Respirometry of Permeabilized Muscle Fibres: Towards Quality Assurance in the Diagnosis of Mitochondrial Function
Towards Quality Assurance
Quality Assurance (QA) is such a broad term (see Note 1), even when the focus is restricted to the model of permeabilized muscle fibres. There are several milestones in the quest towards QA, including continuous quality control and incorporating ‘Best Practice’ in the laboratory. We are well aware of the fact that in practice we may aim at better standards, but will hardly ever establish any final best (see Note 2). QA in general may set impractically high demands on a laboratory, hence the required level of QA depends on the specific application. QA will be different in (i) an experimental study on mt-respiratory function of mouse skeletal muscle, (ii) a comparison of aged humans versus young controls using biopsies, or (iii) the diagnosis of a mt-myopathy in a single patient when an individual is evaluated (she/he really cares) versus a (matched – science has to care) control group.
Against this background, we can reach several unambiguous conclusions:
1. Some level of QA is required in all studies on mt-respiratory function – from basic science to clinical applications.
2. Sharing the practical expertise of different research groups in this rapidly expanding field provides an effective and economical approach towards higher standards of science by implementing QA.
3. Multiple benefits will result from the development and application of appropriate standards of QA - for the individual patient (very few laboratories are involved), the individual scientist (all of us, all of our collaborators), the laboratory, mt-respiratory physiology in terms of scientific reputation (including some companies with positive or negative impacts), the particular segment of our health care system.
The benefits and implications are potentially enormous, considering the impact of mitochondrial medicine on the quality of life: life style related to exercise and nutrition, obesity, degenerative diseases, metabolic syndrome, muscular and cognitive dysfunction, rare mt-diseases, healthy aging, cardiovascular diseases, reducing the risks for a range of cancers, immunological fitness, competitive and noncompetitive sports, hypoxia, ischemia-reperfusion, etc.
It is far more exciting to discuss these challenging topics than to talk about quality control of the chemicals used as inhibitors or in mitochondrial respiration media, tissue wet weight or dry weight measurements, or about valid estimates of the proton leak in a respirometric protocol. A focus on QA, however, helps to eliminate unreliable data which are a source of confusion, lead to unnecessary controversies, or even overshadow the potential of accurate diagnosis of a disease. Explicit implementation of QA will provide a basis of increased recognition and reputation of our field of research, and may be considered as an expression of corporate social responsibility within the mitochondrial physiology network.
1. Quality Assurance (Wikipedia, Oct 2009): Quality assurance, or QA for short, refers to planned and systematic production processes that provide confidence in a product's suitability for its intended purpose. It is a set of activities intended to ensure that products (goods and/or services) satisfy customer requirements in a systematic, reliable fashion. Unfortunately, QA cannot provide and absolute guarantee of the production of quality products but makes this more likely.
Two key principles characterize QA: "fit for purpose" (the product should be suitable for the intended purpose) and "right first time" (mistakes should be eliminated). QA includes regulation of the quality of raw materials, assemblies, products and components; services related to production; and management, production and inspection processes.
2. From Best to Better Practice (Wikipedia, Oct 2009): A ‘Best practice’ is a technique, method, process, activity, incentive or reward that is believed to be more effective at delivering a particular outcome than any other technique, method, process, etc. The idea is that with proper processes, checks, and testing, a desired outcome can be delivered with fewer problems and unforeseen complications. Best practices can also be defined as the most efficient (least amount of effort) and effective (best results) way of accomplishing a task, based on repeatable procedures that have proven themselves over time for large numbers of people.
The term “best practices” has implications of finality, obedience, authority, and universality. The term ‘best practices’ implies that some source has the final answer to a matter in dispute or disarray. The matter is closed, decided, set and resolved. The term "better practices" seems to seek better ways, which may even lead to tweaking the suggested practice to make it even better. It suggests that all of us together can come up with something better than any one of us can arrive at individually, and places authority in the community. The term may imply that the better practice is not universal, but depends on the specific situation.