Toxicology in clinical laboratories: challenging times

Current state-of-the-art approaches for mass spectrometry in clinical toxicology: an overview

INTRODUCTION

Hyphenated mass spectrometry (MS) has evolved into a very powerful analytical technique of high sensitivity and specificity. It is used to analyze a very wide spectrum of analytes in classical and alternative matrices. The presented paper will provide an overview of the current state-of-the-art of hyphenated MS applications in clinical toxicology primarily based on review articles indexed in PubMed (1990 to April 2023).

AREAS COVERED

A general overview of matrices, sample preparation, analytical systems, detection modes, and validation and quality control is given. Moreover, selected applications are discussed.

EXPERT OPINION

A more widespread use of hyphenated MS techniques, especially in systematic toxicological analysis and drugs of abuse testing, would help overcome limitations of immunoassay-based screening strategies. This is currently hampered by high instrument cost, qualification requirements for personnel, and less favorable turnaround times, which could be overcome by more user-friendly, ideally fully automated MS instruments. This would help making hyphenated MS-based analysis available in more laboratories and expanding analysis to a large number of organic drugs, poisons, and/or metabolites. Even the most recent novel psychoactive substances (NPS) could be presumptively identified by high-resolution MS methods, their likely presence be communicated to treating physicians, and be confirmed later on.

British Journal of Biomedical Science in 2018: what have we learned?

In 2018 the British Journal of Biomedical Science published one guideline (in reproductive science) and 40 research articles in the various disciplines the comprise biomedical science. The latter were 24 original articles and 16 'In Brief' short reports. Of these, 23 are of note to only one of the sub-disciplines (seven each to biochemists and microbiologists, six to cell pathologists, and one each to cytologists, immunologists and reproductive scientists). Reflecting the increasing complexity of laboratory science, thirteen papers crossed one boundary (three papers each relevant to biochemists and immunologists, and to haematologists and biochemists), whilst four papers were relevant to three or more disciplines. Indeed, biochemical techniques were used in 18 papers, microbiological techniques in 9, whilst histopathology was relevant to 11 papers. Notably, 20 papers used techniques in chromosome analysis and molecular genetics. The present report will summarise key aspects of these publications that are of greatest relevance to laboratory scientists.

Mass spectrometry in pathology - Vision for a future workflow

Mass spectrometric (MS) techniques are applied in various areas of medical diagnostics. For the detection of microbiological germs and genetic mutations, MS is a method used in routine. Since MS also allows the analysis of proteins and peptides, it seems an ideal candidate to supplement histopatholological diagnostics. Matrix-assisted laser desorption/ionization time-of-flight Imaging MS links molecular analysis of numerous analytes with morphological information about their spatial distribution in cells or tissues. Herein, we review principle MS techniques as well as potential applications in pathology and discuss our vision for a future workflow.