Medical University of Vienna Austria.
Telemedicine can be defined as “any transmission of medical information by means of telecommunication technology”. Numerous well-known teleconsultation applications in medicine are based on the transmission of imaging data, for example, from computed tomography (‘store and forward’) or also on live video streams such as from endoscopic interventions1-3. A solution for point-of-care-monitoring and diagnostics of autoimmune diseases is the usage of a lab-on-chip device that communicates with a laboratory infor-mation server. This concept is subject of a recently started large-scale integrating project founded by the European Commission, known by the acronym ‘POCEMON’ (Point of Care Monitoring).
The main objective of this project is the development of a LOC (lab-on-chip) platform for the entering of the Human Leukocyte Antigen ( HLA) complex where information on autoimmune diseases like multiple sclerosis and rheumatoid arthritis is coded. However, the range of potential applications of this project’s technology is not at all limited to multiple sclerosis and rheumatoid arthritis. At present, diagnostic tests concerning the majority of autoimmune disorders are mainly carried out in large-scale laboratories and the patient only gets the results a few days later. The development of computer-based miniaturised laboratories would permit any level of healthcare—and especially primary—to diagnose genetic abnormalities, diseases or the patient’s general state of health within a matter of minutes.
The concept comprises the combination and integration of high-end information and communication technologies based on microfluidics, microelectronics and microarrays as well as intelligent diagnostic algorithms.
From the technical point-of-view the development of a LOC that is capable of reli-ably detecting a sufficient number of SNPs is the fundamental prerequisite for the whole concept: SNPs can be observed in the human genome frequently (in about one of 1000 nucleotides) and, consequently, biosensors for SNP detection have been gaining in signifi-cance over the last years4. As an example, for Multiple Sclerosis (MS) a number of 49 SNPs has been found to show an association with the disease in a study published by Hafler D et al. 20075.
The key benefits of LOCs as compared with conventional PCR analysis are their port-ability, automation, the reduction of required sample and reagent volume, leading to a reduction of costs and time. In combination with the described telemedicine set-up and the laboratory information server infrastructure, this technology provides the perspective to advance primary healthcare across Europe by supporting point-of-care diagnostics and monitoring of immune system status for the management of chronic autoimmune dis-eases such as MS and RA. The combination of Lab-on-Chip technologies with genomic microarrays of HLA-typing and the integration with intelligent software systems may pro-vide a state-of-the-art diagnosis at primary care level for a large number of autoimmune disorders, so the field of possible future applications is not at all limited to MS and RA. The principle that is being investigated and prepared for clinical routine can be adapted to other pathologies and bring progress for their early detection.
Kurt Alexander Schicho is Professor of Biomedical Engineering at the Medical University of Vienna. His areas of research include Telemedicine, Computer Assisted Surgery. He is a regular speaker at international conferences. He is the scientific consultant at the European Community Research Projekt “POCEMON” (Point-of-Care-Monitoring”). A Lecturer at several private universities of applied sciences, his hobbies include music, sailing.