Proteolytic peptide patterns as indicators for fungal infections and nonfungal affections of human nails measured by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

The discrimination of onychomycoses from endogenous diseases showing macroscopically similar symptoms is difficult. Long-lasting but ineffective antifungal therapies using systemic medicaments with often severe adverse reactions may be the consequence. We introduce a novel mass spectrometric method for the discrimination of fungal infections and nonfungal affections. Horn samples from patients infected by Trichophyton rubrum, from patients with psoriasis affecting nails, and from healthy persons were investigated. Onychomycoses are basically associated with proteolytic attacks of the virulent fungi-secreting proteases partly hydrolyzing the horn material. Endogenous diseases lack these proteolytic activities, conserving intact structural proteins. Tryptical digestion of horn material produced cleavage peptides detectable by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Mass spectra of horn material infected by T. rubrum were clearly different from those originating from healthy test persons and from patients with psoriasis. Two methods were successfully applied to quantify the differences between groups of samples. One is based on the Euclidean match factor, and the other is based on the identification of specific peptide peaks occurring exclusively within one group of persons. The Euclidean match factor distributions and the occurrence of specific peptide peaks allowed a clear differentiation of T. rubrum infections from psoriasis patients and healthy test persons. No differences were found between healthy test persons and psoriasis patients. The method is rapid and does not require any cultivation.