What if we could diagnose infections in minutes, not days? | Dr Neciah Dorh | TEDxBristol
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0:15 - 0:16Every year,
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0:16 - 0:21700,000 people are killed by superbugs
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0:22 - 0:24To put that in perspective,
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0:24 - 0:30that's more than the combined populations
of the cities of Bristol and Bath. -
0:31 - 0:35What's more is that in about thirty years
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0:35 - 0:40that number is expected to rise
to 10 million people a year, -
0:40 - 0:45which would mean that superbugs
would have killed more people than cancer. -
0:48 - 0:50Now, many of us may have heard
the term 'superbug' -
0:50 - 0:53thrown around at some point in our lives.
-
0:53 - 0:58But lets take some time to think about
what it is we're really referring to, -
0:58 - 0:59how we got here,
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0:59 - 1:01and most importantly,
-
1:01 - 1:05how do we get ourselves
out of this crisis? -
1:06 - 1:08So what is a superbug?
-
1:09 - 1:12'Superbug' is a name given
to a particular group of bacteria, -
1:12 - 1:15otherwise known as a strain,
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1:15 - 1:18that cannot be treated
with most of the antibiotics -
1:18 - 1:21available or in use today.
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1:22 - 1:25They're a formidable enemy
when you consider the fact -
1:25 - 1:30that many people would not have lived
to see their sixtieth birthday -
1:30 - 1:35prior to the discovery of penicillin
and other classes of antibiotics. -
1:38 - 1:41Raise your hand if you've ever had
an antibiotic prescribed to you. -
1:43 - 1:45OK.
-
1:45 - 1:48Well, you'll be familiar with the process
I'm about to describe next. -
1:49 - 1:52It probably all started
when you weren't feeling very well: -
1:52 - 1:55a persistent cough, a fever,
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1:55 - 1:59or perhaps that burning sensation
when you'd go for a wee. -
2:00 - 2:02(Laughter)
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2:04 - 2:06Having put up with it all weekend,
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2:06 - 2:10you finally mustered up that courage
to go out and speak to your doctor. -
2:11 - 2:13After reviewing your symptoms,
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2:13 - 2:17you're given a prescription
for antibiotics and told: -
2:17 - 2:21'Come back after the third dose
if your symptoms persist'. -
2:23 - 2:26Now, I'm an engineer,
so I love my flowcharts. -
2:27 - 2:31And they really help me
get my head around what's going on. -
2:31 - 2:34So I took the liberty of putting
this little schematic together. -
2:35 - 2:38So step one: bacterial infection starts.
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2:38 - 2:42Step two: signs and symptoms develop.
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2:43 - 2:48Step three: person goes out
to get medical attention. -
2:50 - 2:53Step four: antibiotic
prescription is given. -
2:53 - 2:57And step five: after three doses,
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2:58 - 3:00check whether symptoms are getting better.
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3:00 - 3:03If yes, carry on.
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3:03 - 3:10If no, order a diagnostic test
to determine what is making you sick, -
3:10 - 3:12and then return to step three.
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3:14 - 3:20Now, I've got the utmost respect
for our friends in the medical profession, -
3:20 - 3:24but this system is fundamentally flawed,
for a couple of reasons. -
3:24 - 3:29Firstly, it encourages your doctor
to start treatment -
3:29 - 3:31before having all the information.
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3:33 - 3:34Secondly,
-
3:34 - 3:37each time we go around that loop,
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3:37 - 3:40what we're actually doing
is killing off all the bacteria -
3:40 - 3:44that cannot defend themselves
against a given antibiotic, -
3:44 - 3:49leaving behind a monolithic group
of bacteria that can. -
3:49 - 3:55In effect, we're helping the enemy
sift out unfit soldiers. -
3:59 - 4:04Now, we're in this predicament
because, still today, -
4:04 - 4:08one of the most commonly used methods
for identifying bacteria -
4:08 - 4:14involves taking a sample of urine,
of mucus, of blood, -
4:14 - 4:19and growing it under varying conditions
to help us piece together the identity. -
4:19 - 4:23Think of it like a process of elimination
carried out in the lab. -
4:24 - 4:27Once the bacteria is identified,
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4:27 - 4:29we then use another process
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4:29 - 4:33to determine which antibiotic
most likely will work. -
4:34 - 4:37The problem is that that takes time,
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4:37 - 4:39two days or more,
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4:39 - 4:42and in some extreme cases,
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4:42 - 4:46people have actually died
before their doctors got the answers. -
4:49 - 4:55Nevertheless, this is our system;
treatment first, diagnostic second. -
4:58 - 5:00So how do we get ourselves out of this?
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5:01 - 5:03Actually, it would be a lot better
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5:03 - 5:07if we could first work out
what's making you sick, -
5:07 - 5:10and then selecting
the most appropriate antibiotic. -
5:10 - 5:16Not only would you get better days sooner,
but we'd also curb the rise of superbugs. -
5:18 - 5:21But to do that,
we'd need a test that's fast. -
5:21 - 5:24I mean, like, really, really fast;
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5:25 - 5:28fast enough to meet the 20 minutes or less
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5:28 - 5:30that you have with your doctor
or your pharmacist. -
5:32 - 5:36But also, it'd also need to be affordable;
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5:36 - 5:38affordable enough
that developing countries -
5:38 - 5:40could make that transition.
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5:41 - 5:45And finally, it would need to be
easy enough to use -
5:45 - 5:48that it's as effortless
as checking your temperature. -
5:49 - 5:53And that is exactly what my team and I
have been working towards -
5:53 - 5:55over the last two years.
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5:56 - 6:01We've been developing a technique
based on receptor-mediated sensing. -
6:01 - 6:06We've quoted it GMS for short,
and it's a lot simpler than it sounds. -
6:07 - 6:11For many bacteria,
the first step of infecting you -
6:11 - 6:14involves sticking themselves
to the cells in your body -
6:14 - 6:17using a hook and loop system
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6:17 - 6:21that's quite similar
to what we've come to love in Velcro. -
6:21 - 6:23(Laughter)
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6:25 - 6:29The hooks in this case
would be specific proteins, or receptors, -
6:29 - 6:32on the surface of the bacteria,
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6:32 - 6:36and the loops would be specific molecules
on the surface of the cells in your body. -
6:37 - 6:42What we've done is created a low-cost,
light-emitting material -
6:42 - 6:44and coated it in loops;
-
6:44 - 6:46let's call them probes.
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6:47 - 6:51When we mix our probes with a sample -
for example, urine - -
6:51 - 6:54they stick to bacteria like Velcro.
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6:54 - 6:57And by measuring the light
coming off of them, -
6:57 - 7:01we can then calculate the number
of bacteria present in that sample. -
7:01 - 7:05The final process itself
will be quite simple. -
7:05 - 7:08Take a bit of urine,
add it to a special cartridge. -
7:08 - 7:12Then place that cartridge
in our very own bug detector. -
7:14 - 7:17The cartridge would mix
the urine with our probes -
7:17 - 7:22before separating out the bacteria
and measuring the light coming off. -
7:22 - 7:26That final step will allow us to determine
whether bacteria is present, -
7:26 - 7:29which one, and how many,
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7:29 - 7:32all within 15 minutes.
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7:32 - 7:36From two days, to 15 minutes.
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7:37 - 7:40Now, as with most scientific developments,
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7:40 - 7:46the journey is fraught with challenges
and sometimes disappointments, frankly. -
7:47 - 7:49And I'll share a couple of them with you.
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7:50 - 7:54One of our first challenges was:
how do you develop a probe -
7:54 - 7:57that effectively mimics
the cells in your body? -
7:59 - 8:02It took a team of researchers at the
University of Bristol -
8:02 - 8:04months of experimenting
-
8:04 - 8:06to get the recipe just right
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8:06 - 8:11to have the right type and balance
of loops to mimic the cell. -
8:11 - 8:15I mean, this is not like bashing out
bad pancakes on a Sunday morning. -
8:15 - 8:18This is the kind of effort
you put into winning Masterchef. -
8:18 - 8:20(Chuckling)
-
8:21 - 8:26The second challenge for us was actually
finding a detection method -
8:26 - 8:31that was low-cost, yet powerful enough
to detect the probes -
8:31 - 8:33once attached to the bacteria.
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8:34 - 8:38For that, we turned to a well-established
technique based on fluorescence. -
8:39 - 8:41Fluorescence is a phenomenon
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8:41 - 8:44where a material stimulated with light
absorbs some of it, -
8:44 - 8:46and re-emits a different colour.
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8:47 - 8:49As a detection technique,
-
8:49 - 8:52we'd effectively take
a specific colour of light, -
8:52 - 8:56shine it at that material,
and observe the colour coming back, -
8:56 - 8:58and that helps us tell what's present.
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9:00 - 9:04So, we've got probes,
they stick to the right bacteria, -
9:04 - 9:06and we can detect them.
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9:06 - 9:07Job done, right?
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9:08 - 9:09Actually, not quite.
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9:11 - 9:13Most of the foods that we eat
actually get broken down -
9:13 - 9:17into light-emitting materials
that end up in your wee. -
9:18 - 9:23And so, these are things like
energy drinks, vitamin supplements, -
9:23 - 9:24pregnancy supplements,
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9:24 - 9:28and all of these together
could lead to false positives. -
9:29 - 9:33In other words, they make it really hard
for us to determine the difference -
9:33 - 9:36between friend or foe.
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9:36 - 9:43And so, differentiating our probes from
the remnants of your last energy drink -
9:43 - 9:45is absolutely important
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9:45 - 9:48for ensuring that we do not report
that bacteria is present -
9:48 - 9:50even when there aren't any.
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9:51 - 9:54This is where the research
took a really interesting turn, -
9:54 - 9:59because getting around this
meant getting familiar with our probes, -
9:59 - 10:01but also getting
really familiar with urine. -
10:04 - 10:08We carried out several experiments
observing how our probes behaved -
10:08 - 10:11when stimulated with
different colours of light. -
10:11 - 10:14Particularly, we're interested
in how much green light is emitted -
10:14 - 10:18for every colour of light
that we stimulated them with. -
10:18 - 10:21This is the profile of our probes,
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10:22 - 10:23and it does not change.
-
10:24 - 10:28So any deviation from that
would then tell us -
10:28 - 10:31that there's other stuff
mixed in with the sample, -
10:31 - 10:36and it would look a little bit like
when it's mixed with urine, for example. -
10:36 - 10:42By measuring that change,
we can actively correct for interference -
10:42 - 10:45from anything else
that's present in the urine. -
10:46 - 10:51So pulling it all together,
the probes help us find the bacteria -
10:52 - 10:55and fluorescence helps us find the probes.
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10:57 - 11:00We're still at the
early stages of our journey, -
11:00 - 11:03but we were able to take
our first prototype into a hospital lab -
11:03 - 11:06where we tested for E. coli
in human urine. -
11:07 - 11:12GMS was able to detect the presence
of urine without any false positives, -
11:12 - 11:19and it correctly reported the absence
of E. coli in the urine in 63% of cases. -
11:19 - 11:21Finally,
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11:21 - 11:23by placing three measurements in parallel,
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11:23 - 11:28we were able to achieve an average time
per test of just four minutes. -
11:30 - 11:33This is certainly not
the end of the story for us. -
11:33 - 11:38We're now developing other forms of loops
to address other harmful bacteria, -
11:38 - 11:42and we aim to test and improve
the system a few more times -
11:42 - 11:44before it gets to your GP.
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11:44 - 11:46But once we do this,
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11:47 - 11:50combining our faster, accurate diagnostics
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11:51 - 11:57with better antibiotic usage
and continued public engagement, -
11:57 - 12:00we could finally tip this war
back in our favour -
12:00 - 12:04and overcome superbugs once and for all.
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12:05 - 12:06Thank you.
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12:06 - 12:08(Applause)
- Title:
- What if we could diagnose infections in minutes, not days? | Dr Neciah Dorh | TEDxBristol
- Description:
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Antimicrobial resistance is a global problem. It’s expected that by 2050, superbug infections will kill more people than cancer. But what if we could cut diagnosis of an infection from days to minutes? Might that help drive down the overuse of antibiotic prescriptions and promote faster and more effective treatment?
That's exactly what Dr Neciah Dorh and his multi-disciplinary team of engineers, data scientists and microbiologists are trying. Their aim is to create a fast, affordable and easy-to-use diagnostic for healthcare practitioners to use. Their starting point: Urinary Tract Infections. UTI’s are the second highest cause of antibiotic prescription within primary care in the UK, with many elderly patients regularly experiencing ineffective antibiotic treatments that often lead to recurrent visits to the doctor or even hospitalisation.
Neciah's TEDx talk explores how fluorescence-based technology can identify and enumerate bacterial infection in less than 15 minutes.Originally St Lucia, Neciah has spent the last 10 years in Bristol, UK and has become a proud member of its Health-tech community. After gaining his BEng and Ph.D. in Electrical and Electronic Engineering from the University of Bristol, his investigations within novel fluorescent detection became the basis of his company, FluoretiQ limited.
His pioneering team is working at the interface of engineering, microbiology and chemistry to deliver the next generation of game-changing diagnostics.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 12:18