Laboratory medicine, molecular pathology, microbiology, medical technology and life sciences are regarded as drivers of innovation, which by themselves or combined are able to generate new impulses in the fields of diagnostics and treatments for specific problems. It is these aspects based on selected trends in the field of laboratory medicine that the first MEDICA LABMED FORUM – which will be taking place within the scope of MEDICA 2017 trade fair in Düsseldorf – will be addressing and discussing with trade visitors. Each day of the event, which is to be staged in hall 18 between 11.00 a.m. and 4.00 p.m. from 13 to 16 November, will be dedicated to a specific topic. Trade visitors to MEDICA – which, with more than 5,000 exhibitors, is the world’s leading medical trade fair – will be given free admission to the English-language forum.
“The forum will be located right at the heart of activities at the trade fair. The joint aim on all four days is to get people out of their ivory towers that are their laboratories with their machines and computers and to address topical questions that are being raised in the trade press and daily newspapers and to which laboratories are able to provide answers. For example: Can cancer be diagnosed from blood, with ‘liquid biopsy’ being the keyword here? How safe and reliable are test strips and other quick tests for diabetes, heart attacks and HIV, with ‘point-of-care testing’ being the keywords here?” says and asks Prof. Dr Georg Hoffmann, who, as Managing Director of Trillium Publishers, is responsible for developing the content of this exciting range of discussions. Such socially controversial topics as long-distance travel and sex tourism, refugees, African epidemics and cheap operations overseas are also to be tackled and linked to the health risks that they pose and ways of preventing such risks.
Risky travel – migration, infection, multiresistance
Migration medicine will be on the agenda on Thursday, 16 November 2017. Chaired by PD Dr Beniam Ghebremedhin of the Helios University Clinic in Wuppertal, a series of 10- to 15-minute pop-up presentations will be addressing a range of subjects related to infectious diseases, e.g. tuberculosis or the presence of MRSA, VRE and carbapenemase-producing gram-negative bacteria in migrants and tourists. Viral infections and measures aimed at preventing and controlling infections will also be on the agenda.
The day dedicated to ‘Dangerous travel companions – infection and multiresistance in the era of migration’ will be addressing a long-known problem that the European Centre for Disease Prevention and Control (ECDC) raised in 2007: Multiresistant germs constitute the most serious threat to health in Europe. It has been extrapolated that the number of infection-related deaths will increase more than 10 times by 2050. “Serious issues that will not be easy to deal with may soon develop if this problem is not brought to the public’s attention more frequently,” warns PD Dr Beniam Ghebremedhin, a physician who also specialises in microbiology. The treatment bottlenecks for 4-MRGN serve as an example of such concerns as does the increasingly rare approval of new antimicrobial substances that could be employed to combat them, says the deputy head of the Institut für Medizinische Labordiagnostik (Institute for Medical Laboratory Diagnostics) at the Helios University Clinic in Wuppertal.
Calls for affordable screening
New resistant pathogens that could be brought to Germany as a result of globalisation and refugees arriving here must also be expected. “The health system here will see itself confronted with tuberculosis, 3-/4-MRGN infections, greater incidences of scabies, relapsing fever caused by lice, vaccination-preventable diseases (e.g. mumps, measles) and parasitic infections (e.g. leishmaniosis, schistosomiasis, malaria)”, says the senior physician. “Multiresistant germs in migrants are of a particularly high priority: many of the people arriving in their destination countries either departed from high-risk countries or have travelled through such regions,” explains Ghebremedhin. “The greatest deficiency in the provision of care to migrants is the lack of support to help them deal with the psychosocial and physical stress they experienced during their migration – which means that there is a risk of reactivation,” says the doctor in summary. But the facts that migrants are housed in close contact with vulnerable groups of people in conjunction with language barriers due to a partial lack of translators also constitute risk factors.
There is great potential for optimisation where laboratory diagnostics are concerned: “There are no affordable procedures for simple comprehensive screening for all the relevant multiresistant gram-negative bacteria nor is it possible to catch all the underlying molecular mechanisms by using routine methods. Such additional factors as time and costs for diagnostics and treatments for patients also need to be discussed – and so there is much work for the manufacturers to do,” warns the biochemist.
Detecting cancer and cardiovascular disease earlier
The LABMED FORUM will be launching on the MEDICA 2017’s opening day with the question: Is it possible to diagnose cancer from blood? “We are going to be illuminating a variety of ‘hot topics’ in oncology from different perspectives and examining any controversies surrounding them. Specialist presentations in the afternoon will be addressing the individual topics in greater detail and within the overall context,” explains Prof. Dr Stefan Holdenrieder who will be the Chairman of the Day.
Holdenrieder of the Deutsche Herzzentrum (German Heart Centre) in Munich says the following about the subjects on the agenda: “Screening and the early detection of tumours offers the unique opportunity of detecting tumours in the very early stages of their development, i.e. when they still haven’t caused any symptoms and can still be cured. However, there are costs associated both with the screening programmes and the uncertainty in patients who have less aggressive tumours that do not require treatment and in whom tumours have been incorrectly suspected. Professor Dr Hans Jørgen Nielsen, Hvidovre Hospital, University of Copenhagen, Denmark, has initiated large-scale studies on types of screening for colorectal cancer with corresponding biomarker projects in Denmark and is a member of the international Early Detection Research Network for Tumours (EDRN). He will be reporting current developments related to the early diagnosis of tumours.”
Interdisciplinary coordination between pathology, laboratory diagnostics and genetics
New molecular and immunological treatment approaches have produced amazing improvements over recent years. Even patients with advanced tumours may still benefit. This requires, however, that tissue be tested for special molecular changes. “These sometimes very expensive treatments are only provided when it is known which ‘switch needs to be activated’. New types of highly sensitive technologies have now also made it possible to detect molecular changes in the DNA that the tumour releases into the blood stream. Progression monitoring during and after treatment could make it possible to confirm efficacy or detect ineffectiveness in the early stages thus allowing treatments to be adapted,” explains Prof. Dr Holdenrieder, Director of the Institut für Laboratoriumsmedizin (Institute for Laboratory Medicine) at the German Heart Centre in Munich. “Some centres are already carrying out blood-based molecular trials during routine diagnostics. Prof. Dr Ian Cree from Lyon will be defining the types of standardisation required and the necessary efficient quality control. Prof. Dr Christopher Poremba, Pathology North Munich and Düsseldorf University, will be outlining the opportunities that molecular pathology is currently presenting and setting out the future potential for interdisciplinary coordination between the different fields of pathology, laboratory diagnostics and genetics.”
The huge technological progress and the consequently rapidly increasing number of diagnostic methods have produced a radical change in the classification of tumours over recent years. These changes require more precise diagnostics, also frequently a stratification of patients for suitable treatments and is associated with greater demands on quality-assured, evidence-based diagnostics. “Cree, who works at the WHO’s IARC department in Lyon, is responsible for the reclassification of tumours and will be talking about the exciting work of assessing diagnostic approaches, coordination between a large variety of disciplines and the necessity for evidence-based standardisation,” says Holdenrieder.
Finally, the prospects for the future of diagnosing tumours, i.e. new methods and developments that have not yet found their way into routine applications are going to be presented by Holdenrieder himself. Circulating tumour cells (CTCs) and cell-free nucleic acids circulating in the blood are currently of particular interest. Both genetic and epigenetic changes in cfDNA, RNA and microRNA patterns in plasma and in circulating exosomes represent promising new approaches. Exosomes are small vesicles that are frequently secreted by tumours and so may constitute a compartment with enriched tumour material in the blood. But much research is still required in many areas before the clinical benefits of these markers and the additional benefits to the diagnostic procedures currently in use can be confirmed.
More certainty in the event of heart attacks and cardiac insufficiencies
“The second day of the forum will be dedicated to discussing the status of blood markers in regard to highly sensitive heart-attack and heart-insufficiency diagnoses. Progress is currently being made in regard to new developments for highly sensitive test procedures that allow such events to be either ruled out or detected at the early stages. Cardiac troponin complexes have now become essential emergency parameters in detecting heart attacks, proBNP plays a significant role in the diagnosis of heart insufficiencies. Other markers present additional benefits and are currently in the process of being integrated into routine diagnostics. Such markers will also provide important indications for further prognoses for patients,” says Holdenrieder looking into the future.
The speakers will also be taking part in a panel discussion during which the latest diagnostic developments for central laboratories and patient-proximate diagnostics will be presented to the forum audience along with current results from stem-cell research (Dr Markus Krane, German Heart Centre in Munich).
POCT in the outpatient sector – useful and necessary
“It would, of course, be desirable for these highly sensitive procedures to also be available to practitioners as point-of-care tests (POCT), for example,” says Holdenrieder. Professor Dr Dirk Peetz, Helios Clinic in Berlin-Buch, will be speaking on the current progress of presently available POCT tests. The necessity for and opportunities of monitoring anticoagulant treatments required as a consequence of acute coronary syndrome are also going to be discussed.
The specific field relating to the use of biomarkers in children with congenital heart defects is going to be presented by PD Dr Oktay Tutarel of the German Heart Centre in Munich. Although this indication is encountered significantly more infrequently than in adults, it is still very important because these children must be regularly monitored throughout their lives to assess the functioning of their hearts and to prevent further organ damage.
The laboratory comes to the patient
Professor Dr Peter Luppa will be guiding us through the field of diabetology on Wednesday, 15 November 2017. “The LABMED FORUM’s charm is that it brings scientists, practitioners and diabetologists as well as the IVD industry together – which promises to make the discussions very interesting!” This day is going to be dedicated to highlighting ‘everything that is important in the field of glucose monitoring’. From analytical technology to its clinical application. The aim from the head of POCT at the Deutsche Gesellschaft für Klinische Chemie u. Laboratoriumsmedizin (German Society of Clinical Chemistry and Laboratory Medicine) is to improve the quality of life for people suffering from diabetes by controlling blood-sugar levels better.
That is why Luppa is hoping to help the participating physicians understand that laboratory medicine is able to offer valuable impulses for diabetologists as well as illness-based benefits for patients and so produce a positive response from them.
As a senior physician, and against the backdrop of good eHealth infrastructure, he thinks that physicians are currently not networking sufficiently with patients in the way care is currently being provided.
Diagnostic innovations in development
The most important topic is the long-term parameter of HbA1c. Its analytical precision needs to be improved. Alternative markers to help with controlling sugar levels are also being sought. Currently, however, only ‘glycated albumin’ in serum has the potential to be usefully employed in the future. Other multiplex proteomics markers are not being scientifically examined for their suitability for diabetics at the moment,” says Luppa.
But there are obstacles that have to be overcome between development and introduction to clinical routines. “This is a multifaceted subject that ranges from legal requirements governing the approval of IVD products (‘CE mark’) to clinical validations that will have to demonstrate the benefits of the new diagnostic tools,” says Luppa adding that legal and organisational framework conditions would also have to be considered.
“The sometimes revised EU directives (in conjunction with the resulting national laws, e.g. MPG and MPBetreibV) have, on the one hand, made it considerably more difficult to introduce new methods but, on the other, have proved to be a huge blessing to the improvement of product quality that benefits patient safety,” says Luppa summarising the situation.
More information about the MEDICA LABMED FORUM is available online at: http://www.medica-tradefair.com/mlf2.
Editorial note: Nina Passoth, life sciences communications (Berlin)
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Düsseldorf, October 2017