Malaria Management through an On-demand Diagnostic Approach using Novel Ionic Probes - Project Summary
Although designed to facilitate home testing, rapid diagnostic test (RDT) have typically been used in a hospital-
based point-of-care (POC) setting for diagnosis of symptomatic patients where parasite density is high (>2000
per microliter of blood). This is, in part, due to the lack of sensitivity and stability of current lateral flow-based
RDT devices. In the current project, we propose to develop a novel on-demand paper-based diagnostic platform
that will enable self-testing (or field analysis) followed by remote and centralized signal detection using portable
mass spectrometers. This diagnostic approach is innovative as it combines new levels of simplicity and
practicality, modest levels of cost, and a centralized detection strategy, which will redefine the breadth of
application and performance/cost ratio for accurate malaria detection. More importantly, our proposed approach
will provide an opportunity to diagnose asymptomatic patients before the disease becomes clinically apparent,
therefore providing affordable community-based surveillance and POC tests. We will achieve this objective
through the rational design of novel ionic probes for coupling to specific antibodies, which will subsequently
enable the implementation of a paper-based immunoassay platform utilizing vertical fluid flow format. Compared
with enzymes, these stable ionic probes make possible the ability to interrupt, store, and restore the
immunoassay test, allowing detection at a later convenient time. In addition, the ionic probes are rationally
designed to yield ions of small masses upon stimulation permitting the use of portable instruments for field
analysis. By targeting all three levels of malaria care (i.e., symptomatic POC patients, surveillance-based
asymptomatic detection and field analysis in an outbreak), we will offer a greater chance of limiting the
188 million cases of malaria and reduce the $12 billion yearly loss in worker productivity. Aim 1 is to
design and synthesize active (cleavable) ionic probes as mass reporters for our proposed mass spectrometry
(MS)-based immunoassay technology. Two signal amplification strategies are also proposed to enable
ultrasensitive detection of low parasite density from a finger prick blood. Aim 2 will develop and optimize the
paper-based MS immunoassay platform by implementing two interrelated tasks: establishment of ionic probe-
mediated immunoassay on ordinary paper substrate, and the development of new on-chip MS detection methods
to facilitate the ease of use of the paper devices. Aim 3 involves validation of the method, through close
collaborative interactions with two molecular biologists (Kingsley Badu – not related to PI; KNUST, Ghana, and
Dr. Cristian Koepfli - University of California, Irvine, Public Health). Dr. James Odei (Clinical Biostatistics, Ohio
State University) is included for proper data analysis and interpretation. As part of this aim, we project screening
of at least 1,600 patients/volunteers with Plasmodium (P) falciparum (in Ghana) using the developed paper
device; we expect to include ~50% children under age 15. The method will also be validated against P. vivax
malaria samples (~600 volunteers expected) collected from Ethiopia.