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Implementation of Molecular Phenotyping Approaches in the Personalized Surgical Patient Journey

Mirnezami, Reza MRCS*; Kinross, James M. PhD*; Vorkas, Panagiotis A. MSc; Goldin, Robert MD, FRCPath; Holmes, Elaine PhD; Nicholson, Jeremy PhD, FRCPath, FMedSci; Darzi, Ara MD, FRCS, FRCP, FMedSci*

doi: 10.1097/SLA.0b013e31823e3c43

Objective: The present review describes commonly employed metabolic profiling platforms and discusses the current and likely future application of these technologies in surgery.

Background: The metabolic adaptations that occur in response to surgical illness and trauma are incompletely understood. Evaluating these will be critical to the development of personalized surgical health solutions. Metabonomics is an advancing field in systems biology, which provides a means of interrogating these metabolic shifts.

Methods: Recent literature regarding metabolic profiling technologies and their applications in surgical practice are discussed. Future strategies are proposed for the incorporation of these and next-generation technologies in the evaluation of all steps in the patient surgical pathway.

Results: Metabolite-based profiling has provided valuable insights into the metabolic irregularities that occur in cancer development and progression across a variety of cancer subclasses including colorectal, breast, prostate, and lung cancers. In addition, metabolic modeling has shown considerable promise in other surgical conditions including trauma and sepsis and in the assessment of pharmacotherapeutic efficacy.

Discussion: Metabonomics offers a posttranscriptional view of system activity providing functional information downstream of the genome and proteome. Information at this level will provide the surgeon with a novel means of evaluating major socioeconomic problems such as cancer and sepsis. In addition, the rapid nature of emerging next generation profiling platforms provides a viable means of “real-time” perioperative metabolic assessment and optimization.

Metabonomics is a rapidly advancing field in systems biology, which can provide valuable insights into the biomolecular adaptations that occur in response to surgical illness, trauma, and surgical intervention. The present review discusses available technologies, recent developments, and likely future applications of this emerging science in surgical practice.

*Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, QEQM, St Mary's Hospital, London, United Kingdom;

Section of Biomolecular Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, The Sir Alexander Fleming Building, South Kensington, London, United Kingdom; and

Department of Histopathology, Imperial College Faculty of Medicine, St Mary's Hospital, London, United Kingdom.

Reprints: Jeremy Nicholson, PhD, FRCPath, FMedSci, Imperial College London, Department of Surgery and Cancer, Room 665, 6th Floor, Sir Alexander Fleming Building, South Kensington Campus, SW7 2AZ. E-mail:

The authors would like to acknowledge the NIHR Biomedical Research Centre for funding currently active and previous surgical metabonomic projects at Imperial College London.

Disclosure: The authors declare that they have nothing to disclose.

J.N. and A.D. contributed equally to the manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.