Future directions for POCT

Please contact the POCT Coordinator for more information on any of the topics presented here.

This page is dedicated to the cutting edge technology of POCT- new products, new science, new inventions. How might POCT enhance or affect diagnostic testing in the years to come? 

Interesting new areas of POCT development
POCI- Point of Care Interpretation- without it, what's the point?
Pharmacogenetics- the future of diagnostic medicine?
Noninvasive device measures glucose level in the ear
pro-BNP (Brain Natiuretic Peptide)
h-FABP (heart-Fatty Acid-Binding Protein)

 

Point of Care Interpretation

 

POCT has to be accompanied by POCI (Point of Care Interpretation), otherwise why bother? At present, if it is blood gases or electrolytes and glucose, or coagulation tests, it is probably acceptable to rely on human memory for the meaning of the results. But if we ever reach the stage of POCT genetic testing before prescribing then it is likely that a profile of multiple loci will be needed and a database of probabilities will have to be available immediately, with the results. 

 

Pharmacogenetics, Personal Medicine and POCT

 

Genetic testing for disease processes and thence the selection of specific drugs tailormade to an individual's polymorphism, will ensure the appropriate dosage in the appropriate circumstances. This diagnostic approach is referred to as pharmacogenetics. 

 

With the likely advent of personalised medicines there will be a big need for diagnostic testing  (biochemical or genetic) to decide which patients benefit (or don't) from which drug. Ultimately the logical place for most of this will be POCT, i.e., just before the medication is or isn't administered. 

 

It seems also, that the genotype screening systems for pharmacogenetic purposes will have some inbuilt algorithm/expert system for interpreting the results. Presumably there will be specific systems for each drug or drug group, developed by the pharmaceutical company's diagnostics arm (if it has one), or by contract with a "boutique" biotech company if it hasn't.

Quite a challenge, both in compiling the necessary data and in making sure it is available where and when needed.

Non-invasive device measures glucose level in the ear

 

A device in development by Infratec, Inc (Wilton, CT, USA) allows glucose measurements to be made by inserting a sensor into the ear for about 10 seconds. Studies have shown that the accuracy and precision are clinically acceptable. The principle behind the device is based on the discovery that natural mid-infrared body emissions change, depending on the glucose concentration of the tissue. The patented device isolates and measures glucose levels from the eardrum by using the body's natural heat emission, averting the need for drawing blood. The aim of Infratec is to develop a commercial cell phone sized device  that will give a direct readout of a person's blood glucose level without the need for drawing blood. 

 

(Ref: LabMedica International Jan-Feb 2003, Vol.20 No.2 pp 1-2).

 

pro-BNP (Brain Natriuretic Peptide)

 

This modified Roche test measures the N-terminal peptide from the pro-BNP molecule.

 

This test is available from Biochemistry Core Lab on a 24/7 basis.

 

Although POCT BNP is available, it is not used in the CDHB.

 

Heart FABP:

The traditional markers Troponin T, Troponin I, and CK-MB offer diagnostic safety not before about 3 hours post myocardial infarction. In contrast, h-FABP (heart-Fatty Acid-Binding Proteins) can be detected as early as 20 minutes after an AMI.

The unique advantages of Heart FABP in myocardial infarction are:

Fatty Acid Binding Proteins are small intracellular molecules- small cytosolic proteins responsible for the transport and deposition of fatty acids inside the cell. Due to its small size, FABP leaks rapidly out of damaged dying cells, leading to a rise of serum levels.

h-FABP has the same kinetics of liberation into the patient's blood as myoglobin, but is more reliable and sensitive marker of myocardial cell death. That is due to the fact that h-FABP concentration in skeletal muscle is significantly lower than myoglobin concentration.

FABPs have a high degree of tissue specificity. Various types of FABP have been detected: 

rennesens GmbH offer an immuno test for h-FABP called CardioDetect®, suitable for POCT and home use. 

 

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