Epidemiologists tell us that ubiquitous testing is the key to detecting and containing pandemic outbreaks, such as COVID-19. The next generation of cheap, accurate tests are built around CRISPR ( and also), with the use of isothermal amplification.
Testing is hard enough in the developed world, where medical facilities are well stocked and well staffed. The developing world needs a more flexible solution - one that can adapt to the constrained resources of a remote setting while providing life saving test information to the larger data effort.
This project focuses on the needs in that remote setting:
- Provide the fundamental piece of equipment (an accurate heatblock) to quickly and accurately detect the presence of COVID-19 (or any other) virus using CRISPR point of care diagnostics
- Be able to operate "off the grid", while storing results for eventual integration with the bigger picture when communication is available
- No reliance on refrigeration, the availability of AC power, cellular connectivity, or sanitary conditions
- Reliable, fault-free operation - as far as possible, make it impossible to use the platform incorrectly or misread test results.
- Accommodate a range of viral test devices, that may have differing test requirements
- Adaptable to test for "the next" pathogen - useful in pandemics to come
The CRISPR diagnostics depend on two separate reactions that occur at separate elevated temperatures. First an isothermal amplification reaction takes about 20 minutes to amplify cDNA from COVID-19, if it is present in the sample. Then a CRISPR reaction cleaves the amplified DNA and signals presence of COVID with a stripe on a paper strip (lateral flow device). Each reaction requires a separate, steady temperature for the test to be accurate.
The device consists of two aluminum heatblocks, one for each reaction, with polyimide heaters. The temperature of the heatblocks is sensed by thermistors, and an inexpensive Arduino computer controls the heaters to be sure the blocks stay at the needed temperatures. There are colored LEDs that indicate when the heatblocks are in the right temperature range, and timers that can be used to time the amplification and CRISPR reactions. All of this runs off any 12VDC supply that can deliver at least 2A (wall bug, car battery, lantern batery, solar panel...).
The device is designed to be foolproof. Once plugged in, it heats the heatblocks, the LEDs indicating when the right temperatures are achieved. The LEDs blink "blue" until the blocks are at temperature, then the LEDs turn "green". If the blocks should go over temperature, the LEDs turn red. There are pushbuttons that activate audible timers for each of the reactions. For the uploaded code, the timers and temperatures are set as described for the SHERLOCK Covid-19 tests (https://www.broadinstitute.org/files/publications/special/COVID-19%20detection%20(updated).pdf)
The physical configuration of the device can be easily changed to accommodate different diagnostic requirements. The submitted example has holes shaped to accept standard laboratory reaction tubes. The blocks were created using ordinary hand tools (saw, drill), and the configuration might be different - the basic design is the same. Similarly, different CRISPR diagnostic protocols may require different temperature settings, and these can all be easily changed by editing the included Arduino program and reloading the program in the Arduino. The Arduino runs two precision PID control loops to guarantee that the chosen temperatures are achieved and maintained.
Here are the results achieved with the given heatblocks and the uploaded Arduino code:
Building the device starts with creating the actual blocks that will be heated. For the demo device, I used hand tools and aluminum bar stock to create blocks suitable for use with standard.5ml centrifuge tubes. These fit a wide range of tests, but one could also create heatblocks suited for lateral flow (paper) tests, and they might need a different geometry. These blocks have small holes drilled to accept the thermistors that measure their temperature.
Once the heatblocks are made, the heater strips can be added. These are very inexpensive polyimide resistance heaters, readily available on Amazon or eBay. They are adhesive backed, and can simply be wrapped around the heatblocks:
With the heaters attached, the thermistors can be inserted and secured, and the heatblocks are ready to use:
The only other custom part of the design is the case. We created a custom 3D printed case (STL file attached), but really anything could be used, as long as it provides room for the components and access for the heatblocks and the 12V jack.
The rest of the parts are all standard electronic components. To keep costs down, MOSFET controllers intended to control LED light strings are used to control the heaters. The heaters draw 1A, which is well within the power range of the MOSFETs.
There is nothing special about the rest of the assembly. The parts are wired together as shown on the schematic and assembled into the custom enclosure.
Operation
In normal use only the 12V power jack is used - the Arduino USB jack is only used to reprogram the Arduino, should it be necessary to change the heatblock temperatures or the timer durations. When the unit it connected to 12V, the two LEDs start to blink blue - indicating that the heatblocks are currently below their target temperatures. The blink rate of the LEDs is proportional to how close the temperature is to the setpoint - shorter "off" times as the setpoint is approached. When the temperature gets within 4 degrees of the setpoint for a block, the related LED turns solid green. It will stay green as long as the block stays within 4 degrees of the setpoint. Should the temperature drift more than 4 degrees above the setpoint, the related LED will blink red. As shown in the graph above, the demo unit comes to temperature in about 5 minutes, and reliably stays there. The heaters are controlled with precision PID control loops implemented in the Arduino, which assure steady temperatures.
A user would place a test reaction first in the RT-LAMP block, and then press the associated timer pushbutton. The speaker starts beeping once a second, and when the timer is up, is gives one long beep. Similarly, after the RT-LAMP reaction is complete, the user moves the reaction to the CRISPR block and pushed that pushbutton to restart the timer. Again the timer beeps once a second, and when done, gives a long beep (with a tone different from that of the RT-LAMP timer).
Once both reactions are finished, the results can be read. This varies with the specific test, but is usually a set of lines on a lateral flow device (paper strip like a home pregnancy test). The published protocols require about an hour for a test from start to finish.
The submitted device is a crucial piece of equpment to enable very quick, accurate, inexpensive testing for Covid-19 and other viruses, using the CRISPR based diagnostic tests. The device is flexible enough to use with a variety of test protocols, accurate enough to give reliable results, and simple enough to be made quickly and cheaply for use anywhere in the world.
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