Metabolomic Markers in Tongue-Coating Samples from Damp Phlegm Pattern Patients of Coronary Heart Disease and Chronic Renal Failure

Hindawi Disease Markers Volume 2019, Article ID 4106293, 14 pages https://doi.org/10.1155/2019/4106293 Research Article Metabolomic Markers in Tongue-Coating Samples from Damp Phlegm Pattern Patients of Coronary Heart Disease and Chronic Renal Failure Yiming Hao ,1 Xue Yuan,2 Jin Yan,3 Minh Pham,4 Dekai Rohlsen,5 Peng Qian ,1 Feng Cheng ,5 and Yiqin Wang 1 1 Shanghai Key Laboratory of Health Identification and Assessment/Laboratory of TCM Four Diagnostic Information, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China 2 Shanghai Haohai Biological Technology Co., Ltd., Shanghai 200052, China 3 Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu Province 210009, China 4 Department of Mathematics and Statistics, University of South Florida, Tampa, FL 33620, USA 5 Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA Correspondence should be addressed to Feng Cheng; and Yiqin Wang; Received 27 May 2019; Accepted 22 July 2019; Published 8 September 2019 Academic Editor: Robert Pichler Copyright © 2019 Yiming Hao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In this paper, we used tongue coating to obtain metabolites in patients with coronary heart disease (CHD) and chronic renal failure (CRF). The metabolites were analyzed to discover the substance that serves as the underlying basis of the damp phlegm pattern. This analysis is based on the Traditional Chinese Medicine (TCM) theory of “different diseases have the same pattern.” The metabolic spectrum was obtained through the Gas Chromatography Mass Spectrometry coupling techniques and analyzed by searching the METLIN and HMDB databases. Some metabolites related to amino acids and glucose metabolism were identified in the tongue-coating samples from damp phlegm pattern patients by comparing them to nondamp phlegm pattern patients and healthy subjects. In addition, there were five common metabolites in the tongue-coating samples from CHD damp phlegm pattern patients compared to CRF damp phlegm pattern patients, which allowed us to understand the theory of “different diseases have the same pattern.” In the future, the metabolites identified in this study may be used as noninvasive and convenient biomarkers to distinguish the damp phlegm pattern of CHD and CRF patients. 1. Introduction Coronary heart disease (CHD) is a disease in which an atherosclerotic lesion of the coronary artery causes stenosis or obstruction of the vascular cavity, which could lead to myocardial ischemia, anoxia, or necrosis. The incidence rate of CHD has increased significantly due to the rapid change of the economy, the alteration of lifestyle, and the tendency of population aging. The morbidity and mortality rates of CHD also increased year by year, and the trend is significant among younger generations. Chronic renal failure (CRF) is a clinical syndrome of chronic progressive renal parenchyma damage caused by various reasons. The main clinical manifestations were atrophy of the kidney; inability to maintain basic functions; retention of metabolites; imbalance of water, electrolyte, and acid base; and systemic involvement. The incidence rate of CRF has increased at a noticeable rate. Nowadays, millions of people worldwide die of complications related to CRF each year [1]. The prevention and control of CRF has become a challenge for researchers and scientists around the world. The damp phlegm pattern is the definition of a certain kind of disease according to the symptoms and signs of patients based on Traditional Chinese Medicine (TCM) theory. According to TCM theory, the damp phlegm pattern is due to internal organ dysfunction, which hinders the movement of water in the body; thus, the water accumulates to form dampness and phlegm. The patients with damp phlegm 2 Disease Markers Table 1: Summary of demographics and clinic characteristics of CHD patients, CRF patients, and healthy subjects. Group Cases Ratio of male to female Average age Average course of disease (year) Healthy subjects 25 1 : 0.79 53 92 ± 4 66 N/A CHD showing the damp phlegm pattern 29 1 : 0.81 72 3 ± 12 67 5 90 ± 2 48 5 66 ± 2 81 CHD showing the nondamp phlegm pattern 29 1 : 0.61 69 41 ± 12 45 CRF showing the damp phlegm pattern 32 1 : 0.60 53 37 ± 17 18 3 66 ± 1 62 CRF showing the nondamp phlegm pattern 30 1 : 1.14 52 16 ± 14 21 3 67 ± 1 79 pattern mainly have full and heavy sensation in the body, greasy tongue coating, and slippery pulse. At present, the damp phlegm pattern as one of the most common TCM patterns has been included in the International Classification of Diseases, 11th Revision (ICD-11), compiled by the World Health Organization (WHO) [2]. One of the TCM theories named “different diseases have the same pattern” means that patients with different diseases may have the same clinical manifestations caused by a common pathogenesis. And the damp phlegm pattern has been considered a common pattern in CHD and CRF. After analyzing the CHD-related pattern literature in TCM collected over the past 40 years, we found that the percentage of patients with the damp phlegm pattern among 34,640 patients with CHD was 13.48% [3]. Some studies found that the damp phlegm pattern was also common in the progression of CRF [4]. However, the molecular mechanism of the damp phlegm pattern in patients with CHD and CRF is still unknown. As an important part of inspection and one of the TCMunique diagnostics, tongue diagnosis is an approach in TCM clinical practice by observing the changes of tongue property and tongue coating to understand the physiological functions and pathological changes of the body. Therefore, the tongue coating of patients with the damp phlegm pattern may have something different from those of healthy people, which may be selected as the disease markers of the damp phlegm pattern. In previous studies, our group has identified proteins in the tongue coating and serum of patients with CHD and CRF showing the damp phlegm pattern by proteomic technique [5–8]. These studies provided new insights into the damp phlegm pattern of TCM at the protein level. In this study, we investigated the metabolites in the tongue coating of damp phlegm pattern patients of CHD and CRF by using metabolomic methods that can obtain large amounts of data about the changes of metabolites in a systemic level [9, 10]. The collection of tongue-coating samples is noninvasive and convenient. Currently, the main metabolomic approaches include Nuclear Magnetic Resonance (NMR), Gas Chromatography Mass Spectrometry (GCMS), and Liquid Chromatography Mass Spectrometry (LCMS). In the three methods, the GC-MS test has higher sensitivity and lower cost. Therefore, we applied GC-MS in this study to investigate the metabolomic (...truncated)