Point of Care Testing Talk.ppt - Lehigh Universityinbios21/PDF/Fall2009/Heindel10072009.pdf · DRUG...
Transcript of Point of Care Testing Talk.ppt - Lehigh Universityinbios21/PDF/Fall2009/Heindel10072009.pdf · DRUG...
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What do these have in common?What do these have in common?
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And this? (thermometer)And this? (thermometer)
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And this?And this?
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And this?And this?
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And this?And this?
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And even this?And even this?
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& this, THE Most Popular!& this, THE Most Popular!
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THESE ARE ALL
POINT OF CARE (POC)POINT-OF-CARE (POC)
ASSAY KITS
Now Just What is “Point of Care”?Now Just What is “Point-of-Care”?
Answer: Home, bed-side, office
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WHY PERFORM “POINT-OF-CARE”?• $7.50 vs. $55.20 [careful here!]• 1 minute response vs. 24 hour p
response• Therapy (response) can be instantlyTherapy (response) can be instantly
coupled to the measurement• Patient sees consequences of action• Patient sees consequences of action• Patient can receive results
fid ti llconfidentially
WHAT’S THE ROLE OF FDA IN POC DIAGNOSTICS?
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What’s the Right Fluid & Why?What s the Right Fluid & Why?
• BloodBlood• Feces
U i• Urine• Mucus • Ejaculate• VitreousVitreous• CSF
S t• Sweat• Saliva
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Ya Gotta Have a Specific “Bio-M k ” POC W ’ W kMarker” or POC Won’t Work
Beta-HCG, 244 amino acids, 36,700 D, made by embryo
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Other Bio-markersOther Bio markersElevated glucose in urine or bloodElevated glucose in urine or blood
High Blood Pressure or Body TemperatureHigh Blood Pressure or Body Temperature
Cardiac (or liver) enzymes ex-organ
Luteinizing Hormone
And many, many others! (some observational)
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“Ferning” & FertilityFerning & Fertility
“High Content Screening”High Content Screening[This is an insult to Chemists!!!]
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Guiacol, Fertility, Blood, and S Kl k LU B A ‘ 4Steve Klasko, LU B.A. ‘74
OH
OCH3
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What Clinical Conditions do we Test for by POC?Test for by POC?
• Glucose (ca 65%)• Pregnancy/ovulation/sperm count (ca 12%)• Pregnancy/ovulation/sperm count (ca 12%)
FertilMARQ “yes” v “no” at 20M swimmers/mL
• Cardiological assays (ca 10%)g y ( )• Coagulation• Infectious Diseases• a) HIV• b) hepatitis• c) bladder infections• Electrolytes, Blood Gases
Al h l I t i ti• Alcohol Intoxication• Heart Attack• Rupture of Liver Cells• Impaired Metabolism of Multi Drug Prescriptions (Saladax)• Impaired Metabolism of Multi-Drug Prescriptions (Saladax)
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How do We Get Specificity?How do We Get Specificity?
• A Specific Chromatographic MigrationA Specific Chromatographic Migration
E ti R iti• Enzymatic Recognition
• Immuno-Recognition
• Electrochemical Reduction
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Electrochem SpecificityElectrochem SpecificityPharmaceutical ExamplesPharmaceutical Examples
DRUG + e- [DRUG]- (at precise potential)Misonidazole -0 64 vMisonidazole -0.64 vClotrimazole -0.19 vStreptozotocin 1 34 vStreptozotocin -1.34 vRitonavir -1.91 v
Precise potential for reduction identifies the drug total current flow measures the amountdrug, total current flow measures the amount
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What are the Justifications?M b i fMost are obvious…a few not so.M it i ti d t b li t h t l bMonitoring anticancer drug metabolism at home or at lab
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Challenges in Configuring the AAssay
• What should we sample?• “Yes” vs “No” (cut-off assay) or precise• Yes vs. No (cut-off assay) or precise
measurement assaySimplicity of Use (th ‘bl li ’ h t)• Simplicity of Use (the ‘blue line’ rushes past)
• Checks-and-balances (air, water, sun, decomp of reagents, stabilizing reagents)
• Handling confirmation of serious finding
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Handling ReagentsHandling Reagents
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CONSTRUCTING AN ASSAY with MAbheavy chains = yellow & light blue, light chains green & dark blue. carbohydrate = red
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CONSTRUCTING AN ASSAYCONSTRUCTING AN ASSAY
MAb[tag] + analyte =MAb[tag] + analyte =
MAb[tag]--analyte then
Anti-MAb to MAb[tag]--analyte
grabs & holds this combo ingrabs & holds this combo in
a narrow target zoneVisual “tag” not bound covalently can be released by the binding event
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Assembling the AssayAssembling the Assay
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What Can Go Wrong?What Can Go Wrong?• Untrained assayerUntrained assayer
• Test is inherently less accurate• Test is inherently less accurate
C it di i i• Community medicine misses a community trend
• Insurance seldom covers “point-of-care”care”
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A FEW FAMOUS FAILURESA FEW FAMOUS FAILURES• Toilet paper fecal blood testToilet paper fecal blood test
Fecal sampling spoon and rubbing paper• Fecal sampling spoon and rubbing paper
• Ejaculate on bulls eye and microwave
• Heated patch for sweat sampling
• Home-use “ferning” assay with scope
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WHAT’s THE FUTURE?• A bright future for R&D and investment where
h i t bi l & di i tchemistry, biology, & medicine meet
• Possible cost savings to the patient (For now, a few tests do appear to cost more per test)
• Major increase in medical effectiveness
• Confidentiality and increased patient ibilit f l h lthresponsibility for personal health
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“Better things for better livingBetter things for better living
through CHEMISTRY”!
http://www.craigmedical.com/