysis:thefirstsampleswerecol- lectedabout15monthsafterthepoisoningandthelastsampleabout3yearslater.
ThesampleswerelabeledwiththeabbreviationVYfollowedbythenumberof monthsafterintoxication.Thedayofintoxication(06.09.2004)wassettotime0.
Samples:VY-15.5(22.12.2005),VY-21.5(23.06.2006),VY-22.9(05.08.2006),VY-23 (08.08.2006),VY-28.5a(20.01.2007),VY-28.5b(21.01.2007),VY-28.5c(22.01.2007), VY-32.2(14.05.2007), VY-34.1(11.07.2007), VY-39.3(14.12.2007) andVY-46.1 (10.07.2008).SamplesVY-28.5atoVY-28.5ccorrespondedtothreecollectsof24h atthreesuccessivedays.Samplesfromhealthyvolunteersmatchedforage(50–55 yearsold)werealsocollectedtoconstitutethecontrolgroup(CTRL50group,n=12).
ThesesampleswereprovidedbytheGenevaUniversityHospital(anonymousurines withnon-pathologicalresults,protocolnumberCE11-111approvedbytheethical commission).
2.3. Analysisofurinesamples
Urinesampleswereanalyzedintriplicatebyusingasolidphaseextractionpro- tocolpriortoUHPLC–MS.AthoroughdescriptioncanbefoundinBadoudetal., 2011.Briefly,1mLofurinewasdilutedwith1mLof2%FAspikedwith10Lofthe internalstandardsolution(ES-d3,EtioS-d5,AS-d4,TG-d3,EG-d3andAG-d4).Oasis HLBcartridgesof30mg(96-wellplate)wereconditionedwith500LofMeOH andequilibratedwith1mLof2%FA.Thedilutedurinesampleswereaddedtothe cartridges.Washingwasdoneby1mLof2%FA,followedby1mLofa5%ammo- niumhydroxide/MeOH(90/10,v/v)solution.Metaboliteswereelutedwith500L ofMeOH/water(40/60,v/v)andthenevaporatedtodrynessunderazotestream.
Thedryresidueswereresuspendedin100LofACN/water(30/70,v/v).
2.4. Instrumentalconditions
AnAcquityUHPLC-QTOF-MS(XevoTM,Waters)systemwasusedfortheanalysis ofsteroidandothermetabolitesinurine.CompoundswereseparatedonanAcquity UPLCcolumn(BEHC18150mm×2.1mm,1.7m),precededbyaVanGuardpre- column(BEHC18,5×2.1mm,1.7m).AgradientofmobilephaseA(0.1%FAin water)andmobilephaseB(0.1%FAinACN)wasusedlinearlyfrom5%to37%B over25min,followedbyawashingstepof95%Bfor3minandare-equilibrationof 8min.Thesamplevolumeinjectedwas10Linthefullloopmodeandthesamples weremaintainedat4◦Cintheautosampler.
TheQTOFXevowasequippedwithanelectrosprayionization(ESI)source operatedinthenegativemode.Followingoperatingconditionswereused:thedes- olvationgasflowwas800L/hwithatemperatureof360◦C,thecapillaryvoltagewas definedat2.4kV,theconevoltagewaskeptconstantat50V,thesourcetempera- turewas120◦C,theconegasflowandthecollisiongasflowweresetto10L/hand 0.25mL/min,respectively.Twofunctionswereusedfortheacquisitions:awide- passquadrupolemodewithlowcollisionenergy(5eV)forthefirstfunction(range m/z95–1000)andacollisionenergyrampof5–70eVforthesecondfunction(MSE, rangem/z50–1000).Datawerecollectedincentroidmodewithascantimeof0.2s andaninterscandelayof0.02s.Dynamicrangeenhancement(DRE)wasusedand recalibrationofthedataweremadewiththeinfusionofasolutionof2ng/mLof Leucine-enkephalin(Sigma–Aldrich,Buchs,Switzerland)throughtheLockSpray probeat20L/min.
2.5. Dataanalysis
Rawdatapre-treatment,includingbaselinecorrection,peakdetection,chro- matogramalignment,peakintegrationandnormalizationwereachievedwith MarkerLynxXSTM(SCN854,Waters).Theparametersweresetasfollows:peak detectionfrom1to29.5mininthem/z95–1000massrange,themasstoleranceset to0.05amu,chromatogramalignmentperformedusingEG-d3internalstandard, thepeakwidthat5%heightsetto25s,thepeak-to-peakbaselinesetto15,themass windowsetto0.05amu,retentiontimewindowsetto0.8min,noiseelimination levelsetto15,themarkerintensitythresholdsetto500countsandthenormal- izationperformedaccordingtothesumofthetotalreconstitutedspectra.Afirst filteringprocedurewasachievedwiththeMarkerLynxXSTMReplicatefunctionto selectonlyreliablepeaks.Individualsampleswerethenconsideredasbiological replicatesandpeakswerekeptforfurtheranalysiswhentheywerepresentatleast in50%ofadefinedgroup(VYsamples,Czechworkers,etc.).Thisstrategyallowed theremovalofnoisyandirrelevantvariablesfromthedatamatrixandareduced datatableof3682ionswasobtained.
Chemistry-drivendimensionalityreductionwasperformedwithin-houserout- inesundertheMATLAB®7environment(TheMathWorks,Natick,USA).Orthogonal partialleastsquaresdiscriminantanalysis(OPLS-DA)modelswerecomputedwith theSIMCA-Psoftware(version12,Umetrics,Umeå,Sweden).Aleave-one-outcross- validationwasachievedtoassessthepredictiveabilityofthemodels.CV-ANOVA (Erikssonetal.,2008)andpermutationtestswereperformedtoensurethevalidity ofthemodels.
3. Resultsanddiscussion
3.1. ExploratoryanalysisoftheCzechcohort:long-termeffectof dioxintoxicityfollowinganacuteoccupationalexposure
Between1965and1968,a groupof Czechchemicalworkers (approximately 80 people) were subjected tointoxication with dioxinsinaherbicideproductionplantinCentralBohemia,aregion of formerCzechoslovakia. Earlyexaminationsweredonein the 1970sandallmensufferedfromchloracne.Thissymptomwasstill reportedfortwopatients,30yearsafterexposurewithextremely highplasmalevelsofTCDD.Plasmalipidalterationswereobserved duringthefollow-upperiodandseveralpatientsmanifestedneu- ropsychological,and neurologicalabnormalities (Pelclova etal., 2001).TCDDlevelsbetween25andabout400timesthenormal populationandchroniceffectsincludinghyperlipidaemia,hyper- tensionanddiabeteswerefurtherdescribed40yearsafterexposure (Pelclovaetal.,2009).Thesepreviousstudiesunderlinedthere- foretheelevatedpersistenceofTCDDinthebodyassociatedwith long-termeffectsonhumanhealth.Ithastobenotedthatthese effectscanbeobservedseveraldecadesaftersevereintoxication andmetabolicdisordersareexpectedtosubsist.Ofthe80intoxi- catedworkers,urinesamplesof11workerscollectedin2011were availableforthepresentstudy.Thesesampleswereanalyzedto evaluatethelong-termeffectofdioxintoxicity(about40yearsafter exposure).
Severaladvantagesarederivedfromtheuseofurineasaref- erencebiofluidtomonitortoxicity,suchaseasyandnon-invasive samplingandreducedsamplepreparationcomparedtobloodas noproteinprecipitationisrequired(Ryanetal.,2011).However, thecomplexityofurinesamplesremainshighwhenperforming untargetedexperiments,evenafterensuringtheproperselectionof consistentdatafromtherawsignal.Additionally,theircontentcan begreatlymodifiedbyseveralphysiologicalandenvironmentalfac- tors,suchasage,diet,diurnalvariationandmedication.Measuring metabolites in urine in an untargeted manner remains there- foreachallengingtaskduetothenumerousconfoundingfactors.
Inclinicalpractice,aknowledge-baseddimensionalityreduction maythereforebehighlydesirabletoavoididiosyncraticresponses relatedtoatherapeuticinterventionduringuntargetedanalyses.
Chemicaldatamayconstituteavaluablesourceofinformationto definecriteriaforselectingvariablesandsimplifyingmultivariate models.
Achemistry-drivendimensionalityreductionwasrecentlypro- posed to filter untargeted metabolomic data and specifically
4 F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx assessurinarysteroidmetabolitesinthecontextofdopingcon-
trol(Boccard et al., 2011). Asdioxin is known to alter steroid metabolism,asimilarprocedurewasappliedinthisstudytofocus onthesteroidsubsetofurinarycompounds(Egelandetal.,1994;
Grochowalskietal.,2001;Kleemanetal.,1990;Manhetal.,2013;
Sechmanetal.,2011).Inpracticalterms,rawdatawereprocessed withMarkerLynxXSTMtogeneratealistof3682peakspersam- ple(seeSection2formoredetails).Eachofthe3682unidentified peakswasthencompared witha seriesofreferencem/zvalues extracted from theLipidMaps database,related to endogenous glucuronidated and sulfated steroid conjugates from the sterol lipidsclass(Fahyetal.,2009).Peaksmatchinga referenceentry withinatoleranceintervalof±0.025amuwereconsideredasputa- tivesteroid-relatedmetabolitesandretainedforfurtheranalysis, whileretentiontimeswerenotconsideredintheselectionpro- cess.Aseriesof284steroid-relatedcompoundswasobtainedafter thissecond selectionstep correspondingtoapproximately7.7%
ofthedetectedfeatures.Thesteroidnatureoftheselectedcom- poundscouldbecheckedbytheanalysisoffragmentationpatterns obtainedintheMSEmode.
DatawerePareto-scaledandanOPLS-DAmodelwascomputed todistinguishexposedpatients(n=11)fromagroupofhealthy volunteers(n=11)onthebasisof the284variables (model#1).
Thismodelingapproach allowsa straightforwardinterpretation oftheresultsbyseparatingthepredictivevariationfromortho- gonalsourcesofsystematicvariability(TryggandWold,2002).The predictivescoresand loadingvectorsarelesspronetoundesir- ablevariationsandrelevantpatternscanbemoreeasilyrelated toa meaningfulbiologicalcontext.Thecontrolgroupwascom- posedof healthy menmatched for age (65–70years old)with non-pathologicalresultsforurine dipstick chemical analyses.A modelwith2latentvariables(onepredictiveandoneorthogonal) wasobtainedandaclearseparationofthetwoclasseswasobserved onthescoreplot(Fig.1A).Themodelvaliditywasestimatedby LOOCVandsatisfactorystatisticalindiceswerereported,i.e.global accuracyof95.5%,specificityof 90.9%,sensitivityof100.0% and CV-ANOVAp-value p<0.05. Due tothe relativelylimited num- berof samplesavailable for buildingthemodel (n=22) and as cross-validationmaybeoverlyoptimisticwhenassessingpredic- tiveability,theriskofoverfittingmustbeconsidered.Despitethis limitation,thecontributionofthe284variableswasassessedby theinvestigationoftheS-plotrelatedtothepredictivecomponent (Fig.1B).Thisrepresentationallowsboththeamplitudeofvariation andthereliability ofeachvariabletobesummarizedin aprac- ticalway bycombiningcovariance andcorrelation information, respectively(Wiklundetal.,2008).Bythesemeans,themostdis- criminantvariablescouldbehighlighted(blackcircles,
䊉
).Someof them,suchasetiocholanoloneglucuronideandandrosteroneglu- curonide,wereunambiguouslyidentifiedbycomparingtheirmass spectraandretentiontimeswithauthenticstandards.Additionally,othersteroid metaboliteswerepartiallyidenti- fied on the basis of accurate mass measurements and several unknownfeaturesweretentativelyassociatedtobileacids.Dioxin- inducedincreasedlevelsofglycocholicacidanditsglucuronide metabolite(m/z464.299at13minand m/z640.333at6.5min), glycodeoxycholic acid (m/z 448.306 at 20.3min), chenodeoxy- cholic acidsulfate or ursodeoxycholic acid sulfate (m/z 471.24 at23.2min)andbothglucuro-andsulfoconjugatesofglycochen- odeoxycholic acid (m/z 624.338 at 22min and m/z 528.262 at 20.3min).Decreasedconcentrationsduetodioxinexposurewere associatedwithglucuroconjugatedformsofthefollowingsteroids:
hydroxyandrosteroneorhydroxyetiocholanolone(m/z481.241at 10.1min),hydroxyDHEAorhydroxytestosterone(m/z479.228at 9.6min),etiocholanolone(m/z465.246at20.6min) andestrone (m/z 445.19at 6.3min). Glycoursodeoxycholic acidglucuronide (m/z 624.336 at 14min) and sulfate (m/z 528.261 at 11.8min)
metabolites were also decreased. Steroids and bile acids have numerousstructuralisomersordiastereoisomersthatcannotbe resolvedbymassspectrometryfragmentation.Thereforethemen- tionedidentifiedmetabolitescouldalsocorrespondtoanisomer oradiastereoisomer.Theidentificationofthesemarkerscanonly bemadewithauthenticstandards,butmodifiedlevelsofthisclass ofcompoundsweredetected.
These results were in accordance with previous studies, as alteredcholesterolmetabolismandbileacidbiosynthesiswasasso- ciated toTCDD toxicity in severalin vitro and invivo models.
TranscriptomicshighlightedalteredmRNAlevelsofgenesrelated tocholesterolandfattyacidsbiosynthesisandglucosemetabolism intheliverofTCDDdaily-exposedmice(Satoetal.,2008).Expres- sion changes in genes involved in cholesterol metabolism and bileacidssynthesisweresimilarlyreportedinratsafterexposure tohigh-doseofTCDD(Fletcheretal.,2005;Moffatetal.,2010).
TCDDexposurewasalsoassociated withthedisruptionoflipid metabolisminguineapigsbyalteringgenesinvolvedinadipogene- sisandlipogenesis(Nishiumietal.,2008).Asawhole,theseresults supportthehypothesisofcholesterolhomeostasisdysregulation followingTCDDexposuremediatedbyAhR.
Asalreadyobservedbyseveralauthorsinvariousmetabolomic studies,thenumberofvariablesinthecurrentmodel(284)istoo highforanexhaustiveidentificationofallputativebiomarkersand for a directinterpretation.Anotherfiltering stepwasthus per- formedbytakingadvantageofthedataoriginatingfromanidenti- fieddioxinacuteintoxication,i.e.urinesofVictorYushchenko.
3.2. ExploratoryanalysisofVictorYushchenkourinesamples:
extremephenotypeduetoanacutepoisoningwithTCDD
VictorYushchenko(VY),candidateforthepresidencyinUkraine waspoisoned withasinglehighdoseofdioxinduringadinner inSeptember2004.Hebecameseverelyill,sufferingofgastritis, colitis,hepatitis,neuropathyandpancreatitis.Chloracneappeared afewweekslater.Thesymptomswereclearlydescribedandprior analysessuggestedanacuteintoxicationwithpureTCDD(Saurat etal.,2012;Sorgetal.,2009).
Asignificantapproachinepidemiologyconsistsintheidenti- ficationandthespecificstudyofpatientswithclinicallyrelevant phenotypes,ratherthanunselectedpatients,toprogressmoreeffi- cientlyintheunderstandingofadisease(Perez-Graciaetal.,2010).
Asmultifactorial effects can produceintricate phenomena hin- deringproperinterpretationinhumanstudies,thesephenotypic extremesareexpectedtofacilitatedetectionofthecharacteristic symptomsofadisease.Inthecontextoftoxicology,acollection ofvariousphenotypescanrangefromchroniclowdosetoacute toxicexposure.Moreparticularly,thecharacterizationofextreme phenotypessuchasacuteintoxicationepisodesmayprovidevalu- ableinformationfor adeeperunderstandingofthecellularand moleculareventsoccurringaftertoxicexposure.Inotherwords, thediscoveryofbiomarkersofanacuteintoxicationcouldprovide informationforabetterunderstandingofTCDDexposure.
DuetothepathologiesVYsufferedandhispoliticalschedule, nostructuredexperimentalsetupcouldbedefinedforsamplecol- lection:samplingandcollectiontimesoftheurinarysampleswere notedbutirregular.UrinessamplesofVYwerecollectedatdiffer- enttimepointsaftertheintoxication(about1yearto4yearsafter thepoisoning,seeSection2).
Preliminaryinvestigationsweredonetoevaluatetheurinesof VYasahomogeneousgroupandtoselectthemostrelevantfea- turesabletodistinguishVYfromacontrolgroupofthesameage.
Furthermore,thispreliminarystudywasmandatorytoexcludethe presenceofundesirabletrendortemporalbiasinthisparticular urineset.Forthelatter,notemporaldriftafterthepoisoningcould beclearlyestablishedusingvariousstatisticaltools.Todecreasethe
F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx 5
Fig.1. OPLS-DAmodel#1basedon284steroid-relatedvariables.(A)Scoreplot:urinesamplesfromCzechchemicalworkersexposedtodioxinaresymbolizedwithblack diamonds()andsamplestakenfromhealthyvolunteersbywhitesquares().(B)S-plot:discriminatingvariablesaresymbolizedbyblackcircles(䊉).
numberofexogenousmarkersoriginatingfromtherapyatapartic- ularsamplingtime,featuresdetectedinatleast50%ofVYsamples wereretained(seeSection2).Thisprocedureallowedmetabolites relatedtospecificdrugdeliverytoberemovedfromthedataand todecreaseintra-individualvariability.
Multivariatedataanalysiswasperformedtodifferentiateurine samplesfromacontrolgroupofvolunteersmatchedforageandthe samplescollectedduringYushchenko’smedicalcare.Paretoscaling wasappliedtothedatatableandanOPLS-DAmodelwascomputed.
Asatisfactorymodelwithonepredictiveandoneorthogonallatent variablewasobtained(model#2)andaclearseparationofthetwo classesofobservationswasobservedonthescoreplot(datanot shown).Cross-validationwascarriedoutindicatinga significant CV-ANOVAp-valuep<0.001.Nofalsenegativeorfalsepositivepre- dictionwasreported.AS-plotwasthenbuilttohighlightthemost relevant markers.Identifications wereinvestigated in multiples opensourcesdatabasessuchastheHumanMetabolomeDatabase, theMETLIN Metabolite Database or Chemspider for exogenous compounds.DespitetheremovalofunreliableMSsignalsduring data pre-treatment, first observations indicated putativestruc- turesmainlymatchingexogenouscompounds.Theseresultswere closelyrelatedtothevariousdrugtherapiesVYreceivedduringthe yearsfollowingpoisoning.
Thetwo firsttop-ranked elevatedmarkerswere assignedto propofol glucuronide (m/z 353.150 at 16min) and 4-hydroxy- propofolhydrogensulfate(m/z273.072at7.2min).Propofolisa widespreadsedative-hypnotic agentusedfor theinduction and maintenanceof generalanesthesia.The metabolismofpropofol is wellstudiedandvarious urinary metabolitesweredescribed (Favettaetal.,2000).Thevariablecorrespondingtothepropofol glucuronidewasfoundtobeveryintenseinsomeurinesamples (e.g.VY-28.5a)anditsMSEspectracorrespondedtotheexpected fragmentation pattern. As a complementary indication for this identification,the medicationreport confirmed that VYwas in surgeryatthecorrespondingsamplingtime points.Otheranes- thetic agents, such as sevoflurane (m/z 166.992 at 6.4min) or its metabolitehexafluoroisopropanol (HFIP, same chemical for- mula:C3H2F6O)werealsohighlighted.Accordingtotheliterature, sevoflurane,HFIPandHFIPglucuronidecouldberetrievedinurine (Accorsietal.,2005).Somenon-steroidalanti-inflammatorydrugs werealsodetected,suchasibuprofenmetabolite(m/z381.151at 21.6min).Overall,severalofthemostcharacteristicallyelevated biomarkersofVYsampleswereduetomedication.Nevertheless, poisoningwithaveryhighdoseofTCDDcouldleadtoexpressed biomarkersthatshouldbedetectedwhateverthedrugtherapy.
It hasto benoted that previousresults of blood and urine VYsamples highlightedsomeabnormallevels ofsteroids(Sorg andSaurat,unpublishedresults).Therefore,thesteroid-basedfil- teringstrategy usedfortheanalysisofsamplesfromtheCzech Cohortwasimplemented.Paretoscalingwasappliedtothedata subset of 284 steroid-related features and an OPLS-DA model wasassessed.Asatisfactorymodelwithonepredictiveandone orthogonallatentvariablewasobtained(model#3)andaclearsep- arationof thetwoclasses ofobservations wasobservedonthe scoreplot(Fig.2).Cross-validationwascarriedoutindicatingahigh accuracyofprediction(90.9%)andahighlysignificantCV-ANOVA p-valuep<0.001.Nofalsenegative(sensitivityof100%)andonlya fewfalsepositivecases(specificityof81.8%)werereported.
AnS-plotwasinvestigatedtohighlightrelevantbiomarkersof acuteTCDDtoxicity.Theurinarylevelsofaseriesof12compounds wereincreasedin VYsamples,while12 others weredecreased when compared tocontrols. Thesevariables and theirputative identificationbasedonreferenceentriesofthesteroidfilteraredis- playedinTable1.Amongthem,somesteroidssuchasDHEAsulfate, androsteronesulfateandandrosteroneglucuronidewereidentified withauthenticstandards,whileotherswereevaluatedbyMSEfrag- mentationandsearchintheliterature(seeSupplementaryMaterial forexamplesofputativeidentification).
Supplementarymaterial related tothis articlecan befound, in the online version, at http://dx.doi.org/10.1016/j.toxlet.
2013.10.031.
These results were consistent with the scarce clinical data reportingtheeffectsofacutedioxintoxicitywithalteredsteroid metabolism and liver damage. The strong induction of the cytochrome P4501A1(CYP1A1) coding genewasreportedin a study combining transcriptomics analysesand immunostaining of Yushchenko’s skin lesions (Sauratet al., 2012). Cytochrome P450enzymesformamultigene familymetabolizingthousands ofendogenouscompoundssuchassteroidsaswellasexogenous chemicalssuchasdrugsortoxicchemicals.Theobservedactiva- tionofCYP1A1wasassociatedwithdioxinmetabolizationandthe reductionofthesystemictoxicity.Alteredcholesterolmetabolism andbileacidbiosynthesiswasalsoassociatedtoTCDDtoxicityand cytochromeP450modulationinseveralinvitroandinvivomod- els(Fletcheretal.,2005;Moffatetal.,2010;Rifkind,2006).These resultssupportthehypothesisofthedioxin-induceddevelopment ofoxidativestressbyalterationsofcytochromeP450sexpression and bile acidshomeostasis dysregulation(Pelclovaet al.,2011;
Reichardetal.,2005).Furthermore,othertranscriptsimplicatedin theregulationofbileacidsynthesissuchasCYP7A1,CYP46A1and
6 F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx
Fig.2.VYOPLS-DAbasedon284steroid-relatedvariables(model#3).(A)Scoreplot:urinesamplesfromVYaresymbolizedwithblacktriangles()andsamplestakenfrom healthyvolunteersbywhitesquares().(B)S-plot:discriminatingvariablesaresymbolizedbyblackcircles(䊉).
CYP27A1wereexpressedintheskinbiopsyofVY(SorgandSaurat, unpublishedresults).The24variableshighlightedtobethemost importantfeaturestodiscriminateVYsampleswereproposedasa metabolicpatternforthedetectionofacutedioxintoxicityaswell asabasisfortheselectionoffeaturesintheCzechdataset.
3.3. Applicationofthephenotype-baseddimensionalityreduction totheCzechcohort
BasedonthebiomarkersobtainedfromtheanalysisofVYsam- ples,anOPLS-DAmodelwascomputedfortheCzechdataseton thebasisofthe24selectedvariables(model#4)asaphenotypic selectionfilter.Aschemeoftheknowledge-basedvariableselection procedureispresentedinFig.3.
Amodelwith2latentvariables(model#4,onepredictiveand oneorthogonal)wasobtainedwithasatisfactorypredictionaccu- racyof 90.9%estimated byLOOCVand asignificantCV-ANOVA p-valuep<0.05.Ithastobenotedthatthetwoclasseswerenot
perfectlyseparated onthescore plot(Fig.4A),but similarlyto model#1,nofalsenegatives(sensitivityof100%)andasmallnum- beroffalsepositivecases(specificityof81.8%)werereportedduring cross-validation.Theseresultsareparticularlyrelevantinthecon- textofchronictoxicitydetection,asnorealcaseofintoxication waswronglypredicted.Thisfurtherconfirmsthereliabilityofthe selectedbiomarkersandtheirabilitytocharacterizebothacuteand long-termdioxinintoxicationphenotypes.
Interestingly,severalcompoundshighlightedinmodel#1were also reported as relevant biomarkers in the restricted subset.
AccordingtotheS-plot(Fig.4B),a smallnumberofcompounds couldberelated totheclassseparation.The upperrightregion correspondingtodecreasedconcentrationsafterdioxinexposure includedglycoursodeoxycholicsulfate(m/z528.261at11.8min), hydroxyDHEAorhydroxytestosteroneglucuronide(m/z479.228 at9.6min),andhydroxyandrosteroneorhydroxyetiocholanolone glucuronide (m/z 481.241 at 10.1min). The lower left area related toincreased levels includedglucuronide metabolitesof
Table1
24Acutedioxintoxicitybiomarkers.
Markers m/z RT(min) Putativeidentifications(orisomericstructure) Proposedformula
1 367.156 15.4 DHEAS C19H28O5S
2 369.172 10.8 Dihydrotestosterone-Sorisomer C19H30O5S
3 369.172 17.3 Isomericstructure C19H30O5S
4 369.172 18.6 Androsterone-S C19H30O5S
5 383.151 7.8 Dihydroxyandrostenone-S C19H28O6S
6 445.190 8.8 Estrone-Gorisomer C24H30O8
7 463.232 17.2 Isomerofepitestosterone-G C25H36O8
8 464.299 13.0 Glycocholicacid C26H43NO6
9 465.245 21.2 Androsterone-G C25H38O8
10 465.248 14.3 Isomericstructure(likeisomerofdihydrotestosterone-G) C25H38O8
11 471.246 26.3 Chenodeoxycholicacid-Sorursodeoxycholicacid-S C24H40O7S
12 479.225 12.0 HydroxyDHEA-GorhydroxyTestosterone-Goroxo-androsterone-G C25H36O9
13 479.228 7.7 HydroxyDHEA-GorhydroxyTestosterone-Goroxo-androsterone-G C25H36O9
14 481.241 10.1 Hydroxyandrosterone-Gorhydroxyetiocholanolone-G C25H38O9
15 483.259 9.3 Hydroxyandrostane-G C25H40O9
16 495.294 25.0 Pregnanediol-3-G C27H44O8
17 528.261 11.8 Glycoursodeoxycholicacid-S C26H43NO8S
18 567.316 20.1 Deoxycholicacid-Gorchenodeoxycholicacid-G C30H48O10
19 583.310 17.2 Cholicacid-Gorisomer C30H48O11
20 583.312 9.7 Cholicacid-Gorisomer C30H48O11
21 624.338 21.1 Glycochenodeoxycholicacid-Gorisomer C32H51NO11
22 624.338 22.0 Glycochenodeoxycholicacid-Gorisomer C32H51NO11
23 640.333 6.5 Glycocholicacid3-Gorisomer C32H51NO12
24 640.333 13.4 Glycocholicacid3-Gorisomer C32H51NO12
-Sisforsulfateand-Gisforglucuronidecompound.Steroidconfirmedwithauthenticstandardsarewritteninbolditalic.
MarkerselevatedbyVYincomparisontothecontrolsarehighlightedingray.
F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx 7
Fig.3. Knowledge-basedvariableselectionprocedure.
chenodeoxycholic acid (m/z 567.316 at 20.1min), glycochen- odeoxycholicacid(m/z624.338at22min)andestrone(m/z445.19 at 8.8min). Furthermore, glycocholic acid and its glucuronide metabolite(m/z464.299at 13minand m/z640.333at6.5min) anddihydrotestosterone sulfate(m/z369.172at10.8min)were alsotentativelyidentifiedasincreasedbiomarkers.
However,ithastobepointedoutthattheroleofeachvariable isnotnecessarilysimilarinbothcasesandcanevenbeopposite.
Actually,thecombinationofthebiomarkersismorerelevantthan theevaluationofasingleparametertakenindividually.VYandthe Czechcohortarecasesofacuteexposure.Urinesamplingwascar- riedoutabout40yearsaftertheexposureoftheCzechworkersand about1–5yearsafterthepoisoningofVY.Thisdifferenceinsamp- lingcouldleadtodifferentbiomarkersofacuteexposure, some related tolong-term toxicity and somefor short/medium term toxicity.Therespectiveroleofthebiomarkerswereinvestigated byexaminingtheirnormalizedloadings(p(corr))tothepredictive
latentvariableofbothmodel#3andmodel#4(Fig.5).Interestingly, somemarkershadasimilarcontributiontobothdioxinexposure cases.Ontheotherhand,biomarkerscharacterizedbyincreased levelsinVYsamplesweremainlyrelatedtosteroids,whilesamples fromtheCzechcohortfollowedadifferenttrend.
Common biomarkers may be due to similar toxic pathway and dissimilaritiesto differentmechanisms. Thearyl hydrocar- bonreceptordoesnotonlyactasatranscriptionfactor binding thedioxinresponsiveelement(DRE)andactivatingmetabolizing enzymessuchasCYP1A1andCYP1B1.AhRisalsoinvolvedinthe regulationofotherpathwaysinaDRE-independentmanner.As anexample,AhRregulatescholesterolbiosynthesisbyinteracting withthesterolelement-bindingprotein2(SREPB2)transcription factor(Tanosetal.,2012).Furthermore,cross-talksbetweenAhR andsomenuclearreceptorssuchastheestrogenreceptor(ER)and theandrogenreceptor(AR)arewelldescribed(Ohtakeetal.,2011;
Pateletal.,2007).ARitselfinfluencesthecholesterolhomeostasis
Fig.4.OPLSmodel#4basedon24acutedioxintoxicitybiomarkers.(A)Scoreplot:urinesamplesfromCzechchemicalworkersexposedtodioxinaresymbolizedwithblack diamonds()andsamplestakenfromhealthyvolunteersbywhitesquares().(B)S-plot:discriminatingvariablesaresymbolizedbyblackcircles(䊉).
8 F.Jeanneretetal./ToxicologyLettersxxx (2013) xxx–xxx
Fig.5.Biomarkers’normalizedloadingsfrommodel#3andmodel#4.Commoncontributionsarehighlightedwithdottedlines.Forputativebiomarkerscandidates,see Table1.
byinteractingwiththeliver Xreceptor (LXR),which canregu- latesulfotransferasesandtherebyandrogensactivity(Krycerand Brown,2011).Inmice,itwasreportedthatTCDDderegulatesgenes ofphaseIandIImetabolismsuchasgenesimplicatedincholesterol metabolism(CYP7A1),aswellastwonuclearreceptors,i.e.theshort heterodimerpartner(SHP)andfarnesoidXreceptor(FXR)(Fletcher etal.,2005).FXR,similarlytoLXR,interactswithsulfotransferases andreducesandrogensactivity(Runge-Morriset al.,2013).The numerouscross-talksandinteractionsbetweennuclearreceptors involvedinsteroidsandbileacidsregulations(FXR,LXR)indicate two-waysregulationsbetweenbileacidsmetabolismandsteroid signaling.Thistwo-wayregulationandthedescriptionofdioxins effectsonbothpathwaysconfirmedtheperturbationsofsteroids andbileacidsdescribed inanimalssuchasrodentsorchickens (Fletcheretal.,2005;Forgacsetal.,2012;Sechmanetal.,2011).Dis- turbancesofsteroidsandbileacidsreportedinthisstudycouldbe supportedbyinferringsimilarmechanismsbetweenhumansand animalsexposedtodioxins,takingintoaccountthegreatvariation ofdosesbetweenthespeciestoobserveatoxiceffect(Mukerjee, 1998).Somenuclearreceptorscouldbeimplicatedinthisprocess, suchasARandLXRorFXR,butthemechanismsstillneedtobe elucidated.Theseresultsprovidedpromisingopportunitiesinthe perspectiveofabetterunderstandingoftheeffectsofdioxinexpo- sureonhumanhealthasareducedlistofpotentialbiomarkersof dioxinintoxicationwasobtained.Atthisstage,theclassicalwayof biomarkersvalidationinvolvestheirproperidentificationthanks tocomparisonswithauthenticstandard.Thebiologicalrelevance andtheclinicalvalidityoftheidentifiedmarkersarethenassessed byinvivostudies(animalincase ofdioxin)and/orinvitrosys- tems.Analternativevalidationistheanalysisofthesemarkersinan independentcohort.Inthefuture,thebiomarkerssubsetshouldbe evaluatedandvalidatedinotherhumancohortsexposedtodioxin.
4. Conclusion
Ametabolomicapproachwasproposedtoassesstheeffectsof acutedioxinexposure.Appropriatedatapre-treatmentprocedures and a chemistry-driven filterwere implemented toreduce the numberofvariablestoconsiderandfocusonthesteroidmetabolite contentofurinesamples.Aseriesof284steroid-relatedvariables wasinvestigatedanda predictiveOPLS-DAmodelwasobtained
fromtheCzechcohort sufferingfromoccupationaldioxinexpo- sure.Thevariables’contributionshighlightedrelevantbiomarkers mainlyrelatedtobileacids.Asasecondstepofdatamining,prior knowledgecollectedduringthetreatmentofVYafterTCDDacute toxicexposureallowedbiologicallymeaningfulcompoundstobe selected.The24mostrelevantbiomarkerswerethenusedtoinves- tigatethelong-termeffectsofexposuretodioxin. Theseresults showedalteredlevelsofendogenoussteroidmetabolitesandmod- ifiedurinarybileacidsprofiles.Takentogether,thesefindingsare compatible withan increasedexpression ofcytochrome P450s, persistenthepatotoxicity,bileacidhomeostasisdysregulationand oxidativestress.Areliablemodelcouldbeevaluated;however,due tothesmallnumberofobservations,additionaltargetedinvesti- gationsofthebiomarkersneedtobeperformedforconfirmation purpose.Theselectionofcharacteristicphenotypeswasdemon- stratedasaveryeffectiveapproachtodetecttoxicitybiomarkers moreeasily.Theintegrationofothertypes ofknowledge-based filterssuchasmetabolicpathwaysisexpectedtooffervaluable alternativestodevelop dedicatedstrategies for theselection of meaningfulvariablesaccordingtothebiologicalcontext.Thelong- termfollow-upofpatientssufferingfromseveredioxinintoxication overdecadesisexpectedtoprovidenewavenuesofresearchto haveabetterunderstandingoftheeffectsofthesechemicalson humanhealth.
Conflictofinterest
Theauthorsdeclarenoconflictofinterest.
Acknowledgements
TheauthorsthankJean-DanielGrafandhisteamforhavingpro- videdtheurinecontrolsamples.TheSwissFoundationforGrants in Biologyand Medicine,and Novartis are thankedfor suppor- tingthis work(grant PASMP3-140064 toJulien Boccard).Fund PrvoukP25/1LF/2forcollectingandshippingsamplesfromPrague toGeneva.
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