Molecular Warehouse: Mobile-enabled molecular diagnostic for remote monitoring of kidney transplant patients

英国有35000名肾移植患者（发达国家超过50万），为了避免移植排斥，他们必须终生服用免疫抑制药物。现代免疫抑制剂已将10年总体肾移植存活率提高到60%，而10年前为40%。然而，目前免疫抑制剂的治疗指数较窄，患者之间的差异需要在临床对患者进行监测。不幸的是，患者和医疗系统在时间和费用上的负担导致检测不频繁，再加上生活方式的改变和药物依从性差，导致免疫抑制剂水平控制不佳，并伴随移植物生存期缩短。考虑到与透析相比，肾脏移植的成本效益是每年24100英镑，患者每年有一个功能正常的移植肾脏，在英国每年约3000个新的肾脏移植，每年移植存活率的提高将为nhs每年节省7200万英镑。为了解决这个问题，Molecular Warehouse正在开发一种自我检测诊断设备，用于快速监测肾移植患者的免疫抑制剂。患者可以在家用智能手机进行测试，测试结果会立即无线发送到一个在线仪表板上，由开处方的医生进行检查和确认。这项测试将首次使以患者为中心的精准医学方法能够用于免疫抑制治疗，改善移植维持和患者的生活质量，并减少NHS的操作成本和等待时间。在开发了系统的功能概念验证后，该项目将与同意支持该项目的主要临床医生合作，开发预生产原型和初步临床测试，以使该产品迅速提供给患者。

There are 35,000 kidney transplant patients in UK (and over 500,000 across developedeconomies), who have to take immunosuppressant medication for the rest of their lives, inorder to avoid graft rejection.Modern immunosupressants have increased 10-year overall kidney graft survival to 60%compared with 40% from a decade prior. However, the narrow therapeutic index and interpatientlevel variability of immunosuppressants currently necessitates patient monitoring inthe clinic.Unfortunately, the burden on the time and cost on both patients and the healthcare systemresults in infrequent testing, which combined with lifestyle changes and poor medicationadherence, leads to immunosuppressant levels being poorly controlled, and concomitantly toshorter graft survival.Considering that the cost benefit of kidney transplantation compared to dialysis is £24,100 peryear for each year that the patient has a functioning transplanted kidney, each year ofimproved graft survival for the ~3,000 new kidney transplants per year in UK would save theNHS £72m per year.To solve this problem, Molecular Warehouse is developing a self-testing diagnostic device forthe rapid monitoring of immunosuppressants in kidney transplant patients. The test can beperformed at home on the patient’s smartphone, and results immediately sent wirelessly to anonline dashboard for review and confirmation by the prescribing doctor.This test will for the first time enable a patient-centric, precision-medicine approach toimmunosuppression therapy, improving transplant maintenance and patient quality of life, andreducing operational costs and waiting times in the NHS.After having developed a functional proof of concept of the system, this project will developthe pre-production prototype and initial clinical testing, in collaboration with leadingclinicians who have agreed to support this project to make this product available to patientsrapidly.