CLN Article

Science Takes Center Stage In Philadelphia

The 68th AACC Annual Scientific Meeting & Clinical Lab Expo brought the latest in research, technology, and practice to Philadelphia from July 31–August 4. More than 20,000 medical and healthcare professionals gathered for the world’s largest event dedicated to laboratory medicine.

Research presented at the meeting demonstrated the ways in which advances in laboratory medicine reveal critical new insights and make extraordinary improvements in patient care, from a first-of-its-kind next-generation sequencing test for HIV drug resistance mutations to a biochip-based test for Alzheimer’s disease. Likewise, educational sessions focused on many of the most urgent problems in healthcare, including the Zika virus, hepatitis C, and efforts to harness the power of molecular diagnostics for personalized medicine.

In Philadelphia, an eight-member editorial board of AACC members followed highlights of the science for the CLN Daily, the official publication of the AACC Annual Scientific Meeting & Clinical Lab Expo, which was produced and distributed onsite. Read the full stories featured in the following snapshots online at www.myadlm.org/publications/cln/cln-daily.

Going Under a Sharper Knife

By Anna Merrill, PhD

Instantaneous and unequivocal differentiation of malignant from benign tissue during tumor resection is the Holy Grail of surgical oncologists, pathologists, and innovators of biomedical technology. In a plenary session, “Direct Mass Spectrometric Profiling of Biological Tissues – A New Paradigm in Histology,” Zoltan Takats, PhD, presented how cutting-edge advances in applied mass spectrometry are making rapid, intraoperative tissue profiling a reality.

Takats directs pioneering work in the field of ambient ionization, which enables mass spectrometry to seek new applications outside the traditional laboratory, such as in the surgical suite. Takats recounted how he set out to develop a technology for in situ chemical characterization of tissues as a valid alternative to frozen sections that would enable real-time intraoperative decision-making. His most significant discovery was that many longstanding surgical instruments relying on thermal ablation produce a large amount of tissue-originated gaseous ions—a by-product that happens to be the exact input needed for mass spectrometric analysis. By modifying standard surgical equipment, the aerosol produced during electrosurgery was processed using mass spectrometry and multivariate spectral analysis to create a tool known as the iKnife.

Breakthroughs in Maternal, Fetal, and Pediatric Medicine 

By Joesph Wiencek, PhD

In a special symposium, speakers from around the world presented oral abstracts that reflected cutting-edge data in several distinct populations, including children and adolescents, and pregnant and postmenopausal women. The presentations were chock-full of innovative science and conclusive data.

Victoria Higgins, PhD, discussed the influence of body mass index on biochemical markers of the metabolic syndrome in a healthy pediatric population. She presented data suggesting that overweight and obese children have altered marker concentrations indicative of type 2 diabetes and cardiovascular risk factors.

Sonia La’ulu, BS, presented comparison data between immunoassays and mass spectrometry for the measurement of free thyroid hormones in pregnancy. Her data suggested that free thyroxine immunoassay measurements appear to be a reasonable surrogate for mass spectrometry in pregnant euthyroid patients. However, she found poor correspondence between free triiodothyronine results by immunoassays and mass spectrometry.

Ioannis Papassotiriou, PhD, captivated the audience with data showing the predictive role for serum growth differentiation factor-15 and chitinase-3-like protein 1 as early markers of diabetic nephropathy in children and adolescents with type 1 diabetes, before they develop severe overt nephropathy.

Reinventing the Future Through Transformative Technology

By Erin Kaleta, PhD

Amid drones, mini mass spectrometry (MS), bedside nucleic acid testing, and micro blood collections, a two-part symposium on technologies of the future packed a lot of excitement. These sessions focused on not-too-distant-future possibilities for laboratory medicine that could significantly improve patient care.

Carl Wittwer, MD, PhD, explored rapid reverse transcription-PCR techniques that can supplement centralized nucleic acid testing. Similarly, J. Michael Ramsey, PhD, presented on the use of small, hand-held, high pressure MS, an emerging technology that offers more flexibility than centralized MS facilities.

In the afternoon session, Timothy Amukele, MD, PhD, revealed his projection that laboratories will transport specimens using drones, or unmanned aerial systems. Access to specialized laboratory testing can be a limiting factor in some healthcare settings, particularly those in geographically challenging or low-resource areas.

James Nichols, PhD, focused on the advantages and limitations of small- volume collections as an alternative to traditional phlebotomy. Nichols explained that when used appropriately, and with adequate quality control, capillary collections offer real opportunities for point-of-care testing, including accessibility to a wider test menu.

Circulating Cell-Free DNA Diagnostics Take Steps Toward Maturity 

By Pradip Datta, PhD

It is amazing how innovative diagnostic tests can become established so quickly. At the 2015 AACC Annual Meeting, Yuk-Ming Dennis Lo, PhD, described in his Wallace H. Coulter Lecture the advances and applications of circulating cell-free DNA (cfDNA) diagnostics. Just one year later, in an afternoon symposium, attendees learned how this versatile technology is now used routinely in clinical practice.

Michael Oellerich, MD, spoke about the application of cfDNA in organ transplant monitoring in female recipients and male donors. For transplantation medicine, the goal is just the right amount of immune-suppressant therapy— personalized, with no rejection, infection, or toxicity. Rossa Chiu, PhD, revealed how cfDNA analysis can serve like a total body scan to find cancer early. Chiu demonstrated how the source organs of cfDNA can be detected through droplet digital PCR, nanopore sequencing, and methylome analysis in clinical cases of pregnancy, hepatocellular carcinoma, and lymphoma.

In addition to these presentations, Glenn Palomaki, PhD, elucidated another important application of the technology—the routine use of cfDNA-based prenatal screening. Palomaki shared his experience working with primary obstetrical care providers.

The Great Cannabis Experiment

By Jaime Noguez, PhD

In a plenary session, “The Great Cannabis Experiment: Medical Miracle? Harmless High? Civil Consequences?” renowned toxicologist Marilyn Huestis, PhD, reviewed recent cannabis legalization efforts as well as the epidemiology of cannabis use and abuse in the United States.

She followed with a discussion of the cannabinoid receptors and how smoking cannabis affects the brain, referencing her research that has elucidated cannabinoids’ mechanisms of action. She also outlined her work documenting the effects of acute and long-term cannabis exposure on the nervous system and in utero, including recently published data demonstrating via imaging studies decreased CB1-cannabinoid receptors in the brain of chronic cannabis smokers.

Huestis also dealt with the social consequences of cannabis legalization, focusing on how cannabis impacts driving and how impairment can be detected. Research has shown that cannabis use can cause a number of mild cognitive deficits that pose potential safety risks, such as increased weaving between lanes and slowed reaction time, which are not accounted for in most new regulations.

Bringing on Mass Spec? Consider This 

By Joe El-Khoury, PhD

In the last 2 decades alone, mass spectrometry (MS) has grown from being a large, expensive, and highly complex platform restricted to academics to an indispensable tool for routine clinical chemistry testing. However, it remains a high-complexity test that requires many considerations before implementation.

In a session, “Building New or Adding On: Fundamentals for Overcoming Challenges in Operationalizing Clinical Mass Spectrometry,” Deborah French, PhD, discussed the essential principles and major applications of clinical liquid chromatography and MS. French described the most commonly used combinations of the different techniques and instruments to provide optimum sensitivity and specificity for the desired analysis. Next, Shannon Haymond, PhD, described ways to facilitate operational quality and sustainability. She elaborated on staff skill requirements and offered guidance on developing training and competency plans.

Both speakers highlighted the enormous potential of this technology and how they rely on it every day for generating high-quality patient results. This was further supported by the very large number of attendees at this session. Fortunately, an overflow room was set up nearby to accommodate all attendees, with moderator Yan Victoria Zhang, PhD, taking questions electronically. 

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