Metabolomics in the clinic: A review of the shared and unique features of untargeted metabolomics for clinical research and clinical testing

For over a decade, metabolomics has been promising to transform the practice of medicine by delivering powerful diagnostic tests. The reality, however, is that the march towards precision medicine has been slower than first anticipated because of the substantial challenges associated with the development, validation and adoption of complex multivariate testing strategies within a highly regulated environment. In this issue, Kennedy and colleagues present their vision for the future of untargeted metabolomics in clinical testing. They highlight the complexities of test design, accurate and precise data acquisition, quality control, data processing and biochemical pathway analysis when hundreds to thousands of unique metabolites are measured in a single clinical sample. The authors outline the current state of (mass spectrometry-based) metabolomics and illustrate the both the potential, and the challenges, of this rapidly evolving landscape.