Swedish researchers develop urine test capable of identifying types of asthma and their severity, which could lead to improved precision medicine diagnoses

The study “shows that measurement with a urine test offers improved accuracy compared to other measurement methods, for example certain types of blood tests,” said a press release from KI.

Researchers at the Karolinska Institute (KI) in Sweden have developed a non-invasive urine test that can identify a patient’s type of asthma and its severity. If developed into a clinical laboratory diagnosis, such a test could also give clinicians a better idea of ​​which treatment is most likely to be effective, a fundamental goal of precision medicine.

Another advantage of this methodology is that it is a non-invasive test. If further studies were to conclude that this urine-based test produces accurate results acceptable for clinical settings, medical laboratories would certainly be interested in offering this test, particularly for use in pediatric patients who are not familiar with the test. Comfortable with venipuncture necessary to collect blood samples. Additionally, given the incidence of asthma in the United States, it is possible that a urine-based asthma test will generate a substantial number of test requests.

The aim of the study, according to researchers at the Karolinska Institute, was to “test whether urinary metabolites of eicosanoids can direct the phenotyping of asthma.” The team used mass spectrometry to measure certain lipid biomarkers (prostaglandins and leukotrienes), which are known to play a key role in the inflammation that occurs during asthma attacks.

According to a press release from KI, “The study is based on data from the Unbiased BIOmarkers in PREDiction of respiratory disease issues (U-BIOPRED) study, which was designed to study severe asthma. The study included 400 participants with severe asthma, which often requires treatment with corticosteroid tablets, nearly 100 people with milder forms of asthma, and 100 healthy control participants.

Researchers from the Karolinska Institute published their study in the American Journal of Respiratory and Critical Care Medicine.

“We found particularly high levels of mast cell mediator metabolites prostaglandin D2 and the eosinophilic product leukotriene C4 in patients with asthma with so-called Type 2 inflammation. Using our methodology, we were able to measure these metabolites with great precision and relate their levels to the severity and type of asthma, ”said Johan Kolmert, PhD (above), post-doctoral researcher at the Institute of Environmental Medicine, Karolina Institute, and first author of the study, in the KI press release. If perfected, such precision could lead to effective precision medicine clinical laboratory testing. (Photo copyright: Karolinska Institute.)

More precise testing could lead to precision medicine guided by biomarkers

In the United States alone, 25,131,132 people currently have asthma, of which about five million are children under the age of 18, according to 2019 CDC statistics. The World Health Organization (WHO) reports that worldwide, “asthma affected approximately 262 million people in 2019 and caused 461,000 deaths”.

People with mild asthma can have good results using steroid inhalers. However, for people with moderate to severe asthma where inhalers are not effective, oral corticosteroids may also be needed. But corticosteroids have been linked to high blood pressure and diabetes, among other negative side effects.

“To replace corticosteroid tablets, several biological drugs have recently been introduced to treat patients with type 2 inflammation characterized by increased activation of mast cells and eosinophils,” said Sven-Erik Dahlén, professor at the Institute of Environmental Medicine of the Karolinska Institute, in the press release.

Currently, there are no simple tests that can determine a patient’s type of asthma. Instead, clinicians rely on lung function tests, patient interviews, allergy tests, and blood tests.

Other non-invasive urine diagnostic tests

In “University of East Anglia Researchers Develop Non-invasive Urine Test for Prostate Cancer,” Dark Daily recently reported on another urine-based prostate cancer test developed in the UK which, according to researchers at the University of East Anglia (UEA) School of Medicine in Norwich, may “determine the disease aggressiveness ”and potentially“ reduce the number of unnecessary prostate cancer biopsies by 32 ”. %. “

Earlier this year, researchers at Brigham and Women’s Hospital and Exosome Diagnostics in Massachusetts studied a non-invasive urine test for transplant rejection. According to a press release, “Patients can spend up to six years waiting for a kidney transplant. Even when they receive a transplant, up to 20% of patients will experience rejection. “

“If rejection is left untreated, it can lead to scarring and complete kidney failure. Because of these issues, recipients may face lifelong challenges, ”said Jamil Azzi, MD, director of the Kidney Transplant Fellowship program at Brigham and Women’s Hospital and associate professor of medicine at Harvard School of Medicine. “Our goal is to develop better tools to monitor patients without performing unnecessary biopsies. We try to catch rejection early, so that we can treat it before the scars develop, ”he said.

Detect bladder cancer with urine tests

Bladder cancer is another condition for which urine tests are being investigated. An article in Trends in urology and men’s health Says, “Several point-of-care urine tests have been developed to help identify patients who may be at higher risk for bladder cancer.” These tests could potentially be used in primary care, which could mean fewer people would need invasive, painful, and risky cystoscopies.

“New tests to help identify patients with hematuria who are at higher risk of cancer would help improve the diagnostic pathway, reduce the number of diagnoses by emergency presentation, reduce the burden on urology services and to spare those without cancer from invasive disease and expensive examinations, such as cystoscopy, ”wrote the authors of the article.

These urine-based tests are still under study by various research teams and more research is needed before clinical trials can be conducted and the tests can be submitted for regulatory approval. Although still in the early stages of development, urine diagnostic tests represent a much less invasive, and therefore safer, means of identifying and treating various diseases.

Studies on how elements in urine could be used as biomarkers for clinical laboratory tests could lead to improved, non-invasive precision medicine diagnostics that could save many lives.

—Dava Stewart

Related information

Increased urinary metabolites of leukotrienes E4 and prostaglandin D2 in severe asthma in adults and children characterized by type 2 inflammation. A clinical observational study

Lipid biomarkers in urine can determine the type of asthma:

The U-BIOPRED Severe Asthma Study: Immunopathological Characterization

New urine test developed to diagnose human kidney transplant rejection

A urine test for bladder cancer: soon available in primary care?

University of East Anglia researchers develop non-invasive urine test for prostate cancer

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