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Problem
Traditionally, infectious diseases are diagnosed by cell culture or PCR-based methods. As these techniques require expensive infrastructure, trained personal, and time, the current practice suffers from three main problems. First, diagnosis is not available everywhere, and therefore pathogens are usually detected in central clinics, rather than at the point-of-care. Second, diagnosis is not accessible to everyone, especially in developing countries proper medical supply is often lacking, due to the high costs. And third, diagnosis is not available within a few hours, which can lead to negligence of laboratory tests, resulting in premature prescription of antibiotics, the primary reason for the recrudescence of resistant bacteria strains.
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Current solutions
Most point-of-care tests that are currently established on the market, like pregnancy tests, are based on antibodies targeting certain metabolites. These tests are therefore restricted to one specific application and require long and expensive design cycles for the development of new tests for other applications.1
Recently, qPCR-based systems were developed that provide a more universal solution for highly automated nucleic-acid detection. According to doctors without borders (link) there are two cartridge-based systems that are currently employed for in-field applications. GeneXpert allows the detection of MRSA in patient samples, and Alere™ q provides an automated bench top platform for nucleic acid testing in any healthcare setting.
These qPCR- and ELISA-based methods represent a significant advance in the portability and usability of point-of-care testing. However, these tests cost around 10$ for consumables and several thousands of $ for the device. This is too high for applications in developing countries for which doctors without borders calls a price of less than 1$ per test.
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Improvement + integrating + disrupting on current solutions
We developed CascAID to combine the portability, affordability, and usability of point-of-care tests with the universality and sensitivity of PCR-based nucleic acid detection. We achieve this by using the tools of synthetic biology to minimize hardware requirements and by supplying CascAID in a low-cost paper-based format.
Due to the rapid, software-aided design of crRNA, CascAID can be easily adapted to a variety of targets - from bacterial infections and rapidly evolving viral epidemics to cancer-associated mutations.
Additionally, the Cas13a enzyme was shown to find targets with a single-nucleotide specificity, superior to PCR-based methods. (CascAID can be entirely conducted on-site by the doctor or patient and therefore reduces the logistic complexity, drastically hastening the diagnostic process).
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Impact on lives
With CascAID we venture to solve global health challenges and therefore impact the lives of people living in the developed world, as well as developing countries.
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Global epidemics
CascAID is available everywhere. Due to its small size and little infrastructure requirements, CascAID can be used in mobile health-stations visiting remote areas, lacking a centralized healthcare system. This minimizes the travel expenses of patients living far from hospitals and therefore aids to receive a timely cure. As CascAID can be rapidly customized to fit local variants of pathogens, it is applicable in any planet region. By employing it as a safety test at airports, would assist in containing the spread of potential global epidemics like Ebola, Zika, or the plague.
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At home testing
CascAID is accessible to everyone. Designed with an open-source philosophy, the hardware, like our fluorescence detector Lightbringer, can be assembled from common low-cost components by anyone. We did a poll, to address the question of whether people would use CascAID to diagnose themselves for infectious diseases at home, without going to a doctor. Although we received a good resonance from the public, we think that a universal tool for nucleic acid testing is very powerful and therefore raises ethical issues. If applied for detection of, e.g., severe genetic diseases or HIV, the presence of a doctor is also essential for psychological reasons, which is why usage of such tests must be debated and regulated appropriately.
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