PROS and CONS TMAU URINE TEST

a  PATIENT ADVOCACY International campaign to research SYSTEMIC BODY ODOR AND HALITOSIS

A 501(c)3 Public Charity, USA A Not For Profit LTD Company, England and Wales

BENEFITS OF TMAU URINE TEST

1. DNA test is expensive and does not indicate whether patient has liver FMO3 enzyme deficiency resulting from liver damage or gut flora excessive production of trimethylamine (TMA).
2. Easier to collect urine instead of blood from patients far away from lab.
3. Psycho-social consequences: All human interaction experienced by body odor and halitosis sufferers is compromised at a most basic level, whether it is in the workplace, education, general public or romantic and family life, leading to discrimination transcending the home, workplace and in the general public.

INSTRUMENTS USED AROUND THE WORLD
FOR URINE OR BLOOD TMAU TESTS

1. Gas Chromatography.
2. Liquid Chromatography.                  ALL ARE EQUALLY AS ACCURATE FOR TMAU TESTING.
3. Mass Spectrometry.
4. Nuclear Magnetic Resonance (NMR).

PROS  &  CONS TMAU URINE TEST

PROS 1.      When results show that the odorous chemical, trimethylamine (TMA), level is above normal range in the urine, it is indicative that others may detect odor coming from the patient's breath or body. When levels are within normal range, TMA is not a source of body or breath odor. 2.      Less costly than DNA testing. 3.      Assists in determining whether the more costly DNA test is indicated – otherwise, patients might never opt for the more expensive genetic sequencing test. 4.      Screening test measures odorous trimethylamine (TMA) levels regardless of the cause.  It indicates the possibility of whether patient has a genetic condition, liver enzyme dysfunction, or simply an excessive amount of TMA production by gut bacteria. 5.      Screening intervention test can assist physician in determining whether the TMAU odor-management protocol* is indicated. Protocol is unhealthy.  There is no test to guide physicians or patients other than this urine screening test. 5.       TMAU urine test has changed the lives of many patients who, under the guidance of their physician, have managed to control their odor symptoms and now live happier lives without the psycho-social barriers they once experienced before symptoms were controlled.

CONS 1.      Samples can more easily become damaged (TMA turns to gas at room temperature) and thus, may give spurious results. 2.      Test is a screening test, thus possibly resulting in misdiagnosis. 3.      Screening interventions tests are not designed to be diagnostic, and often have significant rates of both false positive and false negative results.

*Trimethylaminuria Odor Management Protocol, by Ian Phillips, PhD., and Elizabeth Shephard, PhD.

How TMAU urine test results are interpreted:

• TMAU1 can only be truly confirmed by FMO3 enzyme analysis (difficult because a liver biopsy would be needed) or DNA analysis.
• TMAU2 must be a diagnosis by exclusion.
• TMA-oxide can be used as a guide, but is not diagnostic for TMAU2.
• Therefore, if TMA is increased and TMA-oxide is normal and (as in many cases) FMO3 is not proven to be affected the diagnosis must be TMAU2 by exclusion.
• If TMA is normal and TMA-oxide is significantly high, suggest a re-test following a choline load.

Nigel Manning, Principal Clinical Scientist

Department of Metabolic Biochemistry

Sheffield Children's Hospital, UK

August 2012

María

María de la Torre
Founder and Executive Director

A Public Charity
maria.delatorre@meboresearch.com
www.meboresearch.org
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