Some argue antimicrobial resistance (AMR), the ability of microbes to develop resistance to antimicrobial drugs, is a growing threat. Others say superbugs are already here, citing the increase in strains of antibiotic-resistant tuberculosis worldwide and the spread of staph infections.
There's little argument about this fact, however: if we are not in a post-antibiotic era now, we will be soon. Such an era would see patients dying from common infections caused by bacteria, parasites, virus and fungi, and from minor injuries.
In a study commissioned by British Prime Minister David Cameron, it was found that drug-resistant infections will reach global costs of $100 trillion and will add 10 million deaths a year, by 2050.
In the overall war against antibiotic resistance, the battle against hospital-acquired infections plays a major role. While infections can be caught anywhere, many of the antibiotic-resistant infections occur in hospitals and other medical facilities. Resistance is inevitable, but overly-broad prescriptions, inaccurate prescriptions and misuse of antibiotics exacerbate the problem. According to the Infectious Disease Society, up to 50 percent of antibiotic use is unnecessary or incorrectly applied.
These infections that attack patients, making them sicker than they were when they came in with a previous illness, derail the name and purpose of health care. They cost billions of dollars. They cost thousands of lives.
While a recent report from the Centers for Disease Control and Prevention (CDC) in the U.S. reported a noticeable reduction in some cases of hospital-acquired infections, other infectious diseases, such as influenza and malaria, are becoming increasingly resistant to antibiotics and remain at large.
To be able to slow the development of drug-resistance, medical professionals must treat infections with accurate and specific antimicrobial drugs. The problem here, however, lies in the unknown. If the specific source of the problem (i.e. the bug causing the infection) isn't known, physicians often prescribe an overly-broad antibiotic, hoping it will eliminate the problem. Often it doesn't - it just puts the patient at risk and adds to the factors spurring on drug resistance.
To inspire companies to develop technology that would help physicians isolate the cause of infections and prescribe the right drugs in the right doses, Nesta and Innovate UK launched the Longitude Prize 2014. With a £10 million prize fund, the contest is an effort to combat the growing problem with a "cost-effective, accurate, rapid and easy-to-use test for bacterial infections that will allow health professionals worldwide to administer the right antibiotics at the right time."
One contender for the prize is Professor Chris Toumazou, winner of the European Inventor Award in 2014, and his company, DNA Electronics (DNAe). His semiconductor DNA sequencing technology, Genalysis, is a microchip that turns chemically encoded DNA into digital information that can help treat hospital-acquired infections - in particular, sepsis.
An increasingly problematic infection, sepsis, which results in inflammatory responses in the body triggered by chemicals in the bloodstream, can lead to severe organ failure and death. In the U.K. alone, sepsis kills over 37,000 people a year. The key to preventing this is early treatment of the infection with antibiotics and fluids.
To ensure physicians use the correct drugs to treat these infections, Toumazou developed his semiconductor DNA sequencing technology around a small device the size of a USB stick. To understand its function, the inspiration behind it, and how it can be used as a tool to treat infections and fight the increase of antibiotic resistance, I spoke with Toumazou about his invention and DNAe.
Toumazou, who is a professor at Imperial College London, an inventor, a businessman, and an engineer, was more than happy to discuss how his many hats led him to developing his semiconductor microchip.
"It was a eureka moment when I just took a microchip, and instead of putting electricity on [it], I put DNA, and the microchip turned on. It was sort of 'wow, I've got a really neat way now of sequencing DNA,' " Toumazou said excitedly.
The microchip technology is more than just neat, it's brilliant. On the surface of the microchip, when the electrical gate is peeled off, a chemically sensitive layer of silicon nitride is revealed. Immobilizing the DNA onto the surface and putting down the nucleotides, the building blocks of nucleic acids such as DNA, releases pyrophosphate, which brings on a pH change. The change essentially "turns on" the semiconductor, similar to how a pH probe works, except with the chip the nucleotide bases must be matching. While the chip is detecting the mutations, the DNA is also getting amplified.
"If the DNA matches, you got the mutation and it turns on the semiconductor, and if it doesn't match, it doesn't work," Toumazou explained.
So how can this device, smaller than a thumb, help fight sepsis infections in hospitals? It goes back to isolating the right bug, or the correct source of the problem, and eliminating the bug with a specific antibiotic rather than a broad one. But in the case of sepsis, isolating the bug needs to happen quickly.
"It's really all about speed," he says. The faster you can isolate the DNA of the bug, the sooner the proper antibiotic can be prescribed. It takes too long for hospitals to send cultures to the lab to identify the bug. While the culture is being developed, infections can turn deadly. The semiconductor microchip isolates the DNA of the bug in under an hour, giving physicians time to prescribe the correct, tailored antibiotic, often before pre-sepsis turns into full-blown sepsis.
The quicker the bug is isolated for any infection, the higher the chance the correct antibiotic will be prescribed. If broad or incorrect antibiotics are prescribed less often, medical professionals will contribute less to the development of antibiotic-resistant strains ringing in the post-antibiotic era.
"It's all down to making sure that you've got the right tailored medicine for that individual," Toumazou says. That's why he focuses on personalizing medicine based on quickly identifying mutations. He was inspired to develop tools for personal genetics after his son, Marcus, was found to have a genetic predisposition to renal disease. Marcus lost his kidneys at a young age. Toumazou believes that knowing about the predisposition earlier would have helped him manage Marcus's lifestyle and make it more comfortable. Marcus later received a kidney transplant, but went through a challenging period of time beforehand living with monitors and a dialysis machine.
If his son's medical difficulties were the motivators for Toumazou's interest in personalized genetics, Toumazou's experience as a professor at Imperial College London was the inspiration for his semiconductor microchip. Much of the idea for a device that combines speed and cost to fight infectious disease came from his encounters with clinicians at the school's hospital. These clinicians faced the nightmare of hospital-acquired infections everyday and he heard about the problem firsthand. He realized personalization was not only helpful, it was essential.
With his invention of the semiconductor microchip came a simple, personalized solution of modest size with the potential for drastic change. However, he aims to apply this change not just to healthcare, but to skincare as well.
"We all have predispositions to different genetic diseases. We all metabolize things differently," he said. Take collagen, for example, a protein of the connective tissues that is produced by a person's cells and helps give the skin its firmness and elasticity. Some people are fast degraders of collagen, and some slow. While most don't think about it, the speed of metabolism affects the way the skin reacts to cosmetics. So Toumazou, believing personalization a key to any industry, decided to apply his lab-on-a-chip to cosmetics.
Using his semiconductor microchip, a saliva sample, and just a half-hour of wait time, consumers can get a personalized collection of cosmetic serums. This isn't a personalized cosmetic just to match skin tone or texture. It's quite specifically a personalized cosmetic line to match your DNA. The products have the right concentrations of active ingredients in the right dosages, so your skin can handle it.
"Sometimes people buy blockbuster serums - you could be having so many actives that your skin can't metabolize, or in such concentrations that it could cause more damage to your skin, because it's not personalized," Toumazou explained.
The cosmetic line of his semiconductor technology has opened up in a flagship store called Geneu, based in London. As he says, his work is not just focused on making sick people better and healthy people healthier, "but also beautiful people more beautiful!"
The differences between the applications of his semiconductor chip are vast. The barriers to entry for the skincare market are far less costly than those for the infectious disease market, and the latter has far higher stakes than the former. Yet Toumazou is inspired to personalize both, though switching between the two, he said, is like "going from beauty to the beast."
His Geneu cosmetic line, which he is working on bringing to the U.S., may differ drastically from his DNA-sequencing microchip, which was acquired by Thermo Fisher Scientific and will help physicians treat infections properly, contributing to the fight against superbugs. But he is equally eager and excited to work in both fields, giving consumers and patients access to personalized care at a low cost and a high speed.
