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Increasing lab efficiency using NMR technology.

Technology is at the forefront of advancing workplace efficiency, but adoption of new technologies is often a major investment of time and financial commitment. As millions of newly insured Americans enter the healthcare system under the Affordable Care Act, laboratories around the country must continue to streamline operations to compensate for this increased volume and overall demand on already limited resources. Now more than ever, labs must weigh the cost of adoption and implementation of new technologies against the current reimbursement model and the anticipated long-term savings from improved efficiency and higher-quality data.

Recent advances in analytical technologies such as mass spectrometry and nuclear magnetic resonance (NMR) have not only made lab testing faster, but have significantly enhanced the accuracy and depth of information provided to physicians.

Although adoption of mass spectrometry was slow when it was first introduced, it has rapidly gained momentum in the clinical laboratory, particularly as a replacement for immunoassay testing in toxicology, endocrinology, therapeutic drug monitoring, and other areas. Indeed, mass spectrometry has become standard-of-care in numerous labs across the country. Rather than running dozens of single immunoassays, medical laboratory scientists can now use mass spectrometry methods to deliver more information to physicians in a shorter period of time.

Similarly, NMR technology is emerging as a standard of care in management of cardiovascular and metabolic diseases. NMR is particularly well suited for low-density lipoprotein particle (LDL-P) testing, a modality that has already demonstrated improved efficiencies and outcomes in cardiovascular risk management. Many labs and physicians have come to prefer NMR over traditional labor-intensive and time-consuming lipoprotein quantification methods such as chemical, electrophoretic, and density-gradient separation. Recent advances in NMR technology have reduced the analytical process to two steps, signal acquisition and analysis, which have significantly shortened the time to obtain an accurate quantitative result. (1), (2)

NMR technology has helped researchers accumulate a wealth of knowledge about lipoprotein metabolism and underlying lipoprotein disorders in patients with cardiovascular disease, diabetes, and prediabetes. (2) The clinical utility of LDL-P as measured by NMR has been validated in analyses of data from outcomes studies including the Multi-Ethnic Study of Atherosclerosis (MESA) and the Framing-ham Offspring study. (2), (3) In these hallmark studies, LDL-P has been shown to be more closely associated with cardiovascular events than LDL cholesterol (LDL-C) levels. Using LDL-P levels as a guide, clinicians can personalize disease management by devising treatment strategies tailored to individual patients' risk profiles.

The NMR technology armamentarium was recently augmented by the introduction of an automated clinical analyzer that combines proprietary signal processing algorithms with NMR spectroscopic detection to identify and quantify lipoprotein fractions and subtractions and potentially other small-molecule metabolites. (1), (4) Using this new platform, a blood sample can be analyzed to obtain detailed information about the physical, chemical, and magnetic properties of molecules. NMR detectors, or spectrometers, analyze the plasma or serum component of blood by subjecting it to a short pulse of radio frequency energy within a strong magnetic field. Each lipoprotein panicle within a given diameter range simultaneously emits a distinctive radio frequency signal, similar to resonant sounds for bells of different sizes. Using proprietary software customized for use with NMR technology, the amplitude or "volume" of the NMR signal is directly proportional to the concentration of the particle subclass of lipoprotein particles emitting the signal. (5)

The more sophisticated analysis provided by this technology enables the quantifying of multiple subclasses of lipoprotein particles within minutes instead of days, making lipoprotein analysis by NMR efficient, accurate and affordable. (3), (5) Moreover, clinical analyzers that support next-generation technologies such as NMR have the potential to be an effective and efficient platform for metabolite-based clinical diagnostics.

Laboratories that provide clinically relevant, high-value assays to address a broad range of cardiovascular, metabolic, and other diseases may find they have a competitive edge in the lab services market. For labs considering the proverbial "more for less" approach to diagnostic services, adoption of new technologies such as NMR may be profitable. The adoption decision must take into account the costs of assay/platform conversion and staffing, as well as determining whether implementation of the technology is revenue-generating. One thing is certain: as demand grows for personalized diagnostics, laboratories will need to view technology as an ally in streamlining operations and gaining efficiencies, rather than as an instrument of risk.

References

(1). Otvos JD, Jeyarajah EJ, Cromwell WC. Measurement issues related to lipoprotein heterogeneity. Am J Cardiol. 2002;90(suppl):22i-29i.

(2). DeGoma EM, Knowles JW, Angeli F, Budoff MJ, Rader DJ. The evolution and refinement of traditional risk factors for cardiovascular disease. Cardiol Rev. 2012;20:118-129.

(3). Jeyarajah EJ, Cromwell WC, Otvos JD. Lipoprotein particle analysis by nuclear magnetic resonance spectroscopy. Clin Lab Medicine. 2006;26:847-870.

(4.) Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004;110:227-239.

(5). Otvos JD, Mora S, Shalaurova I, et al. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. Clin Lipidol. 2011;5(2):105-113.

By Deanna Franke, PhD, MT(ASCP), DABCC

Deanna Franke, PhD, MT(ASCP), DABCC, is the Clinical Laboratory Director at LipoScience, Inc., a company dedicated to personalized diagnostics based on nuclear magnetic resonance (NMR) technology. LipoScience offers the NMR LipoProfile[R]test and the Vantera[R] Clinical Analyzer.
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Title Annotation:Management Q&A; nuclear magnetic resonance
Author:Franke, Deanna
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Nov 1, 2013
Words:889
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