Analytical Approaches for Parasitic Biomarkers Diseases Discovery: Trends and Perspectives of Metabolomics in the Clinical Laboratory.

The clinical and laboratory diagnosis of diseases caused by parasites - helminths and protozoa - presents several limitations. To solve these gaps, new technologies have been developed. Metabolomics is in the spotlight due to its potential for discovering biomarkers that can be useful in the clinical laboratory. In this systematic review, we evaluate the main biomarkers identified in parasitic infections by metabolomics and the perspectives for their use in the clinical laboratory. The search was conducted on PubMed, SciELO Brasil and LILACS-Bireme platforms with the combination of descriptors "metabolomics" and "parasites" or "helminth" or "protozoan". A total of 65 studies met our eligibility criteria. Plasmodium spp., Toxoplasma gondii and Schistosoma spp. were the most studied parasites. Experimental infections were more commonly performed, indicating that metabolomics is in the process of being standardized for its application in laboratory routine. Among all metabolites, amino acids were the most commonly observed in parasitic infections. In the context of metabolite detection, the majority of studies employed mass spectrometry (MS), whereas only a limited number utilized nuclear magnetic resonance (NMR) spectroscopy. The main advantage of employing metabolites in diagnostics is their early detectability, overcoming limitations imposed by the parasite's life cycle and excretion dynamics. We demonstrate the potential of metabolomics tools as alternatives to complement the conventional parasitological diagnosis.