New metabolic profiling lab brings personalised medicine to
17 Jan 2011
The newly opened Surgical Metabonomics Laboratory in St Mary's
Hospital, London, could transform the way surgeons make decisions in the
operating theatre by using metabolic profiling of tissue samples.
Researchers will have access to a high resolution solid state
nuclear magnetic resonance (NMR) spectrometer to analyse intact
tissue samples from patients taking part in studies, to investigate
whether it can ultimately give surgeons detailed diagnostic
information while their patients are being operated on.
Scientists at Imperial College London, in partnership with
clinicians at Imperial College Healthcare NHS Trust, have installed
the spectrometer in St Mary’s Hospital. The Surgical Metabonomics
Laboratory will be led by the surgical innovator Professor Lord Ara
Darzi and Professor Jeremy Nicholson, a leading researcher in
biomolecular medicine and Head of the Department of Surgery and
The new NMR machine will rapidly analyse intact
tissue samples from surgery patients.
The science of metabonomics, which involves comprehensively
measuring the metabolic changes in a person’s body, has been
pioneered by the Imperial team over the last 20 years. Techniques
from analytical chemistry, such as NMR spectroscopy and mass
spectrometry, can allow researchers to measure simultaneously all of
the chemicals produced by the body’s metabolism. With knowledge of
which molecules correspond to which conditions in the body, this
“metabolic fingerprint” can provide a wealth of information about
the state of a person’s health.
Metabonomics has previously been applied to samples of bodily
fluids such as blood and urine to look for indicators of disease or
of how a person might respond to a particular drug. Now the Imperial
team have acquired an NMR machine — the first to be installed in a
hospital setting — that will analyse solid tissue samples from
patients undergoing surgery with Imperial College Healthcare.
The research projects are funded by Imperial’s Comprehensive
Biomedical Research Centre. Imperial’s is one of five Comprehensive
Biomedical Research Centres in the UK; it was awarded to Imperial
College Healthcare NHS Trust by the National Institute for Health
Research following a national competition.
The new laboratory forms part of the Academic Health Science
Centre, a unique partnership between the Trust and Imperial College
London, which aims to improve the quality of life of patients and
populations by taking new discoveries and translating them into new
therapies as quickly as possible.
Professor Darzi, Chairman of the Institute of Global Health
Innovation at Imperial College London and an Honorary Consultant
Surgeon with Imperial College Healthcare NHS Trust, said: “People
respond differently to the physical trauma of surgery, but currently
the tools we have to measure how they respond are very limited.
Blood tests are slow and they can only measure one chemical
component at a time; the doctor simply looks at whether a particular
measure has gone up or down. Using NMR, we can simultaneously
measure all of the chemicals that the body is producing, and analyse
those data to give the surgeon real-time information about the
patient’s condition which will help him make decisions.”
Surgeons will be able to take tissue samples and have them loaded
straight into the NMR machine without the need to prepare them. The
research team think it will be possible to give the surgeon a
readily interpretable readout from the analysis within 20 minutes,
which would provide information such as whether the tissue is
infected or how good its blood supply is. Surgeons might also use
the technology to determine exactly which areas of tissue are
One project that the team will undertake at the new laboratory is
to develop an “intelligent knife”. Surgeons commonly use a technique
called electrocautery in operations to seal blood vessels by burning
them with a hot iron. By sucking up the smoke produced in this
procedure into a mass spectrometer, researchers believe they will be
able to tell the surgeon whether the tissue they are burning is
healthy, cancerous or infected.
Professor Nicholson, Head of the Department of Surgery and Cancer
at Imperial College London, said: “This is a radical change of
approach that doesn’t just apply to surgery. We want to be able to
provide a metabolic map of the entire patient journey. Before
surgery, metabonomics could tell the doctor how risky surgery might
be for that patient, or how best to prepare him for surgery. After
the operation, metabonomics might help the doctor to monitor the
patient’s recovery and prescribe the most suitable drugs or diet.
Ultimately we hope to apply this approach to every area of medicine.
“It’s no small task. The analytical chemistry and mathematical
modelling involved are challenging, and not everything we try will
work. But we hope that within two to three years, we’ll have robust
evidence that metabolic profiling can be a really useful tool in
Dr James Kinross, a Clinical Lecturer in the Division of Surgery
at Imperial College London, said: “People have been talking about
personalised medicine for many years now, but so far there have been
few meaningful steps towards delivering on that promise. Genome
sequencing is currently quite slow and expensive, and it can only
tell you so much. Metabonomics takes into account not only what
genes somebody has, but also all of the environmental factors that
influence their biology, such as their diet, what drugs they’re
taking, and what bacteria they have in their body.
“Because of the world class expertise we have here and the close
links between surgeons and biomolecular scientists, Imperial is
uniquely placed to be able to make major advances in this field.
Almost no other institution is in a position to take on the
To help realise the vision of the new centre to enhance surgical
safety and patient care, Imperial has partnered with two of the
world’s leading spectroscopic instrument manufacturers, Bruker
BioSpin and the Waters Corporation, who will help to develop,
optimise and implement NMR and mass spectrometric technologies for
real time diagnostics and prognostic modelling.
“By combining bioinformatics and surgical expertise with advanced
mass spectrometry technology, Imperial College London is setting a
powerful vision for innovative new techniques in the operating
room,” said Rohit Khanna PhD, Vice President of Worldwide Marketing
“At Waters, our success is based upon the ability and imagination
of scientists to apply advances in analytical technology to solve
their most difficult challenges. Bringing metabolic profiling to the
surgical suite is a great example of how a disruptive innovation can
potentially improve patient care with a radical new approach. On
behalf of all Waters employees, we congratulate Imperial on the
launch of the Surgical Metabonomics Laboratory. We look forward to
working together on tomorrow’s innovations.”