Throughout the Spring 2017 semester, our professor, Dr. David Issadore, taught us (a class of eight undergraduates students and one graduate student) about microfluidics and point-of-care diagnostics. The next phase of the course was to come up with a new diagnostic for pediatric tuberculosis. At the end of the semester, our final assignments included submitting an NIH Research Project Grant (R01) proposal and giving a 20-minute presentation for our devices. These assignments greatly prepared us for our trip to Ghana, as we were able to ask questions and get feedback on our proposed devices by speaking to healthcare professionals at Ghanaian hospitals, clinics, and research facilities. The semester course was mainly focused on the technical design of our devices, which enabled us to hone in on the practical and real-world implementation of the devices while in Ghana. This week, the BE Blog will publish our summaries.
In order to address the numerous diagnostic problems specific to pediatric tuberculosis in low-resource settings, we have designed a device that uses a fecal sample rather than the current method of sputum samples. Because many children cannot produce sputum samples with the required quality and quantity of sputum, we decided to use stool samples. This noninvasive substitute will ideally allow us to collect all the bacteria swallowed by the patient. The bacterium that causes the disease, Mycobacterium tuberculosis (MTB), is very hardy and has been found to appear in fecal matter. However, this method may be difficult because there are many other substances in fecal matter that need to be removed. By filtering out these impurities, the presence of the bacteria can be detected.
The device we designed is essentially a disposable cartridge that separates virulent TB bacteria from all other fecal material. This collection can be performed with no power and minimal technician input and can be obtained in any desired volume. The total operation time is predicted to be 90 minutes.
The first aim of our project is to identify a target protein on the surface of the bacteria so that the bacteria can be isolated from the solution. Next, the MTB will be enriched from fecal samples with a single-use filtration device so that a final sample can be provided in a similar form as a sputum sample. This final sample can then be used for smear microscopy, in which technicians look for the presence of the bacteria under a microscope, or for use with the GeneXpert. The GeneXpert is an automated diagnostic test that can identify MTB DNA and resistance to the most potent TB drug, rifampicin. These devices have been distributed to labs and hospitals across Ghana, but they are not yet widely used for general diagnostics.
Because the number of GeneXperts available and the infrastructure supporting them are increasing, we are hopeful that, in the near future, our diagnostic will be able to be used in conjunction with this technology. Upon integration with the GeneXpert system, our device would be able to increase sample specificity for the underserved demographic of pediatric TB patients. In addition, as technology becomes available in smaller, more local clinics, we foresee lower travel burdens for families and lower operational costs for healthcare facilities.
We are beyond grateful for the opportunity to engage with Ghana’s medical system. Before traveling to Ghana, we created a proposal for our fecal diagnostic for pediatric TB. After learning more about the current medical system and infrastructure in place, we were able to revise our ideas in a meaningful way. It is our hope that one day a project of this magnitude can come to fruition.
I’m a rising junior studying Bioengineering at Penn. I’m also the founder of a music group called Band Dance Music (BDM). The overall premise of the group is to take the same music that a DJ plays at a college party but to play it with an 11-piece live band. The idea for this group started before I got to Penn, but it was something that I was confident in pursuing despite all of the other time commitments during the school year.
Starting a band at Penn was definitely a challenge. There are already so many music groups on Penn’s campus that it’s very easy for a group that is just starting out to get drowned out by other more prominent groups. After really pushing marketing hard for auditions, it actually was pretty easy to find students who were interested in the idea behind the group. Interestingly, of the 11 members that are now in the group, nine of them are actually in the School of Engineering and Applied Science.
While bioengineering and band dance music seem like two totally disparate fields, I was actually able to bridge the gap between these areas while taking ENGR105 with Professor Rizk. At the end of this course, we are asked to create a graphical user interface (GUI) that combines the entire course’s material. This GUI is completely free form – it can be in any area of interest that you like.
Since for a while I’d been having trouble arranging music completely by ear, I thought this would be the perfect opportunity to create a GUI that would help me arrange music for the band. There is rarely free time to spare during the school year, so being able to work on a passionate project of mine while also being able to complete my course work was a win-win situation. The GUI definitely took me longer than expected to create since it involved having to process electronic music into parts that would be easier to arrange, but I eventually was able to finish the interface. It featured a tap metronome, a filtering system, and a visual music player so I could streamline the music writing process. Below is a pictures of the GUI I created.
BDM is always looking for more interesting people to join who have a passion for this unique concept for a band. If any bioengineers reading out there are interested, feel free to reach out to me – I’d love to talk more about it. Thanks for reading!
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
As we woke up early to prepare for the nine-hour flight ahead of us, we all acknowledged that time really does fly. Arriving at the Accra airport, we had to say goodbye to our Ghanaian friends Salim, Uncle Ebo, and Nana Yaa. The month has come and gone. It feels like the trip went quickly, but we have learned so much and gained many valuable experiences along the way. From our hospital and clinic visits, to our interactions with an herbalist and a fetish priestess, we were exposed to many healthcare settings found in Ghana. We had the opportunity to present our pediatric tuberculosis diagnostic ideas to a room filled with researchers and clinicians, getting invaluable feedback from multiple experts. Along with our academic pursuits, we also got to explore the Ghanaian culture and learn about customs, traditions, food, and much more. We met many friendly people along the way. These aspects are the memories that we will remember for years to come. As we move beyond this course, we are excited to continue pursuing our interests in biomedical diagnostics and problem solving that can be applied globally. We would like to thank everyone who helped make this unforgettable experience possible.
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
Today marked our last full day in Ghana. In the morning, we set off rather early to start our day in Accra. But first, we had to drop one of our students, Dave, at the airport so he could make his way to Rwanda to visit a college friend. As we traveled to the airport, we had the opportunity to get a better picture of what life is like in Ghana’s capital. It was nice to go back to Accra and see how different it was from Kumasi. It is a much larger city, with various government buildings, people walking about, and large advertising signs every few yards.
Our first stop was the Kwame Nkrumah Memorial Park. Kwame Nkrumah was the first president of Ghana when the country gained independence in 1957. Interestingly, he went to Penn to earn a Master of Arts in philosophy and a Master of Science in education. The mausoleum in Accra contains his and his wife’s bodies. It is surrounded by various water fountains, which are a symbol of life to provide a sense of immortality for Nkrumah. Many Ghanaians want to continue the work that Nkrumah did not get to finish by helping Ghana to continue developing as an independent country. In addition, there is a museum that contains many of his clothes and pictures of him as he met with various world leaders. We even saw a picture of him on Penn’s campus, shaking the hand of then Vice Provost Roy Nichols.
After the tour, we met Dr. Ellis from KCCR for lunch at a nice open-air restaurant, called Buka. Many of us stuck to our favorites of chicken and fried plantains, but some ventured out to try guinea fowl and snails. After lunch, we walked around the area to some nearby vendors, where we were able to shop for last minute gifts. We soon realized how much more expensive Accra was, compared to Kumasi.
We headed back to the hotel to relax a bit before dinner. For our last night in Ghana, we went out to a restaurant that had a live jazz band. We had our last taste of Ghanaian cuisine and had fun dancing to highlife music. Highlife is a genre of music that we only recently learned is popular in both Ghana and Nigeria. To end our last night in Ghana, we headed back to the hotel. After spending some time to prepare, we huddled in the hotel’s lobby for our talent show, and as night turned into morning, we reluctantly headed to our rooms to finish packing for our early departure.
by Ethan Zhao, Bioengineering ’19; and Jason Grosz, Bioengineering ’19
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
Today was the second day that we spent in the coastal city of Cape Coast. Many of us woke up earlier than usual to walk along the beach and explore the resort. While walking along the beach, we noticed large rowboats in the distance that were anchored to the shore by ropes. We originally thought that they were fishing boats, but it turned out that they were digging up sand from the ocean floor to restore sand erosion on the beach.
After breakfast, we traveled outside of Cape Coast to Kakum National Park, which is a dense tropical rainforest on the coast that is home to many wildlife species, including monkeys, leopards, elephants, and antelope. It is also the home of one of Africa’s largest canopy walkways, consisting of rope suspension bridges more than one hundred feet above the forest floor. The views from the bridges were amazing, as we could see for miles across the tops of the rainforest trees. While we were on the bridges, it started drizzling, which was refreshing given the heat. After leaving Kakum National Park, we drove back to Accra, the capital of Ghana, where we will stay for the remainder of our trip.
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
Today, we said goodbye to our Kumasi friends and left the Ashanti region for the final leg of our trip. After our bonus night in the new student hostel (dormitory), we boarded the KNUST bus for a six-hour road trip to Cape Coast. The drive was pleasant, and the scenery became more coastal as we continued. Most people slept through it, but once the ocean became visible, everyone woke up in excitement because we knew we were getting close to Elmina, a beach town just west of Cape Coast.
As we drove through the town, we noticed that it resembled many of the beach towns back home. Our driver, Uncle Ebo, then parked in front of an enormous white castle. It was located on the edge of a peninsula, with a narrow beach to its left and crashing waves to its right. It had cannons situated all along its upper levels and a bustling group of locals hanging out in front of its entrance. It was the Elmina Slave Castle, also known as St. George’s Castle, and the team started to prepare for the tour.
As we entered the castle, the mood became somber. A tour guide provided us with a background of the building, which was a Dutch fort used over the years to facilitate the sale and transport of people from Ghana and the surrounding countries during the slave trade. The first portion of the tour followed the path of a slave during their internment, beginning with the female quarters, then the courtyards used for public punishment, the male quarters, punishment cells, and lastly the final exit where people were loaded onto the ships for their journey across the Atlantic. It was a grim tour to take, and the guide shared some incredibly harrowing stories throughout. The second portion of the tour focused more on other aspects of the fort.
Once we loaded back onto the bus, the team reflected on the experience we had at Elmina Castle as we drove away. After a half-hour drive, we soon arrived to our new rooms at a local beachfront resort called Coconut Grove. Its beautiful facility included a private beach, an ocean-facing restaurant/bar, beachfront swings, a golf course, horse stables, and a crocodile pond (with ~10 real crocodiles!). We went out to a local restaurant with live music, danced a bit, then headed home to enjoy the amenities during one of our last nights together as a team.
by Danielle Tsougarakis, Bioengineering ’20; and Kate Panzer, Bioengineering ’18
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
This morning, we found out that we would be spending our last night in Kumasi in a hostel, which is equivalent to a dormitory at a U.S. college. We packed our belongings and moved into a hostel called “Complex Brunei,” which is an apartment-style dorm for upperclassmen, each room furnished with three beds, a closet, a full bathroom, and a table. We were all excited to get the student experience of staying in a hostel and compare it to the visitor housing at the KCCR guesthouse.
In the afternoon, we had the opportunity to visit the international community school (ICS), a high school founded on the philosophy of bringing competitive, Western-inspired education to Kumasi. A friend of our team member Dave currently works at ICS and suggested we come speak to the prospective college students at the school. That being said, we gave a presentation on how the college application process works in the United States to a group of 10th and 12th graders. After our brief overview, we split into small groups and answered individual questions students had regarding different types of universities, SAT/ACT scores, the importance of a strong essay, and other application essentials. Speaking with the prospective students here and motivating them to apply to American universities was a great experience. Sharing our own college application processes and stories with the students was a fun and engaging way to fuel their academic aspirations. After our well-received presentation, the whole team left feeling accomplished.
For dinner, we had a special surprise outing to a nearby Chinese restaurant, where we shared many different dishes and passed them around on a rotating glass platform. For some of the Ghanaians, this was their first time trying Chinese food, so it was fun to hear their reviews of all the dishes. Upon returning to campus, we continued our beloved tradition of team bonding by playing the Noun Game and card games.
by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science ’20; Katharine Cocherl, Bioengineering ’20; and Hope McMahon, Chemical and Biomolecular Engineering ’18
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
We started our not-so-lazy Sunday with a late start. We enjoyed our last weekend breakfast, provided by the one and only Nana Yaa. A fan favorite is always the avocados and the Milo, which we know we will miss dearly when we get back to the States. Luckily, we all have our personal stashes we plan on bringing back. We all had the much-needed opportunity to do laundry and catch up on life errands. Once mid-afternoon hit, we all decompressed by watching the Ghanaian vs. Ethiopian National Football teams on the television in a nearby dorm. GHANA WON THE FIFA QUALIFIER AND THE CROWD WENT WILD!!!!!
The next thing on the agenda was our farewell ceremony and dinner. We were instructed to wear our Ghanaian clothing that had been made for us during the trip, but some of us had not yet received the alterations back from the seamstress. When Nana arrived, clothes in hand, it was exhilarating to see the final products and wear similar colorfully patterned clothes to our Ghanaian counterparts.
The meal was catered by our favorite kebab stand, along with drinks, tilapia, and banku (the classic combination). Many of the people who have contributed immensely to our trip were there, and we enjoyed good conversation and memories into the night. We were put to shame as we watched the children dance their hearts out, using more rhythm and soul than we would know what to do with. It was so nice to see the program come full circle. We all looked back fondly at the welcome ceremony, where all the faces were unfamiliar but kind. Fast forward to the farewell ceremony, and this time, we saw the same faces and smiles, but now we felt connected to the people behind them.
by Meagan Ita, Ph.D. Student in Bioengineering and GABE Co-President
Cancer is a disease that affects millions, and over the last several decades, researchers have delved deeply into the biological underpinnings of the disease in the hopes of finding a cure. One major discovery is that mistakes in your DNA “instructions” can lead to cancer by crossing the wires in your cellular circuitry, and researchers have developed amazing new drugs that can cause tumors to melt away by targeting these broken components. The problem though is that, most of the time, the tumors come back, and this is a huge barrier to cures.
For a long time, everyone assumed that the reason the tumors came back was DNA mistakes on top of the original mistakes, with these new mistakes blocking the activity of the anti-cancer drug. However, new work led by Sydney Shaffer from the Arjun Raj Lab at Penn Bioengineering, published this week in Nature, challenges this view by looking all the way down at individual cancer cells and seeing how they respond to these drugs on a cell-by-cell basis.
Sydney found that in melanoma, contrary to what researchers thought, it need not be a DNA mistake that leads a cell to become resistant to the drug, but rather a change in cellular identity. Just like your body has cells of all different types, like skin cells and brain cells, cancer cells appear to change between different types, but unlike in the body, cancer cells do it in a seemingly random and uncontrolled way, and the cells exploit this variability to allow those rare cells that have changed their type to survive the drug.
Here, we talk with Sydney about the inspiration, triumphs, and challenges she faced in her research.
What was the initial inspiration for looking at drug resistance in melanoma?
For the first two years of working on this project, we actually didn’t have a clear question in mind. I was just trying a bunch of different experiments with melanoma cells, and I noticed something that we found thought-provoking. Whenever we gave the melanoma cells a particular drug, they would become resistant at exactly the same point in time. At first, this may not seem unusual, but for example, if everyone showed up at a restaurant to eat lunch at exactly noon, you would guess this was not happening purely by chance. Maybe classes let out right beforehand? Or a big meeting? For the melanoma cells, we would similarly expect there to be a range of different times for the cells to become resistant, but instead it all happened at once.
This observation helped us figure out that the drug-resistant cells probably already exist before we treat them. It also got us curious about the particular processes that make the cells resistant, and we spent many lab meetings discussing this observation until one postdoc, Gautham Nair, suggested trying some experiments based upon the classical molecular biology experiments of Luria and Delbrück.
Who were Luria and Delbrück, and how did they influence your work?
Max Delbrück and Salvador Luria (below) were scientists who, in the 1940s, performed a clever experiment that demonstrated that bacteria become resistant to viruses through random DNA mutations. According to Wikipedia, Luria actually had the idea for these experiments while watching slot machines!
Their experiment was super simple: it was basically a statistical way to see whether cells “sense and respond” to a challenge, or whether they just passively get a mutation that lets some fraction of them survive the challenge, basically like Darwinian evolution. The idea is that, in the first scenario, there is no history: every cell has an equal chance to respond when challenged.
But in the second scenario, history matters in that if your great-grandparent was a survivor, then all your relatives would be too. If you could redo history over and over, then sometimes maybe your great-great-great-great-grandparent would be a survivor, and so you would get a whole bunch of survivors when the challenge came. Luria and Delbrück’s results showed that this second scenario was what happened with bacteria, providing the first evidence for genetic mutations in bacteria occurring in the absence of selection, and they both went on to win a Nobel prize in 1969.
Arjun actually had just lectured about these experiments in our graduate course on modeling biological systems. We adapted the same strategy and theory as Luria and Delbrück’s experiments for our work but applied it to melanoma and actually found a different result. Our experiments showed that resistance in melanoma does not arise through a heritable DNA mutation.
Based upon this work, do you have any ideas for how we might prevent resistance in patients?
Yes. The recommended dosing for many of these drugs is daily. Our work would suggest that something like interval therapy might be more effective, for instance, if you gave the drug for a few days, killed many of the tumor cells, and then stopped the drug. During the time that the drug is stopped, the cells that initially survived the drug (we call these cells pre-resistant) could then transition out of this cell state and back to a sensitive state. Then, when the patient takes the drug again, it would be more effective at killing the remaining tumor cells. Another idea would be to find drugs that are specific to the pre-resistant cells and give these drugs in combination with other targeted therapies.
Were there any “Aha!” moments while working on this project?
One of the most exciting moments of this research was when we first found the pre-resistant cells. Hidden among thousands of pictures of empty cells, we were shocked to actually see the rare cells full of brightly tagged resistance genes (below).
What were some low points in working on the project? Do you recall any specific moments that you just felt intellectually and/or emotionally stumped? How did you get through them?
Oh yes, there were definitely low points during this project. One that stands out to me specifically was this one Friday afternoon where I presented at lab meeting. At the time, I only had a little bit of preliminary data. One of the members of the lab asked me a series of questions about resistance: How many different drug doses had I tried? Could I just give a lot and kill them all? What dose of drug is relevant for patients? What about drug resistance? Was I really interested in? All reasonable questions to ask. However, this was really overwhelming to a first-year graduate student because it made me realize that I didn’t have a clearly defined project that I was working on yet. There were just so many different questions that I didn’t know where to start.
Ultimately, with Arjun’s guidance, I came to realize that this was part of the process of figuring out what my thesis project would be, and the vagueness of our ideas at this time was a great thing because it left me open to find a problem that I found really interesting.
At another point in working on this: I remember that we were clearly conceptually stuck. We had identified the rare cells, but it wasn’t clear how to find out if these were the same cells that become resistant to drug. I had an entire lab meeting where we discussed this concern and came to the conclusion that, without some connection between the cells in this state and resistance, the work would be very speculative, which felt unsatisfying to me. Unfortunately, there wasn’t a quick fix to this problem. We just ended up trying a whole bunch of different ideas and eventually one of our strategies worked out.
Were there any funny moments that stand out to you?
Yeah! I was 40 weeks pregnant as we were finishing off our first submission of the paper! As my due date passed, I was really feeling the pressure to finish everything. Each day, I was coming into lab and just hoping I wouldn’t go into labor yet! Actually, the members of our lab had placed bets on when the baby would be born. Fortunately, those who bet on a late arrival ended up winning, and we submitted the paper the day before my daughter, Julien, was born. I was actually still at the hospital when I got the e-mail that the paper went to review.
So even though it might seem like this project is checked off the list with a kick-ass publication, there are probably a bunch of unfinished ideas you have. So,what are you working on next? Will this project ever be “done?”
For sure. The list of unfinished ideas is very long, and some of the questions that came from this work are now being pursued by other people in the lab. Right now, I’m working on ways of measuring the length of time that individual cells remain in these different cell states.
Interested in sharing your research in Penn BE? Contact penngabe@gmail.com for an interview by GABE (Graduate Association of Bioengineers) and let us know!
by Ethan Zhao, Bioengineering ’19; and Jason Grosz, Bioengineering ’19
David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.
Today, we went to see how Kente cloth is made. Kente is a special ceremonial cloth, often woven with a story or message in the pattern. Our tour guide showed us several different kinds of fabric they use, including wool, polyester, and cotton, and demonstrated how they are threaded from the original material with a wooden, hand-operated machine. Next, he brought us to see the Kente cloth weavers at work. It was incredible to see the speed and skill with which the weavers passed the shuttles back and forth between the strands of fabric to create a pattern, while Ghanaian (and sometimes American) pop blared from their handheld radios. Finally, he showed us the land where plants like cacao trees and cotton plants grow. After the tour, we bought a colorful assortment of Kente cloths, bow ties, and wallets.
Next, we went to a series of wood shops to buy various carved wooden souvenirs and to practice our bargaining skills. As we stepped outside the bus, we were immediately surrounded by dozens of shopkeepers, not-so-gently coercing us to check out their own shops. Since there were no listed prices, the prices for everything bought were the result of bargaining. Shopkeepers would often present us with relatively high initial prices, only to offer us “discounts” since we were students or “friends” to make us feel like we were getting a great deal. Overall, it was an overwhelming but exhilarating experience to fight for a price on every good we bought.