Malaria, gonorrhea, and chlamydia are infectious diseases that pose major global health challenges, especially in low-income countries. For example, an estimated 600,000 people die from malaria every year, more than 95% of them in sub-Saharan Africa. The brand-new startup Spotlight Diagnostics (Spotlight Dx), founded by researchers from the Eindhoven University of Technology (TU/e) and medical microbiologists from the Global Health Initiative, is developing a fast and accurate test for detecting infectious diseases that can be used on-site in countries with limited resources. "Our test does not require a lab to measure accurately; a simple reading device is sufficient," says co-founder Claire Michielsen.
Source: IOplus / Elcke Vels
In low-income countries, access to healthcare is often limited . Lack of resources and weak infrastructure make medical care difficult. There is still much room for improvement in the field of diagnostics.
"Care providers often treat patients without knowing exactly what is wrong," says Claire Michielsen . Patients are sometimes given antibiotics when there are no bacteria present. This is not only risky for the patient but also exacerbates the problem of antibiotic resistance.
"To measure is to know - and for that, you need reliable tests," says Michielsen. Spotlight Dx , founded in March this year, is working on a rapid detection of pathogens, with an affordable and user-friendly test.
A genetic fingerprint
Pathogens can be detected in various ways, with PCR being a universally applicable and accurate method. It is well known since the coronavirus pandemic. This technique recognizes pathogens by their unique DNA or RNA - a kind of genetic fingerprint.
Whether it's a virus, bacterium, fungus, or parasite, each has its unique code. This can be multiplied and identified using PCR. The disadvantage is that PCR requires lab capacity with expensive equipment and trained analysts. On the other hand, there are simple rapid tests based on antigen detection. These are cheap and easy, but generally not so sensitive.
"Our test is right in the sweet spot between the two," says co-founder Harm van der Veer . "It focuses on DNA, is almost as sensitive as PCR, but is faster and much easier to use-even outside the lab. In principle, a simple smartphone camera is all you need to read the light emitted by the test."
Zooming in on how the Spotlight Dx technology works
Zooming in on the technology: Spotlight Dx uses CRISPR, best known for gene modification, to recognize the DNA of pathogens. They use Cas9 proteins, which only react when they find the right DNA.
These Cas9 proteins are linked to luciferase proteins, enzymes that emit light as soon as the Cas9 proteins recognize the right DNA. By using a DNA amplification method that, unlike PCR, works at a constant and relatively low temperature, the genetic material of the pathogen can be multiplied quickly and efficiently.
This makes the technique both fast and highly sensitive, and thanks to the light signal, it can also be read with a simple device.
From Arnhem to Uganda
The startup is new, but the test has been in development for years within the research group of co-founder Maarten Merkx. It started with a simple test setup: a light-tight box with a camera inside.
"During the pandemic, we made our first test, focused on COVID-19," says Van der Veer. "We tested it at the Rijnstate hospital in Arnhem on patient material. We compared our results with those of the regular PCR test. It turned out that the test performed remarkably well and was also considerably faster than PCR."
Those initial results were published in the renowned journal ACS Central Science. Since then, the test technology has been further developed through student projects and other initiatives and used to detect various other pathogens.
Small scale applications
Recently, the test was applied on a small scale to samples from patients with the common STIs gonorrhea and chlamydia. Van der Veer explains: "Gonorrhea and chlamydia often cause the same symptoms, but it is important to distinguish between them for treatment. That's why we've developed color variants: blue light means chlamydia. Green light means gonorrhea. This allows you to detect both infections quickly and clearly at the same time."
An important moment is coming up soon. Van der Veer will travel to Uganda to validate the test in a hospital in a rural area (Kumi Hospital). "We will initially focus on malaria," he explains.
"Malaria still causes many deaths worldwide. Currently, antigen tests are mainly used to diagnose the disease, but these are not very sensitive and, due to the increasing presence of mutations, are increasingly failing to detect infections. The WHO has been calling for better tests for years, and we are committed to contributing to this."
Experience in the field
Spotlight Dx was founded by a total of five founders. Two of them - both medical microbiologists - Guido Bastiaens and Erik Schaftenaar spent their PhD research and a large part of their medical careers in Sub-Saharan Africa.
Michielsen: "There, they built up a strong network and saw with their own eyes how great the need is. The combination of medical field and laboratory experience and technological expertise ensures speed and focus within our company."
Spotlight Dx has already sought cooperation with several parties in Sub-Saharan Africa, including universities and research centers in Uganda, Rwanda, and Burkina Faso, to set up validation studies and build local capacity.
They are also working with experts in local policy-making and the diagnostics market to promote the future rollout of the technology in the healthcare system.
A flying start
It is not only the broad network and expertise that are ensuring a flying start. For the validation study in Uganda, the researchers received financial support from the Eindhoven University Fund (UFe) . Since 2019, when the first seed for the development of the test method was sown by the Eindhoven iGEM student team, the research has been supported by UFe.
Biotech Booster , a program of the National Growth Fund, is also giving the startup a push in the right direction. This funding is intended to help knowledge institutions valorize their biotech innovations. Together with Fontys, the TU/e research group applied for this last year. "This Biotech Booster project fits in perfectly with what we want to achieve with Spotlight Dx," says Van der Veer.
Local production of test kits
The ultimate goal is to make a major social impact as a fully-fledged, independent company. "We are not a charity, but are building a company that can continue to exist on its own and grow to make a greater impact," says Michielsen.
Van der Veer adds: "We are starting with the development and production of the test kits in the Netherlands, but ultimately want to move production to the countries where the need is greatest. This will ensure that the technology remains accessible, affordable, and sustainable-even without foreign aid."
