Liquid chromatography tandem mass spectrometry (LC-MS/MS) has evolved into a vital technology used to perform routine tests in many clinical laboratories. With advances in technology, more clinical laboratories have implemented LC-MS/MS as viable clinical analyzers. Paul Jannetto, Ph.D., Consultant in the Clinical Biochemistry Laboratory at Mayo Clinic, authored an article in Clinical Laboratory News on the advantages and clinical applications of LC-MS/MS.
LC-MS/MS is optimal for a wide range of clinical applications, including therapeutic drug monitoring (TDM), toxicology, endocrinology, pediatrics, microbiology, and the emerging field of proteomics. According to the article, many clinical laboratories are now using LC-MS/MS in lieu of other methodologies. LC-MS/MS offers the following advantages:
- Flexibility and versatility in enabling laboratories to offer novel laboratory-developed tests (LDTs) for biomarkers
- Sensitivity, which may allow lower limits of detection for some analytes, such as steroids, compared to immunoassays and other methods
- Multiplex, identify, and quantify several analytes of interest simultaneously
- Cost-savings and increased throughput via simplified or minimal sample preparation for some applications, such as dilute-and-shoot or protein crash
- Extended measuring ranges and the ability to measure multiple steroids at once
LC-MS/MS is used for many clinical applications. Primarily, it was used in newborn screening and to diagnose organic metabolic disorders in clinical labs. Today, LC-MS/MS is the leading technology employed by pediatric laboratories for newborn screening programs. It is also used for therapeutic drug monitoring for immunosuppressant drug like cyclosporine A, tacrolimus, sirolimus, everolimus, and/or mycophenolic acid, in addition to measuring anti-neoplastic agents like busulfan. Additional LC-MS/MS applications include measuring thyroxine, urinary cortisol, 25-hydroxyvitamin D, plasma free metanephrines, and proteomics.
According to Dr. Jannetto, "The future of LC-MS/MS is bright as manufacturers continue to improve, automate, and simplify the technology and make this highly complex instrumentation more like automated, FDA-approved chemistry analyzers."
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