Better medicine for everyone
A few days before he left for Oxford University and his final year as a Rhodes Scholar, Jeeshan Chowdhury took some time to talk about an Edmonton-based project that he never really leaves behind no matter where he goes. He is part of the Improving Health Care Access and Sustainability with Microfluidic Platforms interdisciplinary team, led by Dr. Linda Pilarski, a cancer researcher at the Cross Cancer Institute and the University of Alberta. The team is developing a device for the rapid identification of infections in remote locations or low-resource environments, such as those found in many developing countries.
The device would use molecular testing to diagnose diseases. Sometimes called personalized medicine, molecular testing identifies the molecular characteristics of patients and their diseases. Although molecular tests are highly sensitive and reliable, they are complicated, expensive, and require specialized expertise. The team hopes to get around these roadblocks by developing an innovative device based on gel post technology. The device uses a series of tiny posts (each about 1 mm by 1 mm) made of a substance similar to a solid jelly. Each post is a reaction vessel for a different molecular test and requires only a small sample from a patient, such as skin cells from a cheek swab, urine, or a finger prick of blood to diagnose the patient’s disease.
“We believe we have a testing platform that can do sophisticated molecular testing without requiring a high-tech lab or highly trained personnel,” says Chowdhury. “We have the medicines to cure infections like tuberculosis, malaria, and sleeping sickness, but these diseases all present ambiguously, and a cough, fever, and chills could be a simple cold or potentially deadly tuberculosis. It’s impossible for physicians to make a diagnosis on their own, and current tests are unreliable so doctors don’t trust the results. With reliable molecular diagnosis, we could treat people early and clear the infections before they can spread. For many people in developing countries, getting to a clinic involves a day-long journey. They’re not going to come back again for the test results. With our device, there’s potential to do the test, get the result, and start treatment—all in the same day. This is democratizing technology.”
While the device is in development, other members of the team are working on applying the test to the diagnosis of various diseases. Dr. Stephanie Yanow, who has a joint appointment at the University of Alberta’s School of Public Health and the Alberta Provincial Laboratory for Public Health, is leading the work on a malaria test. The Provincial Lab has optimized and implemented a molecular test for malaria that can identify each of the five species of malaria parasite. “We want to take the test we perform in the high-tech environment of the Provincial Lab and put it on the gel post technology. It would allow countries where malaria is a huge health issue to potentially have the same state-of-the-art diagnostic tool we have in Alberta.”
The lack of reliable malaria tests have led to the indiscriminate use of anti-malarial drugs, which in turn has led to the parasites developing resistance. Drugs that were once highly effective against malaria no longer work, and there are few drugs that remain effective against malaria. The World Health Organization recently changed its malaria policy to state that anti-malarial drugs must only be given if there is a positive diagnosis of malaria. “There is an absolute need for a good diagnostic test that can work in the challenging environments of these countries,” says Dr. Yanow. “When I travel and speak about what we’re doing, people ask me: Where can I buy it? Although my answer is a disappointment, people are keen to work with us to pilot our new technology.”
Dr. Yanow is helping to set up a system for the eventual testing of device prototypes with collaborators in Uganda, Ghana, and Colombia. On the design side, the team is working with the Indian Institute of Technology Bombay which has experience in building devices for use in developing countries.
And what works in low-resource environments could also work here at home. Having test results available immediately at the doctor’s office would streamline healthcare for patients and cut costs. “The core technology has relevance everywhere,” adds Chowdhury. “We’re developing a technology that promises better medicine for everyone.”