Urine metabolome profiling of immune-mediated inflammatory diseases.
Immune-mediated inflammatory diseases (IMIDs) are a group of complex and prevalent diseases where disease diagnostic and activity monitoring is highly challenging. The determination of the metabolite profiles of biological samples is becoming a powerful approach to identify new biomarkers of clinical utility. In order to identify new metabolite biomarkers of diagnosis and disease activity, we have performed the first large-scale profiling of the urine metabolome of the six most prevalent IMIDs: rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn's disease, and ulcerative colitis.



Using nuclear magnetic resonance, we analyzed the urine metabolome in a discovery cohort of 1210 patients and 100 controls. Within each IMID, two patient subgroups were recruited representing extreme disease activity (very high vs. very low). Metabolite association analysis with disease diagnosis and disease activity was performed using multivariate linear regression in order to control for the effects of clinical, epidemiological, or technical variability. After multiple test correction, the most significant metabolite biomarkers were validated in an independent cohort of 1200 patients and 200 controls.



In the discovery cohort, we identified 28 significant associations between urine metabolite levels and disease diagnosis and three significant metabolite associations with disease activity (P FDR < 0.05). Using the validation cohort, we validated 26 of the diagnostic associations and all three metabolite associations with disease activity (P FDR < 0.05). Combining all diagnostic biomarkers using multivariate classifiers we obtained a good disease prediction accuracy in all IMIDs and particularly high in inflammatory bowel diseases. Several of the associated metabolites were found to be commonly altered in multiple IMIDs, some of which can be considered as hub biomarkers. The analysis of the metabolic reactions connecting the IMID-associated metabolites showed an over-representation of citric acid cycle, phenylalanine, and glycine-serine metabolism pathways.



This study shows that urine is a source of biomarkers of clinical utility in IMIDs. We have found that IMIDs show similar metabolic changes, particularly between clinically similar diseases and we have found, for the first time, the presence of hub metabolites. These findings represent an important step in the development of more efficient and less invasive diagnostic and disease monitoring methods in IMIDs.
Rheumatology Research Group, Vall d'Hebron Hospital Research Institute, Barcelona, Spain.
Arnald
A
Alonso
Rheumatology Research Group, Vall d'Hebron Hospital Research Institute, Barcelona, Spain. toni.julia@vhir.org.
Antonio
0000-0001-6064-3620
A
Julià
Centre for Omic Sciences, COS-DEEEA-URV-IISPV, Reus, Spain.|Metabolomics Platform, CIBERDEM, Reus, Spain.
Maria
M
Vinaixa
Hospital Universitari Germans Trias i Pujol, Badalona, Spain.|CIBERehd, Madrid, Spain.
Eugeni
E
Domènech
UGC Reumatología, Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain.
Antonio
A
Fernández-Nebro
Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain.
Juan D
JD
Cañete
Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Carlos
C
Ferrándiz
Hospital Universitario Guadalajara, Guadalajara, Spain.
Jesús
J
Tornero
CIBERehd, Madrid, Spain.|Hospital Universitario de la Princesa and IIS-IP, Madrid, Spain.
Javier P
JP
Gisbert
CIBERehd, Madrid, Spain.|Hospital la Fe, Valencia, Spain.
Pilar
P
Nos
CIBERehd, Madrid, Spain.|Hospital General de Alicante, Alicante, Spain.
Ana Gutiérrez
AG
Casbas
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Lluís
L
Puig
Hospital Universitario de la Princesa and IIS-IP, Madrid, Spain.
Isidoro
I
González-Álvaro
Complejo Hospitalario Juan Canalejo, INIBIC, A Coruña, Spain.
José A
JA
Pinto-Tasende
Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Ricardo
R
Blanco
Centre for Omic Sciences, COS-DEEEA-URV-IISPV, Reus, Spain.|Metabolomics Platform, CIBERDEM, Reus, Spain.
Miguel A
MA
Rodríguez
Centre for Omic Sciences, COS-DEEEA-URV-IISPV, Reus, Spain.|Metabolomics Platform, CIBERDEM, Reus, Spain.
Antoni
A
Beltran
Centre for Omic Sciences, COS-DEEEA-URV-IISPV, Reus, Spain.|Metabolomics Platform, CIBERDEM, Reus, Spain.
Xavier
X
Correig
Rheumatology Research Group, Vall d'Hebron Hospital Research Institute, Barcelona, Spain. sara.marsal@vhir.org.
Sara
S
Marsal
D001172:Arthritis, Rheumatoid / Q000378:metabolism / Q000652:urine; D001327:Autoimmune Diseases / Q000150:complications / Q000652:urine*; D015415:Biomarkers / Q000378:metabolism / Q000652:urine*; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000378:metabolism / Q000652:urine; D003424:Crohn Disease / Q000378:metabolism / Q000652:urine; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000652:urine*; D008180:Lupus Erythematosus, Systemic / Q000378:metabolism / Q000652:urine; D009682:Magnetic Resonance Spectroscopy; D055442:Metabolome; D055432:Metabolomics / Q000379:methods; D011565:Psoriasis / Q000378:metabolism / Q000652:urine
D015415:Biomarkers
Autoimmune diseases; Disease activity; Inflammatory diseases; Metabolomics; Urine biomarkers