Monday, November 26, 2018

Clinical mass spectrometry is more than pain management.

I recently went to demo some mass specs. Boring triple quad routine analysis stuff.

I realized on the second day that every time I said the word "clinical" all the people there heard was "pain management" (is this a US exclusive thing?)

Inspired, I just wanted to take a look at clinical mass spec today and some of the proof that we can do more than just quantify oxycodone in plasma.

<begin rant>

Great new study #1

Great new study #2 (You get HDL, LDL measurements in the clinic all the time -- but this is just a tiny clue to the puzzle of what is wrong. We have the tools to flesh out these differences NOW.)

Great newish study #3 (We don't even need anything special. The tubes that the hospitals are using for collecting samples for DNA analysis? Those are perfect for clinical proteomics analysis!!)

Similar and great newish study #4 (Look, we don't need anything special, Mr. Hospital administrator. We're not asking you to spend an extra $0.06 per patient on a new fancy tube. You're already making more FFPE slides than you will use. We just want one of them....

Great newish study #5 (Personalized medicine for bladder cancer. We can track biomarkers to determine what chemotherapeutic to use and when. Today. With the technology we have now. "personalized medicine" is more than just words for politicians to throw around. This is stuff we can do right now to make patient's lives better and improve the chance they go home.)

Okay -- I should wrap this up. And I'm going to end it with the study that is the first image. And -- yes -- this study has appeared on this blog multiple times, with me focusing on different aspects of it, but --- what a fucking awesome piece of work. I'm thrilled that if you Google image search "clinical proteomics" that is now the second picture that pops up.



<end rant>

1 comment:

  1. First things first: thank you for a great website!

    With respect to clinical proteomics, I totally agree that the technology is now ready to make the leap into clinical routine measurements. but with new advances, comes new challenges. I also think that "borring triple quads" may become an important proteomics tool because they are already installed in clinical labs., whereas nanoLC coupled with HRMS still needs to demonstrate its reliability outside the "protected" research lab.

    In any case, one remaining challenge is to document that proteomics actually makes a difference for patients and tax payers. Counter to what we like to say in the proteomics community there IS actually many great immunoassays and chemical assays being used in the clinic. And they are fast and cheap and difficult to outcompete. The traditional way to do things in clinical plasma protein diagnostics is to perform absolute quantification and this means that each protein must be measured together with calibrants, as well as internal standards and quality control samples. Also, due to the significant inter-laboratory variation seen with all analytical platforms you need to construct your own in-house reference range for EACH protein you measure on EACH specific platform you use. That is a lot work and it can only be justified if proteomics actually makes a difference for patients. You also need trained technicians, more riguors rutine maintance than what is typically done in "research only labs. where the local expert can adjust things daily - in a routine setting this cannot be allowed for. Everything MUST me completely standardized, and you need a clinical chemist to consistently monitor the analytical performance. This is the minimum to bring a new analytical method through accreditation and into clinical use.

    Perhaps with the advance of proteomics the culture in classical clinical chemistry will change, but this change of culture and rules is faced with regulatory challenges and, again, we need to provide evidence that changing the rules is truly worth it. This in itself is a huge challenge - providing statistical evidence that a new clinical marker truly benefit patients in a setting where many clinical parameters are already in play is often very difficult, if not impossible.

    I guess the simple point I am trying to get at is that there is a very big difference between publishing a clinical proteomics paper and providing actual evidence that proteomics is truly useful when integrated into the clinical setting. This is the challenge in clin. proteomics now. Furtunately I believe we starting to see these studies also, but you often need to look outside the typical proteomics journals to find them;-)

    As a die hard clinical proteomics researcher myself, I hope to see more clinical stuff up on your site!
    Thanks again for a great site.