Nearly 20,000 medical professionals and healthcare leaders gathered for AACC's 65th Annual Meeting & Clinical Lab Expo in Chicago from July 27–31. The meeting featured never-before-seen breakthroughs in diagnostic research and technology demonstrating rapid advances in laboratory medicine.
The 2014 AACC Clinical Lab Expo—with more than 700 exhibitors filling the McCormick Place show floor—featured breakthrough innovations, including lab-on-a-chip technology, the first ever human papillomavirus DNA test approved by the Food and Drug Administration for primary cervical cancer screening, and new tests in reproductive health, infectious diseases, drug testing, and more.
Abstracts presented at the meeting spotlighted timely discoveries in the field of laboratory medicine, including research on a portable blood test that can detect low levels of Ebola—and the closely related Sudan virus—in 10 minutes. The test uses the same technology as in home pregnancy tests, which enables it to be performed in the resource-limited settings most prone to Ebola outbreaks and by individuals without extensive medical training.
At the AACC annual meeting, CLN also launched a new publication, the CLN Daily, produced onsite for the meeting in Chicago. Guided by 2014 editor Ann Gronowski, PhD, a board of eight AACC members—all distinguished scientists—took on the challenge of covering their picks of cutting-edge science at the meeting.
Clinical Applications of miRNAs: A New Frontier in Molecular Diagnostics?
Melanie Yarbrough, PhD
The discovery that noncoding regions of the genome such as microRNAs (miRNAs) can influence the pathogenesis of cancer has fascinated scientists. In a symposium on July 29, Muller Fabbri, MD, PhD, and Vincent De Guire, PhD, discussed how miRNAs could have an impact on clinical practice. miRNAs are small RNAs that inhibit gene function by degrading messenger RNA or inhibiting translation. miRNAs have big potential in laboratory medicine: alterations in miRNA expression could serve as biomarkers for cancer and or as prognostics to define therapeutic response. Researchers are also looking at miRNAs as possible therapeutic targets because of their powerful role in many diseases.
Finding a Needle in a Haystack: Can Lipids Predict the Onset of Dementia?
Mari DeMarco, PhD
At a plenary session on July 31, Amrita Cheema, PhD, shared her team's proof-of-concept study published in Nature Medicine that proposes a panel of lipids to detect preclinical Alzheimer's disease (doi:10.1038/nm.3466). Cheema explained how they used mass spectrometry to identify a panel of lipids in blood that could predict the onset of cognitive impairment over a 2–3 year period. Their validation phase included 10 individuals who developed cognitive impairment during the course of the study, along with individuals whose cognitive status was stable over the course of the study—20 normal and 11 impaired. The team's 10-lipid panel predicted the progression from cognitively normal to cognitively impaired in this small group with a sensitivity of 90% and a specificity of 90%. Only additional research will prove whether lipidomics can deliver on what earlier proteomics studies have promised—blood-based biomarkers that correlate with disease pathogenesis.
Not Your Mother's Bath Salts: Challenges of New Designer Drugs
David Colantonio, PhD
At a symposium on July 31, speakers including Marilyn Huestis, PhD, Kara Lynch, PhD, and Robert Kronstrand, PhD, of the National Board of Forensic Medicine took on the emergence of synthetic cannabinoids and other designer drugs. These widely-abused drugs do not produce positive screening results on traditional cannabinoid immunoassays. The speakers highlighted the essential role of high resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS) to identify these drugs and add them to screening libraries. Huestis's talk included an update on her latest work using human hepatocyte cultures and LC-MS/MS to characterize unknown synthetic cannabinoid metabolic profiles.
From Circulating DNA to Bones and Saliva
Ann Gronowski, PhD
AACC's journal Clinical Chemistry brought together some of the most distinguished scientists in laboratory medicine for the journal's hot topics session moderated by Editor-in-Chief Nader Rifai, PhD. The session featured Dennis Lo, MD, PhD, who spoke about plasma genomic and methylomic sequencing for cancer detection. Lo's method uses genome-wide sequencing of plasma DNA to identify copy number aberrations and DNA methylation abnormalities from cancer. Lo and his colleagues have developed this technology alongside similar techniques for fetal genome and epigenome sequencing. The session also featured Ravi Thadhani, MD, who discussed his team's landmark report on bioavailable vitamin D, and Marilyn Huestis, PhD, who spoke about the use of oral fluid for drug testing.
Advanced Molecular Techniques: The Future Is Now
Mark Cervinski, PhD
At an AACC University morning short course on July 27, speakers highlighted the ways in which next-generation sequencing technologies are already guiding targeted cancer therapy. Gregory Tsongalis, PhD, used a case-based approach to explain how Dartmouth-Hitchcock Medical Center analyzes biopsied tumor tissue for mutations in a panel of 50 genes, allowing the clinical team to target a tumor with the combination of chemotherapeutic agents most likely to be effective. J. Greg Howe, PhD, presented data from his practice at Yale on the use of next-generation gene panels for the analysis of prognostic markers of acute myeloid leukemia (AML). Yale has developed a panel to cover additional actionable genes and prognostic markers for AML.
Right Test, Right Patient, Right Time—Wrong Interpretation?
Amy Saenger, PhD
An interactive short course on July 28 developed with the Royal College of Pathologists of Australasia (RCPA) Quality Assurance Program (QAP) grappled with the relationship between the quality of interpretive comments and patient outcomes. Samuel Vasikaran, MD, explained why he recommends that laboratorians only add comments if results are unexpected, influence decisions on management or treatment, or esoteric. He also made the case that laboratorians should individualize comments in the context of patients' clinical condition. Graham Jones, DPhil, MBBS, highlighted data from the RCPA QAP external quality assessments, one of which deals with the quality of comments in patient reports. Both speakers predicted that in the future, participating in external QA for interpretive comments will become a contractual obligation.
When It Comes to Data, Size Matters
Christopher McCudden, PhD
At the July 28 plenary session, big data scholar Viktor Mayer-Schönberger explored how big data analysis can revolutionize healthcare with new analytical approaches. For example, practices are based on averages, where no particular treatment or therapy is optimized for an individual, he noted. But as genomics, metabolomics, real-time monitoring, and other fields in personalized medicine create new synergies, the big data model of computing power and analysis will turn this paradigm on its head. Big data is transforming hypothesis testing, he noted, where now millions of ideas can be tested simultaneously. In the future, algorithms will benefit from such large pools of data that they will make predictions even in the absence of an understanding of causation, leading to unexpected and profound changes to both science and society, he said.