On Friday, March 31, 2023, Dörte Hamann, professor of Integral Immunological Diagnostics at UMC Utrecht held her inaugural lecture, titled “Strong together - the power of medical immunology within laboratory medicine”. In her lecture, Dörte elaborated on the collaboration between and integration of immunological research, medical-immunological diagnostics and clinical immunology. In addition, she focused on the increasing use of predictive biomarkers to select the best medicine for an individual patient with a chronic inflammatory disease. She concluded by calling on all medical diagnostic specialties to join forces. 

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The role of immunology in health care is growing. Thanks to basic and applied immunological research, there is increasing understanding of what goes wrong in patients. Dörte Hamann expands on the importance of immunology: “We apply the knowledge and use the immune system itself to treat and cure diseases, with basic immunological research on the one hand and immunology in the clinic on the other hand. Medical immunology is the link between the two. It is a clinically supportive laboratory specialty and thus forms a bridge between fundamental knowledge of immunology, scientific research and the application of immunological knowledge in the treatment of patients. Medical immunology provides clinicians with support in diagnosis and treatment of patients with diseases involving the immune system, as well as patients in which immune-modulating therapy is used, such as in immunotherapy for cancer and in stem cell and organ transplants. This triangle of immunological research, medical-immunological diagnostics and clinical immunology is at UMC Utrecht strongly embedded in the Center for Translational immunology (CTI). This close collaboration has already resulted in the introduction of several novel biomarkers in daily practice.” 

Trial-and-error 

One of the theme’s within strategic program Infection & Immunity and the CTI is chronic inflammation which affects approximately 7 percent of the population in Europe. Chronic inflammation occurs when the immune system remains activated despite the disappearance of a previously present trigger or in case this trigger is a structure or molecule in the body of the patient such as with auto-immune diseases. It is important that chronic inflammation is treated quickly and adequately since it may result in irreversible damage to the inflamed tissues. Over the years, many drugs have reached the market aiming at rapid and sustained suppression of the inflammation. However, in some patients it is difficult to find the right drug for their disease. Dorte said: “One clear example is the treatment of rheumatoid arthritis (RA). In about 70 percent of patients we can suppress the symptoms adequately with anti-TNFα therapy. For the remaining 30 percent, however, we are forced to use a trial-and-error strategy until we find the right drug. Consequently, personalized medicine is still quite remote for this difficult-to-treat patient group. 

Biomarker research 

Recent research at the CTI has shown that chronic inflammatory disease is often characterized by over-activation of certain immune pathways which can be diagnosed with the help of biomarkers. Most of these pathways are related to various different immune diseases. The result can be that a particular overactivated pathway in one patient may lead to RA, whereas in another patient the same disturbance expresses itself as psoriasis. Dörte: “In addition to investigating the clinical expression of chronic inflammation, at UMC Utrecht we also want to unravel on an individual basis which immune pathway is affected using diagnostic biomarkers. Based on that information we are better able to select the drug - or combination of drugs - with the highest probability of success in that particular patient in terms of both efficacy and side effects.”  

Integration of laboratory specialisms 

In addition to the substantive challenges of the field, medical diagnostic specialists have to join forces to be able to cope with the increasing demands on patient diagnostics due to aging of the population and of rising health care costs. Dörte: “The ideal of one integrated laboratory diagnostics is a long way off. Working together, let alone integrating processes across specialism, whether within the walls of a healthcare institution or nationally, is a very sensitive topic. We all know that we have to make choices, including laboratory diagnostics, to keep healthcare affordable and to make room for the right care. It is now time to move forward and join forces.”