Multiplex Biomarker Approaches to Enable Point-of-Care Testing and Personalized Medicine
This chapter describes how current and future innovations driven by application of multiplex biomarker techniques can help in earlier and more efficacious treatment of patients, suffering from the world’s most devastating and costly diseases. The applicat
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seases such as cardiovascular disorders, type 2 diabetes, obesity, cancer, and mental health disorders can affect people of both sexes at different ages and seriously impair medical health, quality of life, social well-being, and productivity, with a significant negative impact on society and the economy. According to the World Health Organization (WHO), the global burden of noncommunicable diseases is expected reach approximately exceed 30 trillion US dollars within the next 20 years and account for almost half of the global GDP [1]. Given the urgent medical need and the importance of counteracting these negative effects, it is now vital that point-of-care testing gains wider acceptance on the marketplace. The existing methods are simply not working and may also be equally draining on the economy due to the large-scale instrumentation required along with long processing times and the delay in receiving, communicating, and acting upon diagnostic results. One means of overcoming these issues which has been emerging over the last decade is through clinically validated lab-on-a-chip (LOC) approaches. LOCs provide many advantages over existing methods, such as the need for lower biosample volumes, less waste, lower fabrication and reagent costs, improved process control due to faster system response times, and compactness due to integration Paul C. Guest (ed.), Multiplex Biomarker Techniques: Methods and Applications, Methods in Molecular Biology, vol. 1546, DOI 10.1007/978-1-4939-6730-8_28, © Springer Science+Business Media LLC 2017
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and high parallelization of functionality [2, 3]. Most importantly, this translates to a reduced waiting time for the results and tests can even be performed right there in the doctor’s office. One emerging LOC approach involves a new way to diagnose and manage HIV infections. Around 40 million people are infected with HIV in the world today, yet scarcely more than one million of these receive the correct anti-retroviral treatment. In fact, most of the people with HIV have never even been tested for the disease. Currently, measuring the circulating levels of CD4 positive lymphocytes in a person’s blood is the best way to determine if they have HIV and this can also be used for tracking the infection. This is typically achieved using a technique called flow cytometry that is not available in most developing countries where the presence of HIV is disproportionately high since the instrumentation is large, expensive, and complicated and requires trained technicians in the operation and interpretation of data. Recently, a company called ClonDiag developed a LOC device that employs similar static image analysis and counting of CD4 positive cells as in flow cytometry but in a compact and transportable package that does not require extensive laboratory training [4]. Furthermore, it requires only 25 μL of blood and can deliver results within only 20 min. Another LOC device that was developed more recently consists of a printed flexible plastic microchip that can capture an
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