An inside look at the state-of-the-art supports enabling invention
Eye on Innovation
Eye on Innovation features exciting advances taking place at Mayo Clinic Laboratories. This monthly series shines a spotlight on recently developed tests and highlights how Mayo Clinic translates ideas and discoveries into testing resources that improve diagnosis and care for patients across the globe.
Throughout Mayo Clinic, innovation is the thread that weaves through countless initiatives aimed at improving patient care. While Mayo’s most cutting-edge discoveries are often widely known, the vast majority of innovative endeavors occur behind the scenes.
One of the more low-profile assets in Mayo Clinic Laboratories’ innovation arsenal is the media kitchen, where specialized media and reagents used in some of the laboratories’ most esoteric assays come to life.
“Nationally, there aren’t many media labs,” says Jonathon Berry, media lab supervisor. “A lot of academic centers and hospitals do creative things, but very few have a reference laboratory that has the capacity for a media kitchen.”
The media kitchen, or media laboratory, supports testing in three of the clinical microbiology laboratories’ culture-based labs — bacteriology, virology, and mycology — as well as testing for Mayo Clinic’s internal practice.
"THE MEDIA LAB TEAM PREPARES REAGENTS AND MEDIA THAT ARE COMMERCIALLY UNAVAILABLE, ALLOWING CLINICIANS ACCESS TO A BROADER TESTING MENU THAT ASSISTS IN THE CORRECT DIAGNOSIS.”Jonathan Berry, media lab supervisor
Like any kitchen, the media kitchen houses the appliances necessary for storing ingredients, prepping mixtures, and cooking recipes. There is a cooktop stove with a large, canopy vent; a refrigerator for storing ingredients like egg yolk enrichment and tomato juice; a walk-in cooler and stand up freezers to preserve frozen ingredients; and a large pantry for storing nearly 180 different chemicals. There are pots and pans, silverware, spatulas, and a large steam kettle — nicknamed the witch’s cauldron.
The most important resource in the unit, however, isn’t fancy equipment or racks of chemicals, but the employees who work there, Berry says.
“Our team is highly specialized and highly trained. It’s not like just anybody could walk in and make a recipe,” Berry says. “These folks are the chefs and have their own way of doing it that makes it work.”
The majority of the 132 mediums prepared in-house are not available commercially. This includes several that were developed exclusively at Mayo Clinic, and the media lab’s collaboration is integral to the validation process.
For instance, when the bacteriology laboratory recently developed a broad-range 16s rRNA bacterial detection assay, the development technicians who devised the test created a recipe for the necessary test reagent. This recipe, as well as the testing methodology, was published as standard operating procedure for the test. From there, media kitchen technicians were drawn in to validate the recipe. Once validated, the media kitchen assumed the task of manufacturing the reagent for future test orders.
In the same way that Mayo Clinic’s proprietary reagents are validated, so too are reagents developed outside of Mayo Clinic Laboratories.
“The majority of our recipes are found in textbooks,” Berry says. “These are things that can be extremely difficult to make and manufacture, especially on a large scale. Some are expensive to make and are not economically feasible for some vendors.”
Depending on the day, the media kitchen staff might be fulfilling a few large orders or several small orders, but it is always a hive of tightly regulated activity imbued with olfactory experiences.
THE LAB COULD SMELL LIKE ROSES, WHICH IS THE SCENT GIVEN OFF BY PHENYLETHYL ALCOHOL AGAR, OR SMELL NOXIOUS, WHICH HAPPENS WHEN THE STAFF WORKS WITH BRUCELLA AGAR.
At the same time, preserving the integrity of its products is foremost in the minds of the media lab staff.
“If we have a batch of something and it’s for 300 tests, and the pH doesn’t come out right when you test it, maybe you check it again. And if it still doesn’t come out, you have to throw that batch away,” says clinical lab technician John Strande. ”If one’s not coming out, they’re all not coming out. Each plate is a patient, and it comes down to patient care.”
The team’s dedication to meeting patients’ needs was on full display during the early days of the pandemic when, as happened in other laboratories at Mayo, COVID-19 testing volumes skyrocketed.
“Overnight there were issues with product availability, specifically around media,” says Berry, explaining the media shortages related to a range of bacterial, mycology, and viral testing. “This team had to assist in validating a lot of commercially available media that we began to make and validate here because of the concern that it would no longer be available commercially. Overnight we had to be able to pivot to develop and manufacture these products and keep up with the demand.”
The media kitchen isn’t the only unit within Mayo Clinic that has risen to the challenge when asked for help by Mayo Clinic Laboratories. The Division of Engineering, located in the Plummer Building, is often asked to develop tools and instrumentation that cannot be purchased but are necessary for test optimization.
“One of the things we recognize is that Mayo Clinic is always trying to come up with the best and the newest, and not constrain themselves by the equipment,” says John Angeli, unit head of Mayo Clinic’s biomechanical shop. “The work we do is really taking ideas and turning them into a physical entity.”
The nine mechanical engineering technicians who work in the Division of Engineering bring a cumulative 200 years of experience innovating devices or upgrades to existing machinery, Angeli says. Systems Engineering also employs a glassblower who often fulfills laboratory requests for customized test tubes and other specialty glassware.
Among the many supports given to Mayo Clinic Laboratories by Systems Engineering was help ramping up testing capacity during coronavirus surges by creating large-scale storage and transportation solutions. Among the labs impacted by the testing surge was the Clinical Microbiology Laboratory’s Hepatitis and HIV Molecular lab.
“Some of the labs went from 5,000 to 20,000 tests. We worked with them to make all of the trays for carrying the samples, and we built special containment boxes for the samples because there was a lot of concern about re-aerosolization of COVID-positive samples for the lab workers.”
Recently, a request came to Angeli’s team for new parts for a device developed several years ago. At the time, the Mayo Clinic Laboratories’ liquid handling unit asked for a device to help prepare stool specimens, which were collected at home and sent in, for a variety of testing, among them colon cancer screening.
“When they got the samples, they have to blend it to get it to a consistency that can be used in the test machines,” Angeli says. “They wanted a blender that was better than something you could go out and buy at Target, and they wanted special lids so it didn’t splash out when they were mixing. They came in asking for help setting up this equipment to make it more user-friendly.
“The overall early colon cancer testing system is innovative in its own right — it’s changing the way we can diagnose and help patients — and the Mayo labs are still working on improving it.”
Angeli’s team, as well as Berry’s, are propelled to work behind the scenes on collaborations that result in innovative improvements to patient care.
“WE’RE DEFINITELY IN THE BACKGROUND AND, IN ALL HONESTY, WE ARE TOTALLY FINE WITH THAT,” ANGELI SAYS.
“If we are making something for the labs, the physicians, or surgical technicians, just knowing that it’s part of the big picture of Mayo Clinic and all of that is going to help patients, it’s all positive. That is the number one driving factor and where the staff and employees get their fulfillment — knowing what we’re working on is helping someone.”
Tying together the expertise and curiosity of Mayo Clinic autoimmune neurology researchers with eager patients who have rare disease and are looking for answers, the innovative collaboration benefits both patients affected by MOGAD and scientists on the front lines of discovery.
VEXAS syndrome is a severe autoinflammatory disease that results in a spectrum of rheumatologic and hematologic conditions. The underlying cause of newly identified VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome — somatic mutations in the UBA1 gene of blood cells — was discovered at the National Institutes of Health (NIH) in 2020. Within six months, Mayo Clinic Laboratories was able to add a UBA1 test to the MayoComplete panel, as the team simultaneously worked on a single gene assay to allow doctors to test specifically for UBA1 mutations to screen patients for VEXAS syndrome. The team opted for a droplet digital PCR test — a novel and highly accurate approach to testing for UBA1 gene mutations.
Since March 2019, Paul Jannetto, Ph.D., director of the Metals Laboratory at Mayo Clinic, along with his colleagues across the enterprise and his laboratory staff, have developed, validated, and implemented an artificial intelligence (AI)-augmented test with algorithms designed to interpret kidney stone FTIR spectra. With more than 90,000 kidney stones analyzed each year at Mayo Clinic, this new AI-assisted test has streamlined lab processes and improved patient care.