By Paula Keating & Alice Moono.

Humans and our environment are inextricably linked. The Māori phrase kaitiakitanga means guardianship and calls upon our responsibility to care and protect the sky, the sea and the land for future generations. 

Over recent decades clinical laboratories have embraced automation to manage the increasing demand for pathology testing. Most clinical laboratories rely on immunodiagnostic kits on automated platforms.  These diagnostic test kits are transported around the world by air, kept in cold storage with each kit containing many plastic bottles to compartmentalise the different reagents. Although commercial diagnostic kits provide convenience and standardisation, there are alternatives that are kinder to the environment.

For example, laboratories develop in-house assays based on different technologies such as mass spectrometry, flow cytometry or next generation sequencing. The laboratory developed tests generally provide improved analytical accuracy and, in some cases, offer testing that is not yet commercially available. Tertiary hospital laboratories are early adopters of new methodologies to enhance service for their clinical requirements. 

As an example, we highlight four methods to measure immunogenicity to the monoclonal antibody drug infliximab. Infliximab has transformed the treatment of inflammatory diseases however the drug becomes ineffective in patients that develop antibodies to the drug. The tests include two point-of-care devices and an automated chemiluminescence immunoassay. The fourth test is a size exclusion chromatography method termed the homogenous mobility shift assay (HMSA)(1). The HMSA identifies antibodies to infliximab by their ability to bind to a fluorescent form of infliximab resulting in a shift in molecular weight detected on a chromatogram. This method is in routine service at Canterbury Health Laboratory, Christchurch, New Zealand (2). The commercial tests require transport from manufacturing sites in Europe under cold storage and the receiving clinical laboratories must have cold storage facilities available. The storage space required is associated with just-in-time inventory management which affects the frequency of transport. In the table below is a synopsis on the plastic weight used in measuring a patient serum. The HMSA method requires minimal cold storage, transport and substantially lower requirement for plastic consumables. The size exclusion columns can be recycled and the method uses non-toxic phosphate-buffered saline.

When introducing new methods into clinical laboratories, environmental impact should be assessed alongside analytical and clinical performance. The HMSA method illustrates how laboratory innovation can simultaneously provide clinical and economic benefits through reduced plastic consumption, minimal cold storage and lower transport costs. It is time that we embrace kaitiakitanga and demonstrate our commitment to the environment.