title: A metabolomic approach to dry eye disorders. The role of oral supplements with antioxidants and omega 3 fatty acids.
abstract: OBJECTIVE
  We used nuclear magnetic resonance spectroscopy of hydrogen-1 nuclei ((1)H NMR S) to analyze the metabolic profile of reflex tears from patients with dry eye disorders.
  
  
  METHODS
  We performed a prospective case-control study involving 90 participants: 55 patients diagnosed with dry eye syndrome (DESG) and 35 healthy subjects (control group, CG). From the DESG, two subgroups were formed: mild DES (n=22) and moderate DES (n=33). Participants were prescribed an oral nutraceutic supplementation containing antioxidants and essential polyunsaturated fatty acids to be taken as three capsules per day for 3 months. Reflex tears (20-30 µl) were collected from the tear meniscus of both eyes of each subject with a microglass pipette. Nuclear magnetic resonance (NMR) spectra were acquired with a standard one-dimensional pulse sequence with water suppression; 256 free induction decays were collected into 64,000 data points with 14 ppm spectral width.
  
  
  RESULTS
  Basal tears showed a differential metabolomic profile between groups. Almost 50 metabolites were identified by H cholesterol, N-acetylglucosamine, glutamate, amino-n-butyrate, choline, glucose, and formate were detected before supplementation and choline/acetylcholine after supplementation. The metabolic profile of the tears was statistically different between groups, as well as before and after supplementation.
  
  
  CONCLUSIONS
  Our data indicate that DES induces changes in the tear metabolic profile that can be modified with appropriate oral supplementation with antioxidants and essential polyunsaturated fatty acids.
authors.affiliation: Ophthalmic Research Unit "Santiago grisolía," Valencia, Spain ; Ophthalmic Research Unit, Faculty of Medicine, University of Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Galbis-Estrada
authors.affiliation: Ophthalmic Research Unit "Santiago grisolía," Valencia, Spain ; Ophthalmic Research Unit, Faculty of Medicine, University of Valencia, Spain ; Spanish Collaborative Network of Ocular Pathology (OFTARED).
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Pinazo-Durán
authors.affiliation: University and Polytechnic hospital La Fe, Valencia, Spain.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Martínez-Castillo
authors.affiliation: Central Unit of Research in Medicine, University of Valencia, Valencia, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Morales
authors.affiliation: Fundacion Investigacion Hospital Clinico Universitario/INCLIVA, Valencia, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Monleón
authors.affiliation: Ophthalmic Research Unit "Santiago grisolía," Valencia, Spain ; Ophthalmic Research Unit, Faculty of Medicine, University of Valencia, Spain ; Department of Preventive Medicine and CIBER Fisiopatología de la Obesidad y Nutrición, School of Medicine, University of Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Zanon-Moreno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage*; D016022:Case-Control Studies; D019587:Dietary Supplements; D015352:Dry Eye Syndromes / Q000178:diet therapy* / Q000378:metabolism*; D005228:Fatty Acids, Essential / Q000008:administration & dosage; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D055432:Metabolomics; D008875:Middle Aged; D011446:Prospective Studies; D013666:Tears / Q000378:metabolism*
chemical_list: D000975:Antioxidants; D005228:Fatty Acids, Essential; D015525:Fatty Acids, Omega-3