This invention relates to use of various nanostructures to form a sensor array to detect the presence of an identified set of biomarkers associated with certain diseases or medical conditions for medical diagnosis.
An aroma of decaying apples, later identified as acetone, was noted by a physician, John Rollo, in 1796 in a patient with severe diabetes. Various quantitative methods for detecting presence or absence of acetone were subsequently developed for purposes of detecting diabetes in a patient. These methods included gas chromatography with flame ionization detection. Presence of other substances, such as NO, H2O2, carbonyl sulfide, dimethyl sulfide, pentane, methane, isoprene and/or isopentane have been noted in a patient's breath, in association with other diseases. The detection methods for a particular biomarker are often complex and time consuming, and presence of a given biomarker (referred to herein as a “specified component”) is often consistent with presence of any of several diseases. For example, presence of NO in a patient's breath may indicate that the patent has one or more of asthma, COPD, cystic fibrosis and/or lung cancer, among other maladies.
What is needed is a method that is relatively simple, requires no more than about 60 sec to complete, is quantitatively specific for identification of a particular disease or medical condition, and uses a minimum number of chemical or physical tests that can be performed, simultaneously or sequentially, to indicate presence of one disease or medical condition, where possible. Preferably, the system should permit detection of presence of a given biomarker, associated with an identified disease or medical condition, down to a few parts per billion (ppb) concentration.
The invention meets these needs for certain diseases and medical conditions (referred to collectively herein as a “disease D”) by providing a method and associated system that relies upon exposure of a patient's exhaled breath, or similar vapors or gases (collectively referred to as “gases” herein) associated with the patient's body, to a collection or array of sub-arrays of nanostructures (“NSs”), including but not limited to carbon NSs, with each sub-array of one, two or more NSs being functionalized to be sensitive to presence of one or a few biomarkers associated with a given disease D. Pattern recognition techniques are applied to distinguish between a test subject (patient sample gas) with an identifiable disease D and a normal, healthy test subject (healthy sample gas or “HS” gas), preferably collected from one or more healthy other persons that are known to have none of the diseases D. Each different combination of a substrate (e.g., metal, semi-metal, polymer, carbon-based substance, etc.) and functionalization process (e.g., doping, coating, etc.) that is used here is treated as a different sensor.
In
For purposes of illustration, it is assumed that the EPV value manifests some drift with time, according to which a measured EPV value, having no specified component(s) from the sample gas/fluid present, will not remain constant but will change or drift with time. For one class of models, the difference, ΔEPV(t;q;meas)=EPV(t;q;meas)−EPV(t=0;meas), is of primary importance. For another class of models the compensated value EPV(t;q;comp)=EPV(t;q;meas)=EPV(t;q;base) is of primary importance.
In a preferred embodiment, for each specified component SCm, and each different sensor (numbered q=1, . . . , Q), a set of reference electrical parameter values ΔEPV((SCm;r),q;r) are measured for a set of reference concentrations κ(SCm;r). (r=1, . . . , R) of each specified component (m). Q EPV measurements ΔEPV(pat;q) are also provided (q=1, . . . , Q) for the patient.
The electrical parameter values (“EPVs”), comprise electrical current, voltage difference, resistance, impedance, conductance or capacitance. An EPV change value ΔEPV may be positive or negative, depending upon interaction between the specified component and the functionalized NS. Each NS in a sub-array is connected at its first end and second end to first and second electrodes, respectively, and a ΔEPV measurement mechanism is also connected between the first and second electrodes. The method and system can be used to test other types of samples, such as headspace of a sample of urine or blood and aromas from the skin or from an ear.
In a first procedure, pattern recognition or discrimination is implemented by comparing magnitudes of differences of normalized ΔEPV values for the reference set and for the patient, summed over the different sensors for each of the specified components SCm. For each of these sums that is no greater than a threshold number, which may depend upon the specified component SCm, the system interprets this condition as indicating that this specified component is likely present in a substantial or non-negligible concentration in the patient's sample gas (a “surviving” subset of specified components).
For a sum that is greater than the corresponding threshold number, the system optionally interprets this condition as indicating that this specified component is likely present, if at all, in a negligible concentration in the patient's sample gas.
The specified components that survive this comparison process are then subjected to a second procedure. Calibration parameters are estimated, relating a polynomial of concentration values κ for a fixed, surviving specified component to each of the reference set of ΔEPV values. A second sum of magnitudes of differences between the patient's ΔEPV values, suitably weighted, and the calibrated ΔEPV values for the surviving specified components, summed over the different sensors is provided. An optimum numerical value of this non-negative “suitable weight” is expressed as a linear or quadratic polynomial in the concentration value κ that minimizes the second sum, and this optimum combination is used to estimate the concentration value of each of the surviving specified components in the sample gas.
The first procedure identifies specified components that are present in non-negligible concentrations in the patient's sample gas. The second procedure uses a polynomial approximation to estimate concentration values for surviving specified components in the patient's sample gas and identifies which of these estimates may be reasonably accurate. The estimated concentration values for the surviving component(s) are used to estimate whether a disease D may be present.
Up to 32 individually functionalized NS channels were initially tested and confirmed to work as expected. This number has been increased to 64 channels (1 cm×1 cm size), and will be increased further as the perceived need increases, up to 256 channels. An array of 32 NS channels, integrated with a sampling system and associated electronics, has been reduced to postage stamp size, which can fit into, and provide connections to, a cell phone or smart phone with which the sensor array is integrated.
The area density per unit mass for the NS is very high, about 1600 m2/gm in one embodiment, so that an EPV change value ΔEPV is quite sensitive to presence of even a small amount of a sample gas. For example, presence of nitrogen dioxide (NO2) at a concentration of 4.6 parts per billion (ppb) has been detected using one NS array. With an appropriate choice of differently functionalized NSs, the NS sub-array can collectively distinguish between presence of at least two different sample gas components and allow an estimate to be made of most probable concentration value for each component, above a detection threshold concentration. Thus far, I have tested the functionalized NS sub-array on about ten different gases, including nitrous oxide (NO), hydrogen peroxide (H2O2), carbon dioxide (CO2), hydrogen chloride (HCl), ammonia (NH3), chlorine (Cl2), formaldehyde (CH2O), acetone (CH3COCH3), isopropyl alcohol ((CH3)2CHOH), methane (CH4), benzene (C6H6), and sulfur dioxide (SO2).
Of course, as the number of different specified components tested for presence increases, the required number of separately functionalized NSs also increases. The sensors constructed using the functionalized NSs are robust, long lasting (at least three years lifetime), and will operate in the presence of high intensity vibrations, and the measured values can be compensated for varying ambient temperature, varying ambient humidity and varying ambient pressure.
An NS sub-array can be recycled or refreshed, after its use for a particular chemical component, by at least two methods: (1) local heating of the NS sub-array with energy density of the order of 1-100 Joules/cm2 for 10-30 sec and (2) irradiation of the NS sub-array with ultraviolet-emitting LEDs (e.g., with wavelengths in a range (e.g., 254-256 nm) for 1-100 seconds.
The particular electrical parameter change value ΔEPV(t;q;meas), measured for each of the functionalized sensor sub-arrays, may be electrical impedance, resistance, conductance, capacitance, inductance, electrical voltage, electrical current, or some other relevant, measurable electrical value. For electrical current, for example, the change values ΔEPV(t;q;meas) are often measured in μAmps or in mAmps; for resistance, the change value ΔEPV(t;q;meas) (possibly dependent upon time t) are often measured in tens of Ohms, up to several kilo-Ohms.
In a pattern recognition approach adopted here, the pattern is provided by a sequence of combined analytical and empirical relations, with one such relation for each of Q distinct combinations of sensor materials and functionalization processes, and with a least-pth-power analytical procedure for estimating most-probable concentrations values of specified components.
Amplitudes A(SC;q) of the measured values, ΔEPV(SCm;q), are presented on a graph or otherwise provided for each of M specified components (SCm), with each of the sensor materials set forth on the graph.
A set of reference samples of measured ΔEPV values is provided, with each sample initially including the HS gas. Each of a sequence of selected concentration values κ(SCm;r), (e.g., 1 ppm, 5 ppm, 10 ppm, 25 ppm; corresponding to r=1, . . . , R) of a fixed specified compound is added to the initial reference healthy sample (HS) gas, to form a reference test sample. Each of the sensors is exposed to each of the reference test samples, and an EPV value is measured and recorded. The change value ΔEPV occurs in response to exposure to the sample gas, corresponding to one sensor, to (dominating) presence of only one specified compound present at a known concentration value, κ(SCm;r), and to presence of only one reference concentration (r) of the specified chemical component.
A first procedure determines whether a given specified component (SCm), is present in the sample gas measured from the patient. Normalized amplitudes An are first formed for the reference amplitudes A(SCm,q) and for the measurements for the patient, defined as
For each specified component SCm, a first error function
is computed, where p is a chosen positive exponent value and the weight parameters uq are non-negative and may be chosen to satisfy
For computational convenience, the exponent parameter p may be chosen to be p=2, and/or the weights uq may be uniform (uq=1/Q)
The numerical value of the first error function ε1(SCm) is compared with a first threshold value ε1(SCm;thr), which may vary from one specified component to the next. When ε1(SCm) is no greater than ε1(SCm;thr), the system interprets this condition as indicating that the specified component SCm is likely present in the sample gas. The surviving specified components, which satisfy this condition, are denoted SC″m1, where m1 is an index of surviving specified components.
When ε1(SCm) is greater than ε1(SCm;thr), the system interprets this condition as indicating that the specified component SCm is likely (i) not present in the sample gas or (ii) present in the sample gas with a negligible concentration κ(SCm) of the specified component, whose presence can be optionally ignored. One or more specified components SCm may not survive this comparison process and are optionally discarded in the subsequent analysis.
A second procedure provides an estimate of concentration κ(SC″m1), of the surviving specified components in the sample gas. Each of the graphs in
ΔEPV(approx)=a+bκ(SC″m1)+cκ(SC″m1)2, (7)
where a, b and c are parameters, possibly dependent upon SC″m1 and/or q and independent of concentration values κ(SC″m1), to be determined separately for each sensor q and for each surviving specified compound SC″m1, and a is the ΔEPV value, measured for that sensor, where only an HS gas is present. For a fixed specified component SC″m1, with varying concentration values κ(SC″m1r) (r=1, . . . , R; R≥2), a collection of two, three or more measurement pairs (κ(SC″m1;q;r), EPV(SC″m1;r) is assembled, for different SC concentrations, indexed by r.
In one approach, the parameters a, b and c are estimated by minimizing a second error function
with respect to the parameters a, b; and c; (quadratic relationship), or with respect to the parameters a and b (linear relationship). This can be done by setting the partial derivative of ε2 with respect to the corresponding parameter (a, b or c) equal to 0. The result of these minimizations is a coupled set of equations:
Aa+Bb=C, (9)
Da+Eb=F, (10)
for a linear relationship. For a quadratic relationship, Eqs. (16)-(26) are used.
Ga′+Hb′+Jc′=K, (16)
La′+Mb′+Nc′=P, (17)
Ra′+Sb′+Tc′=U, (18)
Solution of the relations (9) and (10), or (16), (17) and (18) is straightforward, using algebraic maneuvers, such as Cramer's rule.
The preceding linear or quadratic relationships are applied separately for each surviving specified component SC″m1, for different SC concentrations r=1, . . . , R; and for each sensor q; only one surviving SC is considered at a time. For purposes of this discussion, the linear relation (c=0) or the quadratic relation between ΔEPV value and SC concentration values can be applied.
The amplitudes for the ΔEPV values, denoted A(SC″m1;q), for the Q distinct sensors for the surviving specified compounds SC″m1=HCl, NO and CH4, are shown as examples in
a′+b′κ(SC″m1;q)=ΔEPV(SC″m1;q), (27)
or as a solution of a quadratic equation
a′+b′κ(SC″m1;q)+c′κ(SC″m1;q)2=ΔEPV(SC″m1;q), (28)
depending upon one's choice of the constitutive relation, Eq. (7), that is used. The associated solutions κ(SC″m1;q;sol), for a fixed SC″m1 and varying q, will not be identical but may be reasonably close to each other.
A selected combination or statistical average κavg(SC″m1) (preferably symmetric in the solution values) is computed for the solution concentration values κ(SC″m1;q;sol) over the sensors, q=1, . . . , Q. One suitable average is an arithmetic average
Another suitable average is a geometric average, formed as a 1/Q power of a finite product of the Q solution concentration values
where it is assumed that none of the solution concentration values κ(SC″;q;sol) is zero or near zero for this surviving specified component SC″m1. Other averages, symmetric or otherwise, can also be used here. The combination κavg(SC″m) is interpreted as a probable concentration value for the surviving specified component SC″m1 in the sample gas.
A Third Error Function
is formed from a square of differences between the combinations or averages κavg (SC″m1) and the solution concentration values κ(SC″m1;q;sol). The third error function ε3 is a measure of standard deviation (SD) relative to a statistically averaged value κavg(SC″m1).
The error value ε3(SC″m1) may be compared with a threshold value ε3(SC″m1;thr) When ε3(SC″m1) is no greater than ε3(SC″m1;thr), the system interprets this condition as indicating that the combination K estimate for avg(SC″m1) estimate for the concentration value(s) κ(SC″m1) is reasonably accurate and can be used as an estimate for the concentration value κ(SC″m1;pat) of the surviving specified component SC″m1 in the sample gas.
When ε3(SC″m1) is greater than ε3(SC″m;thr), the system optionally interprets this condition as indicating that this average κavg(SC″m1) of the solution concentration values κ(SC″m1;q;sol) has questionable accuracy.
Optionally, a baseline measurement, denoted ΔEPV(t;q;0) and shown in
ΔEPV(t;q;comp)=ΔEPV(t;q;meas)−ΔEPV(t;q;0) (32)
for a particular SC and for a particular sensor or NS number q.
In step 42, the NS sub-arrays, or a selected subset thereof, are exposed to the sample gas and at least one ΔEPV measurement is provided in response to this exposure. In step 43 (optional), at least one baseline measurement ΔEPV, denoted ΔEPV (t;q;meas;0), which may be time dependent, is provided for at least one measurement time value t. In step 44 (optional), a baseline measurement ΔEPV (t;q;meas;0) is subtracted from a ΔEPV measurement value to provide a baseline-compensated ΔEPV value ΔEPV(t;q;meas;base), which may depend, but need not depend, upon a time value t.
In step 43 (optional), a baseline ΔEPV measurement, denoted ΔEPV(t;q;0) (HS gas), is also made for each of the Q distinct sensors, where only an HS gas is present. In step 44 (optional), the baseline change value ΔEPV(t;q;0), which may be time dependent, is subtracted from the measured change value ΔEPV to provide a baseline-compensated change value ΔEPV(SC″m1;t;q;comp) for a particular SC and for at least one sensor q, as illustrated in
A computer is provided that is programmed to perform, and does perform, the following tasks, in step 45.
In step 46, normalized change values ΔEPV for a reference set of specified chemical components SCm and for the sample gas are formed, as set forth in Eqs. (1)-(4). In step 46, for each specified component SCm, (a candidate for inclusion in the sample gas) and for each sensor q, a first error function ε1(SCm) is formed as a pth power of weighted magnitudes of differences between the normalized
change values for the reference set and for the sample gas, and these weighted differences are summed over the sensors, q=1, . . . , Q, as set forth in Eq. (5), where the weighting parameters uq are non-negative and the sum of the weighting parameters over the Q sensors is equal to a positive constant (e.g., 1). In step 48, the numerical value of the first error function ε1(SCm) is compared with a first threshold value ε1(SCm;thr), which may vary, but need not vary, with the specified component.
When ε1(SCm1) is no greater than ε1(SCm;thr), the system interprets this condition as indicating that the specified component SCm is likely present in the sample gas, in step 49. A first subset of specified components SCm that satisfy the condition in step 48 become a surviving subset of specified components, {SC″m1}, where m1 is an index for this first subset.
When ε1(SC″m) is greater than ε1(SCm;thr), the system interprets this condition as indicating that the specified component SCm likely (i) is not present in the sample gas or (ii) is present in the sample gas with a negligible concentration κ(SCm;pat), in step 50; and presence of this second subset of specified components in the sample gas is optionally ignored.
In step 51, each of the set of surviving specified components SC″m1, measured at each sensor q, is analyzed or calibrated as in Eqs. (9)-(26), using known concentrations (indexed by r) of the surviving components with their measured change values ΔEPV(κ(SC″m1;q;r)), to identify parameters a, b and/or c, for which a linear polynomial approximation
ΔEPV(SC″m;q;approx)=a+bκ(SC″m), (33A)
or a quadratic polynomial approximation
ΔEPV(κ(SC″m1;q;approx))=a+bκ(SC″m)+cκ(SC″m1)2, (33B)
provides a best linear fit or a best quadratic fit, respectively, for a fixed surviving specified component SC″m1, and a fixed sensor q, for the reference set of concentration values (r=1, . . . , R). The parameters a, b and c are independent of concentration values κ(SC″m;r) but may depend upon the choice of surviving specified compound SC″m1; and/or upon the choice of sensor q.
In step 52, a linear constitutive relation,
a′+b′κ(SC″m1;q)−ΔEPV(SC″m1;q)=0, (34A)
or a quadratic constitutive relation,
a′+b′κ(SC″m;q)+c′κ(SC″m;q)2−ΔEPV(SC″m1;q)=0, (34B)
is analyzed to estimate a solution concentration value κ(SC″m1;q;sol) as a real valued solution for Eq. (34A) or Eq. (34B) for each surviving specified component SC″m1 and for each NS number q (q=1, . . . , Q) In step 53, a combination or average, κavg(SC″m1) is computed, representing an average, of the solution concentration values κ(SC″m;q;sol), over the index q, for example as set forth in Eq. (29) or (30), is formed. The corresponding value κavg(SC″m1) is optionally interpreted as an estimated concentration value for the surviving specified component SC″m1 in the sample gas.
In step 54 (optional), a sum of a square of differences between κavg(SC″m1) and each of the sum of solution concentration values κ(SC″;q;sol) is formed, and an error sum ε3(SC″m1), over the sensor index q is computed.
In step 55 (optional), the error sum ε3(SC″m1) is compared with a threshold value ε3(SC″m1;thr). When ε3(SC″m1) is no greater than ε3(SC″m1;thr), the system interprets this condition as indicating that the estimate κavg(SC″m1) for the concentration value for the surviving specified component SC″m1 in the sample gas is reasonably accurate, in step 56 (optional). When ε3(SC″m1) is greater than ε3(SC″m1;thr), the system interprets this condition as indicating that the estimate κavg(SC″m1) for the concentration value for the surviving specified component SC″m1 in the sample gas has questionable accuracy, in step 57 (optional). In step 58, the system determines whether κavg(SC″m1) is within an identified range R(D) for a disease or medical condition D that is associated with presence of the surviving specified component SC″m1 in the sample gas provided by the patient.
When the question in step 58 is answered affirmatively, the system interprets this condition as indicating that the patient is likely to have, or to be developing, the disease D or medical condition, in step 59 (optional). When the question in step 58 is answered negatively, the system interprets this condition as indicating that the disease or medical condition D is not likely present in the patient, in step 60 (optional). Steps 58, 59, 60 can be applied to a disease D for which a range R(D) of concentration values κ(SC″m1) can be identified. Some ranges can be identified in the Tables 1, 2 and 3.
The materials used for constructing the sensors used here include carbon nanotubes (CNTs), including single wall and multiple wall, and CNTs with nanoparticles. The functionalization processes used here include doping with Pt and/or Pd.
Optionally, the invention includes a smart phone, cell phone tablet or similar communications system, indicated as 29 in
Several groups of researchers have reported relationships, and quantitative results, between selected diseases and detection of particular chemical compounds in a patient's breath, urine, blood and/or other essences from a patient's skin or ear (referred to collectively as “aromas of the body”). Breath biomarkers associated with six identified diseases or disease groups (oxidative stress, metabolic disorders, gastrocentric, exposure to volatile organic compounds, respiratory disorders, and renal failure) are reported by W. Cao and Y. Dunn (Clinical Chemistry, vol. 52:5 (2006) pp 800-811)) and are summarized in Table 1. The oxidative stress disorders include lipid peroxidase, asthma, COPD (several varieties), cystic fibrosis, pulmonary allograft, lung cancer and acute lung transplant rejection. Metabolic disorders include diabetes, gastroenteric diseases include Helicobacter pylori and imbalance of acid-base, Na, K, Ca, P, H, Mg or ketone. Respiratory disorders include ARDS. The biomarker compounds include NO (at least 15 ppb for asthma), CO2, H2O2, ethane, pentane, isopentane, mono-ethylated alkanes, nitrite/nitrate ratio, acetone (normal is around 300 ppb), other ketones, carbonyl sulfate, vinyl chlorides and urine smell.
V.Salomas, et al, Open Access, 9 Apr. 2010, PLOS ONE, report on association of breath biomarkers with particular diseases and/or medical conditions; this work is summarized in Table 2. The top associations differ by gender (adult male versus adult female), with some overlap. Adiponectin, apoliprotein B and C-reactive protein (CRP) are the biomarkers with the first, second and third strongest associations, with diabetes and obesity, with obesity, and with future diabetes, respectively. Ferritin and Interleukin are the biomarkers with the fourth and fifth strongest disease associations for adult males, and Insulin is the biomarker with the fourth strongest association for adult females.
Breath biomarker versus disease associations are also reported by W.Miekisch, et al (Clinical Chemistry, vol 47:6 (2001) pp. 1053-1060) and are summarized in Table 3. The breath biomarkers acetone (normal is about 300 ppb), n-pentane (3.5 nmol/L recovery), isoprene (10.5 nmol/L recovery), isoflurane and dimethyl sulfide are associated with diabetes mellitus, lipid peroxidase, acute lung injury or dysfunction, liver disease or dysfunction (3.9 nmol/L recovery).
A ΔEPV value associated with an aroma or a liquid composition from a patient's urine or a patient's blood can also be used to evaluate whether a particular disease D or medical condition is present. For diabetes, type 1 or type 2, the sample gas is the patient's breath, the surviving specified chemical component SC″m1 is acetone, and the threshold concentration κ(SC″m1;thr) (lower bound) may be taken as 400, 500 or 600 ppb. For asthma, the sample gas is the patient's breath, the surviving specified chemical component SC″m1 is NO, and the threshold concentration κ(SC″m1;thr) (lower bound) may be taken as 20, 25 or 30 ppb. For acute lung injury, the sample gas is the patient's breath, the surviving specified chemical component SC″m1 is isoprene, and the threshold concentration κ(SC″m1;thr) (lower bound) may be taken as 12-15 nmol/liter or higher.
13C, 14C isotopes (urea breath
The invention described herein was made by employees of the United States Government and may be manufactured and used by or for the Government of the United States of America for governmental purposes without the payment of any royalties thereon or therefor.
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