Bringing Body Fluid Tests to the Comfort of Home

What's Available & What's Still in the Works

Setting Up a Body Fluid Testing Lab in Your Garage
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Many medical tests that used to be done at the doctor’s office can now be performed in your home using consumer technology. For instance, men can now test fertility using an at-home sperm “selfie” app YO, developed by the Los Angeles-based Medical Electronic Systems.

Medical Electronic Systems has been making automated semen analyzers for over 20 years. YO is approved by the U.S. Food and Drug Administration (FDA) and measures sperm motility (the number of moving sperm in semen).

It boasts over 97 percent accuracy and costs less than $50, making it an affordable and convenient way to test male fertility in less than three minutes. All the user needs to do is put his sperm on a slide (available from Medical Electronic Systems) and then insert the slide into the YO clip that connects with a smartphone. YO’s app is compatible with both Android and iOS. The app analyzes the sperm sample and also lets the user watch the sample on the phone’s screen as a real-time video. For those wondering about the practicalities of this test, the manufacturer explains that sperm do not touch the phone. Also, the YO kit comes with two disposable kits (so the test can be repeated).

Many other body fluid tests are now available as at-home versions as well. The accuracy of these tests are now often comparable to conventional lab tests. Blood, urine, tears, sweat, saliva, and other body fluids carry a lot of clues about your health.

A large number of at-home kits for biofluids focus on blood and urine. However, kits for less common samples are now coming to market.

Ear Wax

Take ear wax, for example. A mixture of sweat gland secretions and fatty materials, ear wax is a more difficult biofluid to test because it contains certain molecules that are not soluble in water.

However, ear wax can be quite helpful in diagnosing certain conditions, such as fungal infections, cystic fibrosis, and allergic rhinitis.

Just sniffing ear wax can offer the trained nose some insights. For instance, there is a characteristic smell in patients with the metabolic disorder known as maple syrup urine disease (branched-chain ketoacidosis). Some experts speculate that future self-testing ear wax kits might also include more sophisticated ways of testing, such as looking for the presence of volatile organic compounds (VOCs), which can reflect a person’s metabolic condition.

Sweat

Sweat is another bodily fluid that can be monitored passively and non-invasively. Dehydration and physical exhaustion can, for example, be detected using an electronic sweat sensor that measures the balance of electrolytes. Using this health technology, you can receive an alert before a serious problem in the body occurs.

Developing an accurate wearable device that can electrochemically sense sweat has proven difficult. Wei Gao, assistant professor of Medical Engineering at California Institute of Technology, and his colleagues introduced a breakthrough biomonitoring device for sweat that is Bluetooth-enabled and contains a panel of sensors for sodium, potassium, lactate, glucose, and skin temperature.

Their invention was one of the first attempts to use multiple sensors to monitor sweat on a continuous basis with a device that has Bluetooth capabilities. Gao and his team hope that soon this sweat-based technology will measure other health parameters too, such as active drug levels.

Blood

Although convenient, sweat measurements are not always as accurate as blood tests. Therefore, blood-based tests are still more popular. A tiny drop of our blood can provide a wide array of data about our health parameters. Currently, it is also one of the best modes for testing for serious conditions. For instance, since 2012 the FDA has been approving over-the-counter HIV tests that use a tiny amount of blood drawn by the user.

Most experts believe in the efficacy of at-home tests, but sometimes there is user error. A French study that assessed the users’ capability to perform an at-home HIV test independently and without prior training found that over 99 percent of participants administered the test correctly. They used lancet needles to obtain drops of blood and read their results accurately. However, a similar study of HIV self-tests in Africa done by Roger Peck, who works as a research scientist for a non-profit organization PATH that supports health innovation, showed that almost 25 percent of users did not interpret the test correctly. His finding demonstrates some of the potential limitations of at-home body fluid tests performed without professional guidance. Nonetheless, this particular type of health technology makes testing more confidential for individuals who would not take the test otherwise.

Urine

Do-it-yourself urine testing—providing information on glucose, blood, protein, and chemicals in the urine—is becoming more accurate as well. In 2016, new software was introduced by Stanford University scientists that can help eliminate some of the errors of home dipstick urine analysis. Common errors include precise sample delivery, timing, and lightning. The Stanford research team, led by assistant professor Audrey Bowden, came up with a solution that involves a black box (eliminating the lightning bias) and a multilayered system into which the urine sample gets loaded. Their solution ensures that your sample is evenly distributed once inserted in the testing box. Your sample is examined by placing your smartphone over the box and using the phone’s camera to capture the sample. Custom-designed software then analyzes the sample and provides you the results. Initial evaluation showed that this at-home test is as accurate as a urine test done at your doctor’s office.

Feces

We now know that our gut flora is a source of invaluable information about our health as well. Experts in this area argue that our microbiome is much more specific to us than our DNA. Only 10 to 20 percent of our gut microbes are shared with others (compared to 99.9 percent of our DNA). Therefore, the analysis of our feces can provide important insights into our individual health characteristics.

Our microbiome appears to change when we get ill, as well as when we contract certain diseases (e.g. diabetes, depression, and obesity). Scientists are starting to develop affordable tools to map our microbiome and a few home kits are becoming commercially available. However, to get your results, you are still required to send your sample to an accredited lab.

Founded in 2012 by researchers from Stanford, Oxford and UCSF, uBiome is bringing the science of microbial genomics to your home. The company offers a microbiome screening test that includes a simple collection kit you use to swab your toilet paper. After the sample gets analyzed, you are provided with a detailed report on your gut microorganisms, specific infections, and gut conditions. Map My Gut is another test that can identify microbes that live in your gastrointestinal tract. Although microbiome sequencing still depends on an established lab for analysis and interpretation, you can become a citizen scientist when you use these tools to learn about your gut bacteria.

5 in 1

Health innovators are trying to make these types of digital health assessments more comprehensive. Take the Cue, which is a small-base unit reader designed to use unique cartridges to assess different biometric indicators. To use Cue, you need to collect certain bodily fluids, put the sample into a color-coded microfluidic cartridge, and plug it into the Cue base reader. Using specific cartridges Cue can give you information on inflammation, fertility, and vitamin D. It also measures testosterone (from a droplet of saliva) and the flu (from a swab from your nostril). Cue’s smartphone app lets you visualize your health trends and receive smart health alerts and reminders pertaining to your diet and activity. Actionable feedback is a special feature of Cue. For instance, when inflammation markers (CRP) are elevated, the program advises you on anti-inflammatory foods you should include in your daily meals.

Women’s Health Issues

Women who breastfeed usually abstain from drinking. However, there are occasions when alcohol gets consumed. Since alcohol can adversely affect babies, moms often find themselves in a conflicting situation whether to feed their child or not after libations are consumed. UpSpring Baby developed MilkScreen—a simple at-home test that detects alcohol in breast milk—in order to help make the decision to use milk after alcohol was consumed. The device has received mixed reviews from consumers and the results of a study about the product are not available, suggesting that the study was inadequate in some fashion.

At-home health technology regarding women’s reproductive health might be the most well-established in this genre. OvaCue (manufactured by Zetek, Inc.) is an electronic home monitor that tests saliva and vaginal mucus for the hormone estrogen. The vaginal probe detects when a woman’s body switches from estrogen to progesterone, an indicator of ovulation. The device measures the electrical resistance of vaginal fluids and also responds to the concentration of available electrolytes. OvaCue fertility monitor identifies trends and alerts the user of the days of the month where high fertility is indicated. These type of digital health tools can be particularly helpful to women with irregular menstrual cycles and polycystic ovarian syndrome (PCOS).

At-home devices can also be used for the evaluation of menopause. These tests usually use a urine sample to check the levels of follicle stimulating hormone (FSH). Many of these products have received FDA approval. One such product is the Estroven Menopause Monitor. Results from this monitor can help with the decision to potentially start with menopausal treatment. This is an important consideration, especially when trying to manage the risk of osteoporosis (a condition often correlated with menopause). 

Sources:

Gao W, Emaminejad S, Brooks G, et al. Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis. Nature, 2016;529(7587):509-514

Peck R, Lim J, Taegtmeyer M, et al. What Should the Ideal HIV Self-Test Look Like? A Usability Study of Test Prototypes in Unsupervised HIV Self-Testing in Kenya, Malawi, and South Africa. Aids and Behavior, 2014;18:S422-S432

Prazuck T, Karon S, Pialoux G, et al. A Finger-Stick Whole-Blood HIV Self-Test as an HIV Screening Tool Adapted to the General Public. Plos ONE, 2016;11(2):1-10.

Roeselers G, Bouwman J, Levin E. The human gut microbiome, diet, and health: “Post hoc non ergo propter hoc”. Trends in Food Science & Technology, 2016;57:302-305

Shokry E, Pereira J, Antoniosi Filho N, et al. Earwax metabolomics: An innovative pilot metabolic profiling study for assessing metabolic changes in ewes during periparturition period. Plos ONE, 2017;12(8):1-22

Smith G, Dwork N, Javanmard M, et al. Robust dipstick urinalysis using a low-cost, micro-volume slipping manifold and mobile phone platform. Lab On A Chip, 2016;16(11):2069-2078.

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