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SALT LAKE CITY — University of Utah researchers say they are designing a diagnostic method that will be able to accurately identify signs of liver cancer within minutes, saving critical time for patients of the stealthy disease.
The new type of test could forever change how people screen for the disease, said Marc Porter, a U. chemical engineering and chemistry professor who is leading the research along with Dr. Courtney Scaife, a surgeon who both practices and teaches surgery for the university.
Porter said the long-term vision is for the tool itself to become as automatic and portable as a pregnancy test, though additional technology — called a spectrometer — is currently needed to precisely measure the results of the test.
"It's really compact, it's simple and low cost," he said of the test kit.
Liver cancer is difficult to survive because typically it is highly developed by the time symptoms show up, Porter said. It is the second deadliest form of cancer worldwide, resulting in about 788,000 deaths in 2015, according to the World Health Organization.
"All too often, the cancer is diagnosed past when you can actually have surgical intervention," Porter said.
Currently, a blood test taken to determine the presence of liver cancer is usually sent to a lab offsite, where it takes days or even up to two weeks to test and return, said Vincent Horiuchi, spokesman for the U.'s College of Engineering. Those days are precious time that is lost in the fight against the disease, he said.
But the new tool could alert someone to their cancer before they leave a doctor visit, according to Porter. The test, the details of which were published in the latest issue of Analytical Methods scientific journal, is expected to eventually be capable of measuring the presence of five biological indicators — called biomarkers — tightly associated with the presence of liver cancer.
Porter said researchers have currently mastered the basic ability to observe a blood serum sample, after it has been placed on a paper membrane secured in a cartridge only about the size of a domino, for positive indications that there are higher than normal concentrations of one of the five biomarkers. He talked about developing the ability to similarly detect the other four markers as being only a matter of time.
"Within another year to two years, we'll have the test for all five working," Porter said.
Porter was also confident that other types of "less invasive" samples that "doctors believe is useful," such as urine or saliva, will also at some point be used for the same test, further increasing its convenience.
The markers in question are alpha-fetoprotein, a close iteration called alpha-fetoprotein L3, a protein called des-gamma-carboxy prothrombin, antibodies indicating the presence of hepatitis B, and antibodies indicative of hepatitis C. Positive indications of at least two of the five markers would be a very strong predictor of liver cancer, Porter said.
"We hope that (this test) could identify you at risk early in an early stage of this cancer development," he said.
Right after the patient sample is submitted, a droplet made of substances called gold nanoparticles is added to the paper membrane, serving to specifically tag the biomarkers of interest and present a red color if they are in the sample.
That red color is visible to the naked eye when the concentration of a biomarker is high, but the test relies on a handheld spectrometer to detect the precise level of the color's presence, explained Jennifer Granger, an associate researcher at the Nano Institute of Utah who carried out the implementation of the study.
The device is sophisticated enough to also give a detailed estimate of the precise quantity of the biomarker, beyond just confirming whether it is present or not, Granger said. That is helpful because it means going beyond merely indicating a positive result, instead "tell(ing) you the severity of the disease," Horiuchi said.
The test kit is also expected to cost dramatically less than a regular blood test. The goal is to set the price around $3 per kit, Horiuchi said. However, the portable spectrometer used to examine results is much more expensive, usually costing between $15,000 and $17,000, according to Porter.
He said he is confident the cost of the spectrometer will not be expensive enough to deter an "initial investment" by clinics and other medical professionals.
"They're rugged devices," Porter said.
U. researchers will be traveling to Mongolia for a few weeks in the spring of 2019 to introduce the test among rural, nomadic populations, Granger said. The country has the highest incident rate of liver cancer in the world.
"They have a mortality rate six times the global average," Porter said. "It's a devastating situation."
Researchers are planning to bring about half a dozen portable spectrometers to Mongolia on their trip.
The country is already connected to the research, as the U. has worked with health officials there to obtain blood serum samples used to develop the project, Granger said. Largely rural countries such as Mongolia, with wide areas having only long distance access to a major hospital or clinic, are places where the highly mobile testing method would be of most benefit because it would go a long way to "help reach more people," she said.
If a person in Mongolia knows they can get detailed, same-visit results following an inexpensive test, "maybe they would finish their rural family health centers more often," Granger said.
Proactive testing is important because liver cancer is a "silent killer," she said.
"You don't know you're sick until it's too far gone," Granger said.
The test being developed is focusing on liver cancer, but has untapped potential for creating a quick, convenient test for a host of other diseases in the long term, Granger said, if ways of detecting those conditions' biomarkers can be developed. Such diseases that could be tested for include tuberculosis, dengue fever and malaria for starters.
"It's a diagnostic that I think has a lot of potential," she said. "It is so versatile … we can extend it to work on almost anything you can possibly think of."
Development of the test has been done with the sincere belief, Horiuchi said, that eventually it "could save hundreds of thousands of lives per year."
The team's publication in Analytical Methods was co-authored by B&W Tek, a Delaware manufacturer whose spectrometers are being used in the project. The researchers have received grants for the project from the National Institutes of Health, National Cancer Institute and Huntsman Cancer Institute, as well as funding from Salt Lake City-headquartered supplement business USANA.
