Small wonder

Team plans to build miniature device to diagnose chronic kidney disease

From left, Drs. Francis Lin, Paul Komenda (holding a machine used to analyze white blood cells), Claudio Rigatto (holding a smartphone attached to a card reader), and Michael Zhang (holding a model of the 'lab on a chip')
From left, Drs. Francis Lin, Paul Komenda (holding a machine used to analyze white blood cells), Claudio Rigatto (holding a smartphone attached to a card reader), and Michael Zhang (holding a model of the 'lab on a chip').

Winnipeg Health Region
Wave, May / June 2014

Health-care providers around the world may soon be using a palm-sized device capable of using a drop of blood to help diagnose chronic kidney disease and suggest possible treatments, thanks to a group of Winnipeg doctors and scientists.

The group - Drs. Francis Lin, Claudio Rigatto, Paul Komenda, Navdeep Tangri and Michael Zhang - recently received a $500,000 award from the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council of Canada.

Currently, blood analysis to diagnose chronic kidney disease is often done in a specialized lab. The Winnipeg group plans to take the functionality of the equipment found in a specialized lab and put it into a device holding a microfluidic chip.

"We're approaching the idea of a tricorder," says Komenda, referring to the little black box used by Dr. McCoy to diagnose patients on the science fiction TV show Star Trek.

The fictional machine of television fame used sensors to detect that was wrong with a patient. The device being developed by the Winnipeg group will operate a little differently, says Komenda, a clinician with the Manitoba Renal Program and an associate professor of medicine at the University of Manitoba's Faculty of Medicine.

First, a drop of blood is fed into the chip, which is housed in a plastic shell about the size of a credit card. Antibodies located on the chip react to the blood, detecting different protein biomarkers. The device is then plugged into a smartphone, which uses its camera to "read" the signals generated by the biomarkers. The results can then be e-mailed to a consulting physician.

Rigatto, says the device and smartphone combo is akin to having a "lab on a chip."

Currently, the name of the device they're working on is a mouthful - the team calls it a "microfluidics-based point-of-care system for measuring multiple biomarkers of kidney disease." They wanted to call it a tricorder, but that name is trademarked.

The funding will be used over the next three years to build the miniature device and test it in the field, says Rigatto, who is an associate professor of medicine and Head of the Section of Nephrology at University of Manitoba, and a clinician in the Manitoba Renal Program. "Part of the funding goes to recruiting patients who will donate blood, which will be tested simultaneously by our reference standard - the big labs - against this chip-based system. We need to show that our system is as accurate as the testing that goes on in a lab, with their kits and big machines and a lab technician performing the tests," he says. The team has access to a cohort of 2,000-plus chronic kidney disease patients who have already been identified and tested.

Lin, an associate professor in the Department of Physics and Astronomy at the University of Manitoba, is developing the device at his lab. He says the team aims to make it fool-proof, so almost anyone can operate it. They also want it to be able to test multiple biomarkers at one time.

"We believe we'll see better results in combination of multiple biomarkers," says Lin, adding that industry partners stand ready to develop the device for market. "This project will also offer unique training opportunities for researchers in physics, engineering and biomedical sciences."

The new device is not only small; it's also sophisticated in terms of what it can do, says Komenda. As he explains, chronic kidney disease diagnosis has depended on a pair of tests that have been the same for the past four decades.

"We've been testing for serum creatinine, which is a muscle break-down product, and also for levels of protein in the urine. These have been our two best tests for the last 40 years," he says. "Now in 2013/2014, we're coming up with equations that use age, sex, creatinine, level of protein in the urine, as a combination of prediction equations to predict risk of kidney failure two, five years out from now."

Some of these new biomarker tests can be done in Winnipeg, but others have to be sent to Alberta. "Especially tests for the newer biomarkers, such as FGF-23 and IL-6, which are measured using custom assays in research labs or through costly services provided by laboratories," says Rigatto.

Using biomarker tests allow doctors to tailor the treatment to each patient. "At some point in the future, we will quickly be able to identify which patient will be best affected by each of the drugs we have," says Komenda. "That's much more efficient and cost-effective, and minimizes toxicity to patients."

Canada is facing an epidemic of chronic kidney disease, says Rigatto, as it affects about 4.5 million Canadians. Manitoba has the highest incidence - well above the Canadian average - of chronic kidney disease and its major consequence: dialysis. This has a major impact on patients in terms of health and quality of life, and to society in terms of cost to the health-care system, he says.

"One of the biggest challenges we face, especially in Manitoba, is that much of the growth in kidney disease is occurring in remote areas. These are areas that do not have access to primary health care, let alone more technological advances in health care," says Rigatto. "This is where the potential for a hand-held system to be used to assess kidney function and other indicators of risk would be useful."

Only one in 10 people tested for chronic kidney disease will end up on dialysis, says Rigatto. "To help predict this, we're also looking into new genetic biomarkers for early prediction of chronic kidney risk. To be able to do this with a portable system means less disruption for the patients, many of whom have to leave their communities and come to Winnipeg for testing."

Zhang, a decision support analyst with the Winnipeg Health Region, and an adjunct professor of applied computer science at the University of Winnipeg, says it's an honour for the team to receive this highly competitive funding that will critically enable the project to go forward.

"The chip-based approach has the high potential to enable true mobile and personalized health care for chronic kidney disease," says Zhang, adding that the project will also receive support from the Seven Oaks Hospital Renal Program and industry partners.

Susie Strachan is a communications advisor with the Winnipeg Health Region.

Wave: May / June 2014

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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