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Serum branched-chain amino acid to histidine ratio: a novel metabolomic biomarker of knee osteoarthritis
  1. Guangju Zhai1,
  2. Rui Wang-Sattler2,
  3. Deborah J Hart1,
  4. Nigel K Arden3,
  5. Alan J Hakim4,
  6. Thomas Illig2,
  7. Tim D Spector1
  1. 1Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
  2. 2Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
  3. 3NIHR Oxford Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
  4. 4Department of Rheumatology, Whipps Cross Hospital, London, UK
  1. Correspondence to Dr Guangju Zhai, Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; guangju.zhai{at}


Objective There is a pressing need to develop reliable molecular biomarkers in osteoarthritis. The aim of the study was to identify novel serum biomarkers for osteoarthritis using a metabolomics approach.

Methods A two-stage study design was utilised. 123 knee osteoarthritis cases and 299 controls were selected from the TwinsUK cohort as a discovery sample. 76 knee osteoarthritis cases and 100 controls from the Chingford Study were used as replication. Knee osteoarthritis was defined as either radiographic, medically diagnosed or total knee joint replacement due to primary osteoarthritis. All the subjects were unrelated white women. Their serum samples were assessed for targeted metabolite profiling by electrospray ionisation tandem mass spectrometry using the AbsoluteIDQ kit. 163 serum metabolites were assessed and their concentrations obtained. The ratios of metabolite concentrations as proxies for enzymatic reaction rates were calculated and tested for the association with knee osteoarthritis. Significance was assessed after adjustment for multiple testing (Bonferroni method) and potential confounders.

Results In the discovery stage, the authors identified 14 ratios significantly associated with knee osteoarthritis with p≤1.9×10−6. Two of these 14 ratios were successfully confirmed in the replication stage—the ratios of valine to histidine and xleucine to histidine, with p=0.002. The significance remained after adjustment for age and body mass index.

Conclusion This is the first serum-based metabolomic study of osteoarthritis in humans. The branched-chain amino acids to histidine ratio has potential clinical use as an osteoarthritis biomarker and shows the clinical potential of metabolomics.

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  • Funding The study was funded by the European Community Framework 7 large collaborative project grant Treat-OA, The Wellcome Trust, Arthritis Research Campaign. The study also receives support from the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. TDS is an NIHR senior investigator.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the St Thomas' Hospital Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.