By Brian Rinker APRIL 19,
2018
YAOUNDÉ,
Cameroon — On the second floor of an infectious-disease research facility in
this African capital, Dr. Joseph Kamgno, the country’s leading expert on
parasitic roundworms, stood at his desk staring down at the black hard-shelled
case that had just arrived from a bioengineering lab at the University of
California-Berkeley.
The
case contained what appeared to be three ordinary iPhones. But the California
researchers believed these phones could do something extraordinary — help quell
river blindness, the second-leading cause of preventable blindness in the
world.
There
is already an effective treatment, a medication that can kill the baby worms
that cause the blindness. And when nearly everyone in a community takes the
drug every year for a decade or so, it can eliminate the disease from the area.
But
treating communities widely for river blindness is a risky proposition: The
treatment can cause coma or death in a small segment of the population that
harbors a different parasite — another worm known as Loa loa. That’s why large
swaths of Sub-Saharan Africa have been denied treatment for nearly two decades
— because the cure for river blindness for certain people can prove far worse
than the disease.
And
that’s where Silicon Valley technology comes in. The Berkeley researchers
figured out that they could quickly determine who has the Loa loa worm using a
smartphone, customized to work like a microscope. They could then skip the
medication for those people and give it to everyone else. Kamgno, who received
the latest version of the phones in 2016, dubbed the mobile microscopes
“revolutionary.”
The
gadgets, called LoaScopes, are part of a broader effort to harness technology
and innovation in the U.S., including California’s Silicon Valley, to fight
age-old diseases in the developing world.
Over
the years, major California universities — UC-Berkeley, UC-Davis, UCLA — have
built cellphone microscopes geared to look at other bloodborne diseases in
Africa and Asia, such as malaria and tuberculosis. UC-San Francisco researchers
are using satellite images on Google Earth Engine to construct real-time maps
of breeding conditions for malaria that can help predict infection rates in
rural villages.
Drones
are being used to deliver medical supplies to remote villages in Rwanda, and
digital “ledgers” built with blockchain software could be used to track
vaccinations in newborns, said Zvika Krieger, technology and policy expert at
the World Economic Forum Center for the Fourth Industrial Revolution.
To
accomplish their missions, nongovernmental and civil society organizations “are
flocking to Silicon Valley,” he said.
Mobile
Microscopes And Wiggly Worms
The
LoaScope was created in UC-Berkeley’s Fletcher Lab, named after Daniel
Fletcher, a wild-haired scientist who discovered 10 years ago the potential of
cellphones as microscopes. Basically, the camera on the phone is positioned
over a magnifying lens to capture a sample on a slide. Software can then analyze
whatever is on the slide and transmit it to the cloud.
Standard
light microscopes aren’t really mobile, and require electricity and a trained
lab tech to operate. The mobile microscope is cheap, compact and can be used by
anyone familiar with mobile phones, which are increasingly common around the
world, even in remote villages.
Researchers
test the latest version of the LoaScope in a village in Cameroon. (Brian Rinker
for KHN)
The
discovery spun off into a private business called CellScope, while Fletcher’s
academic lab continued to research smartphones as microscopes for the
university.
Several
years ago, Fletcher and his team had never heard of river blindness and knew
very little about neglected tropical diseases in general. The team eventually
became part of a mobile phone revolution in the developing world, in which
public health researchers were ratcheting up efforts to use these pocket
computers to address health problems.
The
Bill and Melinda Gates Foundation have bankrolled the LoaScope project since
its inception in 2011, spending more than $5 million to date.
River
blindness, or onchocerciasis, is a nasty disease that has burdened Africa for
as long as anyone can remember. The disease is spread by black flies, which
drop off and pick up worms as they suck people’s blood. The symptoms — terrible
itching, rotting skin and, after decades of infection, blindness — are caused
by early stage worm larvae that flood the body after adult worms mate.
The
river blindness medication, ivermectin, kills these baby worms effectively. But
when a person harboring tens of thousands of Loa loa worms in each drop of
blood takes ivermectin, all the baby worms die off in a sort of mass
extinction, causing potentially lethal brain swelling.
Upsides
And Downsides
The
small lab in Berkeley got involved with this complicated worm conundrum through
a parasitic disease expert at the National Institutes of Health.
Dr.
Thomas Nutman was tasked with finding a technology that could help solve the
Loa loa problem. At first, he considered a project at UCLA in which a cellphone
picture could be taken in the field, uploaded to the cloud and then analyzed by
someone sitting at a computer in California.
It
sounded good in theory, but because thousands of people had to be tested before
treatment, Nutman needed answers on the spot. Recalling work by Fletcher and
his team, Nutman hopped on a plane to the Bay Area to meet them.
Fletcher
and scientist Mike D’Ambrosio knew they had the technology to see the worms —
but figuring out how to see and count them in just a couple of minutes “seemed
daunting.”
“That’s
where we had the idea to use the motion of the worm as a way to see it,”
D’Ambrosio said. Early stage Loa loa larvae thrash around in the blood more
vigorously than other worms. So D’Ambrosio and his colleagues created an
algorithm to identify Loa loa based on its motion.
The
LoaScope is an iPhone that attaches to a plastic box made by a 3-D printer. A
blood sample on a plastic tube is inserted into the black box, which contains
optics and hardware. Press a button on the screen of the iPhone and it takes a
video of the blood sample and runs the algorithm.
But
relying on bioengineers in the tech-savvy San Francisco Bay Area to create a
solution comes with downsides familiar to anyone who works there: shutdowns and
updates.
Months
before the latest device was scheduled to ship out, the company the scientists
used to sync all their data gathered from the LoaScope to the cloud shut down,
forcing a rewrite of the related software code. Then the hardware company that
made an essential microcontroller board quit production.
“That
is the cost we pay for trying to build something out of consumer-based
electronics and using cloud software that is always changing,” said D’Ambrosio,
who became the lead research scientist for the LoaScope project.
On the
other hand, he added, “the benefit is enormous. We’re able to build these
integrated devices that do amazing things” at low cost.
Another
problem the scientists had was figuring out who would pay for the devices.
“The
business side of it is very unclear,” Fletcher said. “Part of the problem is
that there isn’t a market for neglected tropical diseases.”
The
Gates Foundation doesn’t typically pay to implement projects on a global scale.
However, the foundation is negotiating a deal for a company to manufacture
10,000 LoaScopes, Nutman said.
Back in
Cameroon, Kamgno’s research findings, published in the New England Journal of Medicine in
November, showed that the LoaScope allowed wide treatment with ivermectin, and
produced no adverse reactions in formerly “off-limits” communities. Kamgno’s
research team is now training local health workers to use the LoaScope, and
other countries soon may follow.
“We
were surprised and happy to see that after only two days of training, the local
people were able to do the treatment in their own community,” said Kamgno.
“Almost all the young people have cellphones, and they can understand the
LoaScope so quickly.”
This
story was produced by Kaiser Health
News, which publishes California
Healthline, a service of the California Health Care Foundation.
https://khn.org/news/applying-silicon-valley-smarts-to-age-old-diseases/?utm_campaign=KHN%20-%20Weekly%20Edition&utm_source=hs_email&utm_medium=email&utm_content=62270566&_hsenc=p2ANqtz-_W7d7cYVP2pAeBk9Gy49kX7ZbcA72jMO3iVoQd4z5Hmq7ci2-YMGD8_aGdFiFzS3pm2fqo08oFGcyjIXPatGrUvLuGWQ&_hsmi=62270566
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