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Driving Innovation
op
“Are we better prepared for emerging threats”
Dr Penny Wilson
Innovation Platform Leader, Stratified Medicine
12 November 2012
Foresight Project
The Detection and Identification of
Infectious Diseases
UK Government
Report published April 2006
Infectious Disease Project:
Key Question: How can we use science and technology to improve our capability for detecting, identifying and monitoring infectious diseases in order to improve control?
Ultimate goal: To detect all known and unknown infectious diseases, of plants animals and humans, in ~ 30 years.
Foresight Infectious Diseases: preparing for the future
UK Government
Project structure
Africa
Catalyse
Action
Review of
future risks
Explore future
capabilities
and contexts
Evaluate future
science
Technology analysis -
„User Challenges‟
1. Data mining and data
fusion
2. Genomics and post-
genomics to characterise
new diseases
3. Hand-held / portable
diagnostic devices
4. Fast-throughput screening
at ports and airports
UCs and future risk management
Categories of particular
concern
Potential contribution to
managing future risk
UC1 UC2 UC3 UC4
Evolution of new diseases *** *** ** **
Acquiring resistance in pathogens *** ** *** *
Zoonoses ** ** *** ***
HIV/TB/Malaria ** ** *** *
Plant disease threats *** * *** ***
Acute respiratory infections *** ** *** ***
STIs ** * *** *
Trans boundary animal diseases *** ** *** ***
* *** ** KEY:
Increasing potential
Driving Innovation
Detection and Identification of Infectious
Agents (DIIA) Innovation Platform
• Created to reduce the mortality, morbidity and
economic burden of infectious diseases in
humans and animals
• In July 2012 the platform was brought into the
Stratified Medicine programme
• Continues to address the challenges of adoption
with key stakeholders including DH, NICE and
BIVDA
• Forthcoming call 2012 (proposed)
– Diagnosis of tuberculosis
– Diagnosis of endemic animal diseases
Driving Innovation
Converging technologies • Biomarker discovery
• Biosensors
• Novel chemistries
• The omics (proteomics, genomics)
• MEMS (including microfluidics)
• Sequencing technologies
• Nanotechnology
• Advanced materials
• Bioinformatics
• Information and communication technologies
• Data mining and fusion
• High value manufacturing
Qualitative Field Testing
Inspection of imported nursery stock
Interception of quarantine viruses in imported produce
Control and Graphical User Interface
Modified Loop Mediated Isothermal Amplification (LAMP) Eiken Chemical Company, Japan: Bst Polymerase: Isothermal polymerase 63-65 oC
500 nl volume wells , Syto 82, 560 nm Filter
+ - + + + +
Norihiro Tomita, Yasuyoshi Mori, Hidetoshi Kanda & Tsugunori Notomi Nature Protocols 3, 877 - 882 (2008)
Loop-mediated isothermal amplification (LAMP) of gene sequences and simple visual detection of products
Modifications:
Property of base4innovation Ltd. Confidential.
Technology
Silicon wafer • Silicon wafer with 20nm thick
silicon membrane and 10nm covering of gold.
Nanofabrication • Gold on membrane is etched away to produce a
plasmonic nanostructure
• Nanopore is etched through silicon
Translocation and detection
• Wafer incorporated into microfluidic chamber
• Fluorescently labelled DNA induced to pass through nanopores
• Fluorescence from individually labelled nucleotides detected optically at high speed (up to 1 million bases/second)
Adapted from “Continua Alliance Overview” © Continua Alliance 2007
Service Provider
Domain
Service
Commissioner
Domain
Service User Domain
Continua „ecosystem‟
Driving Innovation
Converging technologies
What‟s the relevance?
What‟s the impact?
Results must lead to a decision
User Challenge Roadmaps – basic template
Now 5 Near 10 25-30 20
Systems
Applications
Technologies
Drivers and trends
Time (Years)
UC2 Roadmap (sections only)
More rapid cost effective NA
sequencing
Early detection of
infection in humans
Identification of known
pathogens
Genome sequences for all
known pathogens
Lab based
detection and
„understanding‟ of
novel pathogens
Continuous improvement in sequencing power
Immune signatures of
human infectious
diseases emerging
International system of
sampling at risk populations
etc agreed
Positioning of international
reference „laboratories‟
and networks agreed
Wild animal
surveillance from
UC1
Significance of novel
pathogenic sequences
recognised
Sampling regimes
upgraded in zoonotic
“hot-spots”
Ability to distinguish
between pathogens
and non-pathogens
International organisation
established to oversee
networks, prioritise threats
and respond (WHO?)
Immediate
vaccine/drug
development for
pathogens with
potential “high impact”
“TIME”
UC2 Roadmap
Now 5 Near 10 25-30 20
More rapid cost effective NA
sequencing
Early detection of
infection in humans
Identification
of known
pathogens
Novel sequencing
technologies (eg
random, high-throughput
single molecule
Genome sequences
for all known
pathogens
Early detection of
infection in animals
Lab and field
devices
(UC3)
Lab based
detection and
„understanding‟
of novel
pathogens
Miniturisation
and effective
UC1 systems
allow transfer
of novel
pathogen
detection to
UC3
Biomarkers
limited, especially
in animals.
Increased understanding of biological processes generating novel biomarkers
Diplomatic initiative and internationalisation
Decreased cost and increased efficiency of genomic sequencing
Bioinformatics and capabilities described by UC1 (eg web crawling, data collection, modelling and remote sensing)
Nucleic acid sequencing
routine
Range of NA amplification
technologies – PCR based
and isothermal, For
detection and quantification
NA microarrays standard,
protein arrays less universal.
Trend to bead based systems
and automation
Increased capacity of
NA arrays with
quantification
Routine protein
arrays for Dx and
marker discovery
Continuous improvement in sequencing power
Multiiple
approaches to
proteomics and
marker discovery
Immune signatures
of human infectious
diseases emerging
Immune signatures
of animal infectious
diseases emerging
International system of
sampling at risk
populations etc agreed
Positioning of international
reference „laboratories‟ and
networks agreed
Wild animal
surveillance from
UC1 Significance
of novel
pathogenic
sequences
recognised
Sampling
regimes
upgraded in
zoonotic “hot-
spots”
Ability to
distinguish
between
pathogens and
non-pathogens
International organisation
established to oversee
networks, prioritise threats
and respond (WHO?)
Immediate vaccine/drug
development for pathogens
with potential “high impact”
Field based
data from
UC1
Comprehensive
databases of known
pathogens
established
UC3 Roadmap (section)
“Time”
Standard platforms
agreed
Wild animal surveillance
defines zoonotic hot-
spots. UC2 informs design
of screening test
Animal biomarkers
for pathogens
Detection of pre-
symptomatic
disease and host
susceptibility
Novel
sequencing/detection
technologies
Devices for increasing numbers of known
diseases available. Trend from UC3A to
UC3B and from professional to non-
skilled users
Smart
objects
Trend from PCR to robust simple
amplification technologies and systems
capable of functioning in extreme environmental
conditions
UC3 devices for
novel human
diseases
UC1 systems mature
enabling full integration
of UC3 devices with
global networks
UC3 devices for all known
pathogens available. Output fully
integrated into international networks
maximising data utility etc
Immune signatures
of animal infectious
diseases emerging
Immune signatures
of human infectious
diseases emerging
UC3 Roadmap
Growing market in personal healthcare, driven by devices for management of chronic diseases, general wellbeing and lifestyle
Nanotechnologies, microfluidics, MEMS, developed for other markets allow reduction in sensor size and improved capabilities
Decreasing size and cost of GC-MS - driven by space flight, environmental and homeland security
Animal DIM
mainly by
symptoms, not
biomarkers
Now Near 10 25-30 20
Standard platforms
agreed
Wild animal
surveillance defines
zoonotic hot-spots.
UC2 informs design
of screening test
Animal
biomarkers for
pathogens
Detection of pre-
symptomatic
disease and host
susceptibility
Novel
sequencing/detection
technologies
Devices for increasing numbers of
known diseases available. Trend from
UC3A to UC3B and from professional to
non-skilled users
Smart
objects
POC devices for
non-ID applications
eg. SMBG and
pregnancy tests
Mobile telephony and pervasive computing allow more rapid networking and greater local data and processing power
Trend from PCR to robust simple
amplification technologies and systems
capable of functioning in extreme environmental conditions
Cheaper microfluidic based biosensor technologies for
nucleic acid and protein determination
POC
technologies
available for
DIM but limited
UC3 devices
emerge for
professional use
Mobile phones
measure pulse,
blood pressure etc
UC3 devices for novel human
diseases
UC1 systems mature
enabling full
integration of UC3
devices with global
networks
UC3 devices for all
known pathogens
available. Output fully
integrated into
international networks
maximising data utility
etc
Immune signatures
of human infectious
diseases emerging Immune signatures
of animal infectious
diseases emerging
Devices linked to networks – UC3B
Stand-alone devices – UC3A
KE
Y
NA sequencing
etc lab based
Compliance-
based
testing UC4
health
checks
Increasing range of
pathogens detectable
in enclosed spaces
Direct DIM of
pathogens using
genomics and
post-genomics
Cheaper microfluidic based biosensor technologies for
nucleic acid and protein determination
Cheaper sequencing and
microarray technologies
Miniaturisation
and pervasive
ICT
UC Synthesis Roadmap
Now Near 10 25-30 20
Internationalisation
Decreasing cost of ICT, data collection devices (from cameras to biosensors) and genome sequencing Miniturisation
Increased levels of global movement
Mobile telephony, pervasive computing and bioinformatics
Increased understanding of biological processes generating novel biomarkers
Temperature
sensing
DIM of spores
Dust collection
Limited correlation of
SLCs and VOCs to
disease status
Mobile
phone
with
location
Web
crawling/
text mining
Collection of
disparate data
from CCTV etc
Integrated
network for
the DIM of all
known and
unknown
pathogens
Standard platforms
agreed
Mobile phones
measure pulse,
blood pressure etc
Advanced miniaturised
chromatographic and
spectroscopic analysis
Semantic mapping
problem solved
Portfolio of novel
markers
UC3 devices for non-
ID applications,
some ID POC
Lab based systems
for early detection and
„understanding‟ of
novel pathogens
Trend from PCR to robust simple
amplification technologies and systems
capable of functioning in extreme environmental conditions
Immune signatures
of human infectious
diseases emerging
Immune signatures
of animal infectious
diseases emerging
Recognition molecules
and biological pathways
from animal olfactory
systems identified
VOC markers
maturing for
plants and
food products
All known and potentially unknown (beyond 25
years) pathogens detectable in cabins,
containers air bridges packages (baggage,
cargo, enclosed spaces)
Flow systems for
managing responses
Comprehensive
databases of known
pathogens
established
Novel
sequencing/detection
technologies
UC3 devices for
professional use
Devices for increasing numbers of
known diseases available. Trend from
UC3A to UC3B and from professional to
non-skilled users
Detection of
pre-
symptomatic
disease and
host
susceptibility
UC3 devices for all
known pathogens
available.
Remote sensing
Abstraction from
unstructured data
Dynamic semantic security
Automatic interpretation of
bioinformatic databases
African electronic data collection spread from SA Northwards
Wild animal
surveillance. Animal DIM
mainly by
symptoms
Immediate vaccine/drug
development for pathogens
with potential “high impact”
Foresight Infectious Diseases: preparing for the future
UK Government
Culture and governance issues SSA China UK
Go
ve
rna
nc
e
International + + +++
Regional/supra-national groupings ++ + ++
National ++ ++ +++
Local/provisional ++ +++ +++
Ability to implement measures through legal or coercive measures ++ +++ +
DIM interaction with control mechanisms + ++ +++
Investment in science and technology + ++ +++
Data-sharing culture ++ + +++
So
cia
l
as
pe
cts
Religious and societal beliefs/concerns +++ +++ +++
+ limited influence
+++ prominent influence Greater importance
In 10 – 25 yrs
Driving Innovation
New hope for sepsis
… This new injection of money and innovative enterprise
into combating this devastating and lethal disease will
hopefully lead to doctors being able to diagnose with
confidence and initiate life-saving therapy early, and
ultimately to fewer people dying needlessly worldwide….
Thank you