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OMX Organic Metabolomics Takes Organic Acid Testing to the Next Level

Monday, March 14, 2022
by Cass Nelson-Dooley, MS

Diagnostic Solutions Laboratory has rocked the functional medicine market with its new metabolomics test: OMX™ Organic Metabolomics. After 30 years of organic acid testing in the functional medicine industry, this test provides a fresh, updated, and much-needed improvement on the organic acid tests of old. What distinguishes Diagnostic Solutions Laboratory’s OMX from other organic acid tests? A systems-based report layout, cutting-edge technology, and new markers that aren’t seen on other organic acid tests. Keep reading to discover why this new and improved test is a must-have in your clinician’s toolbox for a wide range of conditions.

What is a Metabolomics Test?

Metabolomics is the study of the set of metabolites of a cell, organism, or tissue. These are small biochemical substances that are used by, and produced by the body during daily activities. The patterns seen on a metabolomics test are individual to each person and impacted by lifestyle. By analyzing these small molecules, we can identify a person’s individual signature and see problems in biochemistry before standard blood tests show abnormal findings.

The OMX test looks at 32 amino acids as well as 74 organic acids and small molecules that are important for everyday cellular function. Organic acids and other small molecules are intermediate compounds that can define the efficient flow of pathways and substrates such as amino acids to reveal the level of inputs, which together establish the functional status of key areas of health.

Metabolomics is ideally suited for functional medicine, as it seeks to analyze each person’s individual biochemical milieu and determine how it may be promoting or preventing healthy function. Integrative and functional medicine practitioners are looking for root causes that may be causing chronic illness or symptoms – and these root causes can start with metabolic disturbances.

How is the OMX by Diagnostic Solutions Laboratory Different from Other Organic Acid and Amino Acid Tests?

Analyzing the Metabolome

OMX builds on the latest metabolomics research and scientific publications. Thirty years ago, organic acids were a revolutionary way to look at cell metabolism. Today, we are entering a new age that carries organic acid and amino acid testing into the future, where metabolomic signatures are the new face of personalized medicine.

The OMX test helps to identify a patient’s metabolic signature. The test report provides a systems-biology perspective of key metabolic pathways. Practitioners are able to follow an amino acid through its biochemical pathway and see its end products, which helps detect imbalances in the pathway. The report lists the relevant enzymes and cofactors under every marker, making it possible to trace the web of interconnections in the metabolome and develop customized treatments.

Take a look at the section of the test on tryptophan metabolism. By looking at the whole metabolic pathway, we can see tryptophan’s various downstream metabolites including serotonin breakdown (5-hydroxyindoleacetic acid), vitamin B6 markers (xanthurenic acid and hydroxykynurenine), and markers of inflammation [quinolinic acid and the kynurenine/tryptophan (KT) ratio]. Quinolinic acid and kynurenic acid are neuroactive metabolites, affecting NMDA (N-methyl-D-aspartate) receptors in the brain.

In this example, it’s clear that tryptophan is being depleted (low) while the KT Ratio and kynurenic acid are being produced vigorously. Over time, this process can “steal” tryptophan from other tasks such as making serotonin which can lead to insomnia, depression, anxiety, migraines, and more. The increased flow through the pathway to make kynurenic acid may also deplete vitamin B6, a nutrient cofactor. An elevated KT Ratio is considered a marker of inflammation. In this example, the elevated kynurenic acid may be protective to guard against increased quinolinic acid which, along with hydroxykynurenine, can be neurotoxic.

Tryptophan Metabolism Example

Gut Microbial Markers

The OMX test includes clinically relevant urine metabolites of bacteria and fungi. These urine microbial markers can complement the direct, quantitative measurement of gastrointestinal microbes that you get from the GI-MAP test.

When selecting the list of gut microbial markers, Diagnostic Solutions Laboratory prioritized clinical evidence – not just cell studies – to ensure that the microbial markers on the OMX offer additional insight into microbial activity in the human gut. Some of these markers are well-known organic acid markers of microbial metabolism, such as benzoic acid and hippuric acid. Other microbial markers on the OMX test are new to organic testing and have human clinical studies to back up their relevance.

4-Hydroxybenzoic (also p-hydroxybenzoic) acid is a microbial metabolite of these bacteria:

  • Arthrobacter
  • Bifidobacterium
  • Clostridium
  • Corynebacterium
  • Eubacterium
  • Escherichia coli
  • Microbulbifer

 

Equol is a microbial metabolite with impressive clinical benefits for women’s health and a robust research base to back it up (discussed later). 3-5-dihydroxybenzoic acid is new to organic acid testing. It was one of the highest urinary microbial metabolites found in a clinical study of gut microbes. Arabinitol, which includes D-arabinitol, provides information about Candida overgrowth and has a long history in functional medicine testing.

Use these markers to get a view into your patient’s gut microbiome. Levels of these markers are the net result of dietary factors and the microbes that act on them. Use them together with a GI-MAP and wow!

New Markers Not Seen in Other Organic Acid or Amino Acid Testing

Let’s get to the exciting stuff! OMX Organic Metabolomics includes new markers that traditional organic and amino acid testing do not have, including:

Cortisol – Urine cortisol can give practitioners information about their patient’s stress response. Cortisol and hypothalamic-pituitary-adrenal axis function is certainly a piece of the puzzle for many patients with mood disorders and sleep dysfunction.1 A high cortisol may nudge practitioners to run a 4-point salivary cortisol test as they see fit.

Glucose – Urine glucose indicates how patients process their diet and gives practitioners a peek at sugar metabolism or glycolysis. Levels should be low but may elevate in diabetes, kidney disease, pregnancy, or in patients with hereditary abnormalities.2 If glucose is elevated, the microalbumin in the kidney section can give you further insight into kidney health.

Kynurenine/Tryptophan Ratio (KTR) – This is a ratio created from two critical components of the tryptophan pathway (pictured above). When this ratio is high, it indicates that activity of the cytokine-sensitive enzyme, indoleamine 2,3 dioxygenase (IDO), is increased – pulling tryptophan down the pathway and increasing kynurenine production. Higher KTR levels occur in systemic inflammation and have been associated with higher body mass index, obesity, inflammation, renal failure and chronic kidney disease (CKD), cancer, AIDS, sepsis, pregnancy, reduced cognition, and cardiovascular disease. Further, KTR is regarded as a marker for biological aging.3

Equol – Equol is a product of bacterial metabolism on isoflavones from soy. Aside from it serving as evidence of microbial activity in the gut, equol has beneficial health impacts. Equol can modify blood and urine estradiol levels. It is associated with a reduced risk of developing female hormone-related diseases such as breast cancer, hot flashes, and bone loss.4

Microalbumin – Imagine checking for early kidney damage while running a patient’s organic acids test. Urine microalbumin is a standard clinical laboratory test that practitioners can now access as part of a metabolomics work-up. If microalbumin is present consistently in urine, it is associated with early-stage kidney disease.5

 
 

Methodology & Development Team.

OMX uses the latest in small molecule technology, called a triple quadrupole tandem mass spectrometer. High-performance liquid chromatography (HPLC) separation followed by a tandem mass spectrometer (LC-MS/MS), this technique is uniquely suited to accurately detect and quantify small molecules. LC-MS/MS is used primarily by research, pharmaceutical companies, commercial laboratories, and more recently by clinical laboratories. It is superior to immunoassays or conventional high-performance liquid chromatography (HPLC) for low molecular weight analytes and has higher throughput than gas chromatography-mass spectrometry (GC-MS).

It is no small job to take a urine specimen (described by clinical chemists as “dirty”) and clearly identify and accurately measure a group of 106 metabolites. The team that developed the OMX test at Diagnostic Solutions has a proven track record for organic acid and amino acid quantitation, with a list of the publications to prove it.6-9 GC-MS, used by other laboratories, is an older and less sophisticated method. It is not as reliable for measuring organic acids at small concentrations. The Clinical Education Team also has many years of experience in organic acid and amino acid clinical interpretation. When you choose OMX, rest assured that your patient’s metabolomics test is in good hands.

 

What Types of Patients Benefit from the OMX Test?

The OMX test is best used for identifying a healthy patient’s baseline metabolomic profile, which some research has suggested should be part of yearly health evaluations. Metabolomic evaluation can also be helpful in patients with chronic health conditions. To determine which patients are best suited for an OMX test, let’s look at the areas of metabolism that the test measures. Organic acids, amino acids, and other small molecule metabolites in the OMX test give practitioners information about their patient’s underlying biochemical pathways, including:

  • Glucose metabolism and ketones
  • Mitochondrial markers
  • Fatty acid metabolism
  • Neurotransmitter metabolites
  • Amino acid metabolism
  • Inflammatory markers
  • Methylation
  • Glutathione
  • Collagen breakdown
  • B vitamins
  • Dietary indicators
  • Oxidative stress
  • Toxins
  • Kidney health
  • Cortisol
  • Microbial metabolites

 

The OMX Organic Metabolomics test covers a wide range of physiological processes. It casts a wide net to pinpoint exactly where a patient has metabolic disturbance. With these results, practitioners can better customize a treatment plan specific to their patient’s needs.

Conditions That May Benefit from Using the OMX Organic Acids and Amino Acids Test:
  • Alzheimer’s Disease
  • Anxiety
  • Autism Spectrum Disorder
  • Autoimmune/Immune Activation
  • Bipolar Disorder
  • Bowel Disorders/Disease
  • Brain Fog/Mental Focus
  • Cardiovascular Disease
  • Chronic Fatigue
  • Constipation
  • Depression
  • Diarrhea
  • Exercise Intolerance
  • Gas/Bloating
  • Headache/Migraines
  • High Blood Pressure
  • Hyperactivity/ADHD
  • Impaired Digestion
  • Inborn Errors of Metabolism
  • Inflammatory Conditions
  • Insomnia/Sleep Disturbances
  • Insulin resistance/Prediabetes/Diabetes
  • Liver Disease
  • Microbial Processing
  • Nutritional Insufficiencies
  • Obesity
  • Parkinson’s Disease
  • Poor muscle Mass
  • Schizophrenia
  • Skin Conditions
  • Toxicity or Detoxification Challenge
  • Unexplained Chronic Illnesses
  • Weight Loss Resistance

 

Practitioners can get a complete picture of a patient’s metabolic and immune challenges by combining a GI-MAP stool test with the information included in the OMX test. The GI-MAP is appropriate for a variety of digestive symptoms, malnutrition, autoimmune diseases, joint pain, psychiatric disorders, obesity, and more.


REFERENCES

  1. Steen, N. E., et al. (2014). "Altered systemic cortisol metabolism in bipolar disorder and schizophrenia spectrum disorders." J Psychiatr Res 52: 57-62.
  2. Sivanand, S., et al. (2018). "Spatiotemporal Control of Acetyl-CoA Metabolism in Chromatin Regulation." Trends Biochem Sci 43(1): 61-74.
  3. Badawy, A. A. (2017). "Kynurenine Pathway of Tryptophan Metabolism: Regulatory and Functional Aspects." Int J Tryptophan Res 10: 1178646917691938.
  4. Mayo, B., et al. (2019). "Equol: A Bacterial Metabolite from The Daidzein Isoflavone and Its Presumed Beneficial Health Effects. Nutrients 11(9).
  5. McGrath K, Edi R. Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention. Am Fam Physician. 2019 Jun 15;99(12):751-759. PMID: 31194487.
  6. Bishop MJ, Crow BS, Kovalcik KD, George J, Bralley JA. Quantification of urinary zwitterionic organic acids using weak-anion exchange chromatography with tandem MS detection. Journal of Chromatography B. 2007;848(2):303-310.
  7. Crow B, Bishop M, Paliakov E, Norton D, George J, Bralley JA. Analysis of urinary aromatic acids by liquid chromatography tandem mass spectrometry. Biomed Chromatogr. 2008.
  8. Crow B, Bishop M, Kovalcik K, Norton D, George J, Bralley JA. A simple and cost effective method for the quantification of 8-hydroxy-2'-deoxyguanosine from urine using liquid chromatography tandem mass spectrometry. Biomed Chromatogr. 2008;22(4):394-401.
  9. Norton D, Crow B, Bishop M, Kovalcik K, George J, Bralley JA. High performance liquid chromatography-tandem mass spectrometry (HPLC/MS/MS) assay for chiral separation of lactic acid enantiomers in urine using a teicoplanin based stationary phase. Journal of Chromatography. 2007;850(1-2):190-198.
  10. Fujitani, T. (2021, September). Urinary equol levels are positively associated with urinary estradiol excretion in women. Nature Retrieved March 7, 2022. Article number: 19532 (2021)

About the Author

Cass Nelson-Dooley, MS

Cass Nelson-Dooley, MS, studied medicinal plants in the rain forests of Panama, in 2003 as a Fulbright Scholar, and then launched a career in science and natural medicine. She researched the pharmacology of medicinal plants at the University of Georgia and AptoTec, Inc. She has over 15 years of experience teaching doctors about integrative and functional laboratory results.

At Diagnostic Solutions Laboratory, she analyzes GI-MAP stool tests and develops educational tools. Ms. Nelson-Dooley owns Health First Consulting, LLC, a medical writing, patient education, and consulting firm that serves the integrative and functional medicine industry. Ms. Nelson-Dooley is the author of Heal Your Oral Microbiome and has published case studies, book chapters, and journal articles about natural medicine, nutrition, and laboratory testing.