Distributed Biological Foundries for Global Health

Equivocal diagnostics: Making a 'good' point-of-care test for elimination in global health

What is a diagnostic test for? We might assume the answer to this question is straightforward. A good test would help identify what disease someone suffers from, assist health providers to determine the correct course of treatment and/or enable public health authorities to know and intervene in health at the level of the population. In this article, we show that what a specific diagnostic test is for, the value it holds for different actors, and what makes it good, or not, is often far from settled. We tell the story of the development and design of a rapid antibody test for onchocerciasis, or river blindness, tracking multiple iterations of the device through three configurational moments in the framing of onchocerciasis disease and reshaping of the global health innovation ecosystem. Efforts to build that ecosystem for diagnostics are often premised on the notion that public health needs for diagnostics are pre-given and stable; the challenge is seen to be how to incentivize investment and find a customer base for diagnostics in under-resourced settings. By contrast, we show that for any disease, diagnostic needs are both multiple and constantly in flux, and are unlikely to be met by a single, stand-alone product. In the case of the onchocerciasis Ov-16 rapid test, the failure to recognize and address the multiplicity and instability of diagnostic needs in the innovation process resulted in the development of a rapid point of care test that might be manufactured, procured and used, but is unloved by public health experts and commercial manufacturers alike. The equivocal value of the onchocerciasis rapid test, we suggest, reveals the inadequacy of the current global health innovation ecosystem for developing diagnostic 'goods'.

Can biotechnology lead the way toward a sustainable pharmaceutical industry?

The impact-intensive and rapidly growing pharmaceutical industry must ensure its sustainability. This study reveals that environmental sustainability assessments have been conducted for only around 0.2% of pharmaceuticals, environmental impacts have significant variations among the assessed products, and different impact categories have not been consistently studied. Highly varied impacts require assessing more products to understand the industry's sustainability status. Reporting all impact categories will be crucial, especially when comparing production technologies. Biological production of (semi)synthetic pharmaceuticals could reduce their environmental costs, though the high impacts of biologically produced monoclonal antibodies should also be optimized. Considering the sustainability potential of biopharmaceuticals from economic, environmental, and social perspectives, collaboratively guiding their immense market growth would lead to the industry's sustainability transition.

Open hardware: From DIY trend to global transformation in access to laboratory equipment

Open hardware solutions are increasingly being chosen by researchers as a strategy to improve access to technology for cutting-edge biology research. The use of DIY technology is already widespread, particularly in countries with limited access to science funding, and is catalyzing the development of open-source technologies. Beyond financial accessibility, open hardware can be transformational for the access of laboratories to equipment by reducing dependence on import logistics and enabling direct knowledge transfer. Central drivers to the adoption of appropriate open-source technologies in biology laboratories around the world are open sharing, digital fabrication, local production, the use of standard parts, and detailed documentation. This Essay examines the global spread of open hardware and discusses which kinds of open-source technologies are the most beneficial in scientific environments with economic and infrastructural constraints.

Biophysical and biochemical insights in the design of immunoassays

BACKGROUND

Rapid antigen assays have been attractive for decentralized, point of care diagnostics because of their low cost, robustness, and ease of use. The development of a diagnostic assay for a newly emerging infectious disease needs to take into account the progression of a disease, whether there is human to human transmission, and patient biomarker levels with time, and these all impact the choice of antigen targets and affinity agents.

SCOPE OF REVIEW

The factors involved in the biophysical design of rapid antigen immunoassays are discussed, focusing on antigen selection and designing for cross-reactivity. State of the art in the biophysical characterization of protein-ligand or antigen-antibody interactions, the different types of affinity agents used in immunoassays, and biochemical conjugation strategies are described.

MAJOR CONCLUSIONS

Antigen choice is a critical factor in immunoassay diagnostic development, and should account for the properties of the virion, virus, and disease progression. Biophysical and biochemical aspects of immunoassays are critical for performance.

GENERAL SIGNIFICANCE

This review can serve as an instructive guide to aid in diagnostic development for future emerging diseases.

Nanomaterial and interface advances in immunoassay biosensors

Biosensors have been used for a remarkable array of applications, including infectious diseases, environmental monitoring, cancer diagnosis, food safety, and numerous others. In particular, the global COVID-19 pandemic has exposed a need for rapid tests, so the type of biosensor that has gained considerable interest recently are immunoassays, which are used for rapid diagnostics. The performance of paper-based lateral flow and dipstick immunoassays is influenced by the physical properties of the nanoparticles (NPs), NP-antibody conjugates, and paper substrate. Many materials innovations have enhanced diagnostics by increasing sensitivity or enabling unique readouts. However, negative side effects can arise at the interface between the biological sample and biomolecules and the NP or paper substrate, such as non-specific adsorption and protein denaturation. In this Perspective, we discuss the immunoassay components and highlight chemistry and materials innovations that can improve sensitivity. We also explore the range of bio-interface issues that can present challenges for immunoassays.

Open source surgical fracture table for digitally distributed manufacturing

Roughly a third of the surgical procedures the World Bank is prioritizing as essential and cost-effective are orthopedic procedures. Yet in much of the developing world, prohibitive costs are a substantial barrier to universal access. One area where this is clear is surgical fracture tables, which generally cost >US$200,000 new. With the advent of 3-D printing, a new way to reduce medical equipment costs is to use open source hardware licensed designs to fabricate digitally-distributed manufactured medical hardware. That approach is applied here to make surgical tables more accessible. This study describes the design and manufacture of an open source surgical fracture table that uses materials that are widely available worldwide with specialty components being 3-D printed. The bill of materials and assembly instructions are detailed and the fracture table is validated to perform mechanically to specifications. Using an open source desktop RepRap-class 3-D printer, the components can be printed in a little over a week of continuous printing. Including the 3-D printed parts, the open source fracture table can be constructed for under US$3,000 in material costs, representing a 98.5% savings for commercial systems, radically increasing accessibility. The open source table can be adjusted 90–116 cm in height, tilted from +/-15 degrees, the leg height ranges from 31 to 117 cm, the arm supports and foot holder both have a 180-degree range, the foot position has a 54 cm range, and the legs can be adjusted from 55 to 120 degrees. It is mechanically adjusted so does not require electricity, however, surgical staff need to be trained on how to perform needed adjustments during surgery. The open source surgical table has verified performance for mechanical loading over 130 kg, geometric flexibility to allow for wide array of common surgeries, is radiolucent in surgical zones, and is modular and upgradeable.

Affinity Sedimentation and Magnetic Separation With Plant-Made Immunosorbent Nanoparticles for Therapeutic Protein Purification

The virus-based immunosorbent nanoparticle is a nascent technology being developed to serve as a simple and efficacious agent in biosensing and therapeutic antibody purification. There has been particular emphasis on the use of plant virions as immunosorbent nanoparticle chassis for their diverse morphologies and accessible, high yield manufacturing via plant cultivation. To date, studies in this area have focused on proof-of-concept immunosorbent functionality in biosensing and purification contexts. Here we consolidate a previously reported pro-vector system into a single Agrobacterium tumefaciens vector to investigate and expand the utility of virus-based immunosorbent nanoparticle technology for therapeutic protein purification. We demonstrate the use of this technology for Fc-fusion protein purification, characterize key nanomaterial properties including binding capacity, stability, reusability, and particle integrity, and present an optimized processing scheme with reduced complexity and increased purity. Furthermore, we present a coupling of virus-based immunosorbent nanoparticles with magnetic particles as a strategy to overcome limitations of the immunosorbent nanoparticle sedimentation-based affinity capture methodology. We report magnetic separation results which exceed the binding capacity reported for current industry standards by an order of magnitude.

Molecular pharming to support human life on the moon, mars, and beyond

Space missions have always assumed that the risk of spacecraft malfunction far outweighs the risk of human system failure. This assumption breaks down for longer duration exploration missions and exposes vulnerabilities in space medical systems. Space agencies can no longer reduce the majority of the human health and performance risks through crew members selection process and emergency re-supply or evacuation. No mature medical solutions exist to address this risk. With recent advances in biotechnology, there is promise for lessening this risk by augmenting a space pharmacy with a biologically-based space foundry for the on-demand manufacturing of high-value medical products. Here we review the challenges and opportunities of molecular pharming, the production of pharmaceuticals in plants, as the basis of a space medical foundry to close the risk gap in current space medical systems. Plants have long been considered to be an important life support object in space and can now also be viewed as programmable factories in space. Advances in molecular pharming-based space foundries will have widespread applications in promoting simple and accessible pharmaceutical manufacturing on Earth.

Synthetic biology and healthcare

Through the application of the engineering paradigm of ‘design–build–test–learn’ allied to recent advances in DNA sequencing, bioinformatics and, critically, the falling cost of DNA synthesis, Synthetic Biology promises to make existing therapies more accessible and be at the centre of the development of new types of advanced therapies. As existing pharmaceutical companies integrate Synthetic Biology tools into their normal ways of working, existing products are being produced by cheaper and more sustainable methods. Vaccine design and production is becoming driven by the molecular design allied to rapidly scalable production methods to combat the threat of pandemics and the ability of pathogens to escape the immune system by mutation. Advanced therapies, such as chimeric antigen receptor T cell therapy, are able to capitalise on the tools of Synthetic Biology to design new proteins and molecular ‘kill switches’ as well as design scalable and effective vectors for cellular transduction. This review highlights how Synthetic Biology is having an impact across the various therapeutic modalities from existing products to new therapies.