Written by Iain Stewart
An article published in Nature Medicine, 4th August 2011, has shown scientists from Columbia University, New York, have created a new tool for efficient and reliable diagnosis of both HIV and syphilis.
Samuel Sia and his team of researchers have adapted the ‘ELISA’ technique into a portable and cheap procedure that can be used in remote parts of the world, giving results in under twenty minutes. ELISA (or enzyme-linked immunosorbent assay) is a well-known method, routinely used in laboratories, to detect the presence of antigens using antibodies.
Antigens are molecules, which when present in the blood, trigger an immune response from the body. Every cell in our body carries its own antigens, which are recognized as ‘self’, but foreign antigens from bacteria, viruses, and cells that are not our own, stimulate new antibody production.
Sia and colleagues scaled down the recognition of antigens into a plastic tool they term ‘mChip’ (microfluidic chip). All that is required is a microlitre of blood, taken directly from a pinprick, which is then passed through extremely narrow channels in a credit card sized device. The disease antigens are present where the channels form tight loops. When blood from an individual who has the virus flows through these loops, specific antibodies from the blood bind. Next, antibodies attached to silver particles are washed through and bind to the antibodies present, with the result of solid silver loop indicating the patient is positive for the specific disease.
This new tool displays many advantages over the current diagnostic strategies. It is low cost, as the mChip and reagents cost pennies to make. It can diagnose both HIV and syphilis in the same test, taking under twenty minutes compared to previous hours, days and even weeks. Its portable design allows it to be operated at the point-of-care, making it accessible anywhere in the developing world. A microlitre of whole blood is all that is necessary from the patient, while its ease of use requires minimal training for the operator. The result can be read without hi-tech optical equipment, is not open to interpretation, and has been shown to be as reliable as current techniques.
Exposing unborn children to the sexually transmitted disease, syphilis, leads to miscarriages, stillbirths and death of newborns. Fast diagnosis of pregnant mothers, and therefore treatment of syphilis with a single dose of penicillin, can significantly increase the survival of the unborn infant by preventing disease transmission through the placenta. Sia and colleagues’ data suggest 5000 syphilis-related deaths could be avoided in Rwanda alone, whilst the World Health Organisation estimates that the disease is responsible for 500,000 perinatal deaths in sub-Saharan Africa every year.
As well as the obvious impact this technique could have on diagnosing HIV and syphilis at the point-of-care, this test can be used for pre-screening blood donations, and could eventually be used to diagnose a range of infectious diseases in poorly equipped areas all over the world.
Chin, C. et al. Microfluidics-based diagnostics of infectious diseases in the developing world. Nature Medicine. 4th Aug 2011, doi:10.1038/nm.2408
http://www.nature.com/nm/journal/vaop/ncurrent/abs/nm.2408.html
http://www.who.int/reproductivehealth/topics/rtis/syphilis/en/index.html
credit card sized device.
doi:10.1038/nm.2408
channel loops, scale bar 1mm.
doi:10.1038/nm.2408
A woman bathes an infant in rural Manara, Tanzania. Taken from www.who.int.





