From reactive medicine to preventive medicine | Abdennour Abbas | TEDxParis
-
0:05 - 0:08Here's a scenario
that I keep on questioning: -
0:09 - 0:12I fall ill, I make a doctor's appointment
-
0:13 - 0:16and I have the appointment the next day.
-
0:18 - 0:20The day of the visit, the doctor
diagnoses me by observation, -
0:20 - 0:23since he doesn't have
access to bodily fluids, -
0:23 - 0:26and he considers two or three
possible infections. -
0:26 - 0:30Then, he either prescribes me
a broad-spectrum treatment -
0:30 - 0:32to cover all eventualities,
-
0:32 - 0:35or, he tries an illness-specific treatment
-
0:35 - 0:38and if that does not work,
it's changed at the next appointment. -
0:38 - 0:41Next, he calls for blood tests.
-
0:41 - 0:44So, I have the blood tests
on the morning of the third day, -
0:44 - 0:46and I get the results on the fourth day.
-
0:47 - 0:49I call the doctor,
-
0:49 - 0:53and I have my second appointment
with the results on the fifth day. -
0:53 - 0:57Do you know how long it takes an organism
to react to an infection? -
0:57 - 0:59A few hours.
-
0:59 - 1:01The information we need
to tell us what is wrong with us -
1:01 - 1:04is available in our blood
within a few hours. -
1:04 - 1:09But the doctor does not have access
to this information until five days later. -
1:10 - 1:13It's too long, inefficient,
and it costs a lot of money. -
1:14 - 1:18During my PhD thesis, which I wrote
at the University of Lille, France, -
1:19 - 1:20I always thought
-
1:20 - 1:25that big analysis laboratories
were a bit like phone boxes of the 80s - -
1:26 - 1:30it's a comparison which will speak
more to those over 30 - -
1:30 - 1:35I thought that medical tests
would go the same way -
1:35 - 1:39and that we would end up having
our own self-testing kits at home. -
1:41 - 1:44What I didn't understand,
-
1:44 - 1:49while home pregnancy tests
have been on the market since 1970, -
1:49 - 1:52in 2013 we have still not
been able to apply this concept -
1:52 - 1:54to infectious diseases.
-
1:56 - 2:00After my PhD thesis, and a period
spent at the University of California, -
2:00 - 2:01I joined the University of Washington,
-
2:01 - 2:04where I started to work
specifically on self-testing. -
2:04 - 2:08It was then that I understood
that there were two major obstacles -
2:08 - 2:11which prevent this technology
from being scaled up. -
2:11 - 2:13First of all, the issue of sensitivity.
-
2:15 - 2:17In the majority of infections,
-
2:17 - 2:20the molecules we want to detect
are found in very small concentrations, -
2:20 - 2:23which means that the tests
have to be very sensitive. -
2:23 - 2:26Because of this problem,
it wasn't until 2012 -
2:26 - 2:29that the first home testing kit
was authorised in the USA. -
2:29 - 2:32That was the HIV test.
-
2:32 - 2:34France has only just issued
a favourable report -
2:34 - 2:37on their commercialisation
a few weeks ago. -
2:39 - 2:41The problem with these tests
-
2:41 - 2:46is that they are based
on a rectangular, paper test strip. -
2:46 - 2:49Which is the cause of a certain
limitation on sensitivity. -
2:50 - 2:52What is more, HIV tests
-
2:52 - 2:55can only be used
three months after infection, -
2:55 - 3:01since the virus needs time to multiply
and reach sufficient concentrations, -
3:01 - 3:02and in the meantime, it wreaks havoc.
-
3:02 - 3:06So, to avoid losing time,
-
3:06 - 3:10and to be able to detect
very weak concentrations, -
3:10 - 3:14we have developed a different approach
over the course of the last year. -
3:15 - 3:19As usual, the true challenge of technology
-
3:19 - 3:21is not in finding
a solution to the problem, -
3:21 - 3:23but in finding a simple solution.
-
3:23 - 3:26So, instead of cutting
the paper into a rectangle, -
3:26 - 3:32we have cut it into a many-pointed star.
-
3:32 - 3:37With this principle, you just have to put
your sample in the centre of the star, -
3:37 - 3:41and the sample will separate itself
into several components. -
3:41 - 3:45For example, with blood,
red blood cells will go to one side, -
3:45 - 3:49and viruses, if the patient is infected,
will go to the other side. -
3:49 - 3:54After separation, viruses will move
from the centre towards the points. -
3:55 - 3:56Once at the points,
-
3:56 - 4:00the water quickly evaporates,
leaving the viruses behind to accumulate. -
4:00 - 4:05This accumulation will greatly increase
the concentration of the viruses, -
4:05 - 4:08which allows us to achieve sensitivities
-
4:08 - 4:11a billion times higher
than the traditional test. -
4:13 - 4:17Once the viruses are at the points,
we have to detect them, -
4:17 - 4:19and to do that, we have to use antibodies.
-
4:19 - 4:22And it is there where we find
the second obstacle in self-testing, -
4:22 - 4:27which is the delicateness
and high cost of natural antibodies. -
4:27 - 4:30So an alternative had to be found.
-
4:31 - 4:32To understand our work,
-
4:32 - 4:35you must first of all understand
how an antibody works. -
4:35 - 4:38When someone is infected by a virus,
-
4:38 - 4:42the organism reacts
by producing antibodies. -
4:42 - 4:46These antibodies are capable
of recognising and catching the virus, -
4:46 - 4:48thanks to three properties:
-
4:48 - 4:52Firstly, the antibody has to have
spatial conformation; -
4:52 - 4:54a complementary shape to the virus.
-
4:54 - 4:58It is somewhat similar to a key in a lock,
the key being the virus. -
4:58 - 5:00Secondly, the surface of the antibody
-
5:00 - 5:03must have positive and negative charges
which, to put it simply, -
5:03 - 5:06are the opposite of what is present
on the surface of the virus. -
5:06 - 5:08So it is a very exacting phenomenon.
-
5:08 - 5:12And finally, the virus
must be flexible enough -
5:12 - 5:16to adapt to the small variations in shape.
-
5:18 - 5:21The principal is very simple,
but what is complicated, -
5:21 - 5:24is carrying it out on a nanometric scale.
-
5:24 - 5:27What you see here
is a nanoparticle of gold, -
5:27 - 5:31which is 1,000 times finer than a hair.
-
5:32 - 5:36If you want to make a synthetic antibody
which replaces natural antibodies, -
5:36 - 5:39you have to reproduce
these three properties. -
5:40 - 5:41So what we have done is this:
-
5:41 - 5:46to make an antibody
which can recognise a virus, -
5:46 - 5:50we first of all attach
the virus to this particle. -
5:50 - 5:54The technique I'm describing
is called "molecular imprinting." -
5:54 - 5:58So, before going onto the next step,
I'll explain in a few words. -
5:59 - 6:04Think of a virus as something
which you can hold in your hand. -
6:04 - 6:07If you put this virus in modelling clay
and then take it out again, -
6:07 - 6:11you will leave behind an imprint
whose shape complements the virus. -
6:11 - 6:15This imprint is now capable
of recognising the same type of virus, -
6:15 - 6:17it's a synthetic antibody.
-
6:17 - 6:22So, to make a synthetic antibody
which can recognise a virus, -
6:22 - 6:24firstly we attach the virus,
we then expand this polymer, -
6:24 - 6:29which is a sort of modelling clay,
in order to surround the virus. -
6:30 - 6:35We take the virus out,
and we get this magic imprint, -
6:35 - 6:38which is able to recognise
the same type of virus. -
6:39 - 6:41Why do we use gold nanoparticles for this?
-
6:41 - 6:48Because when the synthetic antibody
recognises the virus, -
6:48 - 6:50the nanoparticles start to collect.
-
6:51 - 6:54And when these particles collect,
they change colour. -
6:54 - 7:01This change of colour can show up
as a coloured strip on your test. -
7:01 - 7:02What I have just described
-
7:02 - 7:06is an example of what we can call:
preventive medical technologies. -
7:06 - 7:11These technologies will help you
to understand your health risks, -
7:11 - 7:14and to follow their progression
personally and in real-time. -
7:14 - 7:17I have talked to you
about two technical problems -
7:17 - 7:19which we have resolved in the laboratory.
-
7:19 - 7:26But, in fact, the true problem,
the main obstacle, is not even scientific. -
7:26 - 7:30It is an obstacle which is common
to all preventive medical technologies. -
7:30 - 7:34I'll quickly tell you about two more
preventive medical technologies, -
7:34 - 7:37and explain where the main obstacle lies,
-
7:37 - 7:41and why all of that is so important
for the medicine of the future. -
7:42 - 7:47The second technology
is portable devices or implants. -
7:47 - 7:49To give another example,
-
7:49 - 7:54these days, diabetics control
their blood sugar through self-testing. -
7:55 - 7:58In the future, they will have devices
implanted under their skin, -
7:58 - 8:02which both measure and regulate
the physiological parameters, -
8:02 - 8:03including blood sugar levels,
-
8:03 - 8:07and which transmit this information
to the patient's phone, -
8:07 - 8:09as well as to the doctor.
-
8:09 - 8:11What is new and important here
-
8:11 - 8:14is not the fact of having
a device implanted. -
8:14 - 8:18The first pacemaker was implanted in 1958,
-
8:18 - 8:20and that's what you see here in the heart.
-
8:20 - 8:25So, what is new and important,
is this capacity to collect information -
8:25 - 8:28directly from this device
and send it to the doctor, -
8:28 - 8:33and the fact that the doctor
can control the devices from a distance. -
8:33 - 8:35It's the convergence of technologies.
-
8:37 - 8:43So, this technology has the potential
to completely remove patients -
8:43 - 8:45from the centralised systems of hospitals,
-
8:45 - 8:49whilst still maintaining
a link with the doctor. -
8:49 - 8:53The third and last technology
is even more impressive. -
8:54 - 8:58If someone offers you a box
and tells you that inside, -
8:58 - 9:02there are three illnesses
that you risk getting in your life -
9:02 - 9:03if you do nothing.
-
9:03 - 9:06How many of you would open the box?
-
9:07 - 9:12Remember, this box doesn't contain
three illnesses that you're going to have, -
9:12 - 9:15but the illnesses that you are
at risk of, if you do nothing. -
9:15 - 9:18In order to do something,
I, personally, would open the box. -
9:18 - 9:24You've all received this box,
it's your genetic inheritance. -
9:25 - 9:28We're all predisposed
to certain illnesses, -
9:28 - 9:32and you have to know the risks
to prevent the consequences. -
9:32 - 9:36Ten years ago, you needed
10 million dollars and several months -
9:36 - 9:38to sequence a human genome.
-
9:38 - 9:41Today, you can do it
for 100 dollars, or 72 pounds, -
9:41 - 9:45and receive a list of your
genetic predispositions in a few weeks. -
9:46 - 9:49I know there are some issues
with ethics and regulation, -
9:49 - 9:54but faced with the technology,
the only viable response -
9:54 - 9:57is not banning it, but regulating it.
-
9:57 - 10:02These technologies need to be regulated,
-
10:02 - 10:05and I'm sure you've all seen, like me,
-
10:05 - 10:09that in recent years,
all the governments around the world -
10:09 - 10:15are complaining about incontrollable costs
of health and social security systems. -
10:15 - 10:16But with every new reform,
-
10:16 - 10:21we revert to the same health model,
and look for a new way of financing it. -
10:22 - 10:27My belief is as follows:
it's not a budgeting problem. -
10:27 - 10:31The only way for us to construct
a sustainable health model -
10:31 - 10:37is to shift our focus from curative care
towards preventive technologies. -
10:37 - 10:43From centralised, reactive medicine,
to personalised, preventive medicine. -
10:43 - 10:49The patient must become the key player
in the monitoring of their own health. -
10:49 - 10:52It's more than just
an alternative, it's a necessity. -
10:52 - 10:53Thank you for listening.
-
10:53 - 10:55(Applause)
- Title:
- From reactive medicine to preventive medicine | Abdennour Abbas | TEDxParis
- Description:
-
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.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx
- Video Language:
- French
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 11:02