From reactive medicine to preventive medicine | Abdennour Abbas | TEDxParis

Educated at the University of Lille, today, Abdennour Abbas is a young professor and manager of the "Biosensors and Bionanotechnology" laboratory at the University of Minnesota, Twin Cities, USA. Convinced that home self-diagnosis will be the "next big healthcare transformation," he set himself an objective: create biosensors for "mainstream" devices which can be sold "in any drugstore." To reach his goal, he has come up with a new method of detecting viruses which has already been successfully tested in his laboratory and considered to be a billion times more sensitive than existing tests.

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Here's a scenario
that I keep on questioning:

I fall ill, I make a doctor's appointment

and I have the appointment the next day.

The day of the visit, the doctor
diagnoses me by observation,

since he doesn't have
access to bodily fluids,

and he considers two or three
possible infections.

Then, he either prescribes me
a broad-spectrum treatment

to cover all eventualities,

or, he tries an illness-specific treatment

and if that does not work,
it's changed at the next appointment.

Next, he calls for blood tests.

So, I have the blood tests
on the morning of the third day,

and I get the results on the fourth day.

I call the doctor,

and I have my second appointment
with the results on the fifth day.

Do you know how long it takes an organism
to react to an infection?

A few hours.

The information we need
to tell us what is wrong with us

is available in our blood
within a few hours.

But the doctor does not have access
to this information until five days later.

It's too long, inefficient,
and it costs a lot of money.

During my PhD thesis, which I wrote
at the University of Lille, France,

I always thought

that big analysis laboratories
were a bit like phone boxes of the 80s -

it's a comparison which will speak
more to those over 30 -

I thought that medical tests
would go the same way

and that we would end up having
our own self-testing kits at home.

What I didn't understand,

while home pregnancy tests
have been on the market since 1970,

in 2013 we have still not
been able to apply this concept

to infectious diseases.

After my PhD thesis, and a period
spent at the University of California,

I joined the University of Washington,

where I started to work
specifically on self-testing.

It was then that I understood
that there were two major obstacles

which prevent this technology
from being scaled up.

First of all, the issue of sensitivity.

In the majority of infections,

the molecules we want to detect
are found in very small concentrations,

which means that the tests
have to be very sensitive.

Because of this problem,
it wasn't until 2012

that the first home testing kit
was authorised in the USA.

That was the HIV test.

France has only just issued
a favourable report

on their commercialisation
a few weeks ago.

The problem with these tests

is that they are based
on a rectangular, paper test strip.

Which is the cause of a certain
limitation on sensitivity.

What is more, HIV tests

can only be used
three months after infection,

since the virus needs time to multiply
and reach sufficient concentrations,

and in the meantime, it wreaks havoc.

So, to avoid losing time,

and to be able to detect
very weak concentrations,

we have developed a different approach
over the course of the last year.

As usual, the true challenge of technology

is not in finding
a solution to the problem,

but in finding a simple solution.

So, instead of cutting
the paper into a rectangle,

we have cut it into a many-pointed star.

With this principle, you just have to put
your sample in the centre of the star,

and the sample will separate itself
into several components.

For example, with blood,
red blood cells will go to one side,

and viruses, if the patient is infected,
will go to the other side.

After separation, viruses will move
from the centre towards the points.

Once at the points,

the water quickly evaporates,
leaving the viruses behind to accumulate.

This accumulation will greatly increase
the concentration of the viruses,

which allows us to achieve sensitivities

a billion times higher
than the traditional test.

Once the viruses are at the points,
we have to detect them,

and to do that, we have to use antibodies.

And it is there where we find
the second obstacle in self-testing,

which is the delicateness
and high cost of natural antibodies.

So an alternative had to be found.

To understand our work,

you must first of all understand
how an antibody works.

When someone is infected by a virus,

the organism reacts
by producing antibodies.

These antibodies are capable
of recognising and catching the virus,

thanks to three properties:

Firstly, the antibody has to have
spatial conformation;

a complementary shape to the virus.

It is somewhat similar to a key in a lock,
the key being the virus.

Secondly, the surface of the antibody

must have positive and negative charges
which, to put it simply,

are the opposite of what is present
on the surface of the virus.

So it is a very exacting phenomenon.

And finally, the virus
must be flexible enough

to adapt to the small variations in shape.

The principal is very simple,
but what is complicated,

is carrying it out on a nanometric scale.

What you see here
is a nanoparticle of gold,

which is 1,000 times finer than a hair.

If you want to make a synthetic antibody
which replaces natural antibodies,

you have to reproduce
these three properties.

So what we have done is this:

to make an antibody
which can recognise a virus,

we first of all attach
the virus to this particle.

The technique I'm describing
is called "molecular imprinting."

So, before going onto the next step,
I'll explain in a few words.

Think of a virus as something
which you can hold in your hand.

If you put this virus in modelling clay
and then take it out again,

you will leave behind an imprint
whose shape complements the virus.

This imprint is now capable
of recognising the same type of virus,

it's a synthetic antibody.

So, to make a synthetic antibody
which can recognise a virus,

firstly we attach the virus,
we then expand this polymer,

which is a sort of modelling clay,
in order to surround the virus.

We take the virus out,
and we get this magic imprint,

which is able to recognise
the same type of virus.

Why do we use gold nanoparticles for this?

Because when the synthetic antibody
recognises the virus,

the nanoparticles start to collect.

And when these particles collect,
they change colour.

This change of colour can show up
as a coloured strip on your test.

What I have just described

is an example of what we can call:
preventive medical technologies.

These technologies will help you
to understand your health risks,

and to follow their progression
personally and in real-time.

I have talked to you
about two technical problems

which we have resolved in the laboratory.

But, in fact, the true problem,
the main obstacle, is not even scientific.

It is an obstacle which is common
to all preventive medical technologies.

I'll quickly tell you about two more
preventive medical technologies,

and explain where the main obstacle lies,

and why all of that is so important
for the medicine of the future.

The second technology
is portable devices or implants.

To give another example,

these days, diabetics control
their blood sugar through self-testing.

In the future, they will have devices
implanted under their skin,

which both measure and regulate
the physiological parameters,

including blood sugar levels,

and which transmit this information
to the patient's phone,

as well as to the doctor.

What is new and important here

is not the fact of having
a device implanted.

The first pacemaker was implanted in 1958,

and that's what you see here in the heart.

So, what is new and important,
is this capacity to collect information

directly from this device
and send it to the doctor,

and the fact that the doctor
can control the devices from a distance.

It's the convergence of technologies.

So, this technology has the potential
to completely remove patients

from the centralised systems of hospitals,

whilst still maintaining
a link with the doctor.

The third and last technology
is even more impressive.

If someone offers you a box
and tells you that inside,

there are three illnesses
that you risk getting in your life

if you do nothing.

How many of you would open the box?

Remember, this box doesn't contain
three illnesses that you're going to have,

but the illnesses that you are
at risk of, if you do nothing.

In order to do something,
I, personally, would open the box.

You've all received this box,
it's your genetic inheritance.

We're all predisposed
to certain illnesses,

and you have to know the risks
to prevent the consequences.

Ten years ago, you needed
10 million dollars and several months

to sequence a human genome.

Today, you can do it
for 100 dollars, or 72 pounds,

and receive a list of your
genetic predispositions in a few weeks.

I know there are some issues
with ethics and regulation,

but faced with the technology,
the only viable response

is not banning it, but regulating it.

These technologies need to be regulated,

and I'm sure you've all seen, like me,

that in recent years,
all the governments around the world

are complaining about incontrollable costs
of health and social security systems.

But with every new reform,

we revert to the same health model,
and look for a new way of financing it.

My belief is as follows:
it's not a budgeting problem.

The only way for us to construct
a sustainable health model

is to shift our focus from curative care
towards preventive technologies.

From centralised, reactive medicine,
to personalised, preventive medicine.

The patient must become the key player
in the monitoring of their own health.

It's more than just
an alternative, it's a necessity.

Thank you for listening.

(Applause)