ACBI Summer Scientific Meeting - Limerick.

Kemmy Business School, Limerick.

Report of the Summer Scientific Meeting of the Association held on Friday, 12th June 2009 at the Kemmy Business School in the University of Limerick.

The ACBI Summer Scientific meeting was held in the recently-opened Kemmy Business School at the University of Limerick on Friday, 12th June 2009. Thirty-eight delegates attended the full meeting with a number of others attending the morning or afternoon sessions.

The meeting opened with Dr. Stephen Finn, Consultant Histopathologist at the Mid-Western Regional Hospital speaking on "Lipid metabolism and prostate cancer progression". Dr. Finn began with an overview of lipid metabolism and the progression of prostate cancer. He highlighted the role of fatty acid synthase and beta-catenin in the oncogenicity of prostate cancer. He also detailed the association between obesity, the metabolic syndrome and prostate cancer progression. He set out a number of hypotheses including:- patients with metabolic syndrome are at increased risk of developing lethal prostate cancer and both the metabolic syndrome and obesity contribute to a pro-inflammatory milieu that contributes to the development and progression of precursor lesions. Dr. Finn presented experimental evidence linking lipid metabolism with prostate cancer progression. He underlined how further research will help to identify new markers of prostate carcinogenesis.

Following Dr. Finn’s excellent presentation, Dr. Frances Drummond, Project Manager at the National Cancer Registry Ireland (NCRI), presented a most comprehensive review entitled "Trends in prostatic biopsy and the risk of a prostate cancer diagnosis in the Republic of Ireland". Dr. Drummond reported that Ireland is predicted to have had the highest prostate cancer incidence rate in Europe in 2006. She explored the trends driving prostate cancer and mortality. Her presentation highlighted the large increase in the number of prostate biopsies performed since 1994. The age and PSA level at which biopsy is performed has decreased significantly. There has been an increase in the number of low/medium stage cancers, but the number of high grade cancers diagnosed has also increased. The NCRI has found that biopsy practice varies throughout the country with different practices adopted by urologists and radiologists. Also, the inconsistency of referral practices by GPs was highlighted. The intensity of biopsy is likely to contribute to the high and increasing incidence of prostate cancer.

The afternoon session opened with Dr. Tom Smith, Principal Clinical Biochemist at St. Vincent’s University Hospital in Dublin, providing a comprehensive update on hyperprolactinaemia and macroprolactinaemia. He outlined how in addition to detecting the free, monomeric, bioactive form of circulating prolactin, current immunoassays also react with a high molecular mass complex of prolactin called macroprolactin. He highlighted the potential of unrecognised macroprolactinaemia as a cause of hyperprolactinaemia to result in biochemical misdiagnosis, unnecessary investigations and inappropriate treatment of patients. He compared the available commercial methods for prolactin determination and their varying degrees of reactivity to macroprolactin. Dr. Smith outlined the strategy of PEG precipitation and the need for clinical laboratories to introduce PEG precipitation protocols. He encouraged laboratories to report both the post PEG monomeric prolactin result with an appropriate validated reference interval together with the total prolactin result. A clear understanding of prolactin test results can help clinicians avoid misdiagnosis and mismanagement of hyperprolactinaemic patients.

Following this excellent update by Dr. Smith, delegates were treated to something very different. Professor William O’Connor of the University of Limerick was on hand to provide a fascinating insight into tissue microdialysis. He outlined the theoretical and practical concepts of tissue microdialysis and this technology’s journey from preclinical research to clinical treatment.  Microdialysis is a minimally invasive diffusion-based separation method that allows analytes to freely diffuse across a hollow fiber semi-permeable dialysis membrane. The membrane is perfused with a liquid, which equilibrates with the fluid outside the membrane by diffusion in both directions. Microdialysis in combination with a suitable detection technique allows monitoring of time-dependent changes in local tissue chemistry. Professor O’Connor provided examples of how this technique measures or monitors changes in simple biochemical markers, such as the lactate/pyruvate ratio and glucose, leading to early and effective clinical interventions. According to Professor O’Connor, blood sample analysis only provides a distant echo of the activity occurring in affected tissue whereas microdialysis provides real-time monitoring of biochemical changes in the affected tissue. Microdialysis also achieves near-continuous monitoring of tissue status and negates the need for repeated blood sampling. Finally he outlined the present and future role of the School of Medicine in the University of Limerick in tissue microdialysis clinical research.

To complete the meeting programme, Dr. Ned Barrett, Consultant Biochemist at the Mid-Western Regional Hospital, reflected on laboratory testing at the boundary between normality and disease. He reminded delegates that Robert Boyle of Boyle’s Law fame was the first to suggest that changes in the composition of blood could be used to aid diagnosis. He contrasted the use of laboratory tests in screening, pre-disease and subclinical conditions with the use of laboratory investigations to predict or detect disease progression in long-term conditions. He spoke about the changing expectations and concerns of the patient and the greater emphasis on screening for disease and pre-disease at primary care level and how this can lead to inappropriately requested tests. Dr. Barrett presented interesting audits of catecholamine requesting in the acute hospital setting and CA 125 requests by general practitioners. The findings of the audit of CA 125 requesting raised many interesting questions and lead to good discussion after the lecture. Moving to the other end of the spectrum, Dr. Barrett identified the effective management of chronic conditions as the major concern for healthcare into the future. He suggested that current models of health service delivery are unlikely to be able to cope with future demand. The ageing population, together with adverse trends in diet, exercise, obesity and other risk factors indicate that the level of chronic conditions will increase. He described how health service resources and focus will have to be reorganised and redirected. He illustrated his talk with an audit of thyroid hormone testing in the primary care setting and with the use of HbA1c in assessing the effectiveness of diabetes care. He described tests such as HbA1c and eGFR as ’radar’ detecting the onset and progression of complications. Chronic disease management will require the integration of care across traditional institutional boundaries between primary care and the acute hospitals and this will have important opportunities or consequences for hospital laboratories.

Dr. Ned Barrett closed the meeting by thanking all those who contributed including the organisers, speakers, chairpersons and most importantly the delegates themselves for their attendance and valued input.

A special word of thanks is due to Ms. Paula O’Shea and Dr. Peadar McGing for chairing the morning and afternoon sessions respectively.

Delegates were treated to an outstanding lunch in the Cube Restaurant in the Kemmy Business School.

Dr. Ned Barrett and the team from the Mid-Western Regional Hospital must be commended for putting together such an excellent and topical programme with top class speakers. We are looking forward already to the next ACBI Scientific Meeting in Limerick!

Micheál Ryan,
Senior Clinical Biochemist,
St. John’s Hospital,
Limerick.