External quality assurance in the era of standardization

Metrology in clinical chemistry aims to ensure the equivalence of measurement results from different in-vitro diagnostic measurement devices (IVD MD) for use in healthcare. The metrological traceability of measurement results to higher-order references is the cornerstone to achieving equivalent results. However, other fundamentals are also needed, including the commutability of reference materials and external quality assessment (EQA) materials for monitoring the equivalence of measurement results at the end-user level. This manuscript summarizes the findings and opinions expressed at the Joint Community for Traceability in Laboratory Medicine (JCTLM) workshop held on December 4-5, 2023. The workshop explored the relationship between EQA/proficiency testing and metrological traceability to higher-order references. EQA monitors the equivalence of measurement results from end-user IVD MDs. The workshop discussed the role and challenges of using EQA to improve and maintain the equivalence of measurement results. It also elucidated current developments in establishing the clinical suitability of laboratory results expressed as analytical performance specifications (APS).

Reliable biological and multi-omics research through biometrology

Metrology is the science of measurement and its applications, whereas biometrology is the science of biological measurement and its applications. Biometrology aims to achieve accuracy and consistency of biological measurements by focusing on the development of metrological traceability, biological reference measurement procedures, and reference materials. Irreproducibility of biological and multi-omics research results from different laboratories, platforms, and analysis methods is hampering the translation of research into clinical uses and can often be attributed to the lack of biologists' attention to the general principles of metrology. In this paper, the progresses of biometrology including metrology on nucleic acid, protein, and cell measurements and its impacts on the improvement of reliability and comparability in biological research are reviewed. Challenges in obtaining more reliable biological and multi-omics measurements due to the lack of primary reference measurement procedures and new standards for biological reference materials faced by biometrology are discussed. In the future, in addition to establishing reliable reference measurement procedures, developing reference materials from single or multiple parameters to multi-omics scale should be emphasized. Thinking in way of biometrology is warranted for facilitating the translation of high-throughput omics research into clinical practices.

Traceable calibration with 177Lu and comparison of activity meters at hospitals in Norway and Sweden

INTRODUCTION

The activity meter is used to determine the activity of delivered radiopharmaceuticals, administered activity to patients and reference activity when gamma-cameras are calibrated prior to imaged-based dosimetry. The aim is to describe a procedure for cross-calibration of activity meters at different clinical sites, and report on 177Lu activity results when using factory-set calibration factors compared to when calibration is performed with traceability to a primary standard.

METHODS

Thirty activity meters placed at seven hospitals in Norway and Sweden from four manufacturers: Capintec, Commecer, NuviaTech and Veenstra were included. A stock solution with 177Lu was prepared at the local sites and measured in each activity meter with factory settings. The solution was shipped to the reference site at Lund University for measurements in a secondary standard activity meter. Deviations between local and reference activity measurements were determined for three geometries: 25-mL vial, 10-mL syringe and 1-mL syringe.

RESULTS

The median of the deviations was 6.4 % for the 25 mL vial, 5.9 % for the 10 mL syringe and 6.8 % for the 1 mL syringe. The median of the deviations for the 25 mL vial, was 1.5 % for activity meters from Capintec, 7.0 % for Comecer, 11.0 % for NuviaTech and 2.4 % for Veenstra. The majority of the deviations were positive and the maximum deviation was 14.5 %.

CONCLUSION

The activity of 177Lu measured in an activity meter with factory-set dial settings may yield deviations up to 14.5%, compared to activities measured with traceability to a primary standard. This would imply an undertreatment of patients.

Food allergen analysis: Considerations for establishing a reference measurement system to implement EU legislation

Inconsistent quantification results obtained from various analytical methods for food allergen testing hamper an accurate quantitative risk assessment and its regulatory implementation. In order to overcome such problems, a concept aiming at ensuring the comparability of quantitative food allergen measurement results is presented here. It is based on an approach called reference measurement system for food allergens, which uses a commonly agreed reference, namely the 'mass fraction of total protein of the allergenic ingredient in food'. The necessary system components are outlined, consisting of a primary reference measurement method, a certified reference material and a reference laboratory. This metrology-based concept can be applied to quantify various food allergens determined with different analytical procedures. The example of 'milk in cookies' is used to demonstrate the approach.

A suggested protocol for value assignment using isotope-dilution-LC-MS/MS in reference measurement procedures - Exemplary application for ciprofloxacin in serum

BACKGROUND

Reference measurement procedures for assigning values to calibration materials play a crucial role in the concept of metrological traceability in laboratory medicine. ISO standard 15,193 specifies the requirements for such measurement procedures, albeit in a very general terms.

MATERIALS AND METHODS

A standard structure of analysis series for value assignment by LC-MS/MS was developed and tested,this structure was complemented by a spreadsheet file for result calculation, metadata evaluation, and finally validation and confirmation of individual analysis runs and individual results, and measurement uncertainty evaluation. This framework was applied to a procedure for the quantification of ciprofloxacin in serum as an example.

RESULTS

The approach of a detailed description of the analytical procedures of isotope dilution LC-MS/MS reference measurement methods together with a highly standardized spreadsheet-based method for data processing was found to be practical and efficient. The described measurement procedure for the quantification of ciprofloxacin in serum was found to be fit for purpose.

CONCLUSION

A standardized, detailed procedure for the application of isotope dilution LC-MS/MS in reference measurement procedures can complement the ISO 15193 standard with respect to this particular analytical technique, which is now widely used in the context of metrological traceability in laboratory medicine.

Vibrio-Sequins - dPCR-traceable DNA standards for quantitative genomics of Vibrio spp

BACKGROUND

Vibrio spp. are a diverse group of ecologically important marine bacteria responsible for several foodborne outbreaks of gastroenteritis around the world. Their detection and characterization are moving away from conventional culture-based methods towards next generation sequencing (NGS)-based approaches. However, genomic methods are relative in nature and suffer from technical biases arising from library preparation and sequencing. Here, we introduce a quantitative NGS-based method that enables the quantitation of Vibrio spp. at the limit of quantification (LOQ) through artificial DNA standards and their absolute quantification via digital PCR (dPCR).

RESULTS

We developed six DNA standards, called Vibrio-Sequins, together with optimized TaqMan assays for their quantification in individually sequenced DNA libraries via dPCR. To enable Vibrio-Sequin quantification, we validated three duplex dPCR methods to quantify the six targets. LOQs were ranging from 20 to 120 cp/µl for the six standards, whereas the limit of detection (LOD) was ~ 10 cp/µl for all six assays. Subsequently, a quantitative genomics approach was applied to quantify Vibrio-DNA in a pooled DNA mixture derived from several Vibrio species in a proof-of-concept study, demonstrating the increased power of our quantitative genomic pipeline through the coupling of NGS and dPCR.

CONCLUSIONS

We significantly advance existing quantitative (meta)genomic methods by ensuring metrological traceability of NGS-based DNA quantification. Our method represents a useful tool for future metagenomic studies aiming at quantifying microbial DNA in an absolute manner. The inclusion of dPCR into sequencing-based methods supports the development of statistical approaches for the estimation of measurement uncertainties (MU) for NGS, which is still in its infancy.

Reliable purity assay of highly hygroscopic trichloroacetic acid for the development of high-purity reference material of NMIJ CRM 4074-a

Trichloroacetic acid is known as one of the harmful disinfection byproducts with chlorine of tap water and is regulated according to legally binding standards in Japanese Drinking Water Quality Standards. We developed a high-purity trichloroacetic acid reference material, NMIJ CRM 4074-a, with certified purity as a traceability source of standard solution supplied under the Japan Calibration Service System (JCSS). As trichloroacetic acid is hygroscopic, water could be the main impurity. Although all impurities in the sample can be possibly detected by the freezing point depression method (FPD), it was unclear for trichloroacetic acid whether water was detected by FPD owing to evaporation of water from the sample during fusion. Therefore, we confirmed that water in trichloroacetic acid was detected as an impurity by FPD. The procedure was validated from an increment of purity by FPD due to reduction of water content and an agreement of purity by FPD with those by neutralization titrimetry (NT) and mass balance approach (MBA), both methods were based on different measurement principles from FPD. The certified value was determined to be (0.999 ± 0.003) kg kg^-1 from the purity assay by FPD and NT, and uncertainties due to the homogeneity and stability of the CRM were included in the expanded uncertainty. The reliability of the certified value was verified by the agreement of purities by FPD, NT, and MBA.

Feasibility of using quantitative 1H-NMR spectroscopy and ultra-microbalances for investigation of a PET microplastic reference material

Here, we report on the feasibility of using quantitative NMR and ultra-microbalances for additional measurements of the mass of poly-ethylene terephthalate (PET) particles in a reference material (RM). The microplastic (MP) PET particles were immobilised in solid NaCl following freeze-drying of a 1-ml NaCl suspension. The particles ranged from 30 to about 200 µm (Feret_min). In a 3-day process, more than 500 such units of PET particles in the NaCl carrier were prepared and later used in a large-scale inter-laboratory comparison. The homogeneity of PET in the salt carrier over these 500 units had previously been evaluated with respect to the mass of PET using an ultra-microbalance. In addition to the original results obtained by weighing, two independent results of quantitative ¹H-NMR have been obtained for further investigation of this reference material together with one additional set of weighing data. The NMR data were used for confirmation of the weighed amount of PET (as weighing is non-specific for PET). Average masses of 0.293 ± 0.04 mg and 0.286 ± 0.03 mg of PET were obtained using two different ultra-microbalances (14% RSD for n = 14 and 9% RSD for n = 4, respectively). The corresponding ¹H-NMR data was 0.300 ± 0.02 mg of PET (6.7% RSD for n = 5) and 0.345 ± 0.04 mg of PET (12.5% RSD for n = 14), respectively. The average mass of PET obtained by ¹H-NMR measurements was in agreement with the weighed amounts within their standard deviations. A mean value of 0.306 mg PET with an expanded uncertainty of 0.058 mg (± 19% relative) was calculated, and it is traceable to the SI system of measurements. Measurement of PET by quantitative ¹H-NMR spectroscopy is also reported for a water sample. The PET contained in one RM sample was transferred to 1 L of water to mimic a drinking water sample for microplastics.

Metrological traceability in process analytical technologies and point-of-need technologies for food safety and quality control: not a straightforward issue

Traditional techniques for food analysis are based on off-line laboratory methods that are expensive and time-consuming and often require qualified personnel. Despite the high standards of accuracy and metrological traceability, these well-established methods do not facilitate real-time process monitoring and timely on-site decision-making as required for food safety and quality control. The future of food testing includes rapid, cost-effective, portable, and simple methods for both qualitative screening and quantification of food contaminants, as well as continuous, real-time measurement in production lines. Process automatization through process analytical technologies (PAT) is an increasing trend in the food industry as a way to achieve improved product quality, safety, and consistency, reduced production cycle times, minimal product waste or reworks, and the possibility for real-time product release. Novel methods of analysis for point-of-need (PON) screening could greatly improve food testing by allowing non-experts, such as consumers, to test in situ food products using portable instruments, smartphones, or even visual naked-eye inspections, or farmers and small producers to monitor products in the field. This requires the attention of the research community and devices manufacturers to ensure reliability of measurement results from PAT strategy and PON tests through the demonstration and critical evaluation of performance characteristics. The fitness for purpose of methods in real-life conditions is a priority that should not be overlooked in order to maintain an effective and harmonized food safety policy.

Use of quantitative 1H and 13C NMR to determine the purity of organic compound reference materials: a case study of standards for nitrofuran metabolites

Comparability of measurement results and their metrological traceability to the International System of Units (SI) are fundamental tools to ensure reliable decisions in the social sphere, commerce, and science. The use of appropriate references in analytical chemistry, such as certified reference materials (CRMs) of high purity substances, is one of the required procedures to obtain traceable measurements. When commercial standards with non-certified purity values are used, traceability must be achieved by determining the purity of the standard using a potential primary reference measurement procedure or other appropriate methods. Quantitative nuclear magnetic resonance (qNMR) is a technique with the potential to be used in primary measurement procedures. This work presents the determination of purity by ¹H qNMR for nitrofuran metabolites 3-amino-2-oxazolidinone (AOZ), 3-amino-5-morpholinomethyl-2-oxazolidinone (AMOZ), and 1-aminohydantoin (AHD). Furthermore, a recent qNMR method developed by our group to improve the quantitative performance of measurements using ¹³C nucleus was used to determine the purity of semicarbazide (SEM) nitrofuran metabolite. Purity values obtained by qNMR for AOZ, AMOZ, and AHD standards were compared to values obtained by the mass balance approach using a suite of analytical methods: Karl Fischer (KF) coulometric titration and thermogravimetry (TG) for the determination of water and residual solvents, gas and liquid chromatography for the determination of impurities structurally related to the metabolites. The results obtained by qNMR and mass balance were consistent.Graphical abstract.

The evolving role of commutability in metrological traceability

Commutability is a property of a reference material (RM) which denotes that the analytical response in measurement procedures (MPs) observed for the measurand is the same for the RM as for clinical samples that contain the same amount of the measurand. Matrix-based secondary calibrators are required to be commutable with clinical samples to achieve metrological traceability of results from a clinical laboratory MP to higher order references. Results for clinical samples may not agree among different end-user MPs if a noncommutable RM is used in the calibration hierarchy for one or more of the MPs. Consequently, a useful RM is one that is commutable with clinical samples for all or most MPs in common use. If a matrix-based RM is noncommutable for one or a few MPs, a correction for the noncommutability bias may be added in the calibration hierarchy to enable the results for clinical samples to be metrologically traceable to the RM. Producing a large batch of matrix-based RM requires pooling single donations and making various modifications of the matrix such as spiking with exogenous substances, freezing or lyophilization. These modifications could potentially affect commutability of the RM and compromise its suitability. Documentation of commutability of matrix-based RMs used as calibrators is required by the International Organization for Standardization and the Joint Committee for Traceability in Laboratory Medicine. We describe how commutability was recognized as a critical requirement for metrological traceability and we present recommendations from the IFCC Working Groups on Commutability and on Commutability in Metrological Traceability.

A reference method for determining the total allergenic protein content in a processed food: the case of milk in cookies as proof of concept

The establishment of a reference method for the determination of the allergen protein content in a processed food material has been explored. An analytical approach was developed to enable the comparability of food allergen measurement results expressed in a decision-relevant manner. A proof of concept is here presented, resulting in quantity values for the common measurand, namely ‘mass of total allergen protein per mass of food’. The quantities are determined with SI traceability to enable the comparability of reported results. A method for the quantification of total milk protein content in an incurred baked food at a concentration level clinically relevant is presented. The strategy on how to obtain the final analytical result is outlined. Challenges associated with this method are discussed, in particular the optimal extraction of the marker proteins, the complete digestion and release of the peptides in an equimolar fashion, the use of conversion factors to translate the amount of measured proteins into total milk protein and the estimation of the uncertainty contributions as well as of the combined uncertainty of the final result. The implementation of such a reference method for the determination of the total allergen content in a processed food is an important step, which will provide comparable measurement data of relevance to risk assessors.

Evaluating digital PCR for the quantification of human nuclear DNA: determining target strandedness

Digital polymerase chain reaction (dPCR) methodology has been asserted to be a "potentially primary" analytical approach for assigning DNA concentration. The essence of dPCR measurements is the independent dispersal of fragments into multiple reaction partitions, amplifying fragments containing a target nucleotide sequence until the signal from all partitions containing at least one such fragment rises above threshold, and then determining the proportion of partitions with an above-threshold signal. Should originally double-stranded DNA (dsDNA) fragments be converted into two single strands (ssDNA) prior to dispersal, the dPCR measurements could be biased high by as much as a factor of two. Realizing dPCR's metrological potential therefore requires analytical methods for determining the proportion of ssDNA in nominally dsDNA samples. To meet this need, we have investigated several approaches to this determination: A₂₆₀ ratio, dPCR ratio, cdPCR staircase, and ddPCR enzyme. In our hands, only the endonuclease-based approach provides adequately accurate estimates for relatively small ssDNA proportions. We present four (enzyme, assay) pairs that provide self-consistent results for human nuclear DNA extracts. However, the proportion of ssDNA differs by as much as 50% between assays, apparently related to the guanine-cytosine (GC) content of the fragment near the assay's target sequence. While materials extracted by us have no more than 6% ssDNA content even after long storage, a commercially obtained PCR assay calibrant contains ≈18% ssDNA. Graphical abstract.

Enhancing the accuracy of measurement of small molecule organic biomarkers

Over two decades, the Organic Analysis Working Group (OAWG) of the Consultative Committee for Amount of Substance: Metrology in Chemistry and Biology (CCQM) has organized a number of comparisons for clinically relevant small molecule organic biomarkers. The aim of the OAWG community is to be part of the coordinated international movement towards accuracy and comparability of clinical measurements that will, in turn, minimize the wastage of repeat testing and unnecessary therapy to create a sustainable healthcare industry. International and regional directives/requirements on metrological traceability of calibrators and control materials are in place. Metrology institutes worldwide maintain infrastructure for the practical realization of metrological traceability and demonstrate the equivalence of their measurement capabilities through participation in key comparisons organized under the auspices of the CCQM. These institutes provide certified reference materials, as well as other dedicated value-assignment services benefiting the in-vitro diagnostic (IVD) industry, reference (calibration) laboratories and the clinical chemistry laboratories. The roles of these services in supporting national, regional, and international activities to ensure the metrological traceability of clinical chemistry measurements are described. Graphical abstract.

The role of the CCQM OAWG in providing SI traceable calibrators for organic chemical measurements

Metrological traceability for organic chemical measurements is a documented unbroken chain of calibrations with stated uncertainties that ideally link the measurement result for a sample to a primary calibrator in appropriate SI units (e.g., mass fraction). A comprehensive chemical purity determination of the organic calibrator is required to ensure a true assessment of this result. We explore the evolution of chemical purity capabilities across metrology institute members of the Consultative Committee for Amount of Substance: Metrology in Chemistry and Biology's Organic Analysis Working Group (OAWG). The OAWG work program has promoted the development of robust measurement capabilities, using indirect "mass balance" determinations via rigorous assessment of impurities and direct determination using quantitative nuclear magnetic resonance spectroscopy methods. A combination of mass balance and qNMR has been shown to provide a best practice approach. Awareness of the importance of the traceability of organic calibrators continues to grow across stakeholder groups, particularly in key areas such as clinical chemistry where activities related to the Joint Committee for Traceability in Laboratory Medicine have raised the profile of traceable calibrators.

Evaluating droplet digital PCR for the quantification of human genomic DNA: converting copies per nanoliter to nanograms nuclear DNA per microliter

The highly multiplexed polymerase chain reaction (PCR) assays used for forensic human identification perform best when used with an accurately determined quantity of input DNA. To help ensure the reliable performance of these assays, we are developing a certified reference material (CRM) for calibrating human genomic DNA working standards. To enable sharing information over time and place, CRMs must provide accurate and stable values that are metrologically traceable to a common reference. We have shown that droplet digital PCR (ddPCR) limiting dilution end-point measurements of the concentration of DNA copies per volume of sample can be traceably linked to the International System of Units (SI). Unlike values assigned using conventional relationships between ultraviolet absorbance and DNA mass concentration, entity-based ddPCR measurements are expected to be stable over time. However, the forensic community expects DNA quantity to be stated in terms of mass concentration rather than entity concentration. The transformation can be accomplished given SI-traceable values and uncertainties for the number of nucleotide bases per human haploid genome equivalent (HHGE) and the average molar mass of a nucleotide monomer in the DNA polymer. This report presents the considerations required to establish the metrological traceability of ddPCR-based mass concentration estimates of human nuclear DNA. Graphical abstract The roots of metrological traceability for human nuclear DNA mass concentration results. Values for the factors in blue must be established experimentally. Values for the factors in red have been established from authoritative source materials. HHGE stands for "haploid human genome equivalent"; there are two HHGE per diploid human genome.

Compact devices for generation of reference trace VOC mixtures: a new concept in assuring quality at chemical and biochemical laboratories

Volatile organic compounds (VOCs) in gas mixtures at trace level (nmol/mol) are routinely measured by chemical and biochemical laboratories as climate indicators, indoor air quality pollutants from building materials emissions, contaminants in food and beverages, and biomarkers in body fluids (blood, urine, breath) of occupational exposure or human diseases. Current analytical instruments used for measurements are gas chromatographs equipped with various injector and detector configurations. The assurance of measurement quality is done by using a huge amount of certified liquid VOC standard solutions (or gaseous VOC standard cylinders) with multiple dilutions to reach the required trace level. This causes high standard uncertainty in instrument calibrations, high cost, and high consumption of analysis and laboratory personal time. In this paper, we present the implementation of portable generators producing VOC gas standards at trace level for automatic and direct calibration of VOC detectors employed in various contexts, removing the need for preparation of matrix calibration standards in cylinders. Two compact devices in-house developed by two national metrology institutes-the Istituto Nazionale di Ricerca Metrologica (INRIM) and the Federal Institute of Metrology (METAS)-are here used to dynamically generate reference gas mixtures in an SI traceable way. The two devices are based on different technologies: diffusion and permeation, for INRIM and METAS, respectively. A metrological characterization is given and the practical implementation at chemical and biochemical laboratories is discussed. Graphical abstract Onsite calibration with transportable generation system with similar performances to primary laboratory devices.

Analysis of Nitrite and Nitrate in Foods: Overview of Chemical, Regulatory and Analytical Aspects

In this chapter, several factors that should be considered for selecting and developing suitable analytical methods for determining nitrite/nitrate are presented. Nitrite and nitrate occurrence and suitability are a controversial issue. Nitrite is an approved additive considered a foremost curing ingredient for the preservation of meat products. Nitrate is a natural constituent of the human diet that, however, raises fears for its suggested potential harmfulness related to carcinogenesis and environmental contamination. Chemical, regulatory, and analytical aspects are discussed in the light of the need to obtain reliable data of nitrite and nitrate for law enforcement purposes, exposure estimates, and investigation of their physiological role in the human body. In addition, current metrological aspects to ensure the "fitness for purpose" of the selected method are suggested and discussed.

A radionuclide calibrator based on Cherenkov counting for activity measurements of high-energy pure β¯-emitters

Due to their stability and reproducibility, re-entrant pressurized ionization chambers (also called radionuclide calibrators) are widely used for activity measurements in nuclear medicine services as well as in national metrology institutes to maintain reference standards. Generally, these secondary instruments yield accurate activity measurements for γ-emitting radionuclides. Ionization chambers are easy to use and thus well-adapted to guarantee the metrological traceability between national metrology institutes and end-users. However, the reproducibility of calibration factors can be significantly impaired when measuring high-energy pure β¯-emitters such as radiopharmaceuticals based on ⁹⁰Y. This is because the bremsstrahlung emission contributing to the instrument response is strongly dependent on the geometry of the components surrounding the radioactive solution. The present article describes a new design based on pulse counting to address this problem. It takes advantage of Cherenkov emission resulting from Compton scattering in transparent materials. The interest of Cherenkov counting is to obtain a low-sensitivity detector that enables direct measurements of high-activity solutions (at least up to 10 GBq for ⁹⁰Y-microspheres in aqueous suspensions used in nuclear medicine). A simple design based on a geometry close to an ionization chamber used at LNHB (Vinten 671 type) is described. The feasibility in terms of detection efficiencies (lower than 10^-4 for ⁹⁰Y solutions) of the new radionuclide calibrator is investigated by Monte Carlo calculations using the Geant4 code.

Metrological traceability in mass spectrometry-based targeted protein quantitation: a proof-of-principle study for serum apolipoproteins A-I and B100

In this study, we have followed up on previous liquid chromatography (LC) multiple reaction monitoring (MRM) mass spectrometry (MS) approaches for measurement of apolipoprotein (apo) A-I and apo B100 in serum aiming for implementation of a multiplexed assay in a clinical chemistry laboratory with full metrological traceability. Signature peptides were selected and detected by dynamic MRM, and stable isotope labeled (SIL)-peptides were used as internal standards. Five apo A-I and four apo B100 peptides were measured in serum digests with linearity (R(2)>0.992) in the physiologically relevant concentration ranges. Linearity with regard to protein concentration was ascertained at five concentration levels (R(2)>0.926 and R(2)>0.965, for the apo A-I and apo B100 peptides, respectively). Three native value-assigned sera were used as external calibrators for further method verification. Imprecision values on sample preparation and LC-MS/MS acquisition were below the established minimal specifications for apo A-I and apo B100 (5.0% and 5.3%, respectively). Correlation of LC-MS/MS results with immunoturbidimetric assay results, for normo- and hypertriglyceridemic samples, showed R(2)>0.944 for apo A-I and R(2)>0.964 for apo B100. This LC-MS/MS method has potential for clinical application in normo- and dyslipidemic patients.

BIOLOGICAL SIGNIFICANCE

Measurement of apo A-I and apo B100 may offer an alternative to high and low density lipoprotein cholesterol (HDL-c and LDL-c) methods for cardiovascular disease risk assessment in dyslipidemic patients [1]. An LC-MS/MS method for apo A-I and apo B100 has the advantage of antibody independent and specific detection of protein signature peptides. The introduction of an LC-MS/MS method for apo A-I and apo B100 can serve as an example for many existing and newly developed (multiplex) biomarker methods in quantitative clinical chemistry proteomics (qCCP). Such LC-MS/MS methods should meet basic clinical chemistry principles with regard to test evaluation [2]. Criteria for imprecision should be pre-defined, e.g., based on biological variation. The use of commutable and traceable serum-based calibrators will improve inter-laboratory reproducibility of LC-MS/MS methods and may contribute to a more rapid transition of biomarker discovery to clinical utility with benefit for the patient treatment and improvement of general health care.