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Metabolomic Profiling of Middle Ear Effusion Suggests a Predominant Influence of Age over Viscosity: An HR-MAS NMR
Seokhwan Lee1, Seonghye Kim2, Sojeon Moon2
1Department of Otorhinolaryngology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea.
Abstract:
Otitis media with effusion (OME) involves heterogeneous middle ear effusion (MEE), and its classification based on viscosity (serous/mucous) is often confounded by patient age. This study determined the independent contributions of age and viscosity to the MEE metabolome. In this prospective study, high-resolution magic-angle spinning nuclear magnetic resonance analysis of 83 MEE samples (45 adult serous, 17 child serous < 12 years, and 21 child mucous) was performed. Statistical analyses included principal component analysis, correlation analysis, analysis of covariance (ANCOVA), and age-adjusted receiver operating characteristic curve analysis. Age was the primary metabolic variance determinant, overshadowing viscosity-related differences. Significant age-associated metabolic trends were identified: pyruvate and lactate levels increased with age, whereas glutamate and leucine levels decreased, indicating energy and inflammatory metabolism shifts. After adjusting for age using ANCOVA, taurine, glycine, and choline were significantly associated with effusion viscosity, and a combined panel of these metabolites achieved an age-adjusted area under the curve of 0.707 (95% confidence interval: 0.55-0.89). In conclusion, the MEE metabolic profile was more strongly influenced by patient age than by viscosity, suggesting fundamental differences in OME pathophysiology between children and adults. Nonetheless, specific viscosity-associated metabolites were identified, offering a basis for objective metabolic typing.
Insights
Patient age significantly impacts middle ear effusion (MEE) metabolomics in otitis media with effusion (OME), more than fluid viscosity. Specific metabolites linked to viscosity offer potential for objective classification.
Area of Science:
- Biochemistry
- Metabolomics
- Otolaryngology
Background:
- Otitis media with effusion (OME) is characterized by middle ear effusion (MEE), with classification by viscosity (serous/mucous) often complicated by patient age.
- Understanding the factors influencing MEE composition is crucial for diagnosing and managing OME.
Purpose of the Study:
- To determine the independent effects of patient age and MEE viscosity on the MEE metabolome.
- To identify specific metabolic markers associated with viscosity, adjusted for age.
Main Methods:
- Prospective study analyzing 83 MEE samples using high-resolution magic-angle spinning nuclear magnetic resonance.
- Statistical analyses included principal component analysis, correlation, ANCOVA, and age-adjusted ROC curve analysis.
Main Results:
- Patient age was the primary determinant of MEE metabolic variance, overshadowing viscosity.
- Age-associated metabolic shifts included increased pyruvate/lactate and decreased glutamate/leucine.
- Taurine, glycine, and choline were significantly associated with viscosity after age adjustment (AUC=0.707).
Conclusions:
- MEE metabolomics are predominantly influenced by patient age, suggesting distinct OME pathophysiology in children versus adults.
- Specific viscosity-associated metabolites (taurine, glycine, choline) provide a basis for objective metabolic typing of MEE.
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