September 29, 2000

New lab to offer faster diagnosis

Featured Image

Dr. Yi-Wei Tang stands in the chemistry lab at The Vanderbilt Clinic where the new Molecular Infectious Diseases lab will be installed. Tang will head the new facility, a collaborative venture among the Department of Pathology, Department of Medicine, and Hospital Administration. Testing is expected to begin by Dec. 1. (photo by Dana Johnson)

New lab to offer faster diagnosis

For the first time in eight years Vanderbilt University Medical Center is launching a new clinical laboratory. The new Molecular Infectious Diseases (ID) Laboratory will offer VUMC clinicians and researchers the ability to diagnose infectious diseases at the molecular level.

The lab, headed by Dr. Yi-Wei Tang, assistant professor of Medicine and Pathology, will be housed within the diagnostic laboratories on the fourth floor of The Vanderbilt Clinic. The new facility, a collaborative venture among the Department of Pathology, Department of Medicine, and Hospital Administration, is expected to begin testing by December 1st.

“This lab was thought about for a long time. We worked in my research lab developing new tests and adapting them to the clinical service that will allow us to perform diagnosis of viruses, bacteria, and fungi of the central nervous system,” said Tang.

Tang received his medical degree from Shanghai Medical University in China and his Ph.D. from Vanderbilt. He then went to the Mayo Clinic to obtain his fellowship in clinical microbiology with an emphasis in molecular diagnosis. Two years ago Tang was recruited back to VUMC with dual appointments in Medicine and Pathology.

“Trying to diagnose these organisms through conventional methods is very difficult. The virus or bacteria are present in very limited numbers in cerebral spinal fluid making the samples very hard to work with,” he said. “Routine culturing methods don’t work very well. Cerebral spinal fluid can also toxic to the organisms.

“A good example of a hard to diagnose organism is tuberculosis. It can take up to six weeks to grow and properly identify TB through conventional testing methods. By that time the patient may have already gotten better or may be dead.”

All tests will be performed by Polymerase Chain Reaction (PCR) using DNA amplification techniques. PCR has the ability to make many copies of a very small piece of DNA.

Currently identifying a virus, bacterium, or fungus can be time-consuming detective work for laboratory personnel. Identifying elusive infections with PCR will greatly speed up the process. It may speed up the diagnosis in many cases and shorten turnaround times for many procedures.

“The new Molecular ID Laboratory will complement the existing Molecular Genetics Laboratory, directed by Cindy Vnencak-Jones, Ph.D., which currently performs a number of molecular disease tests, including HIV viral load testing,” said Martha Miers, executive director of Diagnostic Laboratories in Pathology. “After the Molecular ID Laboratory is established, the Molecular Genetics Laboratory will expand its testing of genetic disorders.”

Bryan Brand, associate hospital director in Hospital Administration, is an enthusiastic supporter of the new lab. “This is the way medicine is heading and we need to be a part of that,” he said. “This type of testing is in its infancy but we believe this will evolve to become the standard. We want to be there early to become a leader. We are very lucky to have a great team in Martha Miers, Dr. David Head, chief of Clinical Laboratories, and Dr. Tang as our onboard expert.”

By being able to determine the genetic makeup of various organisms allows not only for identification, but also offers the ability to determine if the organism is from the same strain.

“From a hospital standpoint this will be very effective in detecting and tracking nosocomial infections. There is no doubt it will lead to reductions in healthcare costs and improve patient therapy,” Brand said. “Soon we hope to be able to offer Dr. Tang’s diagnostic services to healthcare providers throughout the region.”

Dr. David Haas, associate professor of Medicine in Infectious Diseases and director of the AIDS Clinical Trials Center, has the challenge of caring for many of Middle Tennessee’s HIV and AIDS patients. A number of Haas’ patients are currently on multi-drug therapies to manage their disease. Haas says that with the ability to diagnose the different HIV genotype here the Molecular Infectious Diseases Lab will allow him to better tailor the treatment of his patients. HIV positive patients require many tests. By being able to have the laboratory diagnosis performed right here it will also greatly reduce the cost of their care.

“This new lab puts patient care at Vanderbilt on the cutting edge of diagnosis and management of infectious diseases. The state-of-the-art tests provided by Dr. Tang will help doctors and patients throughout Tennessee by allowing them to diagnose infections that could not be diagnosed any other way. This is extremely important since proper therapy generally depends on making the correct diagnosis,” Haas said.

Tang says that another advantage of being able to identify infections such as enterovirus and meningitis so quickly in patients is that they can often be sent home right away, rather than being held in house racking up hospital charges. Vanderbilt transplant patients should also benefit from the new lab due to its ability to quickly diagnose cytomegalovirus, a common source of infections.

“We have estimated that in many of these cases we can speed up test results by three days on average, and save at least 1.5 days of hospitalization,” he said. “We also believe this will cut the cost of medications used to treat the patients. Rather than bombarding the patient with a number of medications to cover all the possibilities, the doctor will be able to target the treatment.”

Questions regarding genetics or molecular infectious diseases testing should be directed to Vnencak-Jones (3-9074) or Tang (3-1289), respectively, in the Diagnostic Laboratories. n