Revolutionizing the clinical lab with mass spectrometry

While mass spectrometry (mass spec) is a common basic research tool, over the last decade, the technology has become more widely adopted for use in diagnostic testing in the clinical setting. With new generations of technologies coming to market, clinical labs are utilizing mass spec in routine testing to improve the sensitivity of disease screening, therapeutic drug monitoring, and diagnostic testing that can provide labs with a cost-saving option while getting patients more rapid test results compared to conventional assays.

At this year’s annual European Congress of Clinical Chemistry and Laboratory Medicine (EuroMedLab), Prof. Dr. Robert de Jonge, Prof. Dr. Pieter Vermeersch, Prof. Dr. Mads Nybo and Prof. Dr. Michael Vogeser, shared their insights into how mass spec can help transform clinical laboratories.

For decades, immunoassays were considered by many the gold standard for protein detection in the clinical lab.¹ However, as the need for improved molecular detection sensitivity and specificity in the healthcare industry grew, scientists began to see the challenges of immunoassays. Some of the drawbacks of immunoassays include:²

• Cross-reactivity with related molecules
• Lack of antibody and reagent kits for known protien
• Changes in binding site structure
• Failure to identify small molecule analytes

Due to these barriers, clinical researchers and lab leaders looked to other tools and found that mass spec could address many of the hurdles found when using conventional immunoassays. 

Mass spec is an analytical technique that measures the mass-to-charge ratio (m/z) of molecules, such as peptides, proteins, and drug metabolites, in a sample. In the clinical setting, mass spectrometry helps identify and quantify unknown and known compounds as well as evaluate their molecular structure and chemical composition, with better specificity and sensitivity than other methods.³

At the 2023 EuroMedLab congress, a group of core lab and mass spectrometry experts Drs. de Jonge, Vermeersch, Nybo, and Vogeser talked about pushing the boundaries of automated clinical mass spec and how these services will improve patient care.

Bringing mass spec automation to the forefront

There is a need to move labs towards mass spec workflows that can be done at scale in an automated manner, such that laborious workflows become easier to manage. “Making mass spectrometry automated, perhaps even getting it on a line working 24/7 is a great idea,” said Dr. Nybo. 

Taking advantage of advanced mass spectrometry technologies, including automated solutions, enable lab technicians to step away from the bench and focus more on high-value tasks, such as improving operational efficiency. Dr. Vogeser commented, “The resources of staff, highly specialized staff, is critically limited and will go on to be more and more limited.” By taking an automated approach, we can free up personnel and enable wider clinical lab adoption of mass spec. 

“We moved from the benchtop ELISA assay, radio-immuno assays, to the 24/7 random access platforms and now it's the turn for mass spec,” said Dr. de Jonge, adding that having an automated mass spec workflow “without complete knowledge of the technology that's inside the system” would be the next step in the evolution of the clinical lab.

From clinical diagnostics to therapeutic drug monitoring, mass spec is utilized in many health systems and can be crucial in getting physicians and patients results quickly and efficiently. 

“Therapeutic drug monitoring is definitely hampered by batch-wise analysis,” said Dr. Vermeersch. “The great opportunities would be random access, which would certainly for therapeutic drug monitoring offer much better service to the clinicians for therapeutic drug monitoring parameters you are not performing frequently.” 

Dr. Vermeersch added, “Having a better qualitative result with less potential interference, will also improve the treatment of the patients.”

Additionally, misuse and over-usage of antibiotics is a major issue that can lead to antibiotic-resistant strains of pathogens. Mass spec is a powerful tool that can help identify antibiotic macromolecules, specifically their structural components involved in this resistance. “Laboratory and specifically the monitoring of antibiotics is very crucial and very important,” said Dr. Vogeser. “It will increase the number of requests and what is most important, I'm sure that with this technology, more patients will leave our hospital alive.”

Dr. de Jonge commented that in the Netherlands, the number of mass spec users is increasing, along with the accuracy and precision of the technology. Before the wide adoption of mass spec in the clinical lab, there is a need for standardized, validated protocols and workflows, especially for analysis of higher volumes of samples. As mass spectrometry becomes more widely used by lab leaders, the industry can ensure that through actionable clinical insights generated by mass spec, physicians can diagnose diseases faster and help create immediate personalized therapeutic interventions.

“They come, they have their blood drawn, they go to the clinic, and then the answer should be there. So it's crucial that we have 24/7 automated instruments to guide this and I think that's the future for all of us,” said Dr. Nybo. “Automation is crucial because we have to deliver answers quicker and to more patients every day.”