title: Exploratory urinary metabolomics of type 1 leprosy reactions.
abstract: BACKGROUND
  Leprosy is an infectious disease caused by Mycobacterium leprae that affects the skin and nerves. Although curable with multidrug therapy, leprosy is complicated by acute inflammatory episodes called reactions, which are the major causes of irreversible neuropathy in leprosy that occur before, during, and even after treatment. Early diagnosis and prompt treatment of reactions reduces the risk of permanent disability.
  
  
  METHODS
  This exploratory study investigated whether urinary metabolic profiles could be identified that correlate with early signs of reversal reactions (RR). A prospective cohort of leprosy patients with and without reactions and endemic controls was recruited in Nepal. Urine-derived metabolic profiles were measured longitudinally. Thus, a conventional area of biomarker identification for leprosy was extended to non-invasive urine testing.
  
  
  RESULTS
  It was found that the urinary metabolome could be used to discriminate endemic controls from untreated patients with mycobacterial disease. Moreover, metabolic signatures in the urine of patients developing RR were clearly different before RR onset compared to those at RR diagnosis.
  
  
  CONCLUSIONS
  This study indicates that urinary metabolic profiles are promising host biomarkers for the detection of intra-individual changes during acute inflammation in leprosy and could contribute to early treatment and prevention of tissue damage.
authors.affiliation: Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Oleg A
authors.initials: OA
authors.lastname: Mayboroda
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands.
authors.forename: Anouk
authors.initials: A
authors.lastname: van Hooij
authors.affiliation: Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Rico
authors.initials: R
authors.lastname: Derks
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands.
authors.forename: Susan J F
authors.initials: SJ
authors.lastname: van den Eeden
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Dijkman
authors.affiliation: Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
authors.forename: Saraswoti
authors.initials: S
authors.lastname: Khadge
authors.affiliation: Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
authors.forename: Pratibha
authors.initials: P
authors.lastname: Thapa
authors.affiliation: Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
authors.forename: Chhatra B
authors.initials: CB
authors.lastname: Kunwar
authors.affiliation: Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal.
authors.forename: Deanna A
authors.initials: DA
authors.lastname: Hagge
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands. Electronic address: a.geluk@lumc.nl.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Geluk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007918:Leprosy / Q000175:diagnosis / Q000652:urine*; D008297:Male; D055432:Metabolomics; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Diagnostics; Leprosy; Metabolomics; Reactions; Urine