Simple, 'last-generation' technology to assist African AIDS victims

J. Paul Robinson

A $250,000 gift from Ohio-based manufacturer Parker Hannifin Corp. is helping launch the project.

The $5,000 cell analyzers could measure the blood's content of CD4 cells that indicate how well a patient's immune system is holding up and how far AIDS has advanced. Normal CD4 cell counts of 500-1,500 are depleted by AIDS. By definition, counts of less than 200 and the presence of the HIV virus are diagnostic indicators for AIDS.

"Unless patients in Africa are found to have CD4 counts of less than 200, they cannot receive antiviral treatment, but the machines now in use are too expensive for most Africans to afford," said J. Paul Robinson, a professor in Purdue's schools of biomedical engineering and veterinary medicine whose research is based at the Bindley Bioscience Center in Purdue's Discovery Park.

Sophisticated machines called flow cytometers now are used to perform blood analysis for CD4, but the machines, which cost up to $100,000, are too complex to maintain and too expensive to operate in Africa and other resource-poor nations, Robinson said. The new devices essentially would be simplified flow cytometers.

"The current cost for CD4 tests per patient in Africa is about $12, which is ridiculous since the monthly income of someone in Africa often is less than $10," Robinson said. "We believe that we can build a device that will reduce the cost for CD4 tests to 50 or 25 cents."

The effort has received a boost with the $250,000 donation from Parker Hannifin Corp., which will be formally recognized for its contribution on Thursday (Aug. 3) during a meeting with industry representatives to discuss creation of a proposed National Center for Applied Cytomics at Purdue.

"Parker Hannifin is fortunate enough to be in a position to help start to shape this trend and help to curb this epidemic with a unique initiative being proposed at Purdue University," said Rich Parker, medical products manager for Parker Hannifin. "Parker Hannifin has a tremendous opportunity to support work by this most recognized expert in the field of analytical cytology.

"A development partnership with the collaboration of Parker providing funding and design resources and Purdue providing scientific expertise will be a powerful combination that could have a far-reaching and life-changing impact for millions of people."

Cleveland, Ohio-based Parker Hannifin is a manufacturer of motion and control technologies and systems.

Robinson, who is current president of the International Society for Analytical Cytology, calls the effort to produce and distribute the low-cost devices the Cytometry for Life program.

"We think we can change how people get treated for AIDS in Africa," said Robinson, who is co-director of the Cytometry for Life effort with Gary Durack, a businessman and counselor at the International Society for Analytical Cytology.

Their goal is to raise $1 million for the program.

"We're suddenly one-quarter of the way toward meeting our goal," Robinson said. "With that $1 million, we will be able to build enough instruments to distribute between 1 million and 3 million CD4 tests in countries in sub-Saharan Africa."

Flow cytometry's importance has moved to the forefront for helping fight the AIDS epidemic in Africa, Parker said. Major pharmaceutical manufacturers also have identified cytometry as an enabling technology to help reduce drug development timelines and costs for personalized medicine.

"AIDS has left more than 1 million orphans in the city of Nairobi alone," Parker said. "And the vast majority of the infected are women who are a significant part of the work force in Africa."

Robinson and Durack are working to find additional corporate partners to manufacture the cell-analysis devices.

"All the designs will be provided free to anybody who wants to build this machine," Robinson said. "We will not hold any patents, and the machine will be entirely placed into the public domain."

The Cytometry for Life program has been inspired by the Canada-based Stephen Lewis Foundation, a group dedicated to helping African AIDS victims.

Lewis, the United Nations Secretary General's special envoy for HIV/AIDS in Africa, will visit Purdue on Aug. 24 to meet with officials about the Cytometry for Life program.

Robinson said the scenario has grown more desperate in recent years, with the percentage of AIDS cases in Africa's sub-Saharan nations skyrocketing since 1998. Worldwide, 40 million people are infected with the AIDS virus, including 28 million in sub-Saharan Africa, of which nearly two-thirds are women.

In 2005 alone, 3.2 million people in the region became newly infected, and 2.4 million adults and children died of AIDS-related illnesses, a report by USAID Africa shows. While the region has slightly more than 10 percent of the world's population, more than 60 percent of all individuals infected with HIV/AIDS live in sub-Saharan Africa. And estimates show that more than one in five children in Swaziland, Zambia, Lesotho and Botswana will be orphans by 2010.

"In Africa, 8,500 people die from AIDS daily, and most of those people would live five to 10 years if only they could get antivirals, but they can't receive antiviral drugs unless they have a CD4 count of 200 or less. They have no chance of raising or educating their children," Robinson said.

"From1998 to 2003, the percentage of people testing HIV-positive has increased from around 2 percent to as much as 39 percent of the population in the 10 sub-Saharan African countries."

While the flow cytometer machines now being used are bulky and difficult to operate and maintain, the new machines would be user-friendly, portable, small and battery-powered.

"When you put a $100,000 machine in Africa, it works for a few months, but then what happens?" Robinson said. "Nothing. It doesn't work anymore if it can't be maintained. Or perhaps it's never put to use to begin with because nobody knows how to install it. We have to approach this from a totally different perspective."

The new machines could be made inexpensively because they are based on old technology and will be tailored to perform only one task, analyzing blood for CD4 cells.

"The fancy $100,000 machines are very complicated because they are designed to perform a hundred different tests, but you only need one," Robinson said. "So you are paying for an instrument to do a hundred things when it only needs to do one, and then, at the end of the day, it's not even doing one thing. It's a real tragedy. Our cell analyzers will do only one test and do it well."

He said humanitarian organizations have little choice but to purchase and field the sophisticated machines, even though they are not effective in sub-Saharan Africa. Funding sources shy away from supporting research to create simple devices like his cell analyzer because they are not based on next-generation technologies.

"Other researchers are concentrating on making next-generation devices that work on advanced concepts, but we are doing just the opposite," Robinson said. "We are building last-generation devices because they are cheap, robust and proven effective. They work anywhere. We think of our instrument as the Coulter counters of the 1960s. We're going to flood Africa with lightweight, battery-operated machines that work."

Writers: Emil Venere, (765) 494-4709, venere@purdue.edu

Phillip Fiorini, (765) 496-3133, pfiorini@purdue.edu

Sources: J. Paul Robinson, (765) 494-0757, jpr@flowcyt.cyto.purdue.edu

Rich Parker, (603) 578-1562, rparker@parker.com

Purdue News Service: (765) 494-2096; purduenews@purdue.edu

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