Dr Mirjana Radovanovic

The answer is at your fingertips

Can we use fingerprick blood to optimise and personalise drug therapy?

Dr Mirjana Radovanovic is investigating whether less invasive sampling methods such as fingerprick blood collection and microsampling devices can support more personalised, accessible drug monitoring and therapy optimisation.

Currently, drug dosing is typically guided by standard recommendations based on the clinical indication. However, this 'one-size-fits-all' approach can be problematic. It often fails to account for individual differences in metabolism, body weight, organ function, and genetics, which means it can be inadequate in some patients leading to treatment failure or potentially causing toxicity in others.

“In the era of precision and personalised medicine, we must rethink the idea of standard dosing,” explains Mirjana. “Giving the right drug is crucial, but giving the right dose is just as important.”

"What does this mean in practice? Take, for example, patients undergoing chemotherapy. The goal is to deliver a dose potent enough to destroy cancer cells, but not so aggressive that it harms healthy tissues. It’s a delicate balance, maximising therapeutic benefit while minimising toxicity. Similarly, patients who have received a solid organ transplant rely on lifelong immunosuppressant therapy. Inadequate dosing can lead to organ rejection, while excessive dosing increases the risk of infections and other complications".

To address these challenges, Dr Radovanovic and her team are developing innovative analytical methods that allow for the extraction and precise analysis of drug levels from small blood samples. This technology assists clinicians in tailoring treatment to the individual, delivering truly patient-centred care.

Although much of the current research effort is focused on discovering new and less toxic drugs, comparatively little attention has been paid to optimising the dosing of drugs already in use. This is a critical gap in the field and one the research of Clinical Pharmacology team at University of Newcastle aims to close.

Therapeutic Drug Monitoring (TDM) is a valuable tool for optimising treatment outcomes. “Our research team has demonstrated that it is feasible to perform real-time TDM using minimally invasive sampling techniques”.

The integration of fingerprick sampling into routine care could further enhance accessibility and patient comfort. For instance, cancer patients can receive their first cycle of chemotherapy based on recommended dosing guidelines, followed by a blood test to measure the drug concentration. The results will inform physicians’ decisions, allowing them to adjust the dose in subsequent treatment cycles to ensure the therapy remains both effective and safe.

Through these advances, we are moving closer to a future where personalised, data-driven treatment is the norm not the exception.

From Clinical Lab to Research and Back Again

Before embarking on a research-focused career, Mirjana spent nearly two decades working in clinical laboratories, where she gained extensive and valuable experience across several disciplines, including clinical pharmacology and toxicology, automated and special biochemistry, and endocrinology. Among these areas, it was her work in clinical pharmacology that truly captured her interest, particularly the field of TDM.

Despite its critical role in optimizing patient care, TDM remains underutilised both in Australia and globally, especially for cancer therapies and anti-infective drugs.

Recognising this gap, Mirjana decided to pursue a part-time PhD in Clinical Pharmacology while continuing to work full-time in the lab. Her doctoral research focused on improving the efficiency, expanding the application, and increasing the implementation of Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) in clinical laboratories for diagnostic purposes, including TDM.

This academic journey led her into a clinical pharmacology research lab, where her work began to bridge the gap between research and real-world clinical practice. Today, the research being conducted in the lab is actively being translated back into the clinical setting, contributing to more personalised, evidence-based care and ultimately benefiting patients.

Microsampling for Patient-Centric Drug Optimisation

Another key focus of Dr Radovanovic research is the investigation and evaluation of microsampling devices for drug optimisation. These devices allow patients to collect small volumes of blood, typically from a simple fingerprick, in the comfort of their own homes. The samples are often dried, which renders them non-biohazardous, enabling safe and low-cost transportation via standard mail. This approach helps overcome several logistical challenges commonly associated with traditional blood sampling, including cost, sample stability, and biohazard risks.

“By removing the need for in-clinic blood draws, microsampling significantly expands access to TDM, especially in resource-limited or remote regions. Patients can self-collect samples and send them to a centralised laboratory equipped with advanced analytical tools, such as LC-MS/MS, for accurate measurement of drug concentrations”.

The Clinical Pharmacology research team at University of Newcastle is actively evaluating which microsampling devices are best suited for patient populations and specific drugs, considering factors such as sample volume, accuracy, stability, and ease of use for patients. This work directly contributes to addressing healthcare inequality, by enabling more equitable access to precision dosing and monitoring regardless of geographical location.

“Microsampling holds tremendous potential not only from a patient perspective but also in terms of logistics, cost-efficiency, and environmental sustainability. However, the ultimate success of this approach depends on the quality and reliability of the collected samples, which must meet the rigorous standards required for clinical decision-making”.

Findings from the ongoing trials will help guide the future implementation of microsampling in clinical practice, particularly for TDM applications in hard-to-reach populations.

"The ultimate goal of our team is to facilitate a patient-centric approach to dose optimisation, empowering individuals to take a more active role in their treatment through minimally invasive, at-home blood collection".