CLN Daily 2024
Clinical mass spectrometry plays a key role in detecting metabolic disorders and monitoring drug effectiveness and toxicology, but it is not without its challenges.
During Monday’s session, “Real-Time Mass Spectrometry: Strategies for Rapid Drug and Metabolite Detection to Enhance Clinical Decision Making,” Dennis Dietzen, PhD, DABCC, and Stephen Roper, PhD, DABCC, shared their journeys with evaluating and implementing real-time mass spectrometry for patient care.
Roper kicked off the session by providing an overview of the traditional applications of this technology, including immunosuppressant monitoring and confirmatory drug testing. While mass spectrometry has analytical advantages such as molecular specificity and the ability to simultaneously detect and quantify numerous substances from small sample volumes, Roper reminded us that “mass spectrometry is difficult to implement for clinical situations where prompt turnaround time is required.”
Roper shared several reasons for this, such as sequential throughput, long chromatography time, multi-point calibration curves, manual data review, demanding instrument upkeep, instrument failures, and limited access to trained operators.
According to Roper, real-time mass spectrometry is putting the instruments and methods in the hands of front-line technologists similar to an automated chemistry system with all the demands for rapid turnaround time — not just reporting results during bankers’ hours. He discussed operational challenges and considerations for implementation, such as addressing instrument location and maintenance, meeting the demands of around-the-clock quality control, and keeping staff trained and competent across three shifts 24/7.
Despite these challenges, it’s important to celebrate success too. Roper shared insights on his team’s implementation of real-time mass spectrometry drug screening in children, which enabled time-sensitive clinical decision-making for patient care.
Expanding on clinical applications, Dietzen shared words of wisdom: “One must choose niches for real-time mass spectrometry wisely.” It is key to select the right applications for real-time mass spectrometry in high-risk, high-reward settings. He provided examples of novel real-time mass spectrometry for therapeutic drug monitoring and the “metabolic frozen section,” which is used to rapidly determine 2-hydroxyglutaric acid in gliomas for assessing potential mutant isocitrate dehydrogenase.
He emphasized that such novel mass-spectrometry applications can improve personalized approaches to drug monitoring and cancer diagnosis.
New opportunities come with new challenges. Dietzen described strategies for developing dependable mass spectrometry assays without sacrificing quality. He shared that sample preparation needs to be fast and simple, and that redundancy in hardware and personnel is essential. “Backup plans for failure are a must,” he stressed. “Backup plans to the backup plans are essential.”
There is a growing clinical need for rapid turnaround time of results that can only be generated by mass spectrometry. Dietzen concluded the session with a call to action: “Laboratory medicine professionals and industry partners must both evolve to meet this need.”