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Rodrigo Valero AM, Jorge OQ, Serrano BB, Tejedor SA. Optimization of a rapid method for screening drugs in blood by liquid chromatography tandem mass spectrometry. ADVANCES IN LABORATORY MEDICINE 2023; 4:365-371. [PMID: 38106497 PMCID: PMC10724859 DOI: 10.1515/almed-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Objectives In the recent years, liquid chromatography with tandem mass spectrometry has gained popularity in laboratories. This technique has a higher specificity, detects different analytes from a single specimen, measures analytes in distinct matrices, and substantially reduce analytical interference, with respect to immunoassay. The processing and preparation of biological samples are crucial in chromatography. Interferences in blood testing are usually caused by the presence of phospholipids and proteins. The main objective of this study was to improve analytical processes for drug screening by LC-MS/MS using a novel blood sample preparation method based on protein precipitation and removal of phospholipids. Methods An evaluation was performed of a new method for the preparation of blood samples based on protein precipitation and removal of phospholipids by LC-Q-q-LIT. Results Limit of detection, limit of quantification and measurement range were determined for 56 molecules. The results of 11 cases were compared with those obtained using standard blood collection methods and instruments. Conclusions The novel blood preparation and testing method based on LC-Q-q-LIT, a more sensitive technique, has demonstrated to yield comparable results to traditional methods. In addition, this new technique reduces turnaround time and costs.
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Affiliation(s)
- Alba M. Rodrigo Valero
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Oscar Quintela Jorge
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Begoña Bravo Serrano
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Sara Ayuso Tejedor
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
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2
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Rodrigo Valero AM, Quintela Jorge O, Bravo Serrano B, Ayuso Tejedor S. Optimización de un método de cribado rápido de fármacos en sangre mediante la técnica de cromatografía de líquidos acoplada a espectrometría de masas. ADVANCES IN LABORATORY MEDICINE 2023; 4:372-378. [PMID: 38106500 PMCID: PMC10724858 DOI: 10.1515/almed-2023-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Objetivos La cromatografía líquida acoplada a la espectrometría de masas ha ganado en popularidad en los laboratorios en los últimos años debido a una mayor especificidad de la técnica, la posibilidad de determinar múltiples analitos en una sola inyección de la muestra, la medición de analitos en una variedad de matrices diferentes y a una drástica reducción de las interferencias analíticas en comparación con el inmunoensayo. El tratamiento y preparación de las muestras biológicas es un proceso esencial cuando éstas han de ser analizadas mediante sistemas cromatográficos. Los principales interferentes en el análisis de las muestras de sangre son los fosfolípidos y las proteínas. El objetivo principal de este estudio es mejorar la sistemática analítica toxicológica en el cribado general de fármacos mediante la técnica LC-MS/MS a través de un nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos. Métodos Se ha evaluado el nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos mediante la tecnología LC-Q-q-LIT. Resultados Se ha determinado el límite de detección, el límite de cuantificación y rango de medición para las 56 moléculas seleccionadas y se han comparado los resultados de once casos con las extracciones e instrumentación tradicionales. Conclusiones La metodología propuesta de preparación de muestras en sangre y análisis mediante técnicas más sensibles como LC-Q-q-LIT ha resultado comparable a la metodología tradicional en cuanto a resultados y, ofreciendo, además, una reducción de tiempo y coste.
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Affiliation(s)
- Alba M. Rodrigo Valero
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Oscar Quintela Jorge
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Begoña Bravo Serrano
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Sara Ayuso Tejedor
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
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3
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Vogeser M, Habler K. Rules for mass spectrometry applications in the clinical laboratory. Anal Bioanal Chem 2023:10.1007/s00216-023-04648-0. [PMID: 36964833 DOI: 10.1007/s00216-023-04648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
MS-based analytical methods now play an important role in medical laboratory analysis. Predominantly triple-stage mass spectrometry is used for the quantification of small molecule biomarkers and xenobiotics in blood and urine. The spectrum of applications ranges from completely in-house developed analytical methods, to industrially manufactured kit solutions used on generic equipment, to the first closed MS-based analysis systems. It is to be expected that the weights will shift in the coming years. Thus, operation and evaluation for most applications will remain very challenging and very different from the far more user-friendly and fully automated systems - mainly photometry-based - which are commonly used in clinical laboratories. General regulatory requirements for medical analysis differ significantly between countries globally. General requirements for in-house developed assay methods are valid in some countries, but concrete and methodology-specific rules for operation and quantification when using MS methods in the medical diagnostic laboratory are not applied. This differs significantly from other bio-analytical areas such as food monitoring, pharmaceutical research, or forensics, where legally binding, detailed rules exist in some cases, e.g., for substance identification. Internationally used relevant and helpful general standards with regard to mass spectrometric examination procedures in the clinical laboratory are in particular CLSI 62A and ISO 15189, while the IVDR in the EU primarily regulates the manufacture of diagnostic articles and not their application. In addition, from many years of application experience, some general advice can be recommended as rules that can contribute to robustness and patient safety in the clinical application of MS procedures; with emphasis on: reasonable method description, batch release, competence management, maintenance, and continuity management. This article also proposes some procedural basic requirements for the application of MS procedures in the clinical laboratory.
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Affiliation(s)
- Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Muenchen, Germany.
| | - Katharina Habler
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Muenchen, Germany
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4
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Stone JA, Francisco D, Tone H, Akin J, Fitzgerald RL. A User-Friendly Sample Preparation Alternative for Manual and Automated LC-MS/MS Quantification of Testosterone. Methods Mol Biol 2022; 2546:459-472. [PMID: 36127613 DOI: 10.1007/978-1-0716-2565-1_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We describe an LC-MS/MS method for serum testosterone using a novel extraction media, AC Extraction Plate™ (AC Plate,Tecan Schweiz). The AC Plate principle is essentially that of a liquid-liquid extraction (LLE) but employs a stationary nonpolar phase coated on the wells of 96-well plates instead of a nonmiscible organic solvent for partitioning testosterone out of serum, leaving interfering substances behind. This low complexity sample preparation protocol has been validated for and used in production in our laboratory with both manual and automated liquid handling. The primary advantage of this method is the highly reproducible nature of an extraction method that does not require LC-MS/MS expertise or specialized extraction equipment. We modified the existing vendor application and validated the method for matrix effect, recovery, precision, trueness [accuracy relative to certified reference material (CRM)], specificity, reportable range, sample stability, various sample containers, and correlation with other methods.Method performance is excellent, with a reportable range of 4-750 ng/dL, between-day quality control coefficient of variation (CV) over 12 months of <8%, mean accuracy of <4.0% bias against CRM, no interference from hemolysis, icterus, lipemia, serum separator tube gel, or common steroids/metabolites, and mean bias of 1.3% versus 4 other LC-MS/MS testosterone methods. An investigation of calibration stability and robustness supports sparse (3 versus 6 calibrators) and/or historical calibration for routine use.
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Affiliation(s)
- Judy A Stone
- University of California-San Francisco, San Francisco, CA, USA
| | - Dawn Francisco
- UC San Diego Health, Center for Advanced Laboratory Medicine, San Diego, CA, USA
| | - Heather Tone
- UC San Diego Health, Center for Advanced Laboratory Medicine, San Diego, CA, USA
| | - Joshua Akin
- UC San Diego Health, Center for Advanced Laboratory Medicine, San Diego, CA, USA
| | - Robert L Fitzgerald
- UC San Diego Health, Center for Advanced Laboratory Medicine, San Diego, CA, USA.
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5
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Zahr N, Duce H, Duffy J, Webster C, Rentsch KM. Interlaboratory comparison study of immunosuppressant analysis using a fully automated LC-MS/MS system. Clin Chem Lab Med 2022; 60:1753-1762. [PMID: 36044751 DOI: 10.1515/cclm-2021-1340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES All guidelines recommend LC-MS/MS as the analytical method of choice for the quantification of immunosuppressants in whole blood. Until now, the lack of harmonization of methods and the complexity of the analytical technique have prevented its widespread use in clinical laboratories. This can be seen in international proficiency schemes, where more than half of the participants used immunoassays. With the Cascadion SM Clinical analyzer (Thermo Fisher Scientific, Oy, Vantaa, FI) a fully automated LC-MS/MS system has been introduced, which enables the use of LC-MS/MS without being an expert in mass spectrometry. METHODS To verify the interlaboratory comparison of the immunosuppressant assay on this type of instrument, three centers across Europe compared 1097 routine whole blood samples, each site sharing its own samples with the other two. In other experiments, the effects of freezing and thawing of whole blood samples was studied, and the use of secondary cups instead of primary tubes was assessed. RESULTS In the Bland-Altman plot, the comparison of the results of tacrolimus in fresh and frozen samples had an average bias of only 0.36%. The respective data for the comparison between the primary and secondary tubes had an average bias of 1.14%. The correlation coefficients for patient samples with cyclosporine A (n=411), everolimus (n=139), sirolimus (n=114) and tacrolimus (n=433) were 0.993, 0.993, 0.993 and 0.990, respectively. CONCLUSIONS The outcome of this study demonstrates a new level of result harmonization for LC-MS/MS based immunosuppressant analysis with a commercially available fully automated platform for routine clinical application.
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Affiliation(s)
- Noël Zahr
- Pharmacokinetics and Therapeutic Drug Monitoring Unit, Department of Pharmacology and Clinical Investigation Center (CIC-1901), AP-HP, Sorbonne Université, Paris, France
| | - Helen Duce
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne Duffy
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Craig Webster
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katharina M Rentsch
- Laboratory Medicine, University Hospital Basel, University Basel, Basel, Switzerland
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López GD, Suesca E, Álvarez-Rivera G, Rosato AE, Ibáñez E, Cifuentes A, Leidy C, Carazzone C. Carotenogenesis of Staphylococcus aureus: New insights and impact on membrane biophysical properties. Biochim Biophys Acta Mol Cell Biol Lipids 2021; 1866:158941. [PMID: 33862238 DOI: 10.1016/j.bbalip.2021.158941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/18/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
Staphyloxanthin (STX) is a saccharolipid derived from a carotenoid in Staphylococcus aureus involved in oxidative-stress tolerance and antimicrobial peptide resistance. STX influences the biophysical properties of the bacterial membrane and has been associated to the formation of lipid domains in the regulation of methicillin-resistance. In this work, a targeted metabolomics and biophysical characterization study was carried out to investigate the biosynthetic pathways of carotenoids, and their impact on the membrane biophysical properties. Five different S. aureus strains were investigated, including three wild-type strains containing the crtM gene related to STX biosynthesis, a crtM-deletion mutant, and a crtMN plasmid-complemented variant. LC-DAD-MS/MS analysis of extracts allowed the identification of 34 metabolites related to carotenogenesis in S. aureus at different growth phases (8, 24 and 48 h), showing the progression of these metabolites as the bacteria advances into the stationary phase. For the first time, 22 members of a large family of carotenoids were identified, including STX and STX-homologues, as well as Dehydro-STX and Dehydro-STX-homologues. Moreover, thermotropic behavior of the CH2 stretch of lipid acyl chains in live cells by FTIR, show that the presence of STX increases acyl chain order at the bacterial growth temperature. Indeed, the cooperative melting event of the bacterial membrane, which occurs around 15 °C in the native strains, shifts with increased carotenoid content. These results show the diversity biosynthetic of carotenoids in S. aureus, and their influence on membrane biophysical properties.
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Affiliation(s)
- Gerson-Dirceu López
- Laboratory of Advanced Analytical Techniques in Natural Products (LATNAP), Chemistry Department, Universidad de los Andes, Bogotá D.C., Colombia; Laboratory of Biophysics, Physics Department, Universidad de los Andes, Bogotá D.C., Colombia; Laboratory of Foodomics, Institute of Food Science Research, CIAL, CSIC, Madrid, Spain
| | - Elizabeth Suesca
- Laboratory of Biophysics, Physics Department, Universidad de los Andes, Bogotá D.C., Colombia
| | | | - Adriana E Rosato
- Molecular Microbiology Diagnostics-Research, Riverside University Health System, Professor Loma Linda University, Moreno Valley, CA, USA
| | - Elena Ibáñez
- Laboratory of Foodomics, Institute of Food Science Research, CIAL, CSIC, Madrid, Spain
| | - Alejandro Cifuentes
- Laboratory of Foodomics, Institute of Food Science Research, CIAL, CSIC, Madrid, Spain
| | - Chad Leidy
- Laboratory of Biophysics, Physics Department, Universidad de los Andes, Bogotá D.C., Colombia.
| | - Chiara Carazzone
- Laboratory of Advanced Analytical Techniques in Natural Products (LATNAP), Chemistry Department, Universidad de los Andes, Bogotá D.C., Colombia.
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7
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Abou El Hassan M, Colantonio D, Likhodii S, Nassar BA. The analytical performance of six urine drug screens on cobas 6000 and ARCHITECT i2000 compared to LC-MS/MS gold standard. Clin Biochem 2021; 93:99-103. [PMID: 33844982 DOI: 10.1016/j.clinbiochem.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/16/2021] [Accepted: 04/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immunoassays provide a rapid tool for the screening of drugs-of-abuse (DOA). However, results are presumptive and confirmatory testing is warranted. To reduce associated cost and delay, laboratories should employ assays with high positive and negative predictive values (PPVs and NPVs). Here, we compared the results of urine drug screens on cobas 6000 (cobas) and ARCHITECTi2000 (ARCHITECT) platforms for six drugs against LC-MS/MS to assess the analytical performance of these assays. METHODS Eighty nine residual urine specimens, which tested positive for amphetamine, THC-COOH, benzoylecgonine, EDDP, opiates and/or oxycodone during routine drug testing, were stored frozen until later confirmation by LC-MS/MS. Immunoassays were performed on cobas and ARCHITECT using a split sample. A third aliquot from these samples was tested by LC-MS/MS to assess the percentage of false positive, false negative, true positive and true negative results and calculate the PPVs and NPVs for each immunoassay. RESULTS The PPVs of THC-COOH and EDDP assays were 100% on both platforms. Suboptimal PPVs were achieved for oxycodone (cobas, 57.1% vs ARCHITECT, 66.7%), amphetamine (77.8 vs. 100%), opiates (80.0 vs. 84.6%) and benzoylecgonine (88.9 vs. 84.2%) assays. The NPV was 100% for cobas and ARCHITECT oxycodone assays. Lower NPVs were achieved for THC-COOH (cobas, 28.6% vs ARCHITECT, 25.0%), EDDP (72.7% for both assays), benzoylecgonine (74.4% vs 73.8%), amphetamine (83.3% vs 82.8%) and opiates (100% vs 85.3%). CONCLUSION Overall, cobas and ARCHITECT urine drug screens have comparable analytical performance. Confirmatory testing is warranted for positive test results especially for oxycodone, amphetamine, opiates and cocaine. Negative drug screen results must be interpreted with caution especially for THC-COOH, EDDP, benzoylecgonine, amphetamine and opiates.
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Affiliation(s)
- Mohamed Abou El Hassan
- Clinical Chemistry Division, Provincial Laboratory Services, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| | - David Colantonio
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Sergei Likhodii
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Bassam A Nassar
- Department of Pathology, Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
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Schuster C, Habler K, Vogeser M. Averaging of results derived from different, simultaneously acquired mass transitions in ID-LC-MS/MS - Potential impact on measurement imprecision. CLINICAL MASS SPECTROMETRY 2020; 17:1-3. [PMID: 34820519 DOI: 10.1016/j.clinms.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Background LC-MS/MS allows for many measurands monitoring different mass transitions simultaneously. So far, such alternative mass transitions are usually assessed as "quantifier and qualifier ions" in order to rule out interferences in individual samples. However, quantification can also be based on assessment of alternative mass transitions for both the measurand and its internal standard, with two distinct results for one injection of an individual sample. These paired results can be averaged. The aim of this study was to determine the potential impact of this averaging approach on measurement imprecision. Methods We studied the impact of averaging results from different transitions for four exemplary measurands (linezolid (LIN), piperacillin (PIP), voriconazole (VOR), ethylglucuronide (ETG)). Intra-batch studies were performed with 21 injections of single clinical samples in sequence for each analyte (LIN, PIP, VOR), and a between-batch study with evaluation of data from routine QC samples from 20 series over 20 weeks (ETG). CVs and their confidence intervals were assessed comparatively for quantification based on single transitions, and for averaged results from these two transitions, respectively. Results In all data sets, we observed lower CVs for the averaged results compared to the results obtained from single mass transitions. CVs from averaged results were up to 39.4% lower compared to the CVs observed for results obtained from single transitions for the respective measurands. Conclusion Averaging of quantification results obtained from separate mass transitions acquired simultaneously in ID-LC-MS/MS seems to have the potential to minimize the measurement imprecision for different measurands in short- and long-term settings.
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Affiliation(s)
- Carina Schuster
- Hospital of the University of Munich (LMU), Institute of Laboratory Medicine, Germany
| | - Katharina Habler
- Hospital of the University of Munich (LMU), Institute of Laboratory Medicine, Germany
| | - Michael Vogeser
- Hospital of the University of Munich (LMU), Institute of Laboratory Medicine, Germany
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9
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Vogeser M. From therapeutic drug monitoring to total drug monitoring and drug-omics. ACTA ACUST UNITED AC 2020; 59:287-290. [DOI: 10.1515/cclm-2020-0339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/11/2020] [Indexed: 11/15/2022]
Abstract
Abstract
In view of the role of pharmacotherapy in medicine, on the one hand, and the powerful technical possibilities that are now available on the other hand, therapeutic drug monitoring is a surprisingly neglected area of laboratory medicine. In this viewpoint article, an “omics approach” to pharmacovigilance and drug monitoring is proposed and discussed. A realistic goal for laboratory medicine in the 21st century should indeed be to enable clinicians to check whether the right drug is present in the right patient with an appropriate blood concentration for each compound.
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Affiliation(s)
- Michael Vogeser
- Institute of Laboratory Medicine , Hospital of the University of Munich (LMU) , Marchioninistr. 15 , 81377 Munich , Germany
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After another decade: LC-MS/MS became routine in clinical diagnostics. Clin Biochem 2020; 82:2-11. [PMID: 32188572 DOI: 10.1016/j.clinbiochem.2020.03.004] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
Tandem mass spectrometry - especially in combination with liquid chromatography (LC-MS/MS) - is applied in a multitude of important diagnostic niches of laboratory medicine. It is unquestioned in its routine use and is often unreplaceable by alternative technologies. This overview illustrates the development in the past decade (2009-2019) and intends to provide insight into the current standing and future directions of the field. The instrumentation matured significantly, the applications are well understood, and the in vitro diagnostics (IVD) industry is shaping the market by providing assay kits, certified instruments, and the first laboratory automated LC-MS/MS instruments as an analytical core. In many settings the application of LC-MS/MS is still burdensome with locally lab developed test (LDT) designs relying on highly specialized staff. The current routine applications cover a wide range of analytes in therapeutic drug monitoring, endocrinology including newborn screening, and toxicology. The tasks that remain to be mastered are, for example, the quantification of proteins by means of LC-MS/MS and the transition from targeted to untargeted omics approaches relying on pattern recognition/pattern discrimination as a key technology for the establishment of diagnostic decisions.
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Tandem mass spectrometry in the clinical laboratory: A tutorial overview. CLINICAL MASS SPECTROMETRY 2020. [DOI: 10.1016/j.clinms.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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