The Economist: Follow Your Nose

Published on 01 Dec 17, under Press mentions

Our Breath Biopsy platform and its incorporation into GSK's Phase II Respiratory Disease Clinical Trial was featured in The Economist's Science and Technology section. We've provided the text below.

ARTICLE IN ECONOMIST

Follow your nose

A breathalyser for disease

A better way to diagnose cancer, heart disease and more

HIPPOCRATES, the father of medicine, was known to have used smell as an aid to his work. Generations of doctors followed suit. Syphilis, for instance, is thought to have a characteristic odour; the smell of rotting apples suggests diabetes. Today, things are more sophisticated. All sorts of volatile organic compounds (gases, known as VOCs, that are given off by living organisms) have been identified, in laboratories, as markers of specific diseases from breast cancer to cholera. A paper reported on a “breathprint” for malaria earlier in the month. But despite all this knowledge, a “breathalyser for disease” has stubbornly failed to materialise.

The barrier, as so often with new diagnostic tools, is not whether such things are technically possible, but whether they can be proven to work reliably and usefully when used by doctors. Owlstone Medical, based in Cambridge, thinks it has developed just such a gadget. Its breath analyser is the subject of several big trials. One, called LuCID, is recruiting 4,000 patients across Europe to develop a test for the early detection of lung cancer—a disease that is often diagnosed too late to treat. Another, in collaboration with the Warwickshire NHS Trust, is attempting the detection of early-stage colorectal cancer in 1,400 people (existing screening methods are successful only 9% of the time). Cancer Research UK, a charity, is evaluating the breathalyser for early detection of a laundry list of other cancers (specifically bladder, breast, head and neck, kidney, oesophageal, pancreatic, prostate and brain).

Nor is it just cancer. Owlstone has several deals with drug firms. One, signed on November 27th with GlaxoSmithKline, aims to use the breathalyser to see which patients are responding to treatment for chronic obstructive pulmonary disease. A smaller firm called 4D Pharma is using the device to find out more about a patient’s microbiome—the legions of bacterial hangers-on which every person carries—in order to match drugs to diseases.

One reason Owlstone’s device has generated such interest is that it has a documented record. The basic technology has been in use for many years, detecting chemical warfare agents for military customers. In the medical version, breath is exhaled across a sensor which ionises the VOCs, causing them to gain an electric charge. The molecules are then sorted according to how fast they move through an oscillating electric field. The result is a chemical fingerprint, or “breath biopsy”, with no chemicals, needles or reagents necessary.

The details are, inevitably, trickier. For one thing, everyone’s breath is different, so the device must weed out such natural variation if it is to reliably identify the telltales of sickness. But if the trials are successful, the benefits could be big. Widespread screening could help spot many diseases whose symptoms take time to develop. Doctors in Britain are experimenting with offering CT scans to supermarket shoppers with a history of smoking, who are therefore likelier than most to be harbouring undetected lung cancer. But CT scans are expensive, and deliver a substantial slug of radiation. Breath biopsies are cheap, and free of risk. If they can prove their worth, they will be a breath of fresh air for diagnostics.

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