application mass spectrometry in clinical chemistry
TRANSCRIPT
Application Mass Spectrometry in Clinical Chemistry
Application Mass Spectrometry in Clinical Chemistry
Contents1. Application of MS in Laboratory Medicine
2. Simultaneous Analysis
3. Prospect of Future
Application of MS in Laboratory Medicine
Application of MS in Laboratory Medicine Application of MS in Laboratory Medicine
1. Biochemical genetics
2. Therapeutic Drug monitoring
3. Biomarkers for certain disorders
4. Clinical proteomics
5. Clinical microbiology
Therapeutic Drug monitoring(TDM) Therapeutic Drug monitoring(TDM)
1. Immunoassays(IA)
2. HPLC
3. LC/MS/MS
Immunoassays(IA) Immunoassays(IA)
Usage of the instruments for TDM KAQACL in
2011 Usage of the instruments for TDM KAQACL in
2011
CyclosporineCyclosporine
TDM 및 약물남용검사 신빙도조사 결과보고 (2007)
Mass SpectrometryMass Spectrometry
검사법 비교검사법 비교
Conventional method vs Mass spectrometry
Conventional method vs Mass spectrometry
Immunoassays(IA) : DisadvantageImmunoassays(IA) : Disadvantage
1. 구조가 유사한 compounds (e.g., prodrugs and drug metabolites) 의 교차 -반응에 의한 간섭
1) 간 기능이상 또는 신장기능장애환자에서 더욱 심화 ⇒ 광범위한 수준의 대사물 누적이 발생
2. Human anti-animal antibody 에 의한 간섭효과
1) 치료나 영상촬영을 위한 mouse monoclonal antibody 사용 증가에 따른 human anti-mouse
anti body (HAMA)에 의해 잘 인지되지 않음 2) 특히 two-site mouse monoclonal antibody-based 측정법에서 양성과 음성 간섭을 모두 유발
3. 감도 범위가 한정적이다 .
1) 어린아이 간이식 수술 후 tacrolimus 의 경우 IA 로 측정할 때 낮은 감도로 인해 측정이 안 될 수도 있음 .
LC/MS/MS : AdvantageLC/MS/MS : Advantage
1. Specific (no cross reactivity)
2. Metabolites
3. Cost-effective (?)
Cost-effectiveCost-effective
Yearly CostsYearly Costs
Total for the IAs LC-MS/MS
Apparatus 20,000 50,000
Maintenance 20,000 20,000
Reagents/consumables 150,000 10,000
Technician(s) 50,000 50,000
Total 240,000 130,000
Ther Drug Monit Volume 31, Number 1, February 2009
Calculations experienced in the authors’ laboratory. Based on 15,000 samples analyzed per year. Prices in Euros including VAT. Ap-paratus costs for the LC-MS/MS are based on 250,000 euro for purchase and 50,000 euro depreciation per year during 5 years.
Conventional method vs Mass spectrometry Conventional method vs Mass spectrometry
1. Automation
2. TAT
3. Method development
Simultaneous Analysis
Unknown Drug ScanningUnknown Drug Scanning
Antiepileptic DrugsAntiepileptic Drugs
1. Primidone
2. Gabapentin
3. Carbamazepine
4. Oxcarbazepine
5. Zonisamide
6. Levetiracetam
7. Lamotrigine
8. Phenytoin
9. Topiramte
MRM chro-matogram
MRM chro-matogram
Prospect of Future
• Tests often evolve through this spectrum
– New esoteric testing will grow substantially with the maturation of
genomics and proteomics
– What’s esoteric today may be POCT tomorrow with advances in
technology, new therapeutic options, and new care models
Test evolution Test evolution