Once the dust had settled following the devastating Ebola outbreaks in West Africa, it was discovered that deaths resulting from Ebola were disproportionately concentrated among health care workers. Based on some estimates, .11% of Liberia’s entire general population had died due to Ebola, compared with 8% of its health care workers. In Sierra Leone, the loss was 0.06% of the general population compared with 6.85% of the health workers, while 0.02% of Guinea’s overall population had died compared with 1.45% of all health workers, according to May 2015 data from the World Bank. It was this situation that partly led to the creation of a company called Kinnos, which invented a new substance to decontaminate health care and other potentially contaminated facilities.
Kinnos posited that regular bleach disinfectant was not always sufficient to protect all health workers from highly contagious viruses such as Ebola. Although bleach is recommended by the World Health Organization and other international health agencies as the best and most cost efficient disinfectant for surfaces contaminated by infectious disease, its effectiveness is limited by the fact that it is clear. This makes it easy to “miss spots” and leave gaps in coverage of disinfection. Kinnos created Highlight, a patent-pending powdered additive that colorizes disinfectants. This makes it easier to visualize, ensure full coverage, and adhere to surfaces. The color is only temporary, however; it fades once decontamination is complete.
Highlight is being used by the New York Fire Department and was a winner of the USAID Fighting Ebola Grand Challenge. It has also been field tested by health care workers in Liberia and Guinea. The new technology was spotlighted at TEDMED 2016, taking place this week in Palm Springs, CA.
One of the co-founders of Kinnos, Kevin Tyan, spoke to attendees about the company, which was founded by him and two others when they were undergraduates at Columbia University in 2014. Responding to TEDMED 2016’s overarching question to attendees, “What if?”, Tyan and his colleagues asked, “What if we could highlight invisible threats for our lifesavers?” The development of products such as Highlight could be part of the answer. Another component of fighting emerging diseases such as Ebola and Zika is detecting them early so that proper treatment and precautions can be taken. TEDMED 2016 speaker Charles Chiu, an infectious disease physician and researcher, detailed the development of a tiny next-generation sequencing device (from Oxford Nanopore Technologies) that could improve how quickly and effectively we can diagnose and respond to the next deadly disease. Chiu’s talk fed into the overarching theme of this year’s TEDMED – “What if?” – by posing the question, “What if next generation sequencing could help us diagnose mysterious infectious illnesses.” The device can “detect any infectious agent…no matter whether it is a bacteria, virus, fungus, or parasite” in a single test, and can do so in a matter of hours and in remote, low-resource settings, Chiu explained.
By working with a number of national and international partners, the researchers have been able to bring this instrument and its associated protocols and laptop software to remote areas around the world – Barbados, Brazil, Democratic Republic of the Congo, and Ethiopia – for diagnosis and surveillance of acute febrile illness from pathogens such as Zika virus, Ebola virus, and Plasmodium falciparum malaria. The way this technology works is like quickly finding a needle-in-a-haystack. Clinicians collect a sample – blood, spinal fluid, nasal swabs, or tissue – and generate hundreds of millions of sequence reads. They then diagnose infection by identifying sequences corresponding to all potential viruses, bacteria, fungi or parasites using a bioinformatics program called SURPI, which stands for sequence-based ultra-rapid pathogen identification. “SURPI can analyze 300 million sequences within hours, and is available on servers, the cloud, and even on a laptop,” Chiu noted.
This is warp speed compared to conventional testing, which often involves using cultures, where you grow the organism from days to weeks and can waste “precious time retesting limited amounts of sample looking for an endless array of potential agents,” Chiu explained. By implementing all of this in a single test, patients can obtain “targeted, timely, and effective treatment before it’s too late.”
In addition to testing the technology in other countries, in June 2016 Chiu and his colleagues launched a multi-hospital study on the “Precision Diagnosis of Acute Infectious Diseases.” Over one year, they will enroll 300 patients and compare the metagenomic next-generation sequencing test, which has now been clinically validated in a licensed diagnostic laboratory, to conventional testing. This demonstration project aims to establish the clinical utility and cost-effectiveness of this test for diagnosis of meningitis and encephalitis. Their efforts are particularly timely given that the FDA in May of this year released draft guidance for next-generation sequencing diagnostic devices.
“We are currently in the process of seeking FDA approval for this test, and hope that approval for tests such as these can be fast-tracked as soon as possible and made widely available to patients,” Chiu said. They are also working with NASA on potentially sequencing in space.
In August of this year, astronaut Kate Rubins reported for the first time a successful sequencing run in space on the MinION nanopore platform. “Ultimately, the goals of sequencing in space will include diagnosing infections in astronauts, environmental surveillance, and even the discovery of new life,” Chiu stated. To see these space-age goals realized, the populace will have to live long enough.
Another TEDMED 2016 speaker, Dr. Nir Barzilai, an Israeli internist, is examining a way to target the process of aging to help us live longer, healthier lives. He is spearheading a randomized controlled trial of a medicine, metformin, that aims to interfere with the aging process. Meformin, Barzilai explained, is a generic drug that has been used for over 60 years to treat patients with type 2 diabetes. It directly targets several important mechanisms of aging, and has been shown to extend the health and life spans in organisms including worms and mice. In humans, metformin prevents type 2 diabetes in those at high risk and has been associated with reduced cardiovascular disease risk. In patients who already have type 2 diabetes, metformin is associated with a 30% reduction in cardiovascular risks and death, and a 20-40% reduction in cancer risk. It is also associated with a decrease in cognitive decline and Alzheimer’s disease.
With those preliminary results as a backdrop, Barzilai and his colleagues have launched a study, Targeting Aging with MEtformin (TAME). They will be studying 3,000 elderly volunteers who will be assigned to either placebo or metformin. They will attempt to measure the time it takes for any of age-related diseases — cardiovascular disease, cancer, diabetes, Alzheimer’s disease and death – to manifest. Because the study aims to show how metformin affects the rate of aging, the researchers are working with the FDA so that the drug will carry an “anti-aging” indication if it is proven to be effective for that purpose. Gaining this indication will spur more companies to pursue the development of anti-aging medications, Barzilai stated. He is hopeful that the study will show that “metformin will probably add healthy years to life.”
But metformin is only the beginning: he predicted that next generation drugs will be better and better,” Even a “modest change in people’s health span,” he added, “will be translated into $50 billion in health care savings by the year 2050.”
TEDMED 2016 was held in Palm Springs, CA from 30 November through 2 December 2017. Visit www.TEDMED.com for more information
Guest blogger Tula Michaelides has 25 years of professional experience writing for a variety of audiences, predominantly in the fields of global and U.S. public health. She attended TEDMED 2016.