The 69th AACC Annual Scientific Meeting & Clinical Lab Expo reached record attendance in San Diego, July 30–August 3, with more than 21,300 medical professionals from around the world gathered for the world’s largest event dedicated to laboratory medicine.

The 69th AACC Clinical Lab Expo featured 789 exhibitors and covered 246,000 net square feet, also making this the largest show floor in AACC’s history. Exhibits featured groundbreaking tests from all laboratory medicine disciplines, including mobile health, molecular diagnostics, mass spectrometry, point-of-care, and automation.

Highlights of the conference included five plenary talks on subjects ranging from the future of genome engineering with CRISPR to new strategies in the fight against antibiotic resistance. Jennifer Doudna, PhD, recipient of AACC’s 2017 Wallace H. Coulter Lectureship Award and co-inventor of CRISPR, gave the opening keynote on her current research to refine this revolutionary gene editing tool into a method that could correct disease-causing genes.

In San Diego, an eight-member editorial board of AACC members followed highlights of scientific sessions for the CLN Daily, the official publication of the AACC Annual Scientific Meeting & Clinical Lab Expo, which was produced and distributed onsite. Read all the full stories here.

The Power of CRISPR for Diagnostics

By Octavia Peck-Palmer, PhD

CRISPR is a guide RNA that rapidly finds and binds specific genomic areas and proteins that cut the genome upon arrival, allowing scientists to “edit” the gene. CRISPR co-inventor Jennifer Doudna shed light on the potential for CRISPR-based diagnostics, such as a point-of-care method in which CRISPR would rapidly cleave and identify the nucleic acids of aberrant bacteria or cancer. The guide RNA that is responsible for cutting DNA sequences also has the potential to aid in discriminating between strains of bacteria or viruses, she explained.

For therapeutics, much of the work is at the cellular or tissue level, not the whole organ level, Doudna said. Research also continues on how to deliver CRISPR to the host in a safe manner. CRISPR-guided gene editing in blood disorders and eye diseases may be the first treatments to come out of these discoveries, with treatments for brain diseases following.

Doudna explained how her current research is refining CRISPR to improve its efficiency and prevent off-target mutations. Her laboratory has developed a CRISPR-targeted gene knockdown method with enhanced efficiency. This method employs techniques such as single-particle electron microscopy to delineate the molecular mechanisms underlying the highly diverse CRISPR networks.

New Psychoactive Substances Challenge Detection

By Kamisha Johnson-Davis, PhD

New psychoactive substances (NPS) are structurally unique from target drugs and are designed this way in order to evade identification by the Drug Enforcement Agency as well as detection in drug testing laboratories. Speakers Jennifer Colby, PhD, and Kai Li, MD, emphasized that trends in the use of these substances are changing quickly and vary in different parts of the country. Some of these compounds were synthesized more than 40 years ago but now have re-emerged and made their way into use. With no regulatory oversight on the manufacturing and purity of these products, consuming them poses grave risks.

Laboratories face challenges in detecting these compounds because NPS have variable cross-reactivity with existing immunoassays and because laboratories lack access to analytical methods capable of detecting all of the variations of these designer drugs. Teamwork among medical and clinical toxicologists and clinical laboratories is critical to identify drug compounds in intoxication or poisoning cases, Colby and Li noted. They detailed their success in using broad-spectrum¬ drug screening via high-resolution mass spectrometry to identify the compounds intoxicated patients had ingested.

Young Laboratorians Discover Path to Leadership

By Allison Chambliss, PhD

The path from junior laboratory scientist to senior scientist or director can be daunting. Not many laboratorians have a PhD in leadership. But while leadership may not seem critical early in a career, seizing opportunities for growth and influence can help laboratorians become recognized as leaders long before an official title confers it. Strategies for tackling such opportunities were the focus when, on July 29, AACC members convened at this year’s annual Society for Young Clinical Laboratorians (SYCL) workshop.

Susan Evans, PhD, spoke to the benefits of creating impactful relationships between medical centers and vendors. She illustrated this concept with an example of a collaboration she launched between her company and a large academic medical center. A partnership initially focused on one clinical assay led to a long-standing relationship on many tests.

One way to show leadership is with wise stewardship of finances. But it’s not always easy to tell when the lab is getting a good deal on a new instrument. Juan David Garcia, MBA, BS(MT), delved into negotiating contracts. He reminded the audience that negotiation does not have to stop at capital costs and should include such items as service agreements, lab information system interface costs, and employee training.

Better Outcomes for Young Women Surviving Cancer

By Sarah Wheeler, PhD, NRCC

The war on cancer has been hard fought, with more young women than ever now surviving the disease but facing the possibility of infertility, noted Teresa K. Woodruff, PhD, in a July 31 plenary session.

People often think of fertility management as an elective treatment for those with the means to seek it, rather than a significant health risk associated with loss of this important endocrine function. Infertility and premature menopause can lead to premature death, cardiovascular disease, osteoporosis, neurologic disease, and other disorders.

Woodruff reminded the audience that clinical research is integral to improving fertility management for cancer survivors. Emerging assays provide more options for young women to manage their fertility after cancer treatment. For example, a blot-spot assay for anti-Mullerian hormone enables patients to send in a blood spot from home to assess their ovarian reserve, facilitating an estimate of the reserve of growing follicles each month.

Many oncologists tend to be uninformed about reproductive health, according to Woodruff. This rapidly advancing frontier will require laboratorians’ close attention to ensure that cancer survivors achieve the best possible outcomes.

Is Laboratory Medicine Ready for Artificial Intelligence?

By Adil I. Khan, MSc, PhD

Scientists are now harnessing the speed of modern computers and programming them with cognitive algorithms and sophisticated decision trees to help solve complex medical problems. This rapidly advancing science was the focus of the AACC Annual Meeting Organizing Committee Chair’s Invited Session, “Is Artificial Intelligence in Genomics Ready for Prime Time?”

The first of three distinguished speakers, Michael Berger, PhD, examined the use of the MSK-IMPACT (Integrated Mutation Profiling of Actionable Cancer Targets) assay to look for mutations in some 468 cancer genes. Gene mutations associated with a particular cancer can sometimes be found in other cancers too, possibly making it amenable to the same treatment.

Patrick McNeillie, MD, from IBM’s Watson Health project, discussed how advanced clinical diagnostics algorithms enable computers to relate diverse clinical literature with patient data to generate personalized reports. Nirali Patel, MD, explained how IBM Watson is helping her institution fulfill the promise of individualized healthcare, but emphasized that “[artificial intelligence] can be used to aid physicians in making their diagnoses, but not replace them entirely.”

Creating the Ultimate Consumer Diagnostic Devices

By Mark Kellogg, PhD, MT (ASCP)

In a special session on August 1, the winner and two finalists in the Qualcomm Tricorder XPRIZE competition described their 5-year odyssey to develop consumer devices weighing no more than 5 pounds that could diagnose 13 health conditions and capture real-time vital signs. Philip Charron represented the winning team, Final Frontier Medical Devices, and its DxtER device. Finalists from other teams described their DeepIQ and rHEALTH devices.

The DxtER group focused on developing an artificial intelligence engine “to learn from years of [emergency medicine] experience by modeling the questions and processes used by physicians during patient encounters,” Charron said. rHEALTH evolved around the concept of building the world’s smallest flow cytometer to measure fluorescence of single molecules. In contrast, the DeepIQ uses three modules that measure vitals, blood, and urine, and includes a scope for imaging.

All the presenters agreed that accuracy was key and that medical professionals will still have to be involved, no matter how consumer-friendly a device. “The value is in creating an informed consumer and an informed clinician who could work together for efficient healthcare decisionmaking,” Charron said.