Revolutionizing Surgery with Real-Time Metabolic Profiling

Surgical metabonomics, the metabolic profiling of tissue samples, could transform the way surgeons make decisions in the operating theatre.

Researchers at the Imperial College London (ICL; London, United Kingdom) Surgical Metabonomics Laboratory (SML) are using a high-resolution solid-state nuclear magnetic resonance (NMR) spectrometer to analyze intact tissue samples, without preparation. Surgeons will be able to take tissue samples and have them loaded straight into the NMR machine, receiving a readily interpretable readout from the analysis within 20 minutes, which would provide information such as whether the tissues is infected or how good its blood supply is. Surgeons might also use the technology to determine exactly which areas of tissue are cancerous.

"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,” said Prof. Jeremy Nicholson, PhD, a leading researcher in biomolecular medicine and head of the department of surgery and cancer, who will lead the SML together with surgical innovator Prof. Lord Ara Darzi, MD. "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.”

"People respond differently to the physical trauma of surgery, but currently the tools we have to measure how they respond are very limited,” added Lord Darzi. "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 analyze those data to give the surgeon real-time information about the patient's condition, which will help him make decisions.”

The science of metabonomics involves comprehensively measuring the metabolic changes in a person's body, using techniques from analytical chemistry that 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.

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Imperial College London