Rapid Identification of Dihydropyrimidine Dehydrogenase Deficiency by Using a Novel 2-C-Uracil Breath Test

Purpose: Dihydropyrimidine dehydrogenase (DPD)-deficient cancer patients have been shown to develop severe toxicity after administration of 5-fluorouracil. Routine determination of DPD activity is limited by time-consuming and labor-intensive methods. The purpose of this study was to develop a simple and rapid 2-C-uracil breath test, which could be applied in most clinical settings to detect DPDdeficient cancer patients. Experimental Design: Fifty-eight individuals (50 “normal,” 7 partially, and 1 profoundly DPD-deficient) ingested an aqueous solution of 2-C-uracil (6 mg/kg). CO2 levels were determined in exhaled breath at various time intervals up to 180 min using IR spectroscopy (UBiT-IR300). DPD enzyme activity and DPYD genotype were determined by radioassay and denaturing high-performance liquid chromatography, respectively. Results: The mean ( SE) Cmax, Tmax, over baseline values at 50 min (DOB50) and cumulative percentage of C dose recovered (PDR) for normal, partially, and profoundly DPD-deficient individuals were 186.4 3.9, 117.1 9.8, and 3.6 DOB; 52 2, 100 18.4, and 120 min; 174.1 4.6, 89.6 11.6, and 0.9 DOB50; and 53.8 1.0, 36.9 2.4, and <1 PDR, respectively. The differences between the normal and DPD-deficient individuals were highly significant (all Ps <0.001). Conclusions: We demonstrated statistically significant differences in the 2-C-uracil breath test indices (Cmax, Tmax, DOB50, and PDR) among healthy and DPDdeficient individuals. These data suggest that a single time-point determination (50 min) could rapidly identify DPD-deficient individuals with a less costly and timeconsuming method that is applicable for most hospitals or physicians’ offices.