As diagnostic testing becomes more targeted and automated, new technologies are helping laboratories improve efficiency while delivering more actionable information to clinicians. At ADLM 2026, Thermo Fisher Scientific showcased advances including the Phadia 250 and EliA CTD 13 Screen for connective tissue disease testing and the EXENT Solution for multiple myeloma. In this Q&A with MLO’s editor in chief, Christina Wichmann, Thermo Fisher experts discuss how these innovations can streamline workflows, reduce unnecessary testing and blood draws, and expand the role of biomarkers in more precise diagnosis.

The EliA CTD 13 Screen brings together 13 clinically relevant autoantibody targets in a single assay on the Phadia 250. How does this expand the laboratory's approach to connective tissue disease testing, and how can it support more informed follow-up testing?

Response by Veena Joy: Traditionally, connective tissue disease testing has followed a stepwise approach, beginning with an antinuclear antibody (ANA) screening test and then reflexing to individual autoantibody tests to help narrow the differential diagnosis and support the diagnosis of specific connective tissue diseases.

Thermo Fisher’s EliA CTD 13 Screen represents an evolution of that approach. It evaluates 13 clinically relevant autoantibody targets associated with the most common connective tissue diseases in a single automated assay. Positive screen results can be automatically reflexed to individual autoantibody assays, providing clinicians with more clinically meaningful information from the initial laboratory evaluation.

From a laboratory perspective, this streamlines workflow by consolidating multiple testing steps into a single automated screening assay. Automatic reflex to individual discrete-well autoantibody assays further improves efficiency while minimizing additional hands-on time.

Importantly, this is not about replacing every existing testing algorithm. ANA by indirect immunofluorescence assay (IFA) remains an important tool, particularly in rheumatology and more complex clinical cases. Instead, the EliA CTD 13 Screen expands the laboratory's options by offering a comprehensive, disease-oriented screening strategy that is particularly valuable in primary care and other front-line settings.

Ultimately, the goal is to provide laboratories with greater flexibility by delivering earlier, more clinically meaningful insight through efficient, automated workflows tailored to different patient populations and clinical settings.

One of the potential advantages of more targeted testing is reducing unnecessary testing a patient may need. Can you explain how the new CTD testing pathway could affect the patient experience while also improving laboratory efficiency?

Response by Veena Joy: Patients with connective tissue diseases often present with symptoms that overlap across multiple autoimmune and non-autoimmune conditions, making it difficult to determine which disease-specific tests should be ordered initially. As a result, the diagnostic process can involve multiple rounds of laboratory testing and consultations with multiple healthcare providers before a clearer clinical picture emerges.

By evaluating 13 clinically relevant autoantibodies in a single assay, the EliA CTD 13 Screen provides a targeted, yet clinically comprehensive assessment earlier in the diagnostic pathway. Physicians are able to evaluate the most prevalent connective tissue disease-associated autoantibodies simultaneously, helping them determine which diagnoses may warrant additional clinical investigation and more focused follow-up testing.

For laboratories, there are important workflow advantages as well. Incorporating a well-balanced front-line connective tissue disease screening strategy, particularly in primary care populations, has the potential to reduce the need for multiple individual reflex tests, improving operational efficiency while reducing both testing complexity and associated costs.

From the patient perspective, the greatest potential benefit is a more efficient diagnostic journey. While laboratory testing is only one component of diagnosis, having more clinically relevant information available earlier may help clinicians make more informed decisions about the next steps in evaluation, referral, and management, ultimately helping patients reach the right specialist and the appropriate diagnosis sooner.

Connective tissue diseases can present with overlapping and nonspecific symptoms, making diagnosis challenging. What do the new biomarkers included in the EliA CTD 13 Screen add to the laboratory's ability to differentiate diseases such as lupus, Sjögren's syndrome, systemic sclerosis, polymyositis, dermatomyositis, and mixed connective tissue disease?

Response by Veena Joy: Autoimmune diagnostics continues to evolve as our understanding of connective tissue diseases advances. One of the consistent messages we've heard from laboratories and clinicians is the need for screening approaches that not only detect autoimmunity but also provide information that is more directly relevant to the diseases they are trying to differentiate.

ANA by IFA remains an important part of the diagnostic landscape because of its excellent sensitivity. However, particularly in front-line care where connective tissue diseases are relatively uncommon, that high sensitivity can identify individuals without clinically significant autoimmune disease, leading to additional testing and unnecessary referrals.

To address these challenges, the EliA CTD 13 Screen combines 13 clinically relevant connective tissue disease markers into a single automated assay, providing a front-line screening strategy designed to deliver a thoughtful balance between sensitivity and specificity. Positive screen results can be automatically reflexed to individual autoantibody assays, providing more disease-oriented information from the initial laboratory evaluation.

The EliA CTD 13 Screen expands laboratories' options by combining clinically meaningful insight with the automation and workflow efficiency of the Phadia platform, helping laboratories deliver earlier, more informed clinical insight while supporting the evolving needs of clinicians and patients.

With the EXENT System, Thermo Fisher is applying automated mass spectrometry to multiple myeloma testing. What does the increased sensitivity and specific identification of disease markers mean in practical terms for laboratories and clinicians, particularly when compared with more traditional testing approaches? 

Response by Jill Pauli: In addition to the ability to detect and isotype IgA, IgG and IgM monoclonal protein, EXENT System offers the ability to uniquely identify a patient’s monoclonal protein by its mass to charge ratio and detect possible glycosylation by identifying mass-shifted light chains. This additional information functions like a fingerprint, serving as a unique identifier of a patient's disease. Conventional electrophoretic methods aren’t able to offer this type of clarity, and because of that conventional methods can struggle with distinguishing a patient’s monoclonal protein from other serum proteins or even exogenous therapeutics.

What this means for the laboratory is that instead of trying to read and interpret unclear bands on a gel, a laboratorian is able to report out clearly defined monoclonal proteins that have been automatically identified by the software. This greatly simplifies interpretation.  For the patient, this clarity means more consistent, less ambiguous results.

Automation is a major theme across both the Phadia and EXENT platforms. Beyond reducing hands-on time, where do you see the greatest opportunities for automation to improve laboratory quality, consistency, turnaround time, and the ability to handle increasing testing volumes?

Response by Veena Joy: Automation has the potential to transform far more than laboratory efficiency. As testing volumes continue to grow and laboratory resources become increasingly constrained, automation can help laboratories deliver more standardized, consistent, and reliable results while reducing variability and manual intervention.

The Phadia platform combines fully automated processing with high-quality, clinically relevant assays, helping laboratories improve consistency and turnaround time while minimizing hands-on time. With the EliA CTD 13 Screen, automation also extends to the testing workflow through automatic reflex to individual autoantibody assays, providing clinicians with more detailed diagnostic information without adding additional manual steps for laboratory staff.

The EliA portfolio's discrete-well design further supports analytical performance by allowing each autoantibody assay to be individually optimized rather than requiring all markers to perform under the same assay conditions. Together, these capabilities enable laboratories to scale testing, maintain high-quality performance, and deliver timely results that support patient care.

Response by Jill Pauli: One of the greatest opportunities for automation is making advanced technologies accessible to more clinical laboratories while improving consistency and standardization. The EXENT System simplifies the MALDI-ToF MS workflow, allowing laboratories to leverage mass spectrometry without requiring specialized expertise.

Another important advantage is the automated peak-picking and interpretation software, which helps standardize result interpretation, reduces operator-dependent subjectivity, and minimizes the need for highly specialized personnel. As laboratories face increasing testing demands, this type of automation can improve consistency, streamline workflows, and make advanced diagnostic technologies more practical for routine clinical use.