Metabolomix+

Metabolomix+ : A Non-Invasive Personalized Assessment

The Metabolomix+ is a unique combination of nutritional tests that provides an analysis of key nutritional biomarkers. A first morning void (FMV) urine collection, with optional add-on bloodspot finger stick and buccal swab, the Metabolomix+ nutritional test is a non-invasive, patient-friendly way to assess the functional need for antioxidants, B-vitamins, minerals, digestive support, fatty acids, and amino acids. Insights gained from the Metabolomix+ nutritional test allows clinicians to target nutritional therapies to the precise needs of their patients.

Additional markers are available for an even greater overview of a patient's nutritional status with easy to add modules based on a patient's unique needs.

What is a functional nutritional assessment?

Marked accumulation of organic acids in urine can signal a metabolic inhibition or block. The metabolic block may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect.

Enzymes that are responsible for metabolizing organic acids are vitamin and mineral dependent. With this, elevations in organic acids can reflect a functional need for these nutrients on a cellular and biochemical level, even despite normal serum levels.1-5 Recommendations for nutrient supplementation based on elevated organic acid results are generated using a literature-based proprietary algorithm.

Traditionally, urinary organic acid assessment has been used in neonatal/pediatric medicine to identify genetic inborn errors of metabolism, with severity depending on the degree and type of error.* In many cases of genetic inborn errors, the enzymatic defect may be compensated for by high doses of specific vitamin and mineral cofactors and/or dietary interventions. Intervention with higher-dose nutrient cofactors may also be effective in cases of decreased enzyme activity due to causes other than frank inborn errors.

* Genova's organic acid testing is not intended for the diagnosis of neonatal inborn errors of metabolism.

Which patients might benefit from functional nutritional testing?

Common clinical indications for testing include:

  • Mood Disorders6,7
  • Mitochondrial Dysfunction8
  • Fatigue9
  • Chronic Stress10
  • Inflammation11

Several diseases are associated with abnormal organic acid, amino acid, and fatty acid levels such as depression, anxiety, cardiovascular disease, neurocognitive decline, diabetes, cancer, anorexia, and many others.12-15

About the Metabolomix+ Profile

The Metabolomix+ Profile report allows for easy interpretation and clinically actionable results. It includes a Suggested Supplement Schedule that provides personalized recommendations based on test results. The Interpretation-At-A-Glance section of the report provides facts related to nutrient function, causes and complications of their deficiencies, and dietary sources.

The Metabolomix+ Profile report categorizes results into several metabolic areas:

  • Organic Acids
    • Malabsorption and Dysbiosis
    • Cellular Energy and Mitochondrial Metabolites
    • Neurotransmitter Metabolites
    • Vitamin Markers
    • Toxin and Detoxification Markers
    • Tyrosine Metabolism
  • Amino Acids
    • Nutritionally Essential Amino Acids
    • Nonessential Protein Amino Acids
    • Intermediary Metabolites
    • Dietary Peptide Related Markers
  • Oxidative Stress Markers
  • Essential and Metabolic Fatty Acids - Bloodspot (if selected as add-on profile)
    • Omega 3 Fatty Acids
    • Omega 6 Fatty Acids
    • Omega 9 Fatty Acids
    • Saturated Fatty Acids
    • Monounsaturated Fatty Acids
    • Delta-6 Desaturase Activity
    • Cardiovascular Risk
  • Nutrient and Toxic Elements (if selected as add-on profile)
  • Genomics (if one or more of the following SNPs are selected as add-ons)
    • APO E (C112R + R158C)
    • MTHFR Combined (A1298C + C677T)
    • TNF-α
    • COMT (V158M)

    Genova's Methodology

    Urinary organic and amino acids are measured via GCMS, LC/MS/MS and alkaline picrate. Fatty acids are measured via GCMS. Urinary oxidative stress markers are measured using colorimetric, thiobarbituric acid reactive substances (TBARS) and LC/MS/MS. Nutrient and toxic elements are measured using ICP-MS and Kinetic (Jaffe). Reference ranges are age and gender specific and are based on a questionnaire-qualified healthy cohort. Testing is not performed in patients under 2 years old.

    References

    1. Kałużna-Czaplińska J. Noninvasive urinary organic acids test to assess biochemical and nutritional individuality in autistic children. Clin Biochem. 2011;44(8-9):686-691.
    2. Broquist HP, Luhby AL. Detection and isolation of formiminoglutamic acid from urine in folic acid deficiency in humans. Proc Soc Exp Biol Med. 1959;100(2):349-354.
    3. Sun A-l, Ni Y-h, Li X-b, et al. Urinary methylmalonic acid as an indicator of early vitamin B12 deficiency and its role in polyneuropathy in type 2 diabetes. J Diab Res. 2014;2014.
    4. Kwok T, Cheng G, Lai W, Poon P, Woo J, Pang C. Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons. Nutrition. 2004;20(9):764-768.
    5. Brown R, Thornton MJ, Price J. The effect of vitamin supplementation on the urinary excretion of tryptophan metabolites by pregnant women. J Clin Invest. 1961;40(4):617-623.
    6. Lykouras L, Markianos M, Hatzimanolis J, Malliaras D, Stefanis C. Association of biogenic amine metabolites with symptomatology in delusional (psychotic) and nondelusional depressed patients. Prog Neuro-Psychopharmacol Biol Psych. 1995;19(5):877-887.
    7. Frankenhaeuser M, Lundberg U, Von Wright MR, Von Wright J, Sedvall G. Urinary monoamine metabolites as indices of mental stress in healthy males and females. Pharmacol Biochem Behav. 1986;24(6):1521-1525.
    8. Mitochondrial Medicine Society's Committee on D, Haas RH, Parikh S, et al. The in-depth evaluation of suspected mitochondrial disease. Mol Genet Metab. 2008;94(1):16-37.
    9. Dimmock DP, Lawlor MW. Presentation and Diagnostic Evaluation of Mitochondrial Disease. Pediatr Clin North Am. 2017;64(1):161-171.
    10. Wu H, Jiang K, Gu G, Wu Y, Yu S. [The relationship of occupational stress and the level of some hormone metabolites in urine]. Chin J Indust Hyg Occup Dis. 2014;32(2):83-86.
    11. Jeon SW, Kim Y-K. Inflammation-induced depression: Its pathophysiology and therapeutic implications. J Neuroimmunol. 2017;313:92-98.
    12. Rao TSS, Asha MR, Ramesh BN, Rao KSJ. Understanding nutrition, depression and mental illnesses. Indian J Psychiatry. 2008;50(2):77-82.
    13. O'Connell BS. Select vitamins and minerals in the management of diabetes. Diabetes Spectr. 2001;14(3):133-148.
    14. Harris WS. Omega-3 fatty acids and cardiovascular disease: a case for omega-3 index as a new risk factor. Pharmacol Res. 2007;55(3):217-223.
    15. Spencer SJ, Korosi A, Layé S, Shukitt-Hale B, Barrientos RM. Food for thought: how nutrition impacts cognition and emotion. Sci Food. 2017;1(1):1-8.

    Test Type: Urine Test
    Add-Ons: Urine, Bloodspot, & Buccal Swab
    Turnaround Time: 14 Days

Analyte List
1-Methylhistidine
2-Hydroxyphenylacetic Acid
3-Hydroxyproprionic Acid
3-Methyl-4-OH-phenylglycol
3-Methylhistidine
4-Hydroxyphenylpyruvic Acid
5-OH-Indoleacetic Acid
8-OHdG
APOE (Add-on)
Adipic Acid
Alanine
Alpha-amino-N-butyric acid
Alpha-aminoadipic acid
Aluminum (Add-on)
Anserine (dipeptide)
Antimony (Add-on)
Arabinose
Arachidic (Add-on)
Arachidonic (Add-on)
Arginine
Arsenic (Add-on)
Asparagine
Aspartic acid
Barium (Add-on)
Behenic (Add-on)
Benzoic
Benzoic/Hippuric Acids Ratio
Beta-alanine
Beta-aminoisobutyric acid
Bismuth (Add-on)
COMT (V158M) (Add-on)
Cadmium (Add-on)
Calcium (Add-on)
Carnosine (dipeptide)
Cesium (Add-on)
Chromium (Add-on)
Cis-Aconitic Acid
Citramalic Acid
Citric Acid
Citrulline
Cobalt (Add-on)
Copper (Add-on)
Creatinine
Creatinine (Add-on)
Cystathionine
Cysteine
Cystine
Dihomo-gamma-linolenic (Add-on)
Dihydroxyphenylpropionic Acid
Docosahexaenoic (Add-on)
Docosapentaenoic (Add-on)
Docosatetraenoic (Add-on)
Eicosadienoic (Add-on)
Eicosapentaenoic (Add-on)
Elaidic (Add-on)
Ethanolamine
Formiminoglutamic Acid (FIGlu)
Gadolinium (Add-on)
Gallium (Add-on)
Gamma-Linolenic (Add-on)
Gamma-aminobutyric acid
Glucose
Glutamic acid
Glutamine
Glutaric Acid
Glycine
Gondoic (Add-on)
Hippuric
Histidine
Homogentisic Acid
Homovanillic Acid
Indoleacetic Acid
Iron (Add-on)
Isocitric Acid
Isoleucine
Kynurenic Acid
Lactic Acid
Lead (Add-on)
Leucine
Lignoceric (Add-on)
Linoleic (Add-on)
Lipid Peroxides
Lithium (Add-on)
Lysine
MTHFR (C677T and A1298C) (Add-on)
Magnesium (Add-on)
Malic Acid
Manganese (Add-on)
Margaric (Add-on)
Mercury (Add-on)
Methionine
Methylmalonic Acid
Molybdenum (Add-on)
Nervonic (Add-on)
Nickel (Add-on)
Niobium (Add-on)
Oleic (Add-on)
Ornithine
Orotic Acid
Palmitic (Add-on)
Palmitoleic (Add-on)
Pentadecanoic (Add-on)
Phenylacetic Acid
Phenylalanine
Phosphoethanolamine
Phosphoserine
Platinum (Add-on)
Potassium (Add-on)
Proline
Pyroglutamic Acid
Pyruvic Acid
Rubidium (Add-on)
Sarcosine
Selenium (Add-on)
Serine
Stearic (Add-on)
Strontium (Add-on)
Suberic Acid
Succinic Acid
Sulfur (Add-on)
TNF-a (Add-on)
Taurine
Thallium (Add-on)
Thorium (Add-on)
Threonine
Tin (Add-on)
Tricosanoic (Add-on)
Tryptophan
Tungsten (Add-on)
Tyrosine
Uranium (Add-on)
Urea
Vaccenic (Add-on)
Valine
Vanadium (Add-on)
Vanilmandelic Acid
Zinc (Add-on)
a-Keto-b-Methylvaleric Acid
a-Ketoadipic Acid
a-Ketoglutaric Acid
a-Ketoisocaproic Acid
a-Ketoisovaleric Acid
alpha-Linolenic (Add-on)
b-OH-Butyric Acid
b-OH-b-Methylglutaric Acid
CPT Codes  
1-Methylhistidine 82139
2-Hydroxyphenylacetic Acid 83921
3-Hydroxyproprionic Acid 83921
4-Hydroxyphenylpyruvic Acid 83921
5-OH-Indoleacetic Acid 83497
8-OHdG 83520
Adipic Acid 83921
Aluminum (Add-on) 82108
Antimony (Add-on) 83015
Arachidic (Add-on) 82542
Behenic (Add-on) 82726
Cadmium (Add-on) 82300
Calcium (Add-on) 82340
Citric Acid 82507
Creatinine 82570
Docosatetraenoic (Add-on) 82726
Glutaric Acid 83921
Homogentisic Acid 83921
Homovanillic Acid 83150
Isocitric Acid 83921
Lactic Acid 83605
Lead (Add-on) 83655
Lignoceric (Add-on) 82726
Lipid Peroxides 84311
Magnesium (Add-on) 83735
Malic Acid 83921
Methylmalonic Acid 83921
Nervonic (Add-on) 82726
Nickel (Add-on) 83885
Orotic Acid 83921
Pyruvic Acid 84210
Suberic Acid 83921
Succinic Acid 83921
Tricosanoic (Add-on) 82726
Vanilmandelic Acid 84585
a-Keto-b-Methylvaleric Acid 83921
a-Ketoadipic Acid 83921
a-Ketoglutaric Acid 83921
a-Ketoisocaproic Acid 83921
a-Ketoisovaleric Acid 83921
Specimen Requirements
1 green-top preservative tube - FMV urine (frozen); 1 blue-top amber tube - FMV urine (frozen); 1 green-top tube - FMV urine (frozen); Additional add-ons include 1 bloodspot card; 2 genomic buccal swabs