“Metabolic phenotyping will revolutionise the way we map the surgical patient journey. It will provide us with information before, during and after surgery, ensuring that we deliver surgical care that is truly customised to each patient’s unique metabolic makeup.”
Medical breakthroughs normally take a long time to reach a level where they are in common use, in fact 10 to 15 years is the norm. However, at the world’s first Centre for Surgical Metabonomics, a unique enterprise between Imperial College London and the Imperial College Healthcare NHS Trust, the focus is on translating new discoveries into new therapies as quickly as possible, namely the application of “molecular fingerprinting” technologies in a hospital setting to significantly improve surgical and therapeutic procedures.
Led by Professor Jeremy Nicholson, Head of the Department of Surgery and Cancer and Professor and Surgeon Lord Ara Darzi, the research is initially concentrated on real-time diagnosis of patients on the operating table. Surgeons will take several tiny biopsies of tissue during operations for analysis. The resulting molecular fingerprint will be compared to a database to identify it and assess how healthy it is. Such information will enable surgeons to identify where organs are diseased and need to be operated upon, something which, using existing methods, can take an hour or more – time that some patients simply do not have.
At the heart of the centre is a Bruker AVANCE™ high-resolution solid-state NMR spectrometer, installed at St Mary’s Hospital in Paddington, west London, which can rapidly analyse a patient’s tissue samples to give a surgeon accurate information about their metabolism in 20 minutes. Once determined, the chemical composition of the biological sample – its molecular fingerprint – can provide diagnostic information on diseased tissue, levels of severity and even monitor the effects of applied therapies.
“We are using powerful metabolic screening tools to give doctors more information about the patient’s physiology and their response to treatment,” said Professor Nicholson. “This is a bold step in translational medicine that will help optimise the management of individual patients.”
“The work that we are conducting will unquestionably bring us closer to the ultimate goal of personalised surgical healthcare. The strength of metabolic profiling is that it can provide relevant and interpretable data in a time-frame short enough to be of practical use for the clinician,” said Professor Darzi.
The AVANCE NMR system features an innovative sample changer that can automatically transport 48 samples in multiple batches and maintain the tissue samples at an optimum temperature of between -l6°C and -20°C which is critical to prevent degradation. The screening process rapidly analyses molecules such as lipids, proteins, amino acids and sugars such as glucose.
“The swift 20 minute analysis is comparable to the work of a pathologist. The fastest I’ve ever heard of is results in an hour, but it usually takes longer.” says Dr Manfred Spraul, Director of NMR Applications. “Processing enough samples for each type of statistical model is essential, but the models will improve as more samples are tested. The process is self learning, that’s the beauty of it.”
The Imperial College researchers are currently building databases of metabolic information concentrating on areas like cancer and intestinal infarction, where medical needs remain mostly unmet.