Elevated serum alpha-fetoprotein (AFP) can be observed in liver cirrhosis and hepatocellular carcinoma (HCC). The glycosylation patterns of AFP have been shown to differentiate these conditions, with AFP glycoforms with core fucosylation (AFP-L3) serving as a malignancy risk predictor for HCC. We have developed a method to detect endogenously present AFP proteoforms and to quantify the relative abundance of AFP-L3 glycoforms (AFP-L3%) in serum samples. This method consists of immune enrichment of endogenous AFP, followed by liquid chromatography coupled with high-resolution mass spectrometry (LC–HRMS) intact protein analysis of AFP. Data are available via ProteomeXchange with identifier PXD038606. Based on the AFP profiles in authentic patient serum samples, we have identified that the frequently observed AFP glycoforms without core fucosylation (AFP-L1) are G2S2 and G2S1, and common AFP-L3 glycoforms are G2FS1 and G2FS2. The intensities of glycoforms in the deconvoluted spectrum are used to quantify AFP-L3% in each sample. The method evaluation included reproducibility, specificity, dilution integrity, and comparison of AFP-L3% with a lectin-binding gel shift electrophoresis (GSE) assay. The AFP-L1 and AFP-L3 proteoforms were reproducibly identified in multiple patient serum samples, resulting in reproducible AFP-L3% quantification. There was considerable agreement between the developed LC–HRMS and commercial GSE methods when quantifying AFP-L3% (Pearson r = 0.63) with a proportional bias.

Background: This review provides a description of how the opioid epidemic has impacted drug testing. Methods: Four major service areas of drug testing were considered, including emergency response, routine clinical care, routine forensics, and death investigations. Results: Several factors that the opioid epidemic has impacted in drug testing are discussed, including specimens, breadth of compounds recommended for testing, time to result required for specific applications, analytical approaches, interpretive support requirements, and examples of published practice guidelines. Conclusions: Both clinical and forensic laboratories have adapted practices and developed new testing approaches to respond to the opioid epidemic. Such changes are likely to continue evolving in parallel with changes in both prescription and nonprescription opioid availability and use patterns, as well as emerging populations that are affected by the “waves” of the opioid epidemic.

Occupational exposure to antimony has become rare in the past decades due to antimony mine closures and technological improvement in antimony processing plants in the US. Although antimony’s ubiquitous presence in plasticwares does not pose known health risk, it can present as a potential contaminant to antimony analysis for occupational exposure assessment. To understand the level of antimony contamination from plastic collection devices, we evaluated two different whole blood plastic collection tubes that are routinely used for trace and toxic element assessment: royal blue BD Vacutainer® EDTA tube and Greiner VACUETTE® trace elements sodium heparin tube. We analyzed how different fill volumes may impact the concentrations of antimony detected. Although both collection tubes can introduce antimony contaminations to nitric acid and neutral buffer rinse, the Greiner heparin tube introduces significantly lower amount of antimony to freshly collected whole blood samples compared to the BD EDTA tube. When patients’ samples are collected with BD EDTA tubes, they would exhibit elevated antimony concentrations that can be interpreted as potential antimony exposure. We conclude that the royal blue BD EDTA plastic tube is not suitable to evaluate blood antimony levels, and laboratories need to validate their own alternative sources, when the glass tubes are not available.