‘UMT Removes Guesswork from Malaria Testing’

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Urine Malaria Test is a precise and fast way to test whether a fever is due to malaria or not. A molecular biotechnologist and Chairman, Fyodor Biotechnologies, Dr. Eddy Agbo in this interview with Crusoe Osagie, harped on the new innovation and how it is changing the face of malaria diagnosis in Nigeria

Tell us about the UMT and Fyodor Biotechnologies?

The Urine Malaria Test (UMT) is the world’s first non-blood test that tells in 25 minutes or less if a fever is due to malaria or not, using only a few drops of urine. The UMT is so simple that anyone anywhere can do it. It requires no blood, no reagent nor equipment. It removes the guesswork that drives malaria case management in many healthcare settings in Africa. With the UMT, it is now possible to test if a fever is due to malaria in the comfort of the home or in any healthcare facility, by anyone anywhere. It is a novel tool that can safely and rapidly facilitate universal testing for malaria in all cases of fever.

It has been a long standing practice in many African countries to assume that all fevers, headache/body ache, and general malaise are due to malaria. While these signs are associated with malaria, there are dozens of other diseases that cause similar symptoms. Therefore, we see widespread practice of self medication whereby individuals with fever just take anti-malaria medicines without a test to confirm the cause of their symptoms. In the past where the cases of mosquito bite and malaria were overwhelmingly high, that practice was reasonably permitted. Over the past decade, there has been progressive decline in the cases of malaria in Africa to the extent that only about 30 per cent of all fevers are now due to malaria. This means that it has become even more critical today to test for malaria in all cases of fever or suspected signs of malaria as it is less likely today that a fever is due to malaria than was the case in the past.

So, a critical challenge for most African countries had been: how to make universal malaria testing possible in all cases of fever, and in all private and public healthcare settings. The use of malaria rapid diagnostic tests (RDTs) and use of microscopes are limited by the fact that they require blood, relatively complex to perform, and therefore, unsuitable for home use or in rural community healthcare settings where blood handling with a multi-step test poses major health risks. As a result, private healthcare providers and most public healthcare centres especially in rural communities have been unable to comply with the national and WHO policy of “Test Before You Treat” for managing cases of fever and malaria. As a result, many cases of fever are considered to be malaria and treated presumptively without any firm diagnosis.

Fyodor Biotechnologies Ltd is a Nigerian company that has introduced the novel UMT in the Nigerian market. With its parent company – Fyodor Biotechnologies Corp USA and commercialisation partner – Geneith Pharmaceuticals Nigeria Ltd, Fyodor is driving best practices for healthcare providers, government policy makers, NGO’s and individual citizens to quickly and safely test in all cases of fever, to confirm if due malaria before antimalarial medicine is administered. So, today, if you feel the fever, check it out with the UMT!

How difficult was it to develop UMT?

We worked tenaciously for seven years to develop and clinically validate the UMT. If you think about it, you will say that is almost a life time.

Were you the first person to think about it or attempt to do it?

If I am the first person to think about it, no! The first to attempt it, no!! These underscore the difficulty and demonstrate compelling story of the UMT.

Healthcare providers, public health officials, researchers, and policy makers have long desired a noninvasive test for malaria testing as a way to expand diagnosis in all public and private healthcare settings. So, the blood-based rapid diagnostic tests (RDTs) were tried severally with patient urine samples with poor test accuracy. These outcomes can be explained by two key facts. First, urine is acidic and proteins are denatured in the acidic environment. Second, proteins excreted in urine are intimately exposed to enzymes that break them down into fragments so that malaria rapid blood tests that were developed to target proteins in their natural are not able to efficiently detect them when fragmented. We used recombinant DNA technology to generate recombinant antibody molecules that effectively detect specific malaria parasite proteins or their fragments that are excreted in the patient urine.

How much do you think UMT will affect lives in Nigeria in particular and Africa in general?

I believe that UMT will positively impact the way malaria is diagnosed and treated in Nigeria and other African countries in many ways: Doctors and other healthcare providers in all settings now have the tool to confirm if their febrile patient has malaria or not, and removes presumptive diagnosis. Patients can be appropriately treated for malaria, if positive; again, no more guesswork in malaria diagnosis and treatment. All medicines have some negative side effect on the body. So, because malaria positive patients will be accurately tested and specifically treated, people will not need to expend resources on, nor take medicines they do not need; such practices are a major cost to the overall national health systems in many countries in Africa. Because the UMT is so simple, it can be performed by anyone, anywhere to accurately determine if their fever is due to malaria or not; again, no more guesswork!

Appropriate malaria treatment as a result of specific diagnosis will ensure that the anti-malarial ACT medicines are not misused, which could result resistance by the parasite, as was seen with Chloroquine and other quinine-derived anti-malarial medicines that are no longer effective. A major concern today is that ACT is the only medicine currently effective against malaria, and resistance to this drug will pose a global disaster. Resistance to ACT is already developing in some Southeast Asian countries, and that is a major concern. As a result of this risk, health authorities in Africa, WHO and other multi-lateral malaria control partners have since 2010 mandated a policy of “Test Before You Treat” for malaria in all cases of fever. Before the introduction of the UMT, this was not possible with the blood-based tests.

There is even a broader impact beyond routine malaria diagnosis. In Ebola outbreak situations (which also has fever as an early clinical sign), the UMT could be invaluable for initial safe testing for fever in home or community health settings so that febrile malaria patients would not need to go to a clinic/hospital where many could pick up the Ebola virus in a nosocomial manner. This would be helpful because Ebola virus is not present in urine, so unlike blood, urine is not a biohazardous sample to test.

Let me also add this: there is a major global historical position of the UMT in malaria diagnosis timeline: In 1880, the French Army Surgeon Dr Alphonse Laveran was the first to introduce appropriate diagnosis by demonstrating malaria parasites in the blood of febrile malaria patients. For nearly 100 years, malaria diagnosis was performed solely by microscopy until 1976 when a company called Becton Dickinson first introduced the blood Rapid Diagnostic Test (RDT). The third major global milestone in malaria diagnosis timeline is now the UMT, commercialised about 40 years after the introduction of the RDT.

What were the first responses you got when you tried to develop UMT?

For many people, it was not possible! For other people, they thought I lost my mind because the idea was really revolutionary. But I had a team that also cherished the challenge to think outside the box. So, we chose to see the obstacle as a stepping stone, the challenge as an opportunity. Seven years later, here we are!

How did you hear about Africa Innovation Foundation and what is your impression about what they are doing?

We learnt about the African Innovation Foundation and the Innovation Prize Africa through an acquaintance who pointed us to the Facebook page. Africa sorely needs institutions like AIF that promotes African innovations, and we definitely commend this great initiative. In this regard, the AIF has clearly taken a leadership role on the continent as a driver of innovation, and I believe many other institutions could complement their effort. For example, the Private Healthcare Alliance of Nigeria (PHN) which held an innovation award in Nigeria late last year is another trailblazer focusing on innovations in Nigeria. I’m glad that Fyodor was honoured as the Star Winner of the PHN inaugural award for the Urine Malaria Test. Innovation is key to Africa’s sustained renaissance, and in this case, more is better.

What is your background?

I was born in Mbu, Isi-Uzo LGA of Enugu State, to Mr. Ephraim Agbo (of blessed memory) and Mrs Anthonia Agbo, and the first of seven children. I attended Central School Mbu Amon, Government College Maiduguri (on old Anambra State scholarship) and trained in Veterinary Medicine at the University of Ibadan, Nigeria. After a career as the first Veterinary Officer for the National Youth Service Corps (NYSC), I proceeded to the Netherlands for graduate studies and completed a Masters degree in Biotechnology at Wageningen University and a PhD in Molecular Genetics from Utrecht University.

After working for several years with ID-Lelystad in Holland, I proceeded to John Hopkins University School of Medicine as Research Fellow. In 2008, I founded Fyodor Biotechnologies to begin to identify and translate to product novel biotechnologies that have compelling relevance to healthcare delivery in Africa. With my outstanding team of professionals and partners, we successfully clinically validated the flagship Urine Malaria Test (UMT) in Nigeria, and launched in November 2015, in collaboration with the Federal Ministry of Health/National Malaria Elimination Program, ANDI Centre of Excellence for Malaria Diagnosis at the College of Medicine University of Lagos, University of Nigeria Teaching Hospital, Lagos State Ministry of health, NAFDAC, and others. I warmly acknowledge the support and partnership with these institutions. Very importantly, I acknowledge our Sales and Marketing Partner – Geneith
Pharmaceuticals Ltd whose network of sales reps and excellent logistics are driving the delivery of the UMT to Nigerians.

All these were only possible with the strong solid of my soul mate and wife Ebere, and our four lovely children – Chidera, Ezinwa, Lotti and Zuby, whose support have been immense and unwavering. Above all, none of these could have been possible without the grace, favour and presence of our God Almighty along the way. Fyodor means “Given by God”. I appreciate being part of this story of God’s gift.

Why did you go abroad and what was your experience, especially educational experience?

I went abroad to further my education and to seek better opportunities to improve myself in life. I have been blessed along this path, and appreciate it.

Why do you want to return to Nigeria, considering that it is more comfortable out there in the US or Europe?
I believe that my desired purpose for traveling abroad had been fulfilled. My intent now is to drive the development of Nigeria’s bio-economy – a tall order that I have given myself, but just like the UMT story, one that I believe we can and should do it. Why not? Especially since the time is now.