The 2022 AACC Annual Scientific Meeting & Clinical Lab Expo attracted nearly 17,000 professionals from around the globe July 24−28 in Chicago. The program featured groundbreaking advances in diagnostics and laboratory medicine that covered everything from the future of machine learning to revolutionary molecular methods that promise to transform patient care.
The AACC Clinical Lab Expo featured 781 exhibitors and covered 246,700 square feet in Chicago’s McCormick Place Convention Center. This dynamic exhibit featured new product launches and tests from all laboratory medicine disciplines, including SARS-CoV-2 testing, artificial intelligence, mobile health, molecular diagnostics, mass spectrometry, point-of-care, and advanced laboratory automation.
In Chicago, an editorial board of eight AACC members followed the science at the meeting for CLN Daily, the official publication of the AACC Annual Scientific Meeting & Clinical Lab Expo, which was produced and distributed onsite. Read the full stories these summaries are based on at www.myadlm.org/publications/cln/cln-daily.
Unlocking the Brain’s Secrets
By Stephen Roper, PhD
You may have seen videos of stem cell-derived cardiomyocytes beating in a dish, but did you know that a variety of human organs, like the liver, kidney, and brain, can be partially recreated in vitro? Advances in human pluripotent stem cell (PSC) technology have led to the development of several tissue model systems.
Human organoids are PSC-derived 3D cell cultures that self-organize into semifunctional surrogates of organs. These systems are more representative of in vivo human biology than other cell-based models because they are composed of heterogeneous cell types and mimic the spatial organization patterns of authentic tissue. Importantly, organoids offer insights into the physiology of organs that are not safe or ethical to study by other means.
In his plenary session, Dr. Alysson Muotri explained how researchers are using brain organoids to model neurological conditions, including autism spectrum disorder and some infectious diseases.
For example, brain organoids were used to screen novel antiviral medications during the 2015 Zika virus outbreak and to model the neurotropic effects of SARS-CoV-2 more recently. Importantly, these systems also provide insight into organogenesis, neurotoxicology, and are even helping assess the effects of space travel on brain physiology.
New Developments in Pediatric Drug Testing
By Van Leung-Pineda, PhD
Intoxication cases are often urgent, confounding, and depend heavily on laboratory results. In pediatric cases, the added complexity often involves a multidisciplinary team of clinical providers, social workers, and laboratorians. The decisions from these cases are carefully considered, as they may have long-term repercussions to the welfare and social outcome of the patients, their families, and those providing the medical care.
In the session “Testing Strategies for Detecting Pediatric Drug Exposure: A Case Based Discussion Children Toxicology Cases,” the presenters used cases to explore the application of technologies and workflows directed at improving the weaknesses of the traditional screening and confirmation approach for drug exposure.
One of these cases highlighted the importance of updating urine drug screens—for example, including fentanyl because of the opioid epidemic. Moreover, high-resolution mass spectrometry (HRMS) can identify drugs, such as prescription medication, that many times are not part of an immunoassay screen.
Another leap forward: direct testing with mass spectrometry. Novel approaches use a definitive, qualitative mass spectrometry method and only require a small quantity of sample. Laboratories can overcome concerns about turnaround time by showing the benefits of definitive results for patient care, including fewer false positives.
How Can the Laboratory Ensure Equity in Healthcare?
By Angela Ferguson, PhD
Recently, the medical community is taking a closer look at examples of algorithms and equations that have a racial component to see if they are scientifically valid. The session, “Laboratory Medicine’s Role in Creating Equitable Clinical Laboratories: A Global Call to Action,” explored examples of race-based calculations and set out a roadmap for laboratorians to determine if these equations or algorithms are used in their institutions, and how to discuss their utility with clinicians.
Estimated glomerular filtration rate (eGFR) is the most well-known equation that incorporates a race-based factor. Other algorithms that incorporate a racial component include alpha-fetal protein (AFP) in maternal-fetal screening tests, a calculator to determine the risk of undergoing a vaginal birth after caesarean section (VBAC), and a calculated surgical risk score including age, sex, BMI, and race.
The data that laboratorians have access to is vital, noted speaker Dr. Octavia Peck-Palmer. “The fact that the laboratory generates such large databases of values means we can provide clinicians retrospective data demonstrating how biased an algorithm is,” she said. “Laboratorians are really at the intersection of health, between the lab values and the clinicians.”
Trust But Verify: AI in Precision Medicine
By Zhen Zhao, PhD
Laboratory medicine is one of the areas in which artificial intelligence (AI) can have the greatest impact. In the plenary session, “Biomedical Informatics Strategies to Enhance Individualized Predictive Models,” Dr. Lucila Ohno-Machado introduced how AI models are developed, tested, and validated for precision medicine and examined performance measures that may help clinicians select these models for routine use.
“Directly or indirectly, laboratory medicine gets involved in predictive models,” explained Ohno-Machado. “As genome data gets included in electronic health records as laboratory results, polygenic risk scores (PRS) will be produced for individual patients. Understanding the limitations of current PRS is especially important.”
Ohno-Machado’s research focuses on developing pattern recognition methods that can combine data from different biological levels to serve as bases for individualized predictive models in diagnosis and therapy response. One area of current investigation is the calibration and discrimination of risk adjustment models in different populations, and her laboratory has proposed new methods for their assessment.
Although adoption of predictive models by clinicians is currently uncommon, that could be changing soon with the laboratory’s help. “In my opinion, laboratory medicine experts must be leading medical AI efforts, together with radiologists, anatomic pathologists, clinical geneticists, intensivists, and, of course, biomedical informaticians,” Ohno-Machado said.
The Business of Tripping
By Christine Snozek, PhD
No longer only known as drugs of abuse, psychedelic drugs increasingly are the subject of serious research as potential therapeutic agents. The symposium “Psychedelics in Medicine: Macroeconomics, Microdoses, and the Laboratory Perception” highlighted clinical, business, and laboratory implications of this emerging trend.
In addition to hallucinogens and dissociatives, current psychedelics researchers are studying compounds that produce specific emotional reactions. These are called entactogens or empathogens and include drugs such as methylenedioxymethamphetamine. Clinical trials focus particularly on patients with psychiatric disorders, and studies of psychedelics have shown evidence of both rapid and persistent responses after only 1−2 doses.
Speakers emphasized that drug patents should be of particular interest to laboratorians: As with the explosion of synthetic cannabinoids a decade ago, patented psychedelic derivatives could translate into novel sources of illicit drugs in the underground economy.
These drugs could introduce a novel complication for clinical laboratories when used therapeutically. Heavy-isotope pharmaceuticals are intended in part to ensure labs can differentiate between prescribed and illicit sources of controlled substances. Since most clinical assays only target labeled compounds as internal standards, approval of these drugs could require extensive validation and expansion of current testing.
Laboratorians will need to shift their mindset to meet the need for assays, test names, and interpretive reports geared for therapeutic applications of these drugs.
The Giants on Whose Shoulders We Stand
By Vera A. Paulson, MD, PhD
Chances are if you’ve ever used a RapidCycler or dabbled in cell-free DNA, you recognized the internationally renowned speakers featured during the scientific session “Clinical Chemistry Journal: Hot Topics in Molecular Diagnostics.” Moderator Dr. Nader Rifai, editor-in-chief of Clinical Chemistry, was joined by Dr. Carl Wittwer and Dr. Yuk-Ming (Dennis) Lo.
Wittwer’s story is the stuff of lore. Armed with hair dryers and vacuum cleaners, he revolutionized DNA amplification, reducing turnaround time from hours to minutes. Who better to describe the state of nucleic acid amplification technologies? Wittwer covered not only amplification techniques but probe design, monitoring methods, and digitalization—both their limitations and their myriad of clinical benefits in a variety of diseases. “The limitation on turnaround time for things like PCR is not in the science: it’s in our ability to develop convenient instrumentation,” he said.
Equally enlightening were Lo’s predictions about advancements in circulating nucleic acids. Lo sees laboratories expanding the evaluation of cell-free DNA to longer nucleic acid fragments (up to 24kb), fragmentomics (tissue dependent fragment variability secondary to nuclease activity), and epigenetic modifications.
Over the past 15 years, the field of molecular diagnostics has witnessed unprecedented growth. And the next 10−15 years? “If you can see a connection which other people cannot perceive, this is where the breakthrough usually lies,” Lo said.
See You in Anaheim
The 2023 AACC Annual Scientific Meeting & Clinical Lab Expo will be held in Anaheim, California from July 23–27, 2023. Sign up to receive updates at meeting.myadlm.org/about/get-meeting-updates.