Facile screening for esophageal cancer in LMICs

中低收入国家食管癌的简便筛查

• 批准号: 9221673
• 负责人: Stephen J Meltzer
• 金额: $ 43.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9221673
• 关键词: Back; Benign; Biological Assay; Biological Markers; Car Phone; Cells; Cellular Phone; Cessation of life; ChIP-on-chip; Charge; Clinic; Clinical; Cold Chains; Community Health; Coupled; Cytology; DNA; DNA Methylation; Data; Defect; Deglutition; Deposition; Detection; Devices; Diagnosis; Diagnostic; Diagnostic Trial; Early Diagnosis; Electromagnetics; Endoscopy; Esophageal; Esophageal Squamous Cell; Esophageal Squamous Cell Carcinoma; Esophageal Tissue; Event; Feedback; Fees; Freeze Drying; Gold; Guidelines; Health Personnel; Human; Hypermethylation; Image; Intervention; Lesion; Liquid substance; Malignant Neoplasms; Malignant neoplasm of esophagus; Measurement; Mediating; Medical; Methods; Methylation; Microfluidic Microchips; Nanotechnology; Patient risk; Patients; Performance; Phase; Phonation; Polymethyl Methacrylate; Population; Porifera; Protocols documentation; Quality Control; Reagent; Rehydrations; Resources; Sampling; Screening for cancer; Sensitivity and Specificity; Services; Silicon Dioxide; Site; Specimen; System; Talents; Telephone; Testing; Time; Tube; Uganda; Universities; Validation; advanced disease; base; bisulfite; cancer cell; carcinogenesis; clinical translation; cost; cost effective; cost effectiveness; diagnostic accuracy; early detection biomarkers; epigenetic marker; follow-up; high risk; improved; instrument; low and middle-income countries; methylation testing; microchip; minimally invasive; mortality; noninvasive diagnosis; outcome forecast; point of care; point-of-care diagnostics; portability; prototype; sample collection; screening; superparamagnetic beads; user-friendly

Esophageal squamous cell carcinoma (ESCC) ranks sixth among all cancers worldwide, with 450,000 new cases diagnosed per year and a very poor prognosis. Low-cost, minimally invasive point-of-care population screening for ESCC is badly needed, particularly in LMICs, where 5-year ESCC survival is less than 10%. Altered methylation occurs frequently in human malignancies, including EC, constituting an early event that can serve as an early cancer detection biomarker. However, for DNA methylation to be used in this manner, we need cost-effective, user-friendly and robust tests that permit clinical translation in LMICs. We propose an early ESCC diagnostic strategy comprising a single-use, swallowable sponge to collect esophageal specimens coupled with a smartphone-manipulated microfluidic chip for automated sample processing and methylation detection. This strategy does not require endoscopy (EGD), can be administered by healthcare workers without medical degrees, and uses an on-phone analytic app. The sponge is cheaper (approximately $30 each), less invasive, and easier to perform than EGD ($1500 total cost, including facility fees); there are no room charges, unlike EGD. The microchip integrates DNA extraction, bisulfite DNA conversion, and methylation analysis into a single device. In addition, the microchip interfaces with a cellphone, for both device control and methylation detection and analysis. The integrated device enables detection of DNA methylation from crude samples in a “sample-to-answer” manner, without the need for sending data back to an analytic center off-site. Thus, the proposed platform promises a cost-effective and user-friendly POC strategy for early ESCC detection that is implementable in LMICs. We have also assembled a talented interdisciplinary, intercontinental team to execute this strategy. Our task will be achieved in 2 phases via the following Aims: UG3 PHASE: Aim 1: To assess a streamlined protocol for sample collection, processing and methylation detection. Aim 2: To implement DNA sample processing and methylation detection into a mobile phone- manipulated microfluidic chip system. Aim 3: To test a prototype ESCC diagnostic strategy integrating the DNA methylation detection system with the swallowable sponge for sample collection. UH3 PHASE: Aim 1: To improve the cost-effectiveness and robustness of the methylation diagnostic system for use in LMICs. Aim 2: To develop a method for ambient chip storage and perform on-chip QC tests to verify assay functionality. Aim 3: To conduct an ESCC diagnostic trial in Uganda using our point-of-care strategy.

食管鳞状细胞癌（ESCC）在全球所有癌症中排名第六， 每年确诊的病例数和预后极差。低成本、微创床旁人群 特别是在5年ESCC存活率低于10%的中低收入国家，迫切需要ESCC的筛查。 改变的甲基化经常发生在人类恶性肿瘤中，包括EC，构成了早期事件， 可以作为早期癌症检测的生物标志物。然而，对于以这种方式使用的DNA甲基化， 我们需要具有成本效益、用户友好和可靠的测试，以允许在LMIC中进行临床转化。我们提出了一个 早期ESCC诊断策略，包括一次性可吞咽海绵以收集食管标本 再加上智能手机操控的微流控芯片，用于自动化样品处理和甲基化， 侦测该策略不需要内窥镜检查（EGD），可由医护人员管理 没有医学学位，使用手机分析应用程序。海绵更便宜（约30美元 每个），侵入性更小，比EGD更容易执行（总费用为1500美元，包括设施费）;没有 不像EGD的房间收费。微芯片集成了DNA提取，亚硫酸氢盐DNA转化， 甲基化分析到单个装置中。此外，微芯片与手机接口， 对照和甲基化检测和分析。该集成设备能够检测DNA甲基化 以"样品到答案"的方式从原始样品中提取，而无需将数据发送回分析仪。 中心外。因此，拟议的平台有望为早期的 在LMIC中可实施的ESCC检测。我们还召集了一位才华横溢的跨学科专家， 洲际团队来执行这一战略。我们的任务将通过以下目标分两个阶段实现： UG3阶段：目标1：评估样本采集、处理和甲基化的简化方案 侦测目标2：在移动的电话中实现DNA样本处理和甲基化检测- 微流控芯片系统目的3：测试整合DNA的ESCC诊断策略原型 甲基化检测系统与可吞咽的海绵样品收集。UH3阶段：目标1： 提高用于LMICs的甲基化诊断系统的成本效益和稳健性。目标二： 开发芯片室温储存方法，并进行芯片上QC测试，以验证检测试剂盒功能。目的 3：使用我们的即时护理策略在乌干达进行ESCC诊断试验。