Green Lab Insights: multimodal experimental model, testing appropriateness and sustainability awareness

My doctoral research addresses two pressing priorities in clinical laboratory medicine: the innovation of diagnostic strategies and the integration of environmental sustainability into laboratory practice. The first axis of this research focused on the development and validation of non-invasive tools for the detection of autoantibodies in autoimmune diseases. Traditional serological diagnostics often rely on blood sampling, which, while effective, can be invasive, costly, and logistically challenging. Saliva based testing presents a promising alternative. Through a systematic review of 18 selected studies, the correlation between salivary and serum levels of various autoantibodies was assessed. Building on this evidence, a clinical investigation involving 48 patients was conducted using a novel particle-based multi-analyte technology (PMAT), which confirmed high concordance between salivary and serum samples (Spearman’s rho = 0.725; AUC = 0.97).Parallel to the diagnostic innovations, this doctoral work explored a second, equally critical dimension: environmental sustainability in laboratory medicine. Clinical laboratories contribute significantly to healthcare’s environmental footprint, yet awareness and implementation of green practices remain limited. A Delphi survey was conducted across three hospitals in Turin involving 60 laboratory staff members. Results revealed substantial knowledge gaps but a clear willingness among personnel to engage in ecofriendly practices, indicating fertile ground for change. In addition to perception-based research, a gate-to-grave LCA was applied to quantify the environmental footprint of a routine diagnostic procedure: ANA testing.Analysis of 60 tests at a major referral center in Turin revealed a total carbon footprint of 52.71 kgCO₂eq (approximately 0.88 kgCO₂eq per patient). In collaboration with the University of Florence, we assessed the utility of reflex testing for anti-β2GPI-D1 antibodies in the context of APS. Reflex testing, applied selectively to β2GPI-positive patients, improved diagnostic yield detecting D1 positivity in 28.6% of patients in the development cohort and 36.3% in the validation group, while also reducing unnecessary testing. Broader reflections on diagnostic appropriateness were further explored through a series of projects focused on APS. These investigations shed light on underdiagnosed conditions such as SN-APS and the diagnostic implications of single aPL positivity. By combining expert consensus with empirical data, the research emphasized the necessity of integrating clinical judgment with laboratory results, particularly in ambiguous cases. An analysis of over 600 patients revealed widespread inappropriate aPL testing, especially among non-specialist physicians. These findings highlight the importance of educational initiatives that promote adherence to diagnostic guidelines and foster collaboration between general practitioners and laboratory specialists. To address both educational and environmental needs, the "Green Lab Educational Space and Network" was conceptualized. This interdisciplinary initiative aims to integrate sustainability into health education and clinical laboratory practice. Set to launch in the 2025/2026 academic year, it features five pilot modules focusing on water, energy, waste, reagents, and procurement. International partnerships will support the scalability of the project, which ultimately seeks to embed sustainability within healthcare curricula and everyday clinical routines. I n conclusion, this doctoral research offers a comprehensive contribution to the evolution of laboratory medicine by addressing two fundamental imperatives: diagnostic accuracy and environmental responsibility.