1
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Srinivasan R, Eugene Christo VR, Nambannor Kunnath R, Katare P, Venukumar A, Nambison NKM, Gorthi SS. Optical absorbance-based rapid test for the detection of sickle cell trait and sickle cell disease at the point-of-care. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 279:121394. [PMID: 35660146 DOI: 10.1016/j.saa.2022.121394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
People afflicted with sickle cell disease (SCD) experience severe deterioration in quality of life. The disease is characterized by debilitating pain, anemia, and increased susceptibility to life threatening infections. This genetic disorder is endemic to many parts of the world. Extensive and accurate screening of individuals with sickle cell trait (SCT) in the population, coupled with genetic counselling can inhibit the propagation of the disease. The gold-standard techniques for the detection of sickle hemoglobin, such as capillary electrophoresis, HPLC, and genetic testing, are prohibitively expensive and time-consuming. Mass screening is usually conducted with a low-cost test called the solubility test, which does not offer high specificity. This study proposes a game-changing single-step low-cost method for rapidly yet accurately screening and diagnosing SCD and SCT. This method relies on the hitherto unexplored differences in the optical absorbance between diseased, trait, and normal blood samples, under deoxygenated conditions. The proposed method was tested in two phases of clinical validation: a pilot study and a blind study. A total of 438 patient samples were tested using the proposed method across the two phases. The proposed method offers an average accuracy, sensitivity, and specificity of 97.6%, 96.9%, and 98.6%, respectively. The proposed test has the potential to obliviate the conventional two-step process of screening and diagnostic tests as it can be used at the point-of-care with minimal training and yet yield results reliable enough to assess disability benefit claims.
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Affiliation(s)
- Rajesh Srinivasan
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
| | - V R Eugene Christo
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
| | | | - Prateek Katare
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
| | - Aravind Venukumar
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
| | - Nisanth K M Nambison
- Government Homeopathic Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Sai Siva Gorthi
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India.
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2
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Euliano EM, Sklavounos AA, Wheeler AR, McHugh KJ. Translating diagnostics and drug delivery technologies to low-resource settings. Sci Transl Med 2022; 14:eabm1732. [PMID: 36223447 PMCID: PMC9716722 DOI: 10.1126/scitranslmed.abm1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Diagnostics and drug delivery technologies engineered for low-resource settings aim to meet their technical design specifications using strategies that are compatible with limited equipment, infrastructure, and operator training. Despite many preclinical successes, very few of these devices have been translated to the clinic. Here, we identify factors that contribute to the clinical success of diagnostics and drug delivery systems for low-resource settings, including the need to engage key stakeholders at an early stage, and provide recommendations for the clinical translation of future medical technologies.
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Affiliation(s)
- Erin M. Euliano
- Department of Bioengineering, Rice University; Houston, Texas 77005, USA
| | - Alexandros A. Sklavounos
- Department of Chemistry, University of Toronto; Toronto, Ontario M5S 3H6, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto; Toronto, Ontario M5S 3E1, Canada
| | - Aaron R. Wheeler
- Department of Chemistry, University of Toronto; Toronto, Ontario M5S 3H6, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto; Toronto, Ontario M5S 3E1, Canada
- Institute of Biomedical Engineering, University of Toronto; Toronto, Ontario M5S 3G9, Canada
| | - Kevin J. McHugh
- Department of Bioengineering, Rice University; Houston, Texas 77005, USA
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3
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Doan-Nguyen TP, Crespy D. Advanced density-based methods for the characterization of materials, binding events, and kinetics. Chem Soc Rev 2022; 51:8612-8651. [PMID: 36172819 DOI: 10.1039/d1cs00232e] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Investigations of the densities of chemicals and materials bring valuable insights into the fundamental understanding of matter and processes. Recently, advanced density-based methods have been developed with wide measurement ranges (i.e. 0-23 g cm-3), high resolutions (i.e. 10-6 g cm-3), compatibility with different types of samples and the requirement of extremely low volumes of sample (as low as a single cell). Certain methods, such as magnetic levitation, are inexpensive, portable and user-friendly. Advanced density-based methods are, therefore, beneficially used to obtain absolute density values, composition of mixtures, characteristics of binding events, and kinetics of chemical and biological processes. Herein, the principles and applications of magnetic levitation, acoustic levitation, electrodynamic balance, aqueous multiphase systems, and suspended microchannel resonators for materials science are discussed.
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Affiliation(s)
- Thao P Doan-Nguyen
- Max Planck-VISTEC Partner Laboratory for Sustainable Materials, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand. .,Department of Materials Science and Engineering, School of Molecular Science and Engineering, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand
| | - Daniel Crespy
- Max Planck-VISTEC Partner Laboratory for Sustainable Materials, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand. .,Department of Materials Science and Engineering, School of Molecular Science and Engineering, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand
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4
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Kawooya I, Kayongo E, Munube D, Mijumbi-Deve R, Elliott S, Vandermeer B, Sewankambo N. Point-of-care diagnostic tests for sickle cell disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd014584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ismael Kawooya
- The Center for Rapid Evidence Synthesis; Makerere University, College of Health Sciences; Kampala Uganda
| | - Edward Kayongo
- Pharmacy Department; Case Western Reserve University Uganda Collaboration; Kampala Uganda
| | - Deogratias Munube
- Department of Paediatrics and Child Health; Makerere University, College of Health Sciences; Kampala Uganda
| | - Rhona Mijumbi-Deve
- Center for Rapid Evidence Synthesis; Makerere University, College of Health Sciences; Kampala Uganda
| | - Sarah Elliott
- Cochrane Child Health, Department of Pediatrics; University of Alberta; Edmonton Canada
| | - Ben Vandermeer
- Department of Pediatrics and the Alberta Research Centre for Health Evidence; University of Alberta; Edmonton Canada
| | - Nelson Sewankambo
- School of Medicine; Makerere University College of Health Sciences; Kampala Uganda
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5
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Katamea T, Mukuku O, Mpoy CW, Mutombo AK, Luboya ON, Wembonyama SO. Factors Associated with Acceptability of Newborn Screening for Sickle Cell Disease in Lubumbashi City, Democratic Republic of the Congo. GLOBAL JOURNAL OF MEDICAL, PHARMACEUTICAL, AND BIOMEDICAL UPDATE 2022. [DOI: 10.25259/gjmpbu_7_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective:
Sickle cell disease (SCD) is a major genetic disease that occurs early in childhood and can cause considerable morbidity and even death. Newborn screening (NBS) is one of the effective health services that have lowered the burden of SCD in wealthy countries. Surprisingly, NBS programs are essentially non-existent in subSaharan Africa, where the majority of babies are born with this condition. The objective of this study was to determine the level of acceptability of NBS and the factors influencing it in the population of Lubumbashi city in the Democratic Republic of the Congo.
Material and Methods:
From December 1, 2020, to December 31, 2020, data on sociodemographic characteristics, knowledge, and attitudes related to NBS for SCD were collected from 2032 adults in Lubumbashi city using a semi-structured and pre-tested questionnaire.
Results:
There was a good knowledge of SCD as a hereditary blood disorder (77.7%). NBS’s acceptability rate was 84.5%. Age (P = 0.002), sex (P = 0.025), and religion (p<0.001) were found to be significantly associated with the NBS acceptability.
Conclusion:
According to the findings of this study, NBS is widely accepted in Lubumbashi. The primary challenges to its adoption are likely to be financial and practical rather than social or cultural.
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Affiliation(s)
- Tina Katamea
- Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, the Democratic Republic of the Congo,
| | - Olivier Mukuku
- Department of Maternal and Child Health, Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, the Democratic Republic of the Congo,
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, the Democratic Republic of the Congo,
| | - André Kabamba Mutombo
- Department of Pediatrics, Faculty of Medicine, Official University of Mbujimayi, Mbuji-Mayi, the Democratic Republic of the Congo,
| | - Oscar Numbi Luboya
- Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, the Democratic Republic of the Congo,
| | - Stanislas Okitotsho Wembonyama
- Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, the Democratic Republic of the Congo,
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6
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An R, Man Y, Iram S, Kucukal E, Hasan MN, Huang Y, Goreke U, Bode A, Hill A, Cheng K, Sekyonda Z, Ahuja SP, Little JA, Hinczewski M, Gurkan UA. Point-of-care microchip electrophoresis for integrated anemia and hemoglobin variant testing. LAB ON A CHIP 2021; 21:3863-3875. [PMID: 34585199 PMCID: PMC9714341 DOI: 10.1039/d1lc00371b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anemia affects over 25% of the world's population with the heaviest burden borne by women and children. Genetic hemoglobin (Hb) variants, such as sickle cell disease, are among the major causes of anemia. Anemia and Hb variant are pathologically interrelated and have an overlapping geographical distribution. We present the first point-of-care (POC) platform to perform both anemia detection and Hb variant identification, using a single paper-based electrophoresis test. Feasibility of this new integrated diagnostic approach is demonstrated via testing individuals with anemia and/or sickle cell disease. Hemoglobin level determination is performed by an artificial neural network (ANN) based machine learning algorithm, which achieves a mean absolute error of 0.55 g dL-1 and a bias of -0.10 g dL-1 against the gold standard (95% limits of agreement: 1.5 g dL-1) from Bland-Altman analysis on the test set. Resultant anemia detection is achieved with 100% sensitivity and 92.3% specificity. With the same tests, subjects with sickle cell disease were identified with 100% sensitivity and specificity. Overall, the presented platform enabled, for the first time, integrated anemia detection and hemoglobin variant identification using a single point-of-care test.
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Affiliation(s)
- Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Shamreen Iram
- Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Muhammad Noman Hasan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Yuning Huang
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Ailis Hill
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Kevin Cheng
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Sanjay P Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Hinczewski
- Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
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7
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Brown CD, Aprelev AM, Aliprando M, Harkness EA, Ferrone FA. The flow of sickle blood in glass capillaries: Fundamentals and potential applications. Biophys J 2021; 120:2138-2147. [PMID: 33861996 PMCID: PMC8390806 DOI: 10.1016/j.bpj.2021.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
We have characterized the imbibed horizontal flow of sickle blood into 100-μm-diameter glass capillaries. We find that blood containing sickled cells typically traverses the capillaries between three and four times as slowly as oxygenated cells from the same patient for all genotypes tested, including SS, AS, SC and Sβ+ thalassemia blood. Blood from SS patients treated with hydroxyurea has a viscosity intermediate between the SS and AA values. Blood containing cells that are not rigidified, such as normal red cells or oxygenated sickle cells, follows a simple Lucas-Washburn flow throughout the length of the 3-cm capillary. By fitting the flexible-cell data to the Lucas-Washburn model, a viscosity can be derived that is in good agreement with previous measurements over a range of volume fractions and is obtained using an apparatus that is far more complex. Deoxygenation sickles and thus rigidifies the cells, and their flow begins as Lucas-Washburn, albeit with higher viscosity than flexible cells. However, the flow further slows as a dense mass of cells forms behind the meniscus and increases in length as flow progresses. By assuming that the dense mass of cells exerts a frictional force proportional to its length, we derive an equation that is formally equivalent to vertical imbibition, even though the flow is horizontal, and this equation reproduces the observed behavior well. We present a simple theory using activity coefficients that accounts for this viscosity and its variation without adjustable parameters. In the course of control experiments, we have found that deoxygenation increases the flexibility of normal human red cells, an observation only recently published for mouse cells and previously unreported for human erythrocytes. Together, these studies form the foundation for an inexpensive and rapid point-of-care device to diagnose sickle cell disease or to determine blood viscosity in resource-challenged settings.
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Affiliation(s)
| | - Alexey M Aprelev
- Department of Physics, Drexel University, Philadelphia, Pennsylvania
| | - Maura Aliprando
- Department of Physics, Drexel University, Philadelphia, Pennsylvania
| | - Emily A Harkness
- Department of Physics, Drexel University, Philadelphia, Pennsylvania
| | - Frank A Ferrone
- Department of Physics, Drexel University, Philadelphia, Pennsylvania.
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8
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Techniques for the Detection of Sickle Cell Disease: A Review. MICROMACHINES 2021; 12:mi12050519. [PMID: 34063111 PMCID: PMC8148117 DOI: 10.3390/mi12050519] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
Sickle cell disease (SCD) is a widespread disease caused by a mutation in the beta-globin gene that leads to the production of abnormal hemoglobin called hemoglobin S. The inheritance of the mutation could be homozygous or heterozygous combined with another hemoglobin mutation. SCD can be characterized by the presence of dense, sickled cells that causes hemolysis of blood cells, anemia, painful episodes, organ damage, and in some cases death. Early detection of SCD can help to reduce the mortality and manage the disease effectively. Therefore, different techniques have been developed to detect the sickle cell disease and the carrier states with high sensitivity and specificity. These techniques can be screening tests such as complete blood count, peripheral blood smears, and sickling test; confirmatory tests such as hemoglobin separation techniques; and genetic tests, which are more expensive and need to be done in centralized labs by highly skilled personnel. However, advanced portable point of care techniques have been developed to provide a low-cost, simple, and user-friendly device for detecting SCD, for instance coupling solubility tests with portable devices, using smartphone microscopic classifications, image processing techniques, rapid immunoassays, and sensor-based platforms. This review provides an overview of the current and emerging techniques for sickle cell disease detection and highlights the different potential methods that could be applied to help the early diagnosis of SCD.
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9
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Evaluation of Paper-Based Point of Care Screening Test for Sickle Cell Disease. Indian J Clin Biochem 2021; 37:185-191. [PMID: 35463103 PMCID: PMC8993980 DOI: 10.1007/s12291-021-00962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
The aim of the study is to evaluate the stability and longevity of the paper-based screening test for the sickle cell disease in relation to different temperatures and storage time. Blood stain patterns were interpreted after spotting the blood-buffer mixture (phosphate buffer, saponin and sodium metabisulfite) on chromatographic paper (Whatman no. 3). The stability of the buffer was tested after keeping the buffer at different temperature for 24 h. Longevity of the buffer was tested post storage for various time intervals. Test indicated reproducibility with the buffer stored at 4°C. The 15% metabisulfite buffer was found to be stable up to 180 days at 4°C and showed accurate identification of all genotypes. The tests revealed 100% sensitivity and 100% specificity in identification of HbS. However, the sensitivity of differentiation between sickle cell trait (AS) with disease (SS) was found to be 97.7% with 100% specificity. The paper-based screening test may be used as a method of choice for the screening of sickle cell anemia in community-based screening programs. The low-cost, rapid, and accurate point of care testing tools offer an avenue for effective screening in developing nations.
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10
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Ilyas S, Sher M, Du E, Asghar W. Smartphone-based sickle cell disease detection and monitoring for point-of-care settings. Biosens Bioelectron 2020; 165:112417. [PMID: 32729535 PMCID: PMC7484220 DOI: 10.1016/j.bios.2020.112417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022]
Abstract
Sickle cell disease (SCD) is a worldwide hematological disorder causing painful episodes, anemia, organ damage, stroke, and even deaths. It is more common in sub-Saharan Africa and other resource-limited countries. Conventional laboratory-based diagnostic methods for SCD are time-consuming, complex, and cannot be performed at point-of-care (POC) and home settings. Optical microscope-based classification and counting demands a significant amount of time, extensive setup, and cost along with the skilled human labor to distinguish the normal red blood cells (RBCs) from sickled cells. There is an unmet need to develop a POC and home-based test to diagnose and monitor SCD and reduce mortality in resource-limited settings. An early-stage and timely diagnosis of SCD can help in the effective management of the disease. In this article, we utilized a smartphone-based image acquisition method for capturing RBC images from the SCD patients in normoxia and hypoxia conditions. A computer algorithm is developed to differentiate RBCs from the patient's blood before and after cell sickling. Using the developed smartphone-based technique, we obtained similar percentage of sickle cells in blood samples as analyzed by conventional method (standard microscope). The developed method of testing demonstrates the potential utility of the smartphone-based test for reducing the overall cost of screening and management for SCD, thus increasing the practicality of smartphone-based screening technique for SCD in low-resource settings. Our setup does not require any special storage requirements. This is the characteristic advantage of our technique as compared to other hemoglobin-based POC diagnostic techniques.
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Affiliation(s)
- Shazia Ilyas
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA; Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA
| | - Mazhar Sher
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA; Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA
| | - E Du
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL, 33431, USA; Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Waseem Asghar
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA; Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA; Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL, 33431, USA.
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11
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Ashkarran AA, Mahmoudi M. Magnetic Levitation Systems for Disease Diagnostics. Trends Biotechnol 2020; 39:311-321. [PMID: 32861547 DOI: 10.1016/j.tibtech.2020.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Abstract
Magnetic levitation (MagLev) is a well-documented, robust technique for density measurements and separations. Although the potential of MagLev as an emerging tool in biotechnology has been recently investigated, the practical use of MagLev in diagnosis and disease detection merits further attention. This review highlights the diagnostic capacity of a simple and portable MagLev system and the possibilities and limitations of the MagLev technique for density-based separation, classification, and manipulation of soft matter and biological systems (e.g., cells, proteins), which in turn may pave the way for the discovery of disease-specific biomarkers.
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Affiliation(s)
- Ali Akbar Ashkarran
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, MI, USA
| | - Morteza Mahmoudi
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, MI, USA.
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12
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Ge S, Nemiroski A, Mirica KA, Mace CR, Hennek JW, Kumar AA, Whitesides GM. Magnetic Levitation in Chemistry, Materials Science, and Biochemistry. Angew Chem Int Ed Engl 2020; 59:17810-17855. [PMID: 31165560 DOI: 10.1002/anie.201903391] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Indexed: 12/25/2022]
Abstract
All matter has density. The recorded uses of density to characterize matter date back to as early as ca. 250 BC, when Archimedes was believed to have solved "The Puzzle of The King's Crown" using density.[1] Today, measurements of density are used to separate and characterize a range of materials (including cells and organisms), and their chemical and/or physical changes in time and space. This Review describes a density-based technique-magnetic levitation (which we call "MagLev" for simplicity)-developed and used to solve problems in the fields of chemistry, materials science, and biochemistry. MagLev has two principal characteristics-simplicity, and applicability to a wide range of materials-that make it useful for a number of applications (for example, characterization of materials, quality control of manufactured plastic parts, self-assembly of objects in 3D, separation of different types of biological cells, and bioanalyses). Its simplicity and breadth of applications also enable its use in low-resource settings (for example-in economically developing regions-in evaluating water/food quality, and in diagnosing disease).
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Affiliation(s)
- Shencheng Ge
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA
| | - Alex Nemiroski
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA
| | - Katherine A Mirica
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA
| | - Charles R Mace
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA
| | - Jonathan W Hennek
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA
| | - Ashok A Kumar
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA
| | - George M Whitesides
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA, 02138, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, 60 Oxford Street, Cambridge, MA, 02138, USA.,Kavli Institute for Bionano Science & Technology, Harvard University, 29 Oxford Street, Cambridge, MA, 02138, USA
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13
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Ge S, Nemiroski A, Mirica KA, Mace CR, Hennek JW, Kumar AA, Whitesides GM. Magnetische Levitation in Chemie, Materialwissenschaft und Biochemie. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.201903391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Shencheng Ge
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - Alex Nemiroski
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - Katherine A. Mirica
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - Charles R. Mace
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - Jonathan W. Hennek
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - Ashok A. Kumar
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - George M. Whitesides
- Department of Chemistry & Chemical Biology Harvard University 12 Oxford Street Cambridge MA 02138 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University 60 Oxford Street Cambridge MA 02138 USA
- Kavli Institute for Bionano Science & Technology Harvard University 29 Oxford Street Cambridge MA 02138 USA
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14
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Morandeira L, Sanromán MÁ, Rodríguez A, Deive FJ. Setting the Foundations of Aqueous Three-Phase Systems (A3PS) in the Quest for a Rational Design. Chemphyschem 2019; 20:3311-3321. [PMID: 31654452 DOI: 10.1002/cphc.201900900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/21/2019] [Indexed: 11/06/2022]
Abstract
This work presents the first in-depth study of Aqueous Three-Phase Systems (A3PS) with the main purpose of unveiling their behaviour, hence contributing to the development of this new field. Thus, a complete definition of a quaternary system was carried through by describing all the regions in detail to represent them later on in a regular-tetrahedral diagram. The three aqueous faces of the tetrahedron demonstrated an undeviating influence in the segregation capacity. Furthermore, a method for comparing Aqueous Biphasis Systems (ABS) immiscibilities was set up in order to allow the evaluation and detection of the "limiting ABS" for the three-phase region. Finally, all this information was compiled and utilised to obtain a new strategy for an A3PS rational design, which can be applied with ABS libraries or in an experimental approach. In this sense, this strategy represents an undoubted advance towards future studies and development of A3PS, as this sequential application of the constructed knowledge is assumed to save time and resources.
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Affiliation(s)
- Lois Morandeira
- Department of Chemical Engineering, University of Vigo, 36310, Vigo, Spain
| | - M Ángeles Sanromán
- Department of Chemical Engineering, University of Vigo, 36310, Vigo, Spain
| | - Ana Rodríguez
- Department of Chemical Engineering, University of Vigo, 36310, Vigo, Spain
| | - Francisco J Deive
- Department of Chemical Engineering, University of Vigo, 36310, Vigo, Spain
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15
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Application of a public health strategy to large-scale point-of-care screening for sickle cell disease in rural sub-Saharan Africa. Blood Adv 2019; 2:1-3. [PMID: 30504185 DOI: 10.1182/bloodadvances.2018gs112321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Mandu K, Tusuubira SK, Mwambi B, Webbo F, Atuhairwe C, Taremwa IM. To test or not: occurrence of sickle cell trait and assessment of the awareness toward its screening among patients attending Magale Health Center IV, Namisindwa District, Eastern Uganda. J Blood Med 2018; 9:219-225. [PMID: 30538594 PMCID: PMC6254498 DOI: 10.2147/jbm.s177203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the occurrence of sickle cell trait (SCT), assess patient awareness and evaluate the performance of a sickle cell hemoglobin-S (dithionate-qualitative solubility) point-of-care test among patients seeking care at Magale Health Center IV, Namisindwa District, Eastern Uganda. MATERIALS AND METHODS We conducted a cross sectional study, in which we consecutively enrolled participants aged ≥18 years at Magale Health Center IV. Four milliliters of EDTA blood were collected by venipuncture and screened for SCT using solubility testing, and confirmed with hemoglobin (Hb) electrophoresis at Central Public Health Laboratory (CPHL), Kampala, Uganda. A structured questionnaire was used to assess participants' awareness of SCT. Data were presented as proportion, and measurements of diagnostic test performance were calculated. RESULTS We enrolled 242 participants, of these 58.7% (N = 142) were females. Their mean age was 26.4 years (range 18-49). Of the 242 participants, 11, who represent 4.5% (95% CI: 3.3-5.9), tested positive. The sensitivity, specificity, positive predictive value and negative predictive value of the rapid sickle cell test were 63.64%, 100%, 100% and 98.30%, respectively. There was knowledge gap regarding sickle cell awareness. CONCLUSION The occurrence of SCT was high, and the point-of-care test showed a high diagnostic reliability. The risk of SCT is associated with genetic predisposition as indicated by Hb electrophoresis. Community sensitization is key to avert the associated risk of Hb defects.
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Affiliation(s)
- Keneth Mandu
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda,
| | - Sharifu K Tusuubira
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda,
- Uganda Sickle Cell Rescue Foundation, Kampala, Uganda
| | - Bashir Mwambi
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda,
| | | | - Christine Atuhairwe
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Ivan Mugisha Taremwa
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda,
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17
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Hsu L, Nnodu OE, Brown BJ, Tluway F, King S, Dogara LG, Patil C, Shevkoplyas SS, Lettre G, Cooper RS, Gordeuk VR, Tayo BO. White Paper: Pathways to Progress in Newborn Screening for Sickle Cell Disease in Sub-Saharan Africa. JOURNAL OF TROPICAL DISEASES & PUBLIC HEALTH 2018; 6:260. [PMID: 30505949 PMCID: PMC6261323 DOI: 10.4172/2329-891x.1000260] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sickle Cell Disease (SCD) is among the most common single-gene diseases in the world but evidence-based comprehensive health care has not been implemented where the highest prevalence of SCD occurs, in sub-Saharan Africa (SSA). It represents an urgent health burden, both in terms of mortality and morbidity with an estimated mortality of 8-16% in children under 5 years in SSA. Addressing the high mortality of SCD in SSA and for effective management of SCD, newborn screening (NBS) should be incorporated with prevention of infections (including pneumococcal septicaemia and malaria), parental education and support at all levels of healthcare provision to enable timely recognition. The NBS working group of the Africa Sickle Cell Research Network (AfroSickleNet) collaboration surveyed current projects in NBS in SSA, and current conditions that hinder more widespread implementation of NBS for SCD. Solutions based on new point-of-care testing technology to disseminate education, and implementation science approaches that leverage existing resources are proposed.
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Affiliation(s)
- Lewis Hsu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Obiageli E. Nnodu
- Department of Hematology and Blood Transfusion, University of Abuja, Abuja, Nigeria
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Biobele J. Brown
- Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Furahini Tluway
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania
| | - Shonda King
- Department of Health Social Work, University of Illinois Hospital and Health Sciences Systems, Chicago, IL, USA
| | - Livingstone G. Dogara
- Department of Hematology and Blood Transfusion, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Crystal Patil
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | | | | | - Richard S. Cooper
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Bamidele O. Tayo
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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18
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Ganesh Kumar B, Melikov R, Mohammadi Aria M, Ural Yalcin A, Begar E, Sadeghi S, Guven K, Nizamoglu S. Silk-Based Aqueous Microcontact Printing. ACS Biomater Sci Eng 2018; 4:1463-1470. [PMID: 29911181 PMCID: PMC5997385 DOI: 10.1021/acsbiomaterials.8b00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/07/2018] [Indexed: 12/19/2022]
Abstract
Lithography, the transfer of patterns to a film or substrate, is the basis by which many modern technological devices and components are produced. However, established lithographic approaches generally use complex techniques, expensive equipment, and advanced materials. Here, we introduce a water-based microcontact printing method using silk that is simple, inexpensive, ecofriendly, and recyclable. Whereas the traditional microcontact printing technique facilitates only negative lithography, the synergetic interaction of the silk, water, and common chemicals in our technique enables both positive and negative patterning using a single stamp. Among diverse application possibilities, we exemplify a proof of concept of the method through optimizing its metal lift-off process and demonstrate the fabrication of electromagnetic metamaterial elements on both solid and flexible substrates. The results indicate that the method demonstrated herein is universally applicable to device production and technology development.
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Affiliation(s)
- Baskaran Ganesh Kumar
- Department
of Electrical and Electronics Engineering, Koc University, Istanbul 34450, Turkey
| | - Rustamzhon Melikov
- Department
of Electrical and Electronics Engineering, Koc University, Istanbul 34450, Turkey
| | | | | | - Efe Begar
- Department
of Molecular Biology and Genetics, Koc University, Istanbul 34450, Turkey
| | - Sadra Sadeghi
- Graduate
School of Material Science and Engineering, Koc University, Istanbul 34450, Turkey
| | - Kaan Guven
- Department
of Physics, Koc University, Istanbul 34450, Turkey
| | - Sedat Nizamoglu
- Department
of Electrical and Electronics Engineering, Koc University, Istanbul 34450, Turkey
- Graduate
School of Biomedical Engineering, Koc University, Istanbul 34450, Turkey
- Graduate
School of Material Science and Engineering, Koc University, Istanbul 34450, Turkey
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19
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A modular, open-source, slide-scanning microscope for diagnostic applications in resource-constrained settings. PLoS One 2018; 13:e0194063. [PMID: 29543835 PMCID: PMC5854341 DOI: 10.1371/journal.pone.0194063] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/24/2018] [Indexed: 12/20/2022] Open
Abstract
In this paper we report the development of a cost-effective, modular, open source, and fully automated slide-scanning microscope, composed entirely of easily available off-the-shelf parts, and capable of bright field and fluorescence modes. The automated X-Y stage is composed of two low-cost micrometer stages coupled to stepper motors operated in open-loop mode. The microscope is composed of a low-cost CMOS sensor and low-cost board lenses placed in a 4f configuration. The system has approximately 1 micron resolution, limited by the f/# of available board lenses. The microscope is compact, measuring just 25×25×30 cm, and has an absolute positioning accuracy of ±1 μm in the X and Y directions. A Z-stage enables autofocusing and imaging over large fields of view even on non-planar samples, and custom software enables automatic determination of sample boundaries and image mosaicking. We demonstrate the utility of our device through imaging of fluorescent- and transmission-dye stained blood and fecal smears containing human and animal parasites, as well as several prepared tissue samples. These results demonstrate image quality comparable to high-end commercial microscopes at a cost of less than US$400 for a bright-field system, with an extra US$100 needed for the fluorescence module.
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20
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Simultaneous point-of-care detection of anemia and sickle cell disease in Tanzania: the RAPID study. Ann Hematol 2017; 97:239-246. [PMID: 29147848 DOI: 10.1007/s00277-017-3182-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/09/2017] [Indexed: 12/24/2022]
Abstract
Both anemia and sickle cell disease (SCD) are highly prevalent across sub-Saharan Africa, and limited resources exist to diagnose these conditions quickly and accurately. The development of simple, inexpensive, and accurate point-of-care (POC) assays represents an important advance for global hematology, one that could facilitate timely and life-saving medical interventions. In this prospective study, Robust Assays for Point-of-care Identification of Disease (RAPID), we simultaneously evaluated a POC immunoassay (Sickle SCAN™) to diagnose SCD and a first-generation POC color-based assay to detect anemia. Performed at Bugando Medical Center in Mwanza, Tanzania, RAPID tested 752 participants (age 1 day to 20 years) in four busy clinical locations. With minimally trained medical staff, the SCD POC assay diagnosed SCD with 98.1% sensitivity and 91.1% specificity. The hemoglobin POC assay had 83.2% sensitivity and 74.5% specificity for detection of severe anemia (Hb ≤ 7 g/dL). Interobserver agreement was excellent for both POC assays (r = 0.95-0.96). Results for the hemoglobin POC assay have informed the second-generation assay design to be more suitable for low-resource settings. RAPID provides practical feasibility data regarding two novel POC assays for the diagnosis of anemia and SCD in real-world field evaluations and documents the utility and potential impact of these POC assays for sub-Saharan Africa.
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21
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Kimani FW, Mwangi SM, Kwasa BJ, Kusow AM, Ngugi BK, Chen J, Liu X, Cademartiri R, Thuo MM. Rethinking the Design of Low-Cost Point-of-Care Diagnostic Devices. MICROMACHINES 2017; 8:E317. [PMID: 30400509 PMCID: PMC6190021 DOI: 10.3390/mi8110317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 01/09/2023]
Abstract
Reducing the global diseases burden requires effective diagnosis and treatment. In the developing world, accurate diagnosis can be the most expensive and time-consuming aspect of health care. Healthcare cost can, however, be reduced by use of affordable rapid diagnostic tests (RDTs). In the developed world, low-cost RDTs are being developed in many research laboratories; however, they are not being equally adopted in the developing countries. This disconnect points to a gap in the design philosophy, where parameterization of design variables ignores the most critical component of the system, the point-of-use stakeholders (e.g., doctors, nurses and patients). Herein, we demonstrated that a general focus on reducing cost (i.e., "low-cost"), rather than efficiency and reliability is misguided by the assumption that poverty reduces the value individuals place on their well-being. A case study of clinicians in Kenya showed that "zero-cost" is a low-weight parameter for point-of-use stakeholders, while reliability and standardization are crucial. We therefore argue that a user-driven, value-addition systems-engineering approach is needed for the design of RDTs to enhance adoption and translation into the field.
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Affiliation(s)
- Faith W Kimani
- Kiambu District Hospital, Kiambu 00900, Kenya.
- School of Public Health, Kenyatta University, Nairobi 00100, Kenya.
| | - Samuel M Mwangi
- School of Public Health, Kenyatta University, Nairobi 00100, Kenya.
- Department of Sociology, Kenyatta University, Nairobi 00100, Kenya.
| | - Benjamin J Kwasa
- Department of Aerospace Engineering, Iowa State University, Ames, IA 50011, USA.
| | - Abdi M Kusow
- Department of Sociology, Iowa State University, Ames, IA 00100, USA.
| | - Benjamin K Ngugi
- Department of Information Systems and Operations Management, Suffolk University, Boston, MA 02108, USA.
| | - Jiahao Chen
- Department of Material Science and Engineering, Iowa State University, Ames, IA 50011, USA.
| | - Xinyu Liu
- Department of Mechanical Engineering and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
| | - Rebecca Cademartiri
- Department of Mechanical Engineering and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
- Department of Chemical and Biological Engineering, Iowa State University, Ames, IA 50011, USA.
| | - Martin M Thuo
- Department of Mechanical Engineering and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
- Center for Bioplastics and Biocomposites (CB2), Iowa State University, Ames, IA 50011, USA.
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22
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Substituting Sodium Hydrosulfite with Sodium Metabisulfite Improves Long-Term Stability of a Distributable Paper-Based Test Kit for Point-of-Care Screening for Sickle Cell Anemia. BIOSENSORS-BASEL 2017; 7:bios7030039. [PMID: 28930183 PMCID: PMC5618045 DOI: 10.3390/bios7030039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/17/2022]
Abstract
Sickle cell anemia (SCA) is a genetic blood disorder that is particularly lethal in early childhood. Universal newborn screening programs and subsequent early treatment are known to drastically reduce under-five SCA mortality. However, in resource-limited settings, cost and infrastructure constraints limit the effectiveness of laboratory-based SCA screening programs. To address this limitation our laboratory previously developed a low-cost, equipment-free, point-of-care, paper-based SCA test. Here, we improved the stability and performance of the test by replacing sodium hydrosulfite (HS), a key reducing agent in the hemoglobin solubility buffer which is not stable in aqueous solutions, with sodium metabisulfite (MS). The MS formulation of the test was compared to the HS formulation in a laboratory setting by inexperienced users (n = 3), to determine visual limit of detection (LOD), readout time, diagnostic accuracy, intra- and inter-observer agreement, and shelf life. The MS test was found to have a 10% sickle hemoglobin LOD, 21-min readout time, 97.3% sensitivity and 99.5% specificity for SCA, almost perfect intra- and inter-observer agreement, at least 24 weeks of shelf stability at room temperature, and could be packaged into a self-contained, distributable test kits comprised of off-the-shelf disposable components and food-grade reagents with a total cost of only $0.21 (USD).
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23
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McGann PT, Hoppe C. The pressing need for point-of-care diagnostics for sickle cell disease: A review of current and future technologies. Blood Cells Mol Dis 2017; 67:104-113. [PMID: 28844459 DOI: 10.1016/j.bcmd.2017.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
Sickle cell disease (SCD) is a common and life threatening inherited blood disorder, affecting over 300,000 newborns per year. Over 75% of SCD births occur in sub-Saharan Africa, where the lack of timely and accurate diagnosis results in premature death within the first few years of life for a majority of affected infants. Current methods to diagnosis SCD require expensive laboratory equipment and reagents, and adequately trained laboratory personnel. In addition, test results are often delayed due to transport and batching of samples in a central laboratory. Financial and technical limitations often preclude any form of SCD laboratory testing at the local level in regions where SCD is most prevalent. There has been a recent surge of interest in addressing the global burden of SCD, including improving and optimizing diagnostic capacities. Largely stimulated by a funding opportunity from the NIH, several point-of-care diagnostics have been developed for SCD with a focus on developing devices that are inexpensive, simple, and practical in limited resource settings. In this manuscript, we review the global burden of SCA, including the rationale for the development of POC assays, and carefully review the POC devices currently in development.
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Affiliation(s)
- Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Carolyn Hoppe
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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24
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A Paper-Based Test for Screening Newborns for Sickle Cell Disease. Sci Rep 2017; 7:45488. [PMID: 28367971 PMCID: PMC5377336 DOI: 10.1038/srep45488] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/28/2017] [Indexed: 11/28/2022] Open
Abstract
The high cost, complexity and reliance on electricity, specialized equipment and supplies associated with conventional diagnostic methods limit the scope and sustainability of newborn screening for sickle cell disease (SCD) in sub-Saharan Africa and other resource-limited areas worldwide. Here we describe the development of a simple, low-cost, rapid, equipment- and electricity-free paper-based test capable of detecting sickle hemoglobin (HbS) in newborn blood samples with a limit of detection of 2% HbS. We validated this newborn paper-based test in a cohort of 159 newborns at an obstetric hospital in Cabinda, Angola. Newborn screening results using the paper-based test were compared to conventional isoelectric focusing (IEF). The test detected the presence of HbS with 81.8% sensitivity and 83.3% specificity, and identified SCD newborns with 100.0% sensitivity and 70.7% specificity. The use of the paper-based test in a two-stage newborn screening process could have excluded about 70% of all newborns from expensive confirmatory testing by IEF, without missing any of the SCD newborns in the studied cohort. This study demonstrates the potential utility of the newborn paper-based test for reducing the overall cost of screening newborns for SCD and thus increasing the practicality of universal newborn SCD screening programs in resource-limited settings.
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25
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Abbas JJ, Smith B, Poluta M, Velazquez-Berumen A. Improving health-care delivery in low-resource settings with nanotechnology: Challenges in multiple dimensions. Nanobiomedicine (Rij) 2017; 4:1849543517701158. [PMID: 29942391 PMCID: PMC5998261 DOI: 10.1177/1849543517701158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/07/2017] [Indexed: 01/07/2023] Open
Abstract
In the two decades after 1990, the rates of child and maternal mortality dropped by over 40% and 47%, respectively. Despite these improvements, which are in part due to increased access to medical technologies, profound health disparities exist. In 2015, a child born in a developing region is nearly eight times as likely to die before the age of 5 than one born in a developed region and developing regions accounted for nearly 99% of the maternal deaths. Recent developments in nanotechnology, however, have great potential to ameliorate these and other health disparities by providing new cost-effective solutions for diagnosis or treatment of a variety of medical conditions. Affordability is only one of the several challenges that will need to be met to translate new ideas into a medical product that addresses a global health need. This article aims to describe some of the other challenges that will be faced by nanotechnologists who seek to make an impact in low-resource settings across the globe.
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Affiliation(s)
- James J Abbas
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Barbara Smith
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Mladen Poluta
- Western Cape Department of Health, Cape Town, South Africa
| | - Adriana Velazquez-Berumen
- Essential Medicines and Health Products Department, Health Systems and Innovation Cluster, World Health Organization, Geneva, Switzerland
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26
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Hennek JW, Kumar AA, Wiltschko AB, Patton MR, Lee SYR, Brugnara C, Adams RP, Whitesides GM. Diagnosis of iron deficiency anemia using density-based fractionation of red blood cells. LAB ON A CHIP 2016; 16:3929-3939. [PMID: 27713998 DOI: 10.1039/c6lc00875e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Iron deficiency anemia (IDA) is a nutritional disorder that impacts over one billion people worldwide; it may cause permanent cognitive impairment in children, fatigue in adults, and suboptimal outcomes in pregnancy. IDA can be diagnosed by detection of red blood cells (RBCs) that are characteristically small (microcytic) and deficient in hemoglobin (hypochromic), typically by examining the results of a complete blood count performed by a hematology analyzer. These instruments are expensive, not portable, and require trained personnel; they are, therefore, unavailable in many low-resource settings. This paper describes a low-cost and rapid method to diagnose IDA using aqueous multiphase systems (AMPS)-thermodynamically stable mixtures of biocompatible polymers and salt that spontaneously form discrete layers having sharp steps in density. AMPS are preloaded into a microhematocrit tube and used with a drop of blood from a fingerstick. After only two minutes in a low-cost centrifuge, the tests (n = 152) were read by eye with a sensitivity of 84% (72-93%) and a specificity of 78% (68-86%), corresponding to an area under the curve (AUC) of 0.89. The AMPS test outperforms diagnosis by hemoglobin alone (AUC = 0.73) and is comparable to methods used in clinics like reticulocyte hemoglobin concentration (AUC = 0.91). Standard machine learning tools were used to analyze images of the resulting tests captured by a standard desktop scanner to 1) slightly improve diagnosis of IDA-sensitivity of 90% (83-96%) and a specificity of 77% (64-87%), and 2) predict several important red blood cell parameters, such as mean corpuscular hemoglobin concentration. These results suggest that the use of AMPS combined with machine learning provides an approach to developing point-of-care hematology.
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Affiliation(s)
| | | | - Alex B Wiltschko
- School of Engineering and Applied Sciences, USA and Department of Neurobiology, Harvard Medical School, USA
| | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, USA.
| | | | - George M Whitesides
- Department of Chemistry and Chemical Biology, USA and Wyss Institute for Biologically Inspired Engineering, USA
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27
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McGann PT. Time to Invest in Sickle Cell Anemia as a Global Health Priority. Pediatrics 2016; 137:peds.2016-0348. [PMID: 27244863 PMCID: PMC4894249 DOI: 10.1542/peds.2016-0348] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 11/24/2022] Open
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28
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Nemiroski A, Kumar AA, Soh S, Harburg DV, Yu HD, Whitesides GM. High-Sensitivity Measurement of Density by Magnetic Levitation. Anal Chem 2016; 88:2666-74. [PMID: 26815205 DOI: 10.1021/acs.analchem.5b03918] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This paper presents methods that use Magnetic Levitation (MagLev) to measure very small differences in density of solid diamagnetic objects suspended in a paramagnetic medium. Previous work in this field has shown that, while it is a convenient method, standard MagLev (i.e., where the direction of magnetization and gravitational force are parallel) cannot resolve differences in density <10(-4) g/cm(3) for macroscopic objects (>mm) because (i) objects close in density prevent each other from reaching an equilibrium height due to hard contact and excluded volume, and (ii) using weaker magnets or reducing the magnetic susceptibility of the medium destabilizes the magnetic trap. The present work investigates the use of weak magnetic gradients parallel to the faces of the magnets as a means of increasing the sensitivity of MagLev without destabilization. Configuring the MagLev device in a rotated state (i.e., where the direction of magnetization and gravitational force are perpendicular) relative to the standard configuration enables simple measurements along the axes with the highest sensitivity to changes in density. Manipulating the distance of separation between the magnets or the lengths of the magnets (along the axis of measurement) enables the sensitivity to be tuned. These modifications enable an improvement in the resolution up to 100-fold over the standard configuration, and measurements with resolution down to 10(-6) g/cm(3). Three examples of characterizing the small differences in density among samples of materials having ostensibly indistinguishable densities-Nylon spheres, PMMA spheres, and drug spheres-demonstrate the applicability of rotated Maglev to measuring the density of small (0.1-1 mm) objects with high sensitivity. This capability will be useful in materials science, separations, and quality control of manufactured objects.
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Affiliation(s)
- Alex Nemiroski
- Department of Chemistry and Chemical Biology, ‡Wyss Institute for Biologically Inspired Engineering, and §Kavli Institute for Bionano Science and Technology, Harvard University , Cambridge, Massachusetts 02138, United States
| | - A A Kumar
- Department of Chemistry and Chemical Biology, ‡Wyss Institute for Biologically Inspired Engineering, and §Kavli Institute for Bionano Science and Technology, Harvard University , Cambridge, Massachusetts 02138, United States
| | - Siowling Soh
- Department of Chemistry and Chemical Biology, ‡Wyss Institute for Biologically Inspired Engineering, and §Kavli Institute for Bionano Science and Technology, Harvard University , Cambridge, Massachusetts 02138, United States
| | - Daniel V Harburg
- Department of Chemistry and Chemical Biology, ‡Wyss Institute for Biologically Inspired Engineering, and §Kavli Institute for Bionano Science and Technology, Harvard University , Cambridge, Massachusetts 02138, United States
| | - Hai-Dong Yu
- Department of Chemistry and Chemical Biology, ‡Wyss Institute for Biologically Inspired Engineering, and §Kavli Institute for Bionano Science and Technology, Harvard University , Cambridge, Massachusetts 02138, United States
| | - George M Whitesides
- Department of Chemistry and Chemical Biology, ‡Wyss Institute for Biologically Inspired Engineering, and §Kavli Institute for Bionano Science and Technology, Harvard University , Cambridge, Massachusetts 02138, United States
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McGann PT, Schaefer BA, Paniagua M, Howard TA, Ware RE. Characteristics of a rapid, point-of-care lateral flow immunoassay for the diagnosis of sickle cell disease. Am J Hematol 2016; 91:205-10. [PMID: 26537622 DOI: 10.1002/ajh.24232] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 12/20/2022]
Abstract
Sickle cell disease (SCD) is a common and life-threatening hematological disorder, affecting approximately 400,000 newborns annually worldwide. Most SCD births occur in low-resource countries, particularly in sub-Saharan Africa, where limited access to accurate diagnostics results in early mortality. We evaluated a prototype immunoassay as a novel, rapid, and low-cost point-of-care (POC) diagnostic device (Sickle SCAN) designed to identify HbA, HbS, and HbC. A total of 139 blood samples were scored by three masked observers and compared to results using capillary zone electrophoresis. The sensitivity (98.3-100%) and specificity (92.5-100%) to detect the presence of HbA, HbS, and HbS were excellent. The test demonstrated 98.4% sensitivity and 98.6% specificity for the diagnosis of HbSS disease and 100% sensitivity and specificity for the diagnosis of HbSC disease. Most variant hemoglobins, including samples with high concentrations of HbF, did not interfere with the ability to detect HbS or HbC. Additionally, HbS and HbC were accurately detected at concentrations as low as 1-2%. Dried blood spot samples yielded clear positive bands, without loss of sensitivity or specificity, and devices stored at 37°C gave reliable results. These analyses indicate that the Sickle SCAN POC device is simple, rapid, and robust with high sensitivity and specificity for the detection of HbA, HbS, and HbC. The ability to obtain rapid and accurate results with both liquid blood and dried blood spots, including those with newborn high-HbF phenotypes, suggests that this POC device is suitable for large-scale screening and potentially for accurate diagnosis of SCD in limited resource settings.
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Affiliation(s)
- Patrick T. McGann
- Division of Hematology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Beverly A. Schaefer
- Division of Hematology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Mary Paniagua
- Division of Hematology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Thad A. Howard
- Division of Hematology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Russell E. Ware
- Division of Hematology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
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30
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Piety NZ, Yang X, Kanter J, Vignes SM, George A, Shevkoplyas SS. Validation of a Low-Cost Paper-Based Screening Test for Sickle Cell Anemia. PLoS One 2016; 11:e0144901. [PMID: 26735691 PMCID: PMC4703210 DOI: 10.1371/journal.pone.0144901] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Background The high childhood mortality and life-long complications associated with sickle cell anemia (SCA) in developing countries could be significantly reduced with effective prophylaxis and education if SCA is diagnosed early in life. However, conventional laboratory methods used for diagnosing SCA remain prohibitively expensive and impractical in this setting. This study describes the clinical validation of a low-cost paper-based test for SCA that can accurately identify sickle trait carriers (HbAS) and individuals with SCA (HbSS) among adults and children over 1 year of age. Methods and Findings In a population of healthy volunteers and SCA patients in the United States (n = 55) the test identified individuals whose blood contained any HbS (HbAS and HbSS) with 100% sensitivity and 100% specificity for both visual evaluation and automated analysis, and detected SCA (HbSS) with 93% sensitivity and 94% specificity for visual evaluation and 100% sensitivity and 97% specificity for automated analysis. In a population of post-partum women (with a previously unknown SCA status) at a primary obstetric hospital in Cabinda, Angola (n = 226) the test identified sickle cell trait carriers with 94% sensitivity and 97% specificity using visual evaluation (none of the women had SCA). Notably, our test permits instrument- and electricity-free visual diagnostics, requires minimal training to be performed, can be completed within 30 minutes, and costs about $0.07 in test-specific consumable materials. Conclusions Our results validate the paper-based SCA test as a useful low-cost tool for screening adults and children for sickle trait and disease and demonstrate its practicality in resource-limited clinical settings.
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Affiliation(s)
- Nathaniel Z. Piety
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
| | - Xiaoxi Yang
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
| | - Julie Kanter
- Sickle Cell Center of Southern Louisiana, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
- Department of Pediatrics, Section of Hematology/Oncology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Seth M. Vignes
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
| | - Alex George
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Sergey S. Shevkoplyas
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
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31
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Chu K, Smith ZJ, Wachsmann-Hogiu S. Development of inexpensive blood imaging systems: where are we now? Expert Rev Med Devices 2015; 12:613-27. [PMID: 26305840 DOI: 10.1586/17434440.2015.1075388] [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] [Indexed: 11/08/2022]
Abstract
Clinical applications in the developing world, such as malaria and anemia diagnosis, demand a change in the medical paradigm of expensive care given in central locations by highly trained professionals. There has been a recent explosion in optical technologies entering the consumer market through the widespread adoption of smartphones and LEDs. This technology commoditization has enabled the development of small, portable optical imaging systems at an unprecedentedly low cost. Here, we review the state-of-the-field of the application of these systems for low-cost blood imaging with an emphasis on cellular imaging systems. In addition to some promising results addressing specific clinical issues, an overview of the technology landscape is provided. We also discuss several key issues that need to be addressed before these technologies can be commercialized.
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Affiliation(s)
- Kaiqin Chu
- a 1 Center for Biophotonics, University of California Davis, Sacramento, CA 95817, USA
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32
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Derda R, Gitaka J, Klapperich CM, Mace CR, Kumar AA, Lieberman M, Linnes JC, Jores J, Nasimolo J, Ndung’u J, Taracha E, Weaver A, Weibel DB, Kariuki TM, Yager P. Enabling the Development and Deployment of Next Generation Point-of-Care Diagnostics. PLoS Negl Trop Dis 2015; 9:e0003676. [PMID: 25973602 PMCID: PMC4431858 DOI: 10.1371/journal.pntd.0003676] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ratmir Derda
- Department of Chemistry and Alberta Glycomics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Gitaka
- Department of Clinical Medicine, Mount Kenya University, Thika, Kenya
| | - Catherine M. Klapperich
- Department of Biomedical Engineering and Center for Future Technologies in Cancer Care, Boston University, Boston, Massachusetts, United States of America
| | - Charles R. Mace
- Diagnostics For All, Cambridge, Massachusetts, Unites States of America
- Department of Chemistry, Tufts University, Medford, Massachusetts, United States of America
| | - Ashok A. Kumar
- School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Jacqueline C. Linnes
- Department of Biomedical Engineering and Center for Future Technologies in Cancer Care, Boston University, Boston, Massachusetts, United States of America
| | - Joerg Jores
- International Livestock Research Institute, Nairobi, Kenya
| | - Johnson Nasimolo
- Department of Veterinary Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Joseph Ndung’u
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Evans Taracha
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Abigail Weaver
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Douglas B. Weibel
- Departments of Biochemistry, Biomedical Engineering, and Chemistry, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thomas M. Kariuki
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Paul Yager
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
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Kumar AA, Hennek JW, Smith BS, Kumar S, Beattie P, Jain S, Rolland JP, Stossel TP, Chunda-Liyoka C, Whitesides GM. From the Bench to the Field in Low-Cost Diagnostics: Two Case Studies. Angew Chem Int Ed Engl 2015; 54:5836-53. [DOI: 10.1002/anie.201411741] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Indexed: 12/12/2022]
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34
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Kumar AA, Hennek JW, Smith BS, Kumar S, Beattie P, Jain S, Rolland JP, Stossel TP, Chunda-Liyoka C, Whitesides GM. Vom Labortisch zur Feldforschung: zwei Fallstudien kostengünstiger Diagnostik. Angew Chem Int Ed Engl 2015. [DOI: 10.1002/ange.201411741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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