Diagnostic Tests to Support Late-Stage Control Programs for Schistosomiasis and Soil-Transmitted Helminthiases.

Global efforts to address schistosomiasis and soil-transmitted helminthiases (STH) include deworming programs for school-aged children that are made possible by large-scale drug donations. Decisions on these mass drug administration (MDA) programs currently rely on microscopic examination of clinical specimens to determine the presence of parasite eggs. However, microscopy-based methods are not sensitive to the low-intensity infections that characterize populations that have undergone MDA. Thus, there has been increasing recognition within the schistosomiasis and STH communities of the need for improved diagnostic tools to support late-stage control program decisions, such as when to stop or reduce MDA. Failure to adequately address the need for new diagnostics could jeopardize achievement of the 2020 London Declaration goals. In this report, we assess diagnostic needs and landscape potential solutions and determine appropriate strategies to improve diagnostic testing to support control and elimination programs. Based upon literature reviews and previous input from experts in the schistosomiasis and STH communities, we prioritized two diagnostic use cases for further exploration: to inform MDA-stopping decisions and post-MDA surveillance. To this end, PATH has refined target product profiles (TPPs) for schistosomiasis and STH diagnostics that are applicable to these use cases. We evaluated the limitations of current diagnostic methods with regards to these use cases and identified candidate biomarkers and diagnostics with potential application as new tools. Based on this analysis, there is a need to develop antigen-detecting rapid diagnostic tests (RDTs) with simplified, field-deployable sample preparation for schistosomiasis. Additionally, there is a need for diagnostic tests that are more sensitive than the current methods for STH, which may include either a field-deployable molecular test or a simple, low-cost, rapid antigen-detecting test.

Emerging technologies for point-of-care CD4 T-lymphocyte counting.

A CD4 T-lymphocyte count determines eligibility for antiretroviral therapy (ART) in patients recently diagnosed with HIV and also monitors the efficacy of ART treatment thereafter. ART slows the progression of HIV to AIDS. In the developing world, CD4 tests are often performed in centralized laboratories, typically in urban areas. The expansion of ART programs into rural areas has created a need for rapid CD4 counting because logistical barriers can delay the timely dissemination of test results and affect patient care through delay in intervention or loss of follow-up care. CD4 measurement at the point-of-care (POC) in rural areas could help the facilitation of ART and monitoring of treatment. This review highlights recent technology developments with applications towards determining CD4 counts at the POC.

A simple, inexpensive device for nucleic acid amplification without electricity-toward instrument-free molecular diagnostics in low-resource settings.

BACKGROUND: Molecular assays targeted to nucleic acid (NA) markers are becoming increasingly important to medical diagnostics. However, these are typically confined to wealthy, developed countries; or, to the national reference laboratories of developing-world countries. There are many infectious diseases that are endemic in low-resource settings (LRS) where the lack of simple, instrument-free, NA diagnostic tests is a critical barrier to timely treatment. One of the primary barriers to the practicality and availability of NA assays in LRS has been the complexity and power requirements of polymerase chain reaction (PCR) instrumentation (another is sample preparation). METHODOLOGY/PRINCIPAL FINDINGS: In this article, we investigate the hypothesis that an electricity-free heater based on exothermic chemical reactions and engineered phase change materials can successfully incubate isothermal NA amplification assays. We assess the heater's equivalence to commercially available PCR instruments through the characterization of the temperature profiles produced, and a minimal method comparison. Versions of the prototype for several different isothermal techniques are presented. CONCLUSIONS/SIGNIFICANCE: We demonstrate that an electricity-free heater based on exothermic chemical reactions and engineered phase change materials can successfully incubate isothermal NA amplification assays, and that the results of those assays are not significantly different from ones incubated in parallel in commercially available PCR instruments. These results clearly suggest the potential of the non-instrumented nucleic acid amplification (NINA) heater for molecular diagnostics in LRS. When combined with other innovations in development that eliminate power requirements for sample preparation, cold reagent storage, and readout, the NINA heater will comprise part of a kit that should enable electricity-free NA testing for many important analytes.

A method for characterizing adsorption of flowing solutes to microfluidic device surfaces.

We present a method for characterizing the adsorption of solutes in microfluidic devices that is sensitive to both long-lived and transient adsorption and can be applied to a variety of realistic device materials, designs, fabrication methods, and operational parameters. We have characterized the adsorption of two highly adsorbing molecules (FITC-labeled bovine serum albumin (BSA) and rhodamine B) and compared these results to two low adsorbing species of similar molecular weights (FITC-labeled dextran and fluorescein). We have also validated our method by demonstrating that two well-known non-fouling strategies [deposition of the polyethylene oxide (PEO)-like surface coating created by radio-frequency glow discharge plasma deposition (RF-GDPD) of tetraethylene glycol dimethyl ether (tetraglyme, CH(3)O(CH(2)CH(2)O)(4)CH(3)), and blocking with unlabeled BSA] eliminate the characteristic BSA adsorption behavior observed otherwise.

Diffusion based analysis in a sheath flow microchannel: the sheath flow T-sensor.

This paper describes a microfluidic channel that allows for diffusion-based analysis of adsorbing species without passivation of the channel surfaces. The sheath flow configuration was used to measure the diffusion coefficient of fluorescently labeled species from their spatial distribution within the microchannel by analyzing the derivative of the intensity profile at the interface between two distinct core fluids. Measurements for both a small molecule (rhodamine B) and an intermediate-sized protein (wheat germ agglutinin) were made, demonstrating the utility of the sheath flow T-sensor.

Controlled microfluidic reconstitution of functional protein from an anhydrous storage depot.

A novel method has been developed for preserving molecules in microfluidic devices that also enables the control of the spatial and temporal concentrations of the reconstituted molecules within the devices. In this method, a storage cavity, embedded in a microchannel, is filled with a carbohydrate matrix containing, for example, a reagent. When the matrix is exposed to flowing liquid, it dissolves, resulting in the controlled reconstitution and release of the reagent from the cavity. The technique was demonstrated using two different model systems; the successful preservation and controlled release of beta-galactosidase was achieved. This method has possible applications for simple point-of-care drug delivery and immunoassays, and could be used to pattern the surfaces of microchannels. More broadly, this preservation and controlled release technique can be applied where the preservation and/or spatial and temporal control of chemical concentrations are desired.

Nonlinear decrease of background fluorescence in polymer thin-films - a survey of materials and how they can complicate fluorescence detection in microTAS.

Polymers and plastics are receiving increased attention as materials for microfluidics and microTAS applications. Given the ubiquity of fluorescence detection techniques in micro-analytical systems, the fluorescence properties of polymers and plastics should not be overlooked. We survey some commonly available polymer thin-films for their fluorescence behaviour under standardized conditions to determine which materials are most suitable for high-sensitivity fluorescence detection lab chips. The initial fluorescence intensities of some of the materials surveyed were significantly higher than glass and fused silica controls, and decreased over the three hour period with complex kinetics. We then discuss how this has confounded fluorescence detection in our analytical context, and possible mechanisms for the decrease.