Biomarkers of therapeutic response

Fig. 2 Incorporation of metabonomics-based expert systems into clinical diagnosis for evaluation of disease models and the effectiveness of therapeutic procedures. (View this art in color at www.dekker.com.)

The ''gold standard'' diagnostic method for coronary heart disease (CHD) is X-ray angiography after injection of opaque dye into the blood stream. This is expensive and invasive with an associated 0.1% mortality and 1-3% of patients experiencing adverse effects. Recently, metabo-nomics has provided a method for diagnosis of CHD noninvasively through analysis of a blood serum sample using NMR spectroscopy.1-15-1 Patients were classified, based on angiography, into two groups, those with normal coronary arteries and those with triple coronary vessel disease. Using a training set, the samples from the two classes were easily distinguished. The sample classes of a separate validation set were then predicted based on the model with a sensitivity of 92% and a specificity of 93%. The severity of the disease was diagnosed in patients with stenosis of one, two, or three of the coronary arteries. Separation of the three sample classes was evident although none of the wide range of conventional clinical risk factors that had been measured was significantly different between the classes.

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