A New Era Predicted for LC-MS in the Clinical Lab

September 7, 2016
A New Era Predicted  for LC-MS  in the Clinical Lab
Source: Fulvio314, CC BY-SA 3.0, https://commons.wikimedia.org

Lisa Thomas

Liquid chromatography/mass spectrometry (LC-MS) systems represent a coming together of two powerful analytical tools that are paving the way for the advancement of clinical research methods and diagnostic applications. LC-MS combines the high-specificity chemical separation capabilities of liquid chromatography with the analytical power of mass spectrometry, enabling the flexibility to rapidly optimize target separation from solution and enabling users to selectively detect particular analytes within complex matrices. This ensures the sensitive analytical capabilities of mass spectrometry can be fully exploited, resulting in faster and more precise, and in some cases, more cost-effective diagnostic outputs compared to conventional methods such as immunoassays.

Clinical researchers and diagnostic testing laboratories are harnessing LC-MS systems to increase their testing output. However, there has been some caution with the adoption of these systems due to the upfront investment in equipment, and the time and resources required for the transfer and validation of approved protocols. To combat this, LC-MS systems are being developed with this in mind and are becoming more intuitive to operate, negating the need for specialist personnel. Additionally, the inclusion of routine test menus within clinical laboratories, the availability of on-market IVD test kits, and the production of dedicated assays developed in-house are on the rise, owing to the growth of industry-wide support for LC-MS.

Using LC-MS laboratories can rapidly develop or replicate novel tests for the clinical assessment of a patient’s disease state in a way that conventional immunoassays are unable to in the same time frame. For instance, the narrow therapeutic index and unpredictable pharmacokinetics of many immunosuppressants necessitates the post-treatment monitoring of drug distribution and response. Clinical laboratories are adopting LC-MS over conventional immunoassays for these analyses, as they offer improved analyte specificity and reduced matrix effects, allowing clinicians to sensitively balance therapeutic efficacy against adverse side effects. In addition, LC-MS allows for the simultaneous analysis of multiple immunosuppressants in tandem, a useful tool when monitoring patients taking multiple therapies1.

Incorrect analyses can be problematic. For example, immunoassay-based analyses conducted on thyroid cancer patients are often unable to distinguish between clinically relevant biomarkers for disease progression such as thyroglobin and autoantibodies produced in the body, leading to false readings2. The specificity offered by LC-MS systems means this interference is avoided. This makes it a significant tool, not only for monitoring treatment response and disease classification, but also for evaluating therapeutic uptake and identifying any toxic effects a drug may be having on a patient.

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