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Associate Professor Director of Automated Chemistry and Critical Care Testing Co-Director of Clinical Chemistry


Dr. Cotten received his B.S. in Biochemistry from North Carolina State University and earned his Ph.D. in Pharmaceutical Sciences from the University of North Carolina at Chapel Hill.  He completed a fellowship in Clinical Chemistry at the University of North Carolina in the Department of Pathology and Laboratory Medicine.  He is board certified in Clinical Chemistry and a Fellow of the American Association for Clinical Chemistry Academy.

Research Interests

My research spans a variety of topics in clinical chemistry, toxicology, and data analytics.  These pursuits have developed from clinical issues and challenges that shape the daily practice of pathology and laboratory medicine.

Neonatal Drug Testing

The drug testing needs for the neonatal population were largley overlooked during the early years of the opioid epidemic.  Several projects have sought to address the unique testing needs and laboratory workflows required for this patient population.  This work ranges from investigation of analytical interferences in neonatal drug screens to comprehensive workflow analysis.  Many of these issues also relate to ethical concerns, evidence-based practices, and the needs of stakeholders in the medical, analytical, and legal sectors.  Much of our lab’s work focuses on understanding analytical interferences for key drug classes and evaluating the impact of specimens on drug detection and how these are tied to outcome data for neonatal abstinence syndrome.

Alternative Specimen Types

Another research interest is the use of non-traditional or “alternative” specimen types in the clinical laboratory.  The regulatory implications of using non-FDA approved specimen types can be challenging for clinical laboratories.  My work in this area has focused on evaluation of the analytical performance of rare fluid types in the clinical laboratory and multi-site studies investigating differences in fluid performance across different instrument platforms.  Work in this area has also resulted in the creation of educational materials and framework documents outlining how laboratories should approach validating the performance of alternative matrices.

Nutrition for Precision Health

Our laboratory is the “Clinical Assay Center” for the Metabolomics and Clinical Assays Center component for the NIH Common Fund’s Nutrition for Precision Health, powered by the All of Us Research Program (NPH).  The team includes researchers co-located on the North Carolina Research Campus from UNC Nutrition Research Institute, North Carolina State University, and The University of North Carolina at Charlotte, McLendon Clinical Laboratories at UNC-CH School of Medicine, and the Duke Molecular Physiology Institute, Duke School of Medicine.  Nutrition for Precision Health is a discovery science study that uses “Big Data” and is not a traditional randomized controlled trial, cross-sectional study, or prospective observational cohort study with definitive endpoints for hypothesis testing.  The goal of the NIH Common Fund’s Nutrition for Precision Health, powered by the All of Us Research Program, is to develop algorithms that predict individual responses to food and dietary patterns.

The key objectives of the study are:
1. To examine differences in individuals observed in response to different diets by studying the interactions between diet, genes, proteins, microbiome, metabolism, and other individual contextual factors.
2. To use artificial intelligence (AI) to develop algorithms to predict individual responses to foods and dietary patterns.
3. To validate algorithms for clinical application.

Clinical Activities

As Director of Automated Chemistry and Critical Care Testing, I oversee the high volume chemistry and blood gas testing in the Core Lab, one of the divisions of the McLendon Laboratory at the UNC Medical Center.  This testing covers a wide range of disciplines including cardiac biomarkers, endocrinology, liver and renal function testing, toxicology, acid base/oxygenation status, and tumor markers.  Since 2018 I have served as the Chemistry Rotation Director for Pathology residents in the department.  I am also the Laboratory Director for the UNC Campus Health and NC State Campus Health laboratories as well as several other outpatient clinics in the Triangle region.

News and Events

UNC Researchers to Lead Two Centers for $170-million NIH Nutrition for Precision Health Consortium
North Carolina Research Campus team receives major NIH award for precision nutrition research
Clinical Laboratory News: New Tests, New Metrics for Success
Clinical Laboratory News: Facing Challenges in Neonatal Drug Testing
CAP Today: Devices, decisions: POC glucose in the critically ill
Medical Lab Management: Validating the Performance of Body Fluid Specimens

Select Publications

Block DR, Cotten SW, Franke D, Mbughuni MM. Comparison of Five Common Analyzers in the Measurement of Chemistry Analytes in an Authentic Cohort of Body Fluid Specimens. Am J Clin Pathol. 2022 Jan 31, PMID: 35099516

Hsiao CJ, Fasanysa H, Stoffel M, Beal SG, Winston-McPherson GN, Greene DN, Campbell, Cotten SW, Crews BO, Kuan K, Lapedis CJ, Mathias PC, Peck OM, Patel AG. The lines that held us: Assessing racial and socioeconomic disparities in SARS-CoV-2 testing. J Appl Lab Med. 2021 Jul 8. doi: 10.1093/jalm/jfab059 PMID: 34240171

Cotten SW, Shajani-Yi Z, Cervinski MA, Voorhees T, Tuchman SA, Korpi-Steiner N. Reference intervals and diagnostic ranges for serum free κ and free λ immunoglobulin light chains vary by instrument platform: Implications for classification of patient results in a multi-center study. Clin Biochem. 2018 Aug;58:100-107. doi: 10.1016/j.clinbiochem.2018.06.003. Epub 2018 Jun 7. PMID: 29885308

Pyle-Eilola A, Pagan J, Kayatin A, Povse PN, Riestschlin JA, Cotten SW. Method performance of bicarbonate and electrolytes using duodenal fluid for assessment of exocrine pancreatic function. J Appl Lab Med. 2018 July;3(1):56-64. doi: 10.1373/jalm.2017.024695 PMID: 33626830

Labardee RM, Swartzwelder JR, Gebhardt KE, Pardi JA, Dawsey AC, Brent Dixon R, Cotten SW. Method performance and clinical workflow outcomes associated with meconium and umbilical cord toxicology testing. Clin Biochem. 2017 Dec;50(18):1093-1097. doi: 10.1016/j.clinbiochem.2017.09-016. Epub 2017 Sep 21. PMID: 28941590

Cotten SW. Drug testing in the neonate. Clin Lab Med. 2012 Sep;32(3):449-466. doi: 10.1016/j.cll.2012.06.008. PMID: 22939302 Review.

Cotten SW, Duncan DL, Burch EA, Seashore CJ, Hammett-Stabler CA. Unexpected interference of baby wash products with the cannabinoid (THC) immunoassay. Clin Biochem. 2012 Jun;45(9):605-609. doi: 10.1016/j.clinbiochem.2012.02.029. Epub 2012 Mar 23. PMID: 22465236 (Featured on the “The Colbert Report” Comedy Central, June 21, 2012)


List of publications from PubMed

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