Mass spectrometry (MS) is often reserved for specialized laboratories in the areas of pharmaceutical chemistry and related fields. Although every medical setting may not benefit from having an on-site mass spectrometer, its use in major medical facilities can have significant advantages in improving patient care.
Emergency rooms see any number of perplexing cases, but attempted suicides and accidental overdoses can be difficult to address. In many cases, paramedics and ER doctors may give medications to reverse the effects of an overdose based on limited information. The patient may have been found with empty bottles lying next to them or they may display symptoms consistent with overdoses of common substances, such as narcotics or antidepressants. Since the response must be swift, there is not always adequate time to administer medications to reverse an overdose before toxicology reports are back from the lab.
Basic toxicology information from is not always conclusive. A patient may have any number of substances in their system or standard immunoassays may not be sensitive enough to differentiate between substances within the same drug class. MS is an additional tool that can be useful in toxicological screenings because more information about substances in blood serum can be identified. Having the technology readily available can save time when reversing some of the effects of an overdose is still possible or at least better palliative treatments can be administered. Without knowing the exact substance, there may be little more medical personnel can do than to try and maintain the patient's vitals and allow the toxin to run its course.
Understanding Individual Medication Response
MS is commonly used in the early phases of clinical trials to help determine if potential drug therapies react in the human body as intended. This test may include how much, if any, of the chemical binds to the target receptors, enters cells, or is metabolized by the body. Once medications make it past clinical trials and are widely available, there is a good idea of the expected behavior within the human body. Everyone is different with regards to the effectiveness of medication and possible side effects. MS can be a potentially useful tool in better understanding why some patients may not respond to a specific treatment and what modifications can be made to achieve a better response.
For example, individual differences in the rate at which medication is excreted from the body may help with finding the proper dosage. Biomarkers, which are biological indicators in a person's body, can be identified using MS and possibly have predictive value in finding the right medication and dosage. A patient who metabolizes a specific medication at a faster rate than expected may benefit from a higher dosage to help them reach therapeutic levels. Similarly, a patient who metabolizes medication at an unusually slow rate may experience more side effects than normal and may need a lower dose of medication. Using MS to delve into a patient's response to medications may lessen blind trial-and-error when adjusting dosages and trying different formulations within the same class of medications.
Adjunctive Diagnostic Tool
Just as biomarkers can be useful for their predictive value in developing a treatment strategy, some biomarkers can aid in diagnosing problems before they even surface. In many cases, some endocrine and autoimmune disorders have vague symptoms and may not be diagnosed until symptoms are prolonged or severe. Since there are known biomarkers correlated with certain diseases, MS can be used to identify subacute conditions or help confirm a diagnosis.
For example, anti-cyclic citrullinated peptide (anti-CCP) is most often associated with the development of rheumatoid arthritis. Unless a patient is showing symptoms, this test is unlikely to be performed. Additionally, if there are underlying biomarkers consistent with other diseases, they would be missed since laboratory tests are only looking for a specific autoantibody or antigen. MS can be a useful tool in developing a biomarker profile of patients instead of using individual tests.
MS has many important uses that are relevant to medical settings. By having a mass spectrometer readily accessible, medical facilities can have a wide range of diagnostic and therapeutic tools at their disposal.