Untargeted metabolomic profiling in children identifies novel pathways in asthma and atopy.

[Display omitted] Asthma and other atopic disorders can present with varying clinical phenotypes marked by differential metabolomic manifestations and enriched biological pathways. We sought to identify these unique metabolomic profiles in atopy and asthma. We analyzed baseline nonfasted plasma samples from a large multisite pediatric population of 470 children aged <13 years from 3 different sites in the United States and France. Atopy positivity (At⁺) was defined as skin prick test result of ≥3 mm and/or specific IgE ≥ 0.35 IU/mL and/or total IgE ≥ 173 IU/mL. Asthma positivity (As⁺) was based on physician diagnosis. The cohort was divided into 4 groups of varying combinations of asthma and atopy, and 6 pairwise analyses were conducted to best assess the differential metabolomic profiles between groups. Two hundred ten children were classified as At⁻As⁻, 42 as At⁺As⁻, 74 as At⁻As⁺, and 144 as At⁺As⁺. Untargeted global metabolomic profiles were generated through ultra–high-performance liquid chromatography–tandem mass spectroscopy. We applied 2 independent machine learning classifiers and short-listed 362 metabolites as discriminant features. Our analysis showed the most diverse metabolomic profile in the At⁺As⁺/At⁻As⁻ comparison, followed by the At⁻As⁺/At⁻As⁻ comparison, indicating that asthma is the most discriminant condition associated with metabolomic changes. At⁺As⁺ metabolomic profiles were characterized by higher levels of bile acids, sphingolipids, and phospholipids, and lower levels of polyamine, tryptophan, and gamma-glutamyl amino acids. The At⁺As⁺ phenotype displays a distinct metabolomic profile suggesting underlying mechanisms such as modulation of host–pathogen and gut microbiota interactions, epigenetic changes in T-cell differentiation, and lower antioxidant properties of the airway epithelium. [ABSTRACT FROM AUTHOR]