Everything you think, say or do is the result of a chemical reaction. Elucidating the basis of these chemical reactions is fundamental to understanding physiologic (health and well-being) and pathophysiologic (disease) conditions. The field of Clinical Chemistry explores the biochemistry of these relationships to facilitate a healthy life-style as well as identify disease states, monitor therapy and better predict survival. To achieve these goals, we test.

Understandably, chemical relationships are clinically complex, requiring continuous improvement in test development, test methods and test systems. Identification of novel biochemical markers that specifically reflect disease state is critically important. Once identified, unique chemical methods and sophisticated test instruments may be required for their measurement. These diagnostic tools provide the framework for medical care. As such, they must be highly reliable, accessible and affordable to be of general use for the public at large.

As our population ages, chronic diseases such as diabetes, cardiovascular disorders, obesity and cancer become more prevalent and consume a disproportionate share of the healthcare dollars annually spent worldwide. Fortunately, these diseases become more preventable and treatable as medicine evolves through better understanding these complex biochemical relationships. Research into clinical chemistry address these health concerns along the spectrum of prevention (diet and nutrients), early diagnosis (genomics, proteomics and mass spectrometry) and treatment (circulating tumor cells and cell-free DNA).

Diet and nutrition are essential elements in disease prevention. Recent research suggests the importance of of folic acid and vitamin B12 in cancer, green tea polyphenols in cancer prevention and treatment as well as hypertension, lipid metabolism in atheroprotection, Vitamin D in its expanding role in many disorders, the evolving role of testosterone in health and well-being, iron in liver disease and homocysteine in pregnancy.

Early diagnosis is critical to disease treatment and management. Identification of new and novel biomarkers is a major focus with.. .  research identifying new tumor markers for a variety of malignancies including breast, colorectal, prostate and lung cancer, new markers in heart disease (troponins, BNP, heat shock proteins), allergy and asthma, Alzheimer’s disease, autoimmune disease, etc, New technologies are often required to support the identification and testing of new disease markers include tandem mass spectrometry, microarray technology and next generation sequencing.

Effective monitoring of the clinically ill is critically important to rapidly assess patient progress and provide feedback as to therapeutic strategy. Articles on this topic include staging of tumor burden in colorectal cancer, use of mass spectrometry in treatment of thyroid disease, measurement and characterization of circulating tumor cells in breast cancer, identification of unique bone markers in osteoporosis. With the advent of sophisticated genetic testing systems (next generation sequencing) it is now possible to identify specific mutations in cancer patients for which there are targeted therapies.

The field of clinical chemistry also addresses environmental issues of relevance to the public at large. These include asbestos-related disease, risk of infection, challenges of envenomation in third world countries and exposure to carcinogens including polycyclic aromatic hydrocarbons widely used in industrial settings.

Gregory Makowski is the editor of the Advances in Clinical Chemistry series. The ‘Advances in Clinical Chemistry’ series provides a comprehensive framework for assessing the human condition chemically, highlighting the research and technologies described above. It addition to providing a historical perspective, it explores new technology and is at the forefront for development of new disease markers. Although the series is scientific in nature and targets clinical laboratory and basic scientists, its wide range of health-related topics would be interest to many in the community. All topics have extensive bibliographies for additional research and exploration for those interested.

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About the Editor

Dr Gregory S Makowski is a board certified clinical chemist and fellow of the National Academy of Clinical Biochemistry. Following receipt of his PhD in Biochemistry from the University of Connecticut Storrs, he pursued post-doctoral studies at the University of Connecticut School of Medicine in Farmington that culminated in his joint appointments in the School of Medicine and the Department of Laboratory Medicine at John Dempsey Hospital. He has numerous clinical and basic science publications and serves on various scientific and editorial boards. He is actively engaged in the training of Pathology residents and fellows in the Department of Pathology and Laboratory Medicine at Hartford Hospital. He currently serves as Vice President and Chief Scientific Officer for Clinical Laboratory Partners in Newington CT, USA.