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Pance A, Ng BL, Mwikali K, Koutsourakis M, Agu C, Rouhani FJ, Montandon R, Law F, Ponstingl H, Rayner JC. Novel stem cell technologies are powerful tools to understand the impact of human factors on Plasmodium falciparum malaria. Front Cell Infect Microbiol 2023; 13:1287355. [PMID: 38173794 PMCID: PMC10762799 DOI: 10.3389/fcimb.2023.1287355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Plasmodium falciparum parasites have a complex life cycle, but the most clinically relevant stage of the disease is the invasion of erythrocytes and the proliferation of the parasite in the blood. The influence of human genetic traits on malaria has been known for a long time, however understanding the role of the proteins involved is hampered by the anuclear nature of erythrocytes that makes them inaccessible to genetic tools. Here we overcome this limitation using stem cells to generate erythroid cells with an in-vitro differentiation protocol and assess parasite invasion with an adaptation of flow cytometry to detect parasite hemozoin. We combine this strategy with reprogramming of patient cells to Induced Pluripotent Stem Cells and genome editing to understand the role of key genes and human traits in malaria infection. We show that deletion of basigin ablates invasion while deletion of ATP2B4 has a minor effect and that erythroid cells from reprogrammed patient-derived HbBart α-thalassemia samples poorly support infection. The possibility to obtain patient-secific and genetically modifed erythoid cells offers an unparalleled opportunity to study the role of human genes and polymorphisms in malaria allowing preservation of the genomic background to demonstrate their function and understand their mechanisms.
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Affiliation(s)
- Alena Pance
- Wellcome Sanger Institute, Cambridge, United Kingdom
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Bee L. Ng
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Kioko Mwikali
- Wellcome Sanger Institute, Cambridge, United Kingdom
- Bioscience Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Chukwuma Agu
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | | | - Ruddy Montandon
- Wellcome Sanger Institute, Cambridge, United Kingdom
- Wellcome Centre of Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Frances Law
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | | | - Julian C. Rayner
- Wellcome Sanger Institute, Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
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2
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Tan AF, Thota P, Sakam SSB, Lew YL, Rajahram GS, William T, Barber BE, Kho S, Anstey NM, Bell D, Grigg MJ. Evaluation of a point-of-care haemozoin assay (Gazelle device) for rapid detection of Plasmodium knowlesi malaria. Sci Rep 2023; 13:4760. [PMID: 36959462 PMCID: PMC10036474 DOI: 10.1038/s41598-023-31839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
Plasmodium knowlesi is the major cause of zoonotic malaria in Southeast Asia. Rapid and accurate diagnosis enables effective clinical management. A novel malaria diagnostic tool, Gazelle (Hemex Health, USA) detects haemozoin, a by-product of haem metabolism found in all Plasmodium infections. A pilot phase refined the Gazelle haemozoin identification algorithm, with the algorithm then tested against reference PCR in a larger cohort of patients with P. knowlesi mono-infections and febrile malaria-negative controls. Limit-of-detection analysis was conducted on a subset of P. knowlesi samples serially diluted with non-infected whole blood. The pilot phase of 40 P. knowlesi samples demonstrated 92.5% test sensitivity. P. knowlesi-infected patients (n = 203) and febrile controls (n = 44) were subsequently enrolled. Sensitivity and specificity of the Gazelle against reference PCR were 94.6% (95% CI 90.5-97.3%) and 100% (95% CI 92.0-100%) respectively. Positive and negative predictive values were 100% and 98.8%, respectively. In those tested before antimalarial treatment (n = 143), test sensitivity was 96.5% (95% CI 92.0-98.9%). Sensitivity for samples with ≤ 200 parasites/µL (n = 26) was 84.6% (95% CI 65.1-95.6%), with the lowest parasitaemia detected at 18/µL. Limit-of-detection (n = 20) was 33 parasites/µL (95% CI 16-65%). The Gazelle device has the potential for rapid, sensitive detection of P. knowlesi infections in endemic areas.
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Affiliation(s)
- Angelica F Tan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia.
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
| | | | - Sitti Saimah Binti Sakam
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Yao Long Lew
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Giri S Rajahram
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Hospital Queen Elizabeth II, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | | | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia.
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
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Paica IC, Rusu I, Popescu O, Brînzan A, Pencea I, Dobrinescu C, Kelemen B. Tentative indicators of malaria in archaeological skeletal samples, a pilot study testing different methods. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:109-116. [PMID: 36724549 DOI: 10.1016/j.ijpp.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study attempts to integrate multiple methods to investigate the presence of malaria in human skeletal samples from an archaeological context. MATERIALS 33 well preserved human remains originating from a 17th-century archaeological site in southeastern Romania. METHODS The human bone samples were analyzed using rapid diagnostic tests for malaria antigens and PCR amplification of Plasmodium falciparum apical membrane antigen 1. A preliminary test was performed to identify and briefly characterize the presence of hemozoin using a combination of TEM imaging and diffraction. RESULTS The rapid diagnostic tests indicated that more than half of the examined samples were positive for Plasmodium antigens, but no traces of the parasites' genetic material were detected despite repeated attempts. The TEM images indicated that hemozoin might be a promising diagnostic marker of malaria in ancient bones. CONCLUSIONS The indisputable identification of malaria in the analyzed archaeological population was not possible as none of the applied methodological strategies turned out to be straightforward. SIGNIFICANCE This study reinforces the intricacy and limitations of unequivocally identifying malaria in past populations and sets the stage for future studies on such life-threatening infectious disease in a geographical space, which is currently underrepresented in the bioarchaeological literature. LIMITATIONS The low sample size and the lack of consistency across all assays hindered understanding the role of malaria in the studied population. SUGGESTIONS FOR FURTHER RESEARCH Further thorough multidisciplinary approaches on malaria detection in ancient settlements would be appropriate to inform our knowledge of its origins, frequency, and pathogen changes over centuries.
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Affiliation(s)
| | - Ioana Rusu
- Department of Molecular Biology and Biotechnology, Faculty of Biology and Geology, Babeș-Bolyai University, Cluj-Napoca, 400006, Romania; Molecular Biology Centre, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babeș-Bolyai University, Cluj-Napoca, 400271, Romania.
| | - Octavian Popescu
- Institute of Biology Bucharest of Romanian Academy, Bucharest, 060031, Romania; Molecular Biology Centre, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babeș-Bolyai University, Cluj-Napoca, 400271, Romania; Emil G. Racoviță Institute, Babeș-Bolyai University, Cluj-Napoca, 400006, Romania
| | - Alexandru Brînzan
- Institute of Biology Bucharest of Romanian Academy, Bucharest, 060031, Romania
| | - Ion Pencea
- Department of Metallic Material Science and Physical Metallurgy, University Politehnica of Bucharest, Bucharest, 060042, Romania
| | - Cătălin Dobrinescu
- Department of Research-Development and Projects, Museum of National History and Archaeology, Constanţa, 900745, Romania
| | - Beatrice Kelemen
- Department of Molecular Biology and Biotechnology, Faculty of Biology and Geology, Babeș-Bolyai University, Cluj-Napoca, 400006, Romania; Molecular Biology Centre, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babeș-Bolyai University, Cluj-Napoca, 400271, Romania
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Deshmukh SS, Byaruhanga O, Tumwebaze P, Akin D, Greenhouse B, Egan ES, Demirci U. Automated Recognition of Plasmodium falciparum Parasites from Portable Blood Levitation Imaging. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105396. [PMID: 35957519 PMCID: PMC9534981 DOI: 10.1002/advs.202105396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/03/2022] [Indexed: 06/15/2023]
Abstract
In many malaria-endemic regions, current detection tools are inadequate in diagnostic accuracy and accessibility. To meet the need for direct, phenotypic, and automated malaria parasite detection in field settings, a portable platform to process, image, and analyze whole blood to detect Plasmodium falciparum parasites, is developed. The liberated parasites from lysed red blood cells suspended in a magnetic field are accurately detected using this cellphone-interfaced, battery-operated imaging platform. A validation study is conducted at Ugandan clinics, processing 45 malaria-negative and 36 malaria-positive clinical samples without external infrastructure. Texture and morphology features are extracted from the sample images, and a random forest classifier is trained to assess infection status, achieving 100% sensitivity and 91% specificity against gold-standard measurements (microscopy and polymerase chain reaction), and limit of detection of 31 parasites per µL. This rapid and user-friendly platform enables portable parasite detection and can support malaria diagnostics, surveillance, and research in resource-constrained environments.
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Affiliation(s)
- Shreya S. Deshmukh
- Department of BioengineeringStanford University Schools of Engineering and MedicineStanfordCA94305USA
- Canary Center for Early Cancer DetectionBioacoustic MEMS in Medicine LabDepartment of RadiologyStanford University School of MedicinePalo AltoCA94305USA
| | | | | | - Demir Akin
- Canary Center for Early Cancer DetectionBioacoustic MEMS in Medicine LabDepartment of RadiologyStanford University School of MedicinePalo AltoCA94305USA
| | - Bryan Greenhouse
- Department of MedicineUniversity of California San FranciscoSan FranciscoCA94110USA
| | - Elizabeth S. Egan
- Department of PediatricsStanford University School of MedicineStanfordCA94305USA
- Department of Microbiology and ImmunologyStanford University School of MedicineStanfordCA94305USA
| | - Utkan Demirci
- Canary Center for Early Cancer DetectionBioacoustic MEMS in Medicine LabDepartment of RadiologyStanford University School of MedicinePalo AltoCA94305USA
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Fernando D, Thota P, Semege S, Booso R, Bell D, de A. W. Gunasekera KT, Ranaweera P. Evaluation of a haemozoin-based rapid diagnostic test for diagnosis of imported malaria during the phase of prevention of reestablishment in Sri Lanka. Malar J 2022; 21:263. [PMID: 36088431 PMCID: PMC9464370 DOI: 10.1186/s12936-022-04283-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Sri Lanka, an island nation, has eliminated endemic malaria transmission. Maintaining elimination in the continued presence of vectors requires vigilance in screening people travelling from high malaria-risk areas and a rapid response with focal screening for infections identified in the community. Such screening requires accurate and very rapid assays that enable an immediate response. Both microscopy and rapid diagnostic tests (RDTs) have limitations including sensitivity and speed in screening large numbers, while polymerase chain reaction (PCR) is practical only as laboratory confirmation. This study assessed the utility of ‘Gazelle’, a novel rapid malaria assay based on magneto-optical detection of haemozoin, a by-product of malaria parasite metabolism. Methods Between October 2020 and March 2021, two groups of individuals were screened for malaria by four methods, namely, microscopy, Rapid Diagnostic Test (RDT), Gazelle and PCR. Passive case detection was carried out for confirmation of diagnosis amongst individuals suspected of having malaria. Individuals at high-risk of acquiring malaria, namely persons returning from malaria endemic countries, were screened by active case detection. Results Of the 440 individuals screened for malaria, nine malaria positives were diagnosed by PCR, microscopy and the HRP2 band of RDT, which included five Plasmodium falciparum infections, two Plasmodium ovale, and one each of Plasmodium vivax and Plasmodium malariae. Gazelle correctly detected the P. vivax, P. ovale and P. malariae infections within the 2 min test time, but did not detect two P. falciparum infections giving a sensitivity of 77.8%. Specificity was 100%. Discussion The Gazelle, a portable bench top device proved useful to screen a large number of blood samples for non-falciparum parasites within 5 minutes of sample input. Species differentiation, and improvement in P. falciparum detection, will be important to broaden utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04283-7.
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Towards rainbow portable Cytophone with laser diodes for global disease diagnostics. Sci Rep 2022; 12:8671. [PMID: 35606373 PMCID: PMC9126638 DOI: 10.1038/s41598-022-11452-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/18/2022] [Indexed: 11/08/2022] Open
Abstract
In vivo, Cytophone has demonstrated the capability for the early diagnosis of cancer, infection, and cardiovascular disorders through photoacoustic detection of circulating disease markers directly in the bloodstream with an unprecedented 1,000-fold improvement in sensitivity. Nevertheless, a Cytophone with higher specificity and portability is urgently needed. Here, we introduce a novel Cytophone platform that integrates a miniature multispectral laser diode array, time-color coding, and high-speed time-resolved signal processing. Using two-color (808 nm/915 nm) laser diodes, we demonstrated spectral identification of white and red clots, melanoma cells, and hemozoin in malaria-infected erythrocytes against a blood background and artifacts. Data from a Plasmodium yoelii murine model and cultured human P. falciparum were verified in vitro with confocal photothermal and fluorescent microscopy. With these techniques, we detected infected cells within 4 h after invasion, which makes hemozoin promising as a spectrally selective marker at the earliest stages of malaria progression. Along with the findings from our previous application of Cytophone with conventional lasers for the diagnosis of melanoma, bacteremia, sickle anemia, thrombosis, stroke, and abnormal hemoglobin forms, this current finding suggests the potential for the development of a portable rainbow Cytophone with multispectral laser diodes for the identification of these and other diseases.
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Field Evaluation of a Hemozoin-Based Malaria Diagnostic Device in Puerto Lempira, Honduras. Diagnostics (Basel) 2022; 12:diagnostics12051206. [PMID: 35626361 PMCID: PMC9140950 DOI: 10.3390/diagnostics12051206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/01/2023] Open
Abstract
The diagnosis of malaria in Honduras is based mainly on microscopic observation of the parasite in thick smears or the detection of parasite antigens through rapid diagnostic tests when microscopy is not available. The specific treatment of the disease depends exclusively on the positive result of one of these tests. Given the low sensitivity of conventional methods, new diagnostic approaches are needed. This study evaluates the in-field performance of a device (Gazelle™) based on the detection of hemozoin. This was a double-blind study evaluating symptomatic individuals with suspected malaria in the department of Gracias a Dios, Honduras, using blood samples collected from 2021 to 2022. The diagnostic performance of Gazelle™ was compared with microscopy and nested 18ssr PCR as references. The sensitivity and specificity of Gazelle™ were 59.7% and 98.6%, respectively, while microscopy had a sensitivity of 64.9% and a specificity of 100%. The kappa index between microscopy and Gazelle™ was 0.9216 using microscopy as a reference. Both methods show similar effectiveness and predictive values. No statistical differences were observed between the results of the Gazelle™ compared to light microscopy (p = 0.6831). The turnaround time was shorter for Gazelle™ than for microscopy, but the cost per sample was slightly higher for Gazelle™. Gazelle™ showed more false-negative cases when infections were caused by Plasmodium falciparum compared to P. vivax. Conclusions: The sensitivity and specificity of Gazelle™ are comparable to microscopy. The simplicity and ease of use of the Gazelle™, the ability to run on batteries, and the immediacy of its results make it a valuable tool for malaria detection in the field. However, further development is required to differentiate Plasmodium species, especially in those regions requiring differentiated treatment.
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Field validation of a magneto-optical detection device (Gazelle) for portable point-of-care Plasmodium vivax diagnosis. PLoS One 2021; 16:e0253232. [PMID: 34157032 PMCID: PMC8219132 DOI: 10.1371/journal.pone.0253232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022] Open
Abstract
A major challenge for malaria is the lack of tools for accurate and timely diagnosis in the field which are critical for case management and surveillance. Microscopy along with rapid diagnostic tests are the current mainstay for malaria diagnosis in most endemic regions. However, these methods present several limitations. This study assessed the accuracy of Gazelle, a novel rapid malaria diagnostic device, from samples collected from the Peruvian Amazon between 2019 and 2020. Diagnostic accuracy was compared against microscopy and two rapid diagnostic tests (SD Bioline and BinaxNOW) using 18ssr nested-PCR as reference test. In addition, a real-time PCR assay (PET-PCR) was used for parasite quantification. Out of 217 febrile patients enrolled and tested, 180 specimens (85 P. vivax and 95 negatives) were included in the final analysis. Using nested-PCR as the gold standard, the sensitivity and specificity of Gazelle was 88.2% and 97.9%, respectively. Using a cutoff of 200 parasites/μl, Gazelle’s sensitivity for samples with more than 200 p/uL was 98.67% (95%CI: 92.79% to 99.97%) whereas the sensitivity for samples lower than 200 p/uL (n = 10) was 12.5% (95%CI: 0.32% to 52.65%). Gazelle’s sensitivity and specificity were statistically similar to microscopy (sensitivity = 91.8, specificity = 100%, p = 0.983) and higher than both SD Bioline (sensitivity = 82.4, specificity = 100%, p = 0.016) and BinaxNOW (sensitivity = 71.8%, specificity = 97.9%, p = 0.002). The diagnostic accuracy of Gazelle for malaria detection in P. vivax infections was comparable to light microscopy and superior to both RDTs even in the presence of low parasitemia infections. The performance of Gazelle makes it a valuable tool for malaria diagnosis and active case detection that can be utilized in different malaria-endemic regions.
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Deshmukh SS, Shakya B, Chen A, Durmus NG, Greenhouse B, Egan ES, Demirci U. Multiparametric biophysical profiling of red blood cells in malaria infection. Commun Biol 2021; 4:697. [PMID: 34103669 PMCID: PMC8187722 DOI: 10.1038/s42003-021-02181-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
Biophysical separation promises label-free, less-invasive methods to manipulate the diverse properties of live cells, such as density, magnetic susceptibility, and morphological characteristics. However, some cellular changes are so minute that they are undetectable by current methods. We developed a multiparametric cell-separation approach to profile cells with simultaneously changing density and magnetic susceptibility. We demonstrated this approach with the natural biophysical phenomenon of Plasmodium falciparum infection, which modifies its host erythrocyte by simultaneously decreasing density and increasing magnetic susceptibility. Current approaches have used these properties separately to isolate later-stage infected cells, but not in combination. We present biophysical separation of infected erythrocytes by balancing gravitational and magnetic forces to differentiate infected cell stages, including early stages for the first time, using magnetic levitation. We quantified height distributions of erythrocyte populations-27 ring-stage synchronized samples and 35 uninfected controls-and quantified their unique biophysical signatures. This platform can thus enable multidimensional biophysical measurements on unique cell types.
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Affiliation(s)
- Shreya S Deshmukh
- Department of Bioengineering, Stanford University Schools of Engineering and Medicine, Stanford, CA, USA
- Canary Center for Early Cancer Detection, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bikash Shakya
- Department of Pediatrics; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna Chen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Naside Gozde Durmus
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth S Egan
- Department of Pediatrics; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Utkan Demirci
- Canary Center for Early Cancer Detection, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA.
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de Melo GC, Netto RLA, Mwangi VI, Salazar YEAR, de Souza Sampaio V, Monteiro WM, de Almeida E Val FF, Rocheleau A, Thota P, Lacerda MVG. Performance of a sensitive haemozoin-based malaria diagnostic test validated for vivax malaria diagnosis in Brazilian Amazon. Malar J 2021; 20:146. [PMID: 33712019 PMCID: PMC7953757 DOI: 10.1186/s12936-021-03688-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background Vivax malaria diagnosis remains a challenge in malaria elimination, with current point of care rapid diagnostic tests (RDT) missing many clinically significant infections because of usually lower peripheral parasitaemia. Haemozoin-detecting assays have been suggested as an alternative to immunoassay platforms but to date have not reached successful field deployment. Haemozoin is a paramagnetic crystal by-product of haemoglobin digestion by malaria parasites and is present in the food vacuole of malaria parasite-infected erythrocytes. This study aimed to compare the diagnostic capability of a new haemozoin-detecting platform, the Gazelle™ device with optical microscopy, RDT and PCR in a vivax malaria-endemic region. Methods A comparative, double-blind study evaluating symptomatic malaria patients seeking medical care was conducted at an infectious diseases reference hospital in the western Brazilian Amazon. Optical microscopy, PCR, RDT, and Gazelle™ were used to analyse blood samples. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa values were calculated. Results Out of 300 patients, 24 test results were excluded from the final analysis due to protocol violation (6) and inconclusive and/or irretrievable results (18). Gazelle™ sensitivity was 96.1 % (91.3–98.3) and 72.1 % (65.0–78.3) when compared to optical microscopy and PCR, respectively whereas it was 83.9 % and 62.8 % for RDTs. The platform presented specificity of 100 % (97.4–100), and 99.0 % (94.8–99.9) when compared to optical microscopy, and PCR, respectively, which was the same for RDTs. Its correct classification rate was 98.2 % when compared to optical microscopy and 82.3 % for PCR; the test’s accuracy when compared to optical microscopy was 98.1 % (96.4–99.7), when compared to RDT was 95.2 % (93.0–97.5), and when compared to PCR was 85.6 % (82.1–89.1). Kappa (95 % CI) values for Gazelle™ were 96.4 (93.2–99.5), 88.2 (82.6–93.8) and 65.3 (57.0–73.6) for optical microscopy, RDT and PCR, respectively. Conclusions The Gazelle™ device was shown to have faster, easier, good sensitivity, specificity, and accuracy when compared to microscopy and was superior to RDT, demonstrating to be an alternative for vivax malaria screening particularly in areas where malaria is concomitant with other febrile infections (including dengue fever, zika, chikungunya, Chagas, yellow fever, babesiosis).
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Affiliation(s)
- Gisely Cardoso de Melo
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil.
| | | | - Victor Irungu Mwangi
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | | | - Vanderson de Souza Sampaio
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil.,Fundação de Vigilância em Saúde (FVS) - Manaus, Manaus, Amazonas, 69093-018, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Fernando Fonseca de Almeida E Val
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Anne Rocheleau
- Hemex Health, 4640 SW Macadam Avenue, Suite 250 , Portland, Oregon, 97239, USA
| | - Priyaleela Thota
- Hemex Health, 4640 SW Macadam Avenue, Suite 250 , Portland, Oregon, 97239, USA
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil.,Instituto Leônidas & Maria Deane (ILMD) Fiocruz, Manaus, Amazonas, 69057-070, Brazil
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Molecular Imaging of a Zirconium-89 Labeled Antibody Targeting Plasmodium falciparum-Infected Human Erythrocytes. Mol Imaging Biol 2021; 22:115-123. [PMID: 31004274 DOI: 10.1007/s11307-019-01360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Nuclear imaging is an important preclinical research tool to study infectious diseases in vivo and could be extended to investigate complex aspects of malaria infections. As such, we report for the first time successful radiolabeling of a novel antibody specific to Plasmodium-infected erythrocytes (IIIB6), its in vitro assessment and molecular imaging in nude mice. PROCEDURES In vitro confocal microscopy was used to determine the stage-specificity of Plasmodium-infected erythrocytes recognised by IIIB6. To enable micro-positron emission tomography (PET)/X-ray computed tomography (CT) imaging, IIIB6 was conjugated to Bz-DFO-NCS and subsequently radiolabeled with zirconium-89. Healthy nude mice were injected with [89Zr]IIIB6, and pharmacokinetics and organ uptake were monitored over 24 h. This was followed by post-mortem animal dissection to determine the biodistribution of [89Zr]IIIB6. RESULTS IIIB6 recognised all the relevant stages of Plasmodium falciparum-infected erythrocytes (trophozoites, schizonts and gametocytes) that are responsible for severe malaria pathology. [89Zr]IIIB6-radiolabeling yields were efficient at 84-89 %. Blood pool imaging analysis indicated a pharmacological half-life of 9.6 ± 2.5 h for [89Zr]IIIB6. The highest standard uptake values were determined at 2-6 h in the liver followed by the spleen, kidneys, heart, stomach and lung, respectively. Minimal activity was present in muscle and bone tissues. CONCLUSION In vitro characterization of IIIB6 and pharmacokinetic characterization of [89Zr]IIIB6 revealed that this antibody has potential for future use in Plasmodium-infected mouse models to study malaria in a preclinical in vivo setting with PET/CT imaging.
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Kumar R, Verma AK, Shrivas S, Thota P, Singh MP, Rajasubramaniam S, Das A, Bharti PK. First successful field evaluation of new, one-minute haemozoin-based malaria diagnostic device. EClinicalMedicine 2020; 22:100347. [PMID: 32490369 PMCID: PMC7256309 DOI: 10.1016/j.eclinm.2020.100347] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/21/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Early and accurate diagnosis of malaria is critical to the success of malaria elimination. However, the current mainstay of malaria diagnosis in the field, such as light microscopy and rapid diagnostic tests (RDTs), have limitations due to low parasite density or mutation in diagnostic markers. METHODS We evaluated an inexpensive, robust, rapid, malaria diagnostic device, called Gazelle, that employs magneto-optical detection to identify haemozoin crystals (Hz) produced by all species of human malaria parasites in infected individuals. A beam of polarised light is passed through the lysed diluted blood sample under the influence of high (~.55T) and low magnetic fields. The difference in light transmission through the sample between the high and low magnetic fields indicates presence of Hz, suggesting possible malarial infection. A total of 300 febrile patients were screened at the malaria clinic of Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, India, from August 2018 to November 2018. Malaria diagnosis was done using four diagnostic methods: Gazelle, light microscopy, RDT, and malaria specific Polymerase Chain Reaction (PCR). Measures of diagnostic accuracy were compared. FINDINGS Out of 300 febrile patients enroled and tested for the presence of malaria parasites, 262 patient samples were included in the final analysis. The sensitivity and specificity of Gazelle was 98% and 97% in comparison to light microscopy, 82% and 99% to PCR and 78% and 99% to RDT, respectively. The results of the four diagnostic methods were comparable and statistically no significant differences in sensitivity or specificity was observed between these methods. Enhanced diagnostic accuracy of Gazelle in malaria patients with no prior history of malaria treatment was observed in this study. INTERPRETATION The diagnostic ability of Gazelle was comparable to light microscopy and better than RDTs even in low parasitemia and in presence of pfhrp2/3 deletion mutant parasites. Gazelle may be a novel valuable diagnostic tool in resource poor settings where (i) microscopy is not feasible and (ii) pfhrp2/3gene deleted parasite are present. Its speed, cost-efficiency, and alternative to lack of microscopists makes it an important adjunct in field settings. FUNDING HemexDx, India.
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Affiliation(s)
- Rajat Kumar
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Anil K. Verma
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Shweta Shrivas
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | | | - Mrigendra P. Singh
- National Institute of Malaria Research-Field station (NIMR-FS), Jabalpur, Madhya Pradesh, India
| | - S. Rajasubramaniam
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Aparup Das
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Praveen K. Bharti
- ICMR-National Institute of Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
- Corresponding author.
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Christner M, Frickmann H, Klupp E, Rohde H, Kono M, Tannich E, Poppert S. Insufficient sensitivity of laser desorption-time of flight mass spectrometry-based detection of hemozoin for malaria screening. J Microbiol Methods 2019; 160:104-106. [DOI: 10.1016/j.mimet.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
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Rifaie-Graham O, Pollard J, Raccio S, Balog S, Rusch S, Hernández-Castañeda MA, Mantel PY, Beck HP, Bruns N. Hemozoin-catalyzed precipitation polymerization as an assay for malaria diagnosis. Nat Commun 2019; 10:1369. [PMID: 30911004 PMCID: PMC6433922 DOI: 10.1038/s41467-019-09122-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 02/22/2019] [Indexed: 12/19/2022] Open
Abstract
Methods to diagnose malaria are of paramount interest to eradicate the disease. Current methods have severe limitations, as they are either costly or not sensitive enough to detect low levels of parasitemia. Here we report an ultrasensitive, yet low-resource chemical assay for the detection and quantification of hemozoin, a biomarker of all Plasmodium species. Solubilized hemozoin catalyzes the atom transfer radical polymerization of N-isopropylacrylamide above the lower critical solution temperature of poly(N-isopropylacrylamide). The solution becomes turbid, which can be observed by naked eye and quantified by UV-visible spectroscopy. The rate of turbidity increase is proportional to the concentration of hemozoin, with a detection limit of 0.85 ng mL-1. Malaria parasites in human blood can be detected down to 10 infected red blood cells μL-1. The assay could potentially be applied as a point-of-care test. The signal-amplification of an analyte by biocatalytic precipitation polymerization represents a powerful approach in biosensing.
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Affiliation(s)
- Omar Rifaie-Graham
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700, Fribourg, Switzerland
| | - Jonas Pollard
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700, Fribourg, Switzerland
| | - Samuel Raccio
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700, Fribourg, Switzerland
| | - Sandor Balog
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700, Fribourg, Switzerland
| | - Sebastian Rusch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
- University of Basel, Petersgraben, 4000, Basel, Switzerland
| | | | - Pierre-Yves Mantel
- Department of Medicine, University of Fribourg, Route Albert-Gockel 1, 1700, Fribourg, Switzerland
| | - Hans-Peter Beck
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
- University of Basel, Petersgraben, 4000, Basel, Switzerland
| | - Nico Bruns
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700, Fribourg, Switzerland.
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Kazarine A, Baakdah F, Gopal AA, Oyibo W, Georges E, Wiseman PW. Malaria Detection by Third-Harmonic Generation Image Scanning Cytometry. Anal Chem 2019; 91:2216-2223. [PMID: 30601655 DOI: 10.1021/acs.analchem.8b04791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite global efforts aimed at its elimination, malaria is still a significant health concern in many countries across the world. The disease is caused by blood-borne parasites, Plasmodium species, and is transmitted by female Anopheles mosquitoes and presents with generic febrile symptoms that are challenging to diagnose clinically. To adequately tackle this issue, an effective detection method is required for screening potential malaria patients for infection. To this day, the gold standard for malaria detection remains basic light microscopy of Giemsa-stained patient blood smears to first enable detection and manual counting to determine the parasite density by a microscopist. While effective at detecting parasites, this method requires both significant time and skilled personnel. As an alternate approach, we propose a new malaria detection method that we call third-harmonic generation image scanning cytometry (THGISC) based on the combination of third-harmonic generation imaging, high-speed motorized scanning, and automated software processing. Third-harmonic generation (THG) is a nonlinear optical process in which the frequency of incident photons is tripled within the sample material. We have previously demonstrated that hemozoin, a metabolic byproduct of the malaria parasite, presents a significant THG signal. We now present a practical approach that uses the selectivity of this contrast mechanism to perform label-free image scanning cytometry of patient blood smears for automated malaria detection. In this work, we applied this technique to lab-cultured parasites and parasites in whole blood obtained from malaria patients. We also compared its effectiveness to parasite counts obtained by classical methods. The ability to easily and rapidly determine parasitemia by THG offers potential not only for the easy confirmation of malaria diagnoses following symptoms, but also the tracking of treatment progress in existing patients, potentially allowing physicians to adjust medication and dosage for each individual.
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Affiliation(s)
- Alexei Kazarine
- Department of Chemistry , McGill University , 801 Sherbrooke Street West , Montreal , Quebec H3A 0B8 , Canada
| | - Fadi Baakdah
- Institute of Parasitology , McGill University , Sainte Anne de Bellevue , Quebec H9X 3 V9 , Canada
| | - Angelica A Gopal
- Department of Chemistry , McGill University , 801 Sherbrooke Street West , Montreal , Quebec H3A 0B8 , Canada
| | - Wellington Oyibo
- ANDI Centre of Excellence for Malaria Diagnosis, College of Medicine , University of Lagos , Idi-Araba, Lagos 100254 , Nigeria
| | - Elias Georges
- Institute of Parasitology , McGill University , Sainte Anne de Bellevue , Quebec H9X 3 V9 , Canada
| | - Paul W Wiseman
- Department of Chemistry , McGill University , 801 Sherbrooke Street West , Montreal , Quebec H3A 0B8 , Canada.,Department of Physics , McGill University , 3600 University Street , Montreal , Quebec H3A 2T8 , Canada
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McBirney SE, Chen D, Scholtz A, Ameri H, Armani AM. Rapid Diagnostic for Point-of-Care Malaria Screening. ACS Sens 2018; 3:1264-1270. [PMID: 29781606 DOI: 10.1021/acssensors.8b00269] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite significant success in therapeutic development, malaria remains a widespread and deadly infectious disease in the developing world. Given the nearly 100% efficacy of current malaria therapeutics, the primary barrier to eradication is lack of early diagnosis of the infected population. However, there are multiple strains of malaria. Although significant efforts and resources have been invested in developing antibody-based diagnostic methods for Plasmodium falciparum, a rapid and easy to use screening method capable of detecting all malaria strains has not been realized. Yet, until the entire malaria-infected population receives treatment, the disease will continue to impact society. Here, we report the development of a portable, magneto-optic technology for early stage malaria diagnosis based on the detection of the malaria pigment, hemozoin. Using β-hematin, a hemozoin mimic, we demonstrate detection limits of <0.0081 μg/mL in 500 μL of whole rabbit blood with no additional reagents required. This level corresponds to <26 parasites/μL, a full order of magnitude below clinical relevance and comparable to or less than existing technologies.
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Affiliation(s)
| | | | - Alexis Scholtz
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Hossein Ameri
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, United States
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Jamjoom GA. Evidence for a role of hemozoin in metabolism and gametocytogenesis. MALARIAWORLD JOURNAL 2017; 8:10. [PMID: 34532233 PMCID: PMC8415077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hemozoin is generally considered a waste deposit that is formed for the sole purpose of detoxification of free heme that results from the digestion of hemoglobin by Plasmodium parasites. However, several observations of parasite multiplication, both in vertebrate and invertebrate hosts are suggestive of a wider, but overlooked, metabolic role for this product. The presence of clinical peripheral blood samples of P. falciparum with high parasitemia containing only hemozoin-deficient (non-pigmented) asexual forms has been repeatedly confirmed. Such samples stand in contrast with other samples that contain mostly pigmented circulating trophozoites and gametocytes, indicating that pigment accumulation is a prominent feature of gametocytogenesis. The restricted size, i.e. below detection by light microscopy, of hemozoin in asexual merozoites and ringforms of P. falciparum implies its continuous turnover, supporting a role in metabolism. The prominent interaction of hemozoin with several antimalarial drugs, the involvement of proteins in hemozoin formation, and the finding of plasmodial genes coding for a heme-oxygenase-like protein argue for a wider and more active role for hemozoin in the parasite's metabolism. The observed association of hemozoin with crystalloids during ookinete development is consistent with a useful function to it during parasite multiplication in the invertebrate host. Finally, alternative mechanisms, other than hemozoin formation, provide substitute or additional routes for heme detoxification.
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Affiliation(s)
- Ghazi A. Jamjoom
- College of Applied Medical Sciences, and King Fahd Medical Research Center, King Abdulaziz University, Jeddah, P.O. Box 415 Jeddah 21411, Saudi Arabia,*
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Grimberg BT, Grimberg KO. Hemozoin detection may provide an inexpensive, sensitive, 1-minute malaria test that could revolutionize malaria screening. Expert Rev Anti Infect Ther 2016; 14:879-83. [PMID: 27530228 PMCID: PMC5224914 DOI: 10.1080/14787210.2016.1222900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/08/2016] [Indexed: 12/25/2022]
Abstract
Malaria remains widespread throughout the tropics and is a burden to the estimated 3.5 billion people who are exposed annually. The lack of a fast and accurate diagnostic method contributes to preventable malaria deaths and its continued transmission. In many areas diagnosis is made solely based on clinical presentation. Current methods for malaria diagnosis take more than 20 minutes from the time blood is drawn and are frequently inaccurate. The introduction of an accurate malaria diagnostic that can provide a result in less than 1 minute would allow for widespread screening and treatment of endemic populations, and enable regions that have gained a foothold against malaria to prevent its return. Using malaria parasites' waste product, hemozoin, as a biomarker for the presence of malaria could be the tool needed to develop this rapid test.
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Affiliation(s)
- Brian T Grimberg
- a School of Medicine - Center for Global Health and Diseases , Case Western Reserve University , Cleveland , OH , USA
| | - Kerry O Grimberg
- b School of Medicine, Department of Radiology , Case Western Reserve University , Cleveland , OH , USA
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Mohapatra S, Ghosh A, Singh R, Singh DP, Sharma B, Samantaray JC, Deb M, Gaind R. Hemozoin Pigment: An Important Tool for Low Parasitemic Malarial Diagnosis. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:393-7. [PMID: 27658589 PMCID: PMC5040090 DOI: 10.3347/kjp.2016.54.4.393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 06/12/2016] [Accepted: 07/20/2016] [Indexed: 11/23/2022]
Abstract
Low parasitemic condition in malaria remains a diagnostic challenge; as the available diagnostic methods failed to detect. Currently, hemozoin (Hz) pigment is gaining attention in the diagnosis of malaria. The major drawback is ease of detection of Hz in routine practice. A pilot study was conducted to evaluate the role of Hz pigment and to compare the performance of quantitative buffy coat assay (QBC) and PCR in such conditions. Clinically suspected cases of malaria were examined by both Giemsa stain and immunochromatographic test (ICT). Samples positive by ICT and negative by Giemsa stain were further examined by nested PCR targeting 18S rRNA and QBC for the presence of malaria parasites and pigments. Thirty blood samples fulfilled the inclusion criteria out of which 23 were Plasmodium vivax (Pv), 4 Plasmodium falciparum (Pf), and 3 mixed (Pv and Pf) by immunochromatographic test. Twenty-one out of 30 (70%) were positive by nested PCR in comparison to 25/30 (83%) by QBC. Samples containing both malaria parasites and Hz pigment by QBC completely showed concordance with the PCR result. However, 61% of total samples containing only Hz pigment were observed positive by PCR. Hz pigment remains an important tool for malaria diagnosis. Identification of leukocytes containing pigments by QBC not only indicates recent malarial infections but also puts light on severity of the disease. QBC assay is a rapid, highly sensitive, and cost-effective method to detect malaria parasites and Hz pigment especially in low parasitemic conditions.
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Affiliation(s)
- Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arnab Ghosh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchi Singh
- National Institute of Pathology, Safdarjung Hospital, New Delhi, India
| | | | - Bhawna Sharma
- Department of Microbiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Manorama Deb
- Department of Microbiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Chen F, Flaherty BR, Cohen CE, Peterson DS, Zhao Y. Direct detection of malaria infected red blood cells by surface enhanced Raman spectroscopy. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2016; 12:1445-51. [PMID: 27015769 PMCID: PMC4955673 DOI: 10.1016/j.nano.2016.03.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/04/2016] [Accepted: 03/02/2016] [Indexed: 02/05/2023]
Abstract
Surface enhanced Raman spectra (SERS) of normal red blood cells (RBCs) and Plasmodium falciparum infected RBCs (iRBCs) at different post invasion time were obtained based on silver nanorod array substrates. Distinct spectral differences were observed due to the cell membrane modification of RBCs during malaria infection. The SERS spectra of ring stage iRBCs had a characteristic Raman peak at Δv=1599cm(-1) as compared to those of normal RBCs, while the trophozoite and schizoid stages had identical SERS spectra with a characteristic peak at Δv=723cm(-1), which is significantly different from ring stage iRBCs, consistent with ongoing modification of the iRBC membrane. Since ring stage iRBCs of P. falciparum are found circulating in blood, such a difference provides a new strategy for rapid malaria detection. The limit of detection as well as the ability to detect a mixed iRBC and RBC solution was also investigated.
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Affiliation(s)
- Funing Chen
- Department of Physics and Astronomy, the University of Georgia, Athens, GA, USA; Nanoscale Science & Engineering Center, the University of Georgia, Athens, GA, USA.
| | - Briana R Flaherty
- Department of Infectious Diseases, the University of Georgia, Athens, GA, USA; Center for Tropical and Emerging Global Diseases, the University of Georgia, Athens, GA, USA
| | - Charli E Cohen
- Department of Infectious Diseases, the University of Georgia, Athens, GA, USA
| | - David S Peterson
- Department of Infectious Diseases, the University of Georgia, Athens, GA, USA; Center for Tropical and Emerging Global Diseases, the University of Georgia, Athens, GA, USA
| | - Yiping Zhao
- Department of Physics and Astronomy, the University of Georgia, Athens, GA, USA; Nanoscale Science & Engineering Center, the University of Georgia, Athens, GA, USA
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Kasetsirikul S, Buranapong J, Srituravanich W, Kaewthamasorn M, Pimpin A. The development of malaria diagnostic techniques: a review of the approaches with focus on dielectrophoretic and magnetophoretic methods. Malar J 2016; 15:358. [PMID: 27405995 PMCID: PMC4942956 DOI: 10.1186/s12936-016-1400-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
The large number of deaths caused by malaria each year has increased interest in the development of effective malaria diagnoses. At the early-stage of infection, patients show non-specific symptoms or are asymptomatic, which makes it difficult for clinical diagnosis, especially in non-endemic areas. Alternative diagnostic methods that are timely and effective are required to identify infections, particularly in field settings. This article reviews conventional malaria diagnostic methods together with recently developed techniques for both malaria detection and infected erythrocyte separation. Although many alternative techniques have recently been proposed and studied, dielectrophoretic and magnetophoretic approaches are among the promising new techniques due to their high specificity for malaria parasite-infected red blood cells. The two approaches are discussed in detail, including their principles, types, applications and limitations. In addition, other recently developed techniques, such as cell deformability and morphology, are also overviewed in this article.
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Affiliation(s)
- Surasak Kasetsirikul
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Jirayut Buranapong
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Werayut Srituravanich
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Morakot Kaewthamasorn
- Animal Vector-Borne Diseases Research Group, The Veterinary Parasitology Unit, Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Alongkorn Pimpin
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand.
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Lukianova-Hleb E, Bezek S, Szigeti R, Khodarev A, Kelley T, Hurrell A, Berba M, Kumar N, D'Alessandro U, Lapotko D. Transdermal Diagnosis of Malaria Using Vapor Nanobubbles. Emerg Infect Dis 2016; 21:1122-7. [PMID: 26079141 PMCID: PMC4480396 DOI: 10.3201/eid2107.150089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Our laser device rapidly and noninvasively detected malaria in a patient and identified parasite-positive mosquitoes. A fast, precise, noninvasive, high-throughput, and simple approach for detecting malaria in humans and mosquitoes is not possible with current techniques that depend on blood sampling, reagents, facilities, tedious procedures, and trained personnel. We designed a device for rapid (20-second) noninvasive diagnosis of Plasmodium falciparum infection in a malaria patient without drawing blood or using any reagent. This method uses transdermal optical excitation and acoustic detection of vapor nanobubbles around intraparasite hemozoin. The same device also identified individual malaria parasite–infected Anopheles mosquitoes in a few seconds and can be realized as a low-cost universal tool for clinical and field diagnoses.
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Towards ultrasensitive malaria diagnosis using surface enhanced Raman spectroscopy. Sci Rep 2016; 6:20177. [PMID: 26858127 PMCID: PMC4746575 DOI: 10.1038/srep20177] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/23/2015] [Indexed: 01/03/2023] Open
Abstract
We report two methods of surface enhanced Raman spectroscopy (SERS) for hemozoin detection in malaria infected human blood. In the first method, silver nanoparticles were synthesized separately and then mixed with lysed blood; while in the second method, silver nanoparticles were synthesized directly inside the parasites of Plasmodium falciparum. It was observed that the first method yields a smaller variation in SERS measurements and stronger correlation between the estimated contribution of hemozoin and the parasitemia level, which is preferred for the quantification of the parasitemia level. In contrast, the second method yields a higher sensitivity to a low parasitemia level thus could be more effective in the early malaria diagnosis to determine whether a given blood sample is positive.
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Ishmukhametov RR, Russell AN, Wheeler RJ, Nord AL, Berry RM. A Simple low-cost device enables four epi-illumination techniques on standard light microscopes. Sci Rep 2016; 6:20729. [PMID: 26853732 PMCID: PMC4745110 DOI: 10.1038/srep20729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/11/2016] [Indexed: 12/02/2022] Open
Abstract
Back-scattering darkfield (BSDF), epi-fluorescence (EF), interference reflection contrast (IRC), and darkfield surface reflection (DFSR) are advanced but expensive light microscopy techniques with limited availability. Here we show a simple optical design that combines these four techniques in a simple low-cost miniature epi-illuminator, which inserts into the differential interference-contrast (DIC) slider bay of a commercial microscope, without further additions required. We demonstrate with this device: 1) BSDF-based detection of Malarial parasites inside unstained human erythrocytes; 2) EF imaging with and without dichroic components, including detection of DAPI-stained Leishmania parasite without using excitation or emission filters; 3) RIC of black lipid membranes and other thin films, and 4) DFSR of patterned opaque and transparent surfaces. We believe that our design can expand the functionality of commercial bright field microscopes, provide easy field detection of parasites and be of interest to many users of light microscopy.
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Affiliation(s)
- Robert R Ishmukhametov
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Aidan N Russell
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Richard J Wheeler
- The Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Ashley L Nord
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Richard M Berry
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
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Rapid Point-of-Care Diagnosis of Malaria and Dengue Infection. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hemozoin Detection for Human Malaria Diagnosis Investigated in Rodent Models: How Similar Is Similar? Trends Parasitol 2015; 32:94-96. [PMID: 26704075 DOI: 10.1016/j.pt.2015.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 01/09/2023]
Abstract
New malaria diagnostic methods based on hemozoin (Hz) detection have been reported recently and were investigated in rodent models. These models are likely to produce unduly favorable results compared to the reality of Plasmodium falciparum malaria. Thus, for malaria diagnostics, results from rodent malaria experiments must be interpreted with caution.
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Bell D, Wilson BK. New Malaria Tests: Square Pegs for Round Holes? Trends Parasitol 2015; 31:612-613. [PMID: 26597021 DOI: 10.1016/j.pt.2015.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
To eradicate malaria new technologies are needed, not least in the detection of parasites. However, malaria program implementation is complex, and solutions that appear obvious fit less well on close inspection. Understanding the gaps in current programs is essential to selecting approaches likely to transition successfully to the field.
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Affiliation(s)
- David Bell
- The Global Good Fund, Intellectual Ventures Laboratory, 3150 139th Ave SE, Bellevue, WA 98005, USA.
| | - Benjamin K Wilson
- The Global Good Fund, Intellectual Ventures Laboratory, 3150 139th Ave SE, Bellevue, WA 98005, USA
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Rebelo M, Tempera C, Bispo C, Andrade C, Gardner R, Shapiro HM, Hänscheid T. Light depolarization measurements in malaria: A new job for an old friend. Cytometry A 2015; 87:437-45. [PMID: 25808846 DOI: 10.1002/cyto.a.22659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 02/27/2015] [Indexed: 12/15/2022]
Abstract
The use of flow cytometry in malaria research has increased over the last decade. Most approaches use nucleic acid stains to detect parasite DNA and RNA and require complex multi-color, multi-parameter analysis to reliably detect infected red blood cells (iRBCs). We recently described a novel and simpler approach to parasite detection based on flow cytometric measurement of scattered light depolarization caused by hemozoin (Hz), a pigment formed by parasite digestion of hemoglobin in iRBCs. Depolarization measurement by flow cytometry was described in 1987; however, patent issues restricted its use to a single manufacturer's hematology analyzers until 2009. Although we recently demonstrated that depolarization measurement of Hz, easily implemented on a bench top flow cytometer (Cyflow), provided useful information for malaria work, doubts regarding its application and utility remain in both the flow cytometry and malaria communities, at least in part because instrument manufacturers do not offer the option of measuring depolarized scatter. Under such circumstances, providing other researchers with guidance as to how to do this seemed to offer the most expeditious way to resolve the issue. We accordingly examined how several commercially available flow cytometers (CyFlow SL, MoFLo, Attune and Accuri C6) could be modified to detect depolarization due to the presence of free Hz on solution, or of Hz in leukocytes or erythrocytes from rodent or human blood. All were readily adapted, with substantially equivalent results obtained with lasers emitting over a wide wavelength range. Other instruments now available may also be modifiable for Hz measurement. Cytometric detection of Hz using depolarization is useful to study different aspects of malaria. Adding additional parameters, such as DNA content and base composition and RNA content, can demonstrably provide improved accuracy and sensitivity of parasite detection and characterization, allowing malaria researchers and eventually clinicians to benefit from cytometric technology.
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Affiliation(s)
- Maria Rebelo
- Molecular Microbiology and Infection Unit, Instituto De Medicina Molecular, Faculdade De Medicina, Lisbon, Portugal
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