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At Clinical Mass Spec Meeting, Ion Mobility, Dried Blood Spots, Cardiac Biomarkers Vie for Attention

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PALM SPRINGS, Calif. (GenomeWeb) – The 2017 US edition of the Mass Spectrometry: Applications to the Clinical Lab (MSACL) closed on Thursday after three days of talks across tracks dedicated to metabolomics, endocrine system testing, small molecules, mass spec-based imaging technologies, and practical applications. Among continuing trends, new technologies with more potential than present applications popped up and demanded that conference-goers take notice.

Multi-omics and mass spec-based imaging remained hot topics. Cardiovascular biomarkers received special focus, David Herold, CEO of the Association for MSACL, told GenomeWeb. And more embryonic technologies like ion mobility spectrometry — an orthogonal separation technology to chromatography and mass spec — and dried blood spots popped up in several talks and posters.

"Not that far in the past, mass spec in the clinic was a radical new idea," Chris Chouinard, a postdoc at the Pacific Northwest National Laboratory, told GenomeWeb. "Ion mobility is that next tool that hopefully the clinical world will be quick to adopt."

In the metabolomics track, University of California, Los Angeles Professor Emeritus Don Catlin delivered the keynote address, providing an overview of 30-plus years of anti-doping testing in Olympic sports. Mass spec has long been the lab workhorse for testing of performance-enhancing drugs, but the technology still has trouble detecting agents like erythropoietin (EPO), he said. However, new methods to detect glycosylation of recombinant EPO are in the works. While not a problem yet, gene doping is coming, Catlin said, and anti-doping agencies are bracing for how to deal with that paradigm shift.

Further down the presentation list in that track, Chouinard presented on work using ion mobility mass spec with large patient cohorts for multi-omics analysis of gestational diabetes and preeclampsia patients. The talk featured a new technology to increase the length of the separation path, enabling the resolution needed to look at cis- and trans- isomers.

Chris Cox, of the Colorado School of Mines, presented a follow up to his work on using metal oxide laser ionization mass spec technology for fatty acid profiling in infectious disease diagnostics. He suggested that the technique could provide strain- and species-level classification for yeast and other fungi, as well as bacteria.

On Thursday, University of Florida professor Rick Yost described potential applications for standalone ion mobility spectrometry, such as a marijuana breathalyzer, as well as in disease diagnostics.

Scientists from Waters also presented a poster on the use of ion mobility separation in tandem with desorption electrospray ionization mass spec for imaging.

In the small molecule detection track, Amadeo Pesce, adjunct professor at the University of California, San Diego, described data suggesting alcohol metabolite testing can be easily confounded by incidental exposure to substances other than booze, including handcleaning agents.

In an MSACL-focused research note released today, Leerink analyst Puneet Souda said that small molecule drug-monitoring testing would continue to drive sales in clinical mass spec. "It appears to us that therapeutic drug monitoring still continues to drive sales of LC-MS systems in clinical lab settings despite a significant reduction in rates," from more than $2,000 per sample down to now $230 per sample, he said. "With the current opioid epidemic spreading across the country, we believe the demand will continue to drive high-single-digit sales growth in this segment."

Dried blood spot technology received the attention of a full session in the small molecules track, with talks from Christophe Stove of Ghent University, Jane Dickerson of Seattle Children's Hospital, and Jack Henion of Q2 Solutions. In a Thermo Fisher Scientific-sponsored talk, King's College Hospital researcher Lewis Couchman described early experiences using paper spray mass spec in a clinical setting. And Michael Gelb of the University of Washington described the potential for newborn screening for lysosomal storage diseases using dried blood spots and tandem mass spec.

The endocrine track included a presentation by the University of Calgary's Joshua Buse on how mass spec analysis helped resolve a highly irregular patient case study of elevated salivary cortisol. Combined with Roche Cobas immunoassays, LC-MS/MS analysis helped show that the hypercortisolism was factitious, or artificial, leading to a diagnosis of Munchausen syndrome.

An entire session, chaired by Buse, focused on mass spec analysis of B-type natriuretic peptide, an important cardiovascular biomarker. Calcium metabolism also received special attention, with talks from Mark Kushnir of the ARUP Institute for Clinical & Experimental Pathology and the University of Washington's Andy Hoofnagle.

Cardiovascular biomarkers received even more attention in the proteomics track, with Laboratory Corporation of America and Cleveland HeartLab presenting information on mass spec-based assays.

Out on the exhibition hall floor, poster presentations indicated several trends. Rapid evaporative ionization mass spec and desorption electrospray ionization mass spec remain popular methods for mass spec-based imaging. Meanwhile, machine learning algorithms are beginning to find their way into mass spec data analysis.

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