American Association for Clinical Chemistry
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Bruns Steps Down as Clinical Chemistry Editor

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Bruns Steps Down as Clinical Chemistry Editor
17-Year Tenure Marked by Accomplishment and Change
By Deborah Levenson

Over the past decade, Clinical Chemistry has come to be recognized as the premier journal in the field of laboratory medicine. The publication will reach a milestone at the end of this year when David E. Bruns, MD, leaves his post as Editor after 17 years and Nader Rifai, PhD, Professor of Pathology at Harvard Medical School, takes over AACC’s flagship scientific journal. Under direction from Bruns—only the third editor the journal has had in its 53-year history—Clinical Chemistry’s impact factor has steadily climbed and its reputation for quality and excellence in scientific publishing has become widely recognized.

Bruns, who is Professor of Pathology at University of Virginia in Charlottesville and Director of Clinical Chemistry and Toxicology and Associate Director of the Medical Diagnostics Laboratory at the University of Virginia Health System, has brought about major changes that have increased the journal’s stature since he began as editor in 1990. Chief among them was an early focus on molecular diagnostics. “Since then molecular diagnostics has become an integral part of what constitutes the field of clinical chemistry,” he pointed out, noting the current edition of the field’s major textbook is newly named the Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Notably, Bruns was a key player in establishing a Molecular Diagnostics Laboratory at the University of Virginia more than 20 years ago, when the field was in its infancy.

“David is a very tough act to follow,” noted Rifai. “In a nutshell, David managed to transform Clinical Chemistry from a small, not terribly well-known journal to a world-class, highly recognized, and very respected publication. He took it to a whole new level, and that’s a major achievement.”

At the Cutting Edge: Embracing Technology

Under Bruns’s direction, the journal became an early adopter of online access in 1998 when it went became available through Stanford University’s HighWire press Web site, which now links Clinical Chemistry with about 1,000 biomedical journals. “Online journal access has revolutionized the way scientists and physicians work,” Bruns observed, adding that HighWire’s hosting of top-ranked, society-sponsored journals has helped to enhance Clinical Chemistry’s reputation. The journal was also ahead of many of its peers when it implemented online submission of papers in 2002. Since then, the number of submissions has jumped 50%. “That figure is a testimony to both the quality and impact factor of the journal,” Bruns asserted.

During his tenure, the journal has published a number of ground-breaking papers. A 1992 paper by Geza Bodor and colleagues sticks out in Bruns’ mind. “This paper ushered in the use of cardiac troponin I as a test for myocardial infarction. It described the first monoclonal antibodies against troponin I, demonstrated their use in an assay, and showed the use of the assay in patients,” Bruns noted.

AACC’S award for Outstanding Contribution for a Publication in Clinical Chemistry has recognized authors of papers on such important topics as rapid testing for Group A strep in women at delivery and how to report research on diagnostic accuracy. Other pioneering papers have focused on various clinical aspects of cardiac troponins, free PSA, homocysteine, CRP, fetal nucleic acids in maternal plasma, and catecholamines. “If you want a preview of what is coming to the clinical laboratory soon, look at an issue that is three years old,” he said, adding that Clinical Chemistry’s first paper on the topic probably appeared 5 years ago.

Another measure of the journal’s stature is its international acceptance, reflected by citations in more than 1,000 other journals each year and online submissions by authors around the world. Between 2002 and 2007, more than half of submissions came from abroad, according to Bruns. “I believe that this international reputation reflects our adherence to high standards for the clinical and the chemical aspect of every paper, as well as the effort that we put into what I view as the primary ethical responsibility of an editor—to provide expert, fair, and timely peer review of submitted manuscripts,” he explained.

Bruns credited the work of peer reviewers, the journal’s editorial board, reviewers, manuscript editors, and the production and AACC staff for making his years as editor gratifying. “The most personally rewarding thing has been the great privilege of working with incredibly talented people,” Bruns noted. He gave special recognition to the efforts of Jack Ladenson, Chair of the Editorial Board in the early 1990s and Professor of Clinical Chemistry, Pathology and Immunology and Internal Medicine at Washington University in St. Louis; Associate Editors Tom Annesley, PhD, Professor of Pathology at University Michigan in Ann Arbor and James Boyd, MD, Associate Professor of Pathology, Director of Core Lab Automation, and Associate Director of Clinical Chemistry and Toxicology at University of Virginia; and Sandy Weaver, the journal’s Senior Editorial Assistant.

Boyd also had praise for Bruns’ leadership. “David has an amazing ability to stay current in a very broad range of topics. He has been visionary in his stint as editor for Clinical Chemistry, recognizing the new directions in which the field was headed, and working to change the journal to capture and present information in these new areas,” Boyd commented.

A Respected Laboratorian

Bruns’ accomplishments extend well beyond his work at Clinical Chemistry. At the University of Virginia, he purified a unique form of amylase, developed a monoclonal antibody to it, and used both in one of the first monoclonal assays in clinical enzymology. With a pathology resident, David Herold, MD, PhD, now Professor-in-Residence at the University of California, San Diego School of Medicine, he discovered poisoning by polyethylene glycol (PEG), reproduced the syndrome in rabbits, and characterized its enzymatic metabolism. His studies led to FDA actions that limited use of PEG.

In research that NIH funded for more than 20 years, he and his wife, M. Elizabeth Bruns, now retired from the Department of Pathology at University of Virginia, studied roles of calcium-regulating hormones in mice and humans. These studies focused on the vitamin D-dependent calcium-binding protein (calbindin) in rodents and on parathyroid hormone-related protein and its receptor in the human uteroplacental unit. The pair showed that epidermal growth factor increased the vitamin D-dependent calcium-binding protein of the intestine.

Outside the research laboratory, Bruns has also been instrumental in developing guidelines for how studies report the diagnostic accuracy of medical tests. Intrigued by a 1995 Journal of the American Medical Association paper criticizing the conduct of diagnostic accuracy trials and how they were reported in journals, he attended an Oxford University workshop about systematic review, a cornerstone of evidence-based medicine. That seminar emphasized the importance of forming very specific clinical questions and explicit statement of how they are answered, a point he took to heart. “Systematic review is very different from a standard narrative review, which can lead to bias. I figured that in order for any Clinical Chemistry paper to have impact on the practice of clinical medicine, it had to be good enough to be included in systematic reviews,” he explained. Clinical Chemistry published proposed standards for reporting studies of diagnostic accuracy in 1997 and more definitive standards in 2000. The topic captured the interest of clinical epidemiologists and the editors of most of the large medical journals and led to 2003 publication of the well-known 2003 STARD (Towards Complete and Accurate Reporting of Studies on Diagnostic Accuracy) statement on studies of diagnostic accuracy. Bruns was a co-author of STARD, which was published in 15 journals in the U.S., Europe, and Japan. Bruns and others continue to evaluate its recommendations.

Bruns’ list of accomplishments also includes conceiving and helping to develop a molecular assay for genotyping HCV by melting curve analysis, first detailed in Clinical Chemistry in 2002 and again in 2004. In addition, he has been an editor of major chemistry textbooks published by Elsevier Saunders. These include the fourth edition of the Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, Fundamentals of Molecular Diagnostics, published in May, and the sixth edition of the Tietz Fundamentals of Clinical Chemistry, due out later this year.

Service to the Field

In addition to Bruns’ extensive involvement with Clinical Chemistry and AACC, he is a past President of both the Academy of Clinical Laboratory Physicians and Scientists and the Association of Clinical Scientists, and he has held positions in the International Federation of Clinical Chemistry and Laboratory Medicine and National Academy of Clinical Biochemistry. He also served on the steering committee that organized the 2000 STARD Group conference in Amsterdam.

Bruns has received many honors and awards, including AACC’s 1987 Award for Outstanding Contributions to Research and the 1998 Award for Outstanding Contributions to Clinical Chemistry, and in 2001, the Bernard F. Gerulat Memorial Award, Presidential Citation and the Norman Kubasik Memorial Award. AACC also recognized him with the Miriam Reiner Award in 2003 and Presidential Citations in 2001 and 2005.Bruns will receive the 2007 Distinguished Scientist Award from the National Academy of Clinical Biochemistry on Wednesday. In addition to his service as Clinical Chemistry Editor, he has also served on the editorial board of Annals of Clinical Laboratory Science and Clinical Chemistry. Bruns has been an invited speaker at more than 100 seminars and an author of more than 233 publications.