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Preventive diagnostics is the future of laboratory diagnostics


Dusseldorf, Germany – Diagnostics systems that “sound the alarm” already in the foreground of an illness will be the focus of future developments in laboratory diagnostics. The medical industry will provide a comprehensive overview of the latest laboratory diagnostic systems during the MEDICA 2008 in Dusseldorf, the 40th World Forum for Medicine international trade fair with congress (November 19-22).

Visitors can check out the latest developments in laboratory medicine during the world’s largest medical trade fair with approximately 4,200 exhibitors from 65 nations. What potential does laboratory medicine offer?

The future of laboratory medicine lies in the development of procedures with which the risk for certain diseases can be estimated. Professor Dr Karl Lackner, lab physician at the University Clinic of Mainz and president of the German Society for Clinical Chemistry and Laboratory Medicine sees a “huge need in nearly all areas of medicine” for early screening in laboratory diagnostics. This so-called pre-symptomatic diagnostic screening, is receiving a huge wave of support through “the speedy development of technical possibilities,” he says.

One cause equals one disease. Laboratory diagnostics show impressive results when it comes to monocausal cases. As a result, several genetically related diseases can be predicted today with a very high rate of reliability. However, up till now this has only applied to rare diseases that do not play a large role in medicine with respect to numbers.

However, human sciences with multicausal diseases have proven to have much less success. Whether arterial sclerosis or diabetes, “we are having a much more difficult time here,” says Dr Lackner.

There are areas in which laboratory diagnostics has done wonders, such as with regard to enzymes and substrates of the organism. Both of these are under control and they form the analytical basis of today’s laboratory diagnostics.

Proteins and their components, the nucleic acids, as well as carbohydrates and fats are significant groups of the biomolecules that among others still need to be conquered from a laboratory analytical point of view. The goal here is to be able to assess the risk of certain individual diseases more closely.

However, especially in light of fats (lipids) and carbohydrates, laboratory medicine has little to show for with the exception of detection of glucose, cholesterol and triglycerides and their medical significance. At the same time, the main degradation product of cholesterol, cerebrosterol plays a significant role in Alzheimer’s disease (as a biochemical progress indicator). In the world of lipids, this shows that there is still a great void analytically speaking. Dr Lackner says: “Worldwide there is currently only a handful of research groups that can measure this.”

Laboratory medicine has come along way with proteins

Success can also be claimed in another important substance group. Proteins and their components, nucleic acids that form a significant group of biomolecules in addition to carbohydrates and lipids (best known exponent is desoxyribonucleic acid) have now become well familiar in laboratory medicine.

An example of advances in laboratory diagnostics with proteins is the so-called PSA value, the laboratory medical evidence of the so-called tumour marker “prostate specific antigen,” a glycoprotein found exclusively in prostate tissue. Dr Lackner considers the PSA test one “of the best tumour markers of all.”

And yet the highly praised test still is not conclusive. Different diseases of the prostate, such as a benign growth or an infection can lead to an increase of the PSA level in blood. An increased value does not necessarily mean there is a tumor. Time and again the test declares healthy patients sick and sick patients healthy. “We are still no where near,” stresses Dr Lackner, being able to use the PSA test to place men on the safe side on a regular basis.

And so the search continues for specific biomarkers. Molecular biologists have taken on the challenge to find in the genome. This is a huge project for the researchers, since there are probably around 40,000 human genes.

After the short-lived and now subsiding genome euphoria occurring around the millennium, today, proteins are now advancing more into the analytical foreground as active target molecules of life. Protein molecules are considered more specific and more dynamic than genes and can reflect the status of a cell much better. As a result, scientists are hoping to obtain direct access to the molecular cause of diseases through direct analysis of the proteins as active molecules including new approaches for a medicinal, target-oriented therapy.

Proteins in cardiological diagnostics

Analytical detection or exclusion of a protein that causes heart attacks, the heart muscle-specific troponin, has proven to be effective in the world of proteins. Troponins are proteins that are present in skeletal and heart muscle. When heart muscle cells die as a result of a heart attack, the protein which normally only exists in heart muscle cells enters the blood and can be detected by a test (immunoassays) approximately three hours after the damage. This detection is therefore very specific for damage to the heart muscles.

It is currently unclear whether medicine will be developed for home use. It could be feasible to develop laboratory diagnostic monitoring systems that check the efficacy of a medication and its dosage, which is adjusted completely to the individual needs of a patient. Perhaps it may even be possible to develop probes that can determine the individual efficacy of a medicinal therapy prior to the beginning of treatment. It is estimated that five of 100 patients admitted on an inpatient basis are hospitalized as a result of adverse drug effects.

Information on MEDICA 2008, regarding topics of the MEDICA congress as well as product information of the exhibitors (eg, with regard to laboratory technology and diagnostics) can be obtained on the Internet at: http://www.medica.de

(Source; Medica. Author: Claus Schwing, Independent Journalist, Biomedical Engineer, Ulrichstein)