MICA: Development of a novel host blood test using TRanscripts to Identify bacterial Meningitis - TRIM test study
Lead Research Organisation:
University of Liverpool
Department Name: Institute of Infection and Global Health
Abstract
Brain infections, such as bacterial meningitis, still cause death and disability in the UK and worldwide.
The key decision for a doctor is to decide whether a patient has bacterial meningitis, or whether they have a similar condition (a clinical mimic), such as viral meningitis. In both cases the patient often looks the same. However, bacterial infection needs immediate treatment with antibiotics whereas a mimic does not.
The essential test for distinguishing between the two is the lumbar puncture (a needle passing between the bones in the spine). The lumbar puncture is often delayed, or not performed at all. This can result in delayed antibiotic treatment for those who need it, or unnecessary antibiotics in those who do not, as well as a patient not receiving a diagnosis.
We offer a novel test measuring the body's response to bacterial infection in the blood. This means patients can be tested without having to wait for the lumbar puncture. We believe this test will help doctors to more accurately decide which patients do or do not need antibiotics. This will promote appropriate treatment, reduce unnecessary antibiotics, reduce in-patient stay, improve patient care and reduce the burden on health staff and hospitals.
We are working with an industrial company who are experts in developing diagnostic tests, to develop our test for clinical use. We are also linking with many expert clinical teams in the UK, Europe, Brazil and Africa to assess our test on a large number of patients to ensure it is accurate.
Through this project we will confirm the test is accurate and refine the test so that it can be used in hospitals in under the next 5 years.
The key decision for a doctor is to decide whether a patient has bacterial meningitis, or whether they have a similar condition (a clinical mimic), such as viral meningitis. In both cases the patient often looks the same. However, bacterial infection needs immediate treatment with antibiotics whereas a mimic does not.
The essential test for distinguishing between the two is the lumbar puncture (a needle passing between the bones in the spine). The lumbar puncture is often delayed, or not performed at all. This can result in delayed antibiotic treatment for those who need it, or unnecessary antibiotics in those who do not, as well as a patient not receiving a diagnosis.
We offer a novel test measuring the body's response to bacterial infection in the blood. This means patients can be tested without having to wait for the lumbar puncture. We believe this test will help doctors to more accurately decide which patients do or do not need antibiotics. This will promote appropriate treatment, reduce unnecessary antibiotics, reduce in-patient stay, improve patient care and reduce the burden on health staff and hospitals.
We are working with an industrial company who are experts in developing diagnostic tests, to develop our test for clinical use. We are also linking with many expert clinical teams in the UK, Europe, Brazil and Africa to assess our test on a large number of patients to ensure it is accurate.
Through this project we will confirm the test is accurate and refine the test so that it can be used in hospitals in under the next 5 years.
Technical Summary
Bacterial meningitis remains a significant cause of morbidity and mortality in the UK and worldwide, with considerable costs.
The key step in early patient management is to distinguish bacterial meningitis, which needs immediate antibiotic treatment, from the many mimics, such as viral meningitis, which do not. The essential test for distinguishing the two is the lumbar puncture, but this is often delayed, or not performed at all. Many patients are therefore treated with unnecessary antibiotics until a diagnosis of bacterial meningitis is excluded, contributing greatly to the burden of antimicrobial resistance.
A novel, rapid blood test measuring TRanscripts to Identify bacterial Meningitis (TRIM test) will improve management and reduce unnecessary antimicrobials.
Using samples from our multicentre observational UK Meningitis Study, funded by the National Institute for Health Research and the Meningitis Research Foundation, we have identified 5 highly discriminatory host transcripts in the blood of adults with bacterial meningitis. The markers exhibit high sensitivity (100%), specificity (90%) and negative predictive value (100%) in distinguishing patients with bacterial meningitis from the mimics
Working with Fast-Track Diagnostics Ltd, we have developed the TRIM test, a real-time PCR multiplex assay. We will validate it in an independent set of samples recruited through our UK and European clinical networks (France, Denmark and Holland). We will also begin to assess test accuracy in lower-middle income populations in Brazil and Malawi.
This work builds on the Liverpool Brain Infection Group's experience for delivering diagnostic tests for brain infections, for example, tests for Japanese encephalitis, now used across Asia.
The results will be used to produce the TRIM test system as a commercial diagnostic, and apply for subsequent funding, through the National Institute for Health Research, to assess its impact and health economic benefits.
The key step in early patient management is to distinguish bacterial meningitis, which needs immediate antibiotic treatment, from the many mimics, such as viral meningitis, which do not. The essential test for distinguishing the two is the lumbar puncture, but this is often delayed, or not performed at all. Many patients are therefore treated with unnecessary antibiotics until a diagnosis of bacterial meningitis is excluded, contributing greatly to the burden of antimicrobial resistance.
A novel, rapid blood test measuring TRanscripts to Identify bacterial Meningitis (TRIM test) will improve management and reduce unnecessary antimicrobials.
Using samples from our multicentre observational UK Meningitis Study, funded by the National Institute for Health Research and the Meningitis Research Foundation, we have identified 5 highly discriminatory host transcripts in the blood of adults with bacterial meningitis. The markers exhibit high sensitivity (100%), specificity (90%) and negative predictive value (100%) in distinguishing patients with bacterial meningitis from the mimics
Working with Fast-Track Diagnostics Ltd, we have developed the TRIM test, a real-time PCR multiplex assay. We will validate it in an independent set of samples recruited through our UK and European clinical networks (France, Denmark and Holland). We will also begin to assess test accuracy in lower-middle income populations in Brazil and Malawi.
This work builds on the Liverpool Brain Infection Group's experience for delivering diagnostic tests for brain infections, for example, tests for Japanese encephalitis, now used across Asia.
The results will be used to produce the TRIM test system as a commercial diagnostic, and apply for subsequent funding, through the National Institute for Health Research, to assess its impact and health economic benefits.
Planned Impact
Bacterial meningitis is a devastating disease. Delays in antibiotic treatment can have life-altering and life-limiting consequences. Conversely, overuse of antibiotics in patients who do not have bacterial meningitis may contribute to increasing antibiotic resistance.
Once established, the TRIM test will guide treatment rationalisation. It will prompt provision of antibiotics where bacterial infection was clinically regarded as improbable, reducing the patient's risk of disability or even death. Alternatively, it can trigger stopping antibiotics where the test indicates bacterial infection is unlikely, reducing the patient's risk of adverse drug reactions, and lowering the risk of hospitals' harboring bacteria resistant to antibiotics.
Reducing unnecessary courses of antibiotics, will shorten in-patient stay, ultimately reduce hospital costs and improve overall patient care. We estimate the TRIM test could save NHS hospitals up to £21.9M per year, by stopping antibiotics and the extended in-patients stay associated with unnecessary treatment with antibiotics.
The TRIM blood test also has potential to reduce the need for urgent lumbar puncture (LP). This is particularly useful in clinically unstable patients. It will free up medical staff and negate additional investigations (imaging, coagulation screen) to confirm the LP can be performed safely in a busy department.
The TRIM test will reduce the burden of suspected meningitis on hospital staff involved in diagnosis and treatment of adults with suspected meningitis in Europe, including staff in emergency, medical admissions unit, intensive care, infectious disease, neurology, microbiology and virology departments, as well as laboratory staff performing diagnostics.
The Hospital Episodes and Statistics database reports over 17,500 finished consultant episodes; 10,600 admissions; an average stay of 17.6 days; totaling over 140,200 bed-days from meningitis or mimics per year. The TRIM test could reduce unnecessary bed days, in turn reducing the burden on staff.
As part of this project, we will begin to gauge the test's global utility, potentially expanding end-users to health-care staff in Brazil, Malawi and beyond. Streamlining the TRIM test for use on a point-of-care (POC) device would be particularly useful for LMIC patients, where hospitals often do not have adequate infrastructure or funding to maintain high-quality microbiology or diagnostic laboratories. Furthermore, POC devices would enable patient testing at district hospitals or even health-care centers remote from microbiology or diagnostic laboratories.
Beyond meningitis, we have observed the test exhibits high accuracy in distinguishing bacterial from viral infection in adults in a range of clinical syndromes; including pneumonia, urinary tract infection, sepsis. Again, for suspected pneumonia patients the test could potentially be deployed as a POC test in GP surgeries.
Once established, the TRIM test will guide treatment rationalisation. It will prompt provision of antibiotics where bacterial infection was clinically regarded as improbable, reducing the patient's risk of disability or even death. Alternatively, it can trigger stopping antibiotics where the test indicates bacterial infection is unlikely, reducing the patient's risk of adverse drug reactions, and lowering the risk of hospitals' harboring bacteria resistant to antibiotics.
Reducing unnecessary courses of antibiotics, will shorten in-patient stay, ultimately reduce hospital costs and improve overall patient care. We estimate the TRIM test could save NHS hospitals up to £21.9M per year, by stopping antibiotics and the extended in-patients stay associated with unnecessary treatment with antibiotics.
The TRIM blood test also has potential to reduce the need for urgent lumbar puncture (LP). This is particularly useful in clinically unstable patients. It will free up medical staff and negate additional investigations (imaging, coagulation screen) to confirm the LP can be performed safely in a busy department.
The TRIM test will reduce the burden of suspected meningitis on hospital staff involved in diagnosis and treatment of adults with suspected meningitis in Europe, including staff in emergency, medical admissions unit, intensive care, infectious disease, neurology, microbiology and virology departments, as well as laboratory staff performing diagnostics.
The Hospital Episodes and Statistics database reports over 17,500 finished consultant episodes; 10,600 admissions; an average stay of 17.6 days; totaling over 140,200 bed-days from meningitis or mimics per year. The TRIM test could reduce unnecessary bed days, in turn reducing the burden on staff.
As part of this project, we will begin to gauge the test's global utility, potentially expanding end-users to health-care staff in Brazil, Malawi and beyond. Streamlining the TRIM test for use on a point-of-care (POC) device would be particularly useful for LMIC patients, where hospitals often do not have adequate infrastructure or funding to maintain high-quality microbiology or diagnostic laboratories. Furthermore, POC devices would enable patient testing at district hospitals or even health-care centers remote from microbiology or diagnostic laboratories.
Beyond meningitis, we have observed the test exhibits high accuracy in distinguishing bacterial from viral infection in adults in a range of clinical syndromes; including pneumonia, urinary tract infection, sepsis. Again, for suspected pneumonia patients the test could potentially be deployed as a POC test in GP surgeries.
Organisations
- University of Liverpool (Lead Research Organisation)
- Amsterdam Medical Center (Collaboration)
- Fast Track Diagnostics Ltd. (Collaboration)
- Aalborg University Hospital (Collaboration)
- Gadjah Mada University (Collaboration)
- PATH (Collaboration)
- UgenTec (Collaboration)
- UNIVERSITY OF SYDNEY (Collaboration)
Publications
Palmos AB
(2022)
Proteome-wide Mendelian randomization identifies causal links between blood proteins and severe COVID-19.
in PLoS genetics
Ray STJ
(2021)
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study.
in The Lancet. Child & adolescent health
Patterson EI
(2020)
Methods of Inactivation of SARS-CoV-2 for Downstream Biological Assays.
in The Journal of infectious diseases
Description | Invited consultant to the World Health Organisation. I contributed to development of their road map for 'Defeating Meningitis by 2030' |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Membership of a guideline committee |
URL | http://www.who.int/publications/m/item/defeating-meningitis-by-2030-a-global-road-map. |
Guideline Title | Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management |
Description | Invited member for the National Institute for Clinical Excellence guideline committee on Meningitis and meningococcal septicaemia: recognition, diagnosis and management. |
Geographic Reach | National |
Policy Influence Type | Citation in clinical guidelines |
URL | https://www.nice.org.uk/guidance/ng240 |
Description | HEIF Knowledge Exchange Infection theme |
Amount | £51,240 (GBP) |
Organisation | Higher Education Innovation Funding (HEIF) |
Sector | Public |
Country | United Kingdom |
Start | 01/2022 |
End | 07/2022 |
Description | NIHR Global Health Research Group on Improving the Management of Acute Brain Infections at University of Liverpool - Supplement |
Amount | £237,075 (GBP) |
Funding ID | 17/63/110 supplement |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 03/2021 |
End | 03/2022 |
Description | NIHR Health Protection Research Unit in Emerging and Zoonotic Infections |
Amount | £3,891,431 (GBP) |
Funding ID | NIHR200907 |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 03/2020 |
End | 03/2025 |
Description | To develop a novel diagnostic test that can differentiate scrub typhus from other causes of acute encephalitis syndrome (AES) in children |
Amount | £10,000 (GBP) |
Organisation | The Encephalitis Society |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 11/2022 |
End | 06/2024 |
Description | UK Research Partnership Investment Fund (UKRPIF): Proof of concept: Our Transcripts Identifying Meningitis assay maintains accuracy on BLINK-DX's low-cost digital-droplet PCR instruments - Developing an accessible meningitis diagnostic for lower-middle i |
Amount | £30,068 (GBP) |
Organisation | Higher Education Funding Council for England |
Sector | Public |
Country | United Kingdom |
Start | 09/2022 |
End | 07/2023 |
Title | Development of prototype host-transcript based diagnostic assay for discrimination of bacterial infection from mimics among suspected meningitis patients |
Description | As part of TRIM test study, we have developed a prototype TRIM real-time (RT) PCR assay. Development includes building the component parts of the assay, including:- primers , probes, prototype multiplex fluorescent probe sets and compatibility testing these components with associated proprietary RT-PCR assay reagents and instruments. The prototype assay (with associated protocols) has been made available to other laboratories for assessment. |
Type Of Material | Technology assay or reagent |
Year Produced | 2020 |
Provided To Others? | Yes |
Impact | This assay is being assessed by other laboratories within collaborative research and industrial settings. |
Title | Translating the TRIM assay for Digital PCR instruments |
Description | In Collaboration with Blink DX, Jena, Germany, We are developing and assessing the TRIM assay for use with their Blink-X instrument. The instrument offers to measure all TRIM markers in parallell in single reaction. This offers to reduce the volume needed to conduct the TRIM assay. |
Type Of Material | Technology assay or reagent |
Year Produced | 2024 |
Provided To Others? | No |
Impact | Method in development. But currently feasible to measure TRIM markers in parallell. |
URL | https://assets-global.website-files.com/61f09c21168a0c4911b3898f/659ce9bc6e91b9ccf3ca5191_BLINK-DX-T... |
Description | Collaboration with Aarlborg University Hospital, Denmark |
Organisation | Aalborg University Hospital |
Country | Denmark |
Sector | Hospitals |
PI Contribution | We have shared TRIM study data and research protocol with them and supplied them with patient sample collection tubes and a standardised CRF. We are contributing to direct hospital costs of patient recruitment and sample collection. |
Collaborator Contribution | They are coordinating patient recruitment and clinical sample collection across multiple hospitals in Denmark. They are collecting anonymised clinical and microbiological and treatment data on the recruits They are storing collected samples and organising shipment of samples in batches to University of Liverpool (UoL). |
Impact | They have started successful patient recruitment, sample and data collection. Sets of clinical samples have been shipped to UoL |
Start Year | 2019 |
Description | Collaboration with Amsterdam Medical Centre, Netherlands |
Organisation | Amsterdam Medical Center |
Department | Department of Neurology |
Country | Netherlands |
Sector | Hospitals |
PI Contribution | We have shared TRIM study data and research protocol with them and supplied them with patient sample collection tubes and a standardised CRF. We are contributing to direct hospital costs of patient recruitment and sample collection. |
Collaborator Contribution | They are coordinating patient recruitment and clinical sample collection in the Netherlands They are collecting anonymised clinical and microbiological and treatment data on the recruits They are storing collected samples and organising shipment of samples in batches to University of Liverpool (UoL). |
Impact | They have started successful patient recruitment, sample and data collection. A set of samples have been shipped to UoL |
Start Year | 2019 |
Description | Collaboration with PATH |
Organisation | PATH |
Country | Global |
Sector | Charity/Non Profit |
PI Contribution | We are collaborating with PATH to develop a research partnership to build a near-point of care instrument to discriminate bacterial causes of sepsis from clinical mimics. We are contributing KE to support development of a near-point of care instrument based on our unique sets of host-transcript markers and our interpretive algorithm. |
Collaborator Contribution | PATH are contributing knowledge on links to LMIC sites to recruit patient samples to assess the downstream device. They are introducing us to potential industrial partners to consider developing components of the near-POC-instrument. They are also providing research support and expertise to develop a application to NIH to help fund development of a prototype device. |
Impact | Collaborative application to US NIH - ongoing |
Start Year | 2021 |
Description | Collaboration with Ugentec, Belgium |
Organisation | UgenTec |
Country | Belgium |
Sector | Private |
PI Contribution | We have collaborated with Ugentec (under a CDA) to develop customised test decision algorithm for our novel PCR multiplex assay |
Collaborator Contribution | They have begun adaptation of their Fast Finder algorithm so that it can analyse the results of our prototype TRIM PCR assay and provide an automated decision algorithm on whether the patient sample is likely to be from a bacterial meningitis patient or a clinical mimic. |
Impact | Prototype custom Fast Finder algorithm has been developed. Algorithm is being assessed. Usability and accuracy assessments have begun. |
Start Year | 2019 |
Description | Collaboration with University of Sydney, |
Organisation | University of Sydney |
Country | Australia |
Sector | Academic/University |
PI Contribution | Collaboration with the Centre for Infectious Diseases, University of Sydney. Mutual research interests in Meningitis and working in CNS infections in Indonesia Scoping areas of research for joint work |
Collaborator Contribution | Scoping areas of research for joint work and formulating an agreement |
Impact | n/a |
Start Year | 2024 |
Description | Partnership with Fast Track Diagnostics |
Organisation | Fast Track Diagnostics Ltd. |
Country | Malta |
Sector | Private |
PI Contribution | We have identified a set of discriminatory host transcript markers that when measured in combination accurately distinguish bacterial meningitis from clinical mimics (patent applications by UoL) As part of a MRC Industrial collaborative agreement we have shared the transcript combination and measurement algorithm with FTD. Based on this information FTD are assisting in development of a multiplex PCR assay for clinical use and providing regulatory support for CE marking. |
Collaborator Contribution | Ongoing optimisation of novel host transcript based multiplex PCR assay to diagnose bacterial meningitis. Ongoing development of controls to be included into the final assay. Optimisation of assay format for stability - lyophilisation. Assessment of assay precision (CV). |
Impact | Prototype multiplex PCR assay in standard and lyophilised format. Initial development of external plasmid controls to be used in the assay. |
Start Year | 2019 |
Description | Partnership with Gadjah Mada University (GMU) |
Organisation | Gadjah Mada University |
Country | Indonesia |
Sector | Academic/University |
PI Contribution | Our team provided support in setting up and conducting the clinical diagnostic interventional study in Yogyakarta region, Indonesia. We also provided training in molecular and antigen testing for pathogens in the research and linked clinical Microbiology laboratories. This included remote and hands on training (at the local site) in safe extraction of nucleic acid from clinical samples (cerebro-spinal fluid and blood; then running real-time PCR using pathogen specific primers on the nucleic acid. It also included examples of troubleshooting the results and the importance of including control panel in the PCR run to check for contamination and accurate detection. We also provided training in performing antigen testing (via ELISAs) and rapid tests. We have provided clinical and laboratory consumables. Lab. consumables include nucleic acid extraction kits, pathogen specific primers, control samples and laboratory plastics (e.g. PCR plates, sealers, cryovials, ELISAs for pathogen (antigen) testing and Rapid LFA tests for Cryptococcal Antigen testing) We have also supported training and provided consumables to enable the local research team to perform the TRIM assay and work with us to assess the performance of the assay using samples recruited from Indonesian patients (children and adults) with suspected meningitis. |
Collaborator Contribution | The research team have set-up the clinical study at their linked hospital (working with their clinical colleagues) and successfully obtained local ethical and MTA permissions. They have advertised and recruited a research team - including support staff for clinical, laboratory and administrative roles in the study. They have successfully started the study and recruiting patients. They have collected clinical and laboratory research data. They have collected and stored appropriate clinical samples. The laboratory has also commenced sample processing and undertaken nucleic extraction from a sub-set of the collected patient samples. The laboratory is conducting pathogen antigen detection tests, such as testing for Cryptococcus pathogen using rapid antigen tests. The research team has also collaborated with their hospital laboratory team and supported training and promoted translation of diagnostic tests (such as GenXpert MTB and CRAG rapid antigen tests ) to being clinically available and utilised for assisting diagnoses and management of hospital in-patients with suspected meningitis. |
Impact | Gain in local expertise / experience in conducting a clinical trial Gain in local expertise / experience in performing laboratory based molecular and antigen testing Local recruitment of patients with suspected CNS infection Local collection of patient samples from recruited / consenting patients with suspected CNS infection Local processing of patient samples for molecular pathogen testing. Introduction and local undertaking of clinical sample testing for pathogens using rapid antigen tests and pathogen specific PCR in hospital laboratories to support clinical diagnosis and management of patients with suspected meningitis. These tests/approaches were not previously employed by the local hospital laboratories. |
Start Year | 2019 |
Title | DETECTION OF BACTERIAL INFECTION |
Description | Novel host transcript based test that accurately discriminates bacterial meningitis from clinical mimics using blood. |
IP Reference | EP3365462 |
Protection | Patent granted |
Year Protection Granted | 2018 |
Licensed | No |
Impact | Granting of this patent has strengthened our position with our industrial partners and increased our appeal with other interested industrial partners. |
Title | DETECTION OF BACTERIAL INFECTIONS |
Description | The present invention relates to methods of detecting an infection in a subject based on the relative abundance of target molecules indicative of the expression of at least the gene pair DUSP1 and IFI27. In particular, the invention relates to a method of distinguishing between a bacterial infection or a non-bacterial infection in a subject, especially between bacterial and non-bacterial lower respiratory system infections using the gene pair. Further, the invention provides the medical use of therapeutic agents in the treatment of a bacterial or non-bacterial infection in a subject identified as having such an infection through use of a method of the invention, and monitoring the therapeutic effectiveness. |
IP Reference | WO2019197833 |
Protection | Patent application published |
Year Protection Granted | 2019 |
Licensed | No |
Impact | This publication has strengthened our position with our industrial partners and increased our appeal to other diagnostic companies. The patent filing demonstrates our novel host transcript diagnostic markers can be used to support clinical diagnosis in other bacterial syndromes, beyond central nervous system infection |
Title | Development of TRIM assay |
Description | TRanscripts Identifying Meningitis (TRIM) assay is a novel host transcript based multiplex assay that offers to accurately distinguish bacterial meningitis from clinical mimics using blood from patients with suspected meningitis. A novel combination of biomarkers have been translated into multiplex PCR assay. Accuracy of this assay has been tested in an initial cohort of patients. We are currently undertaking a multi-country clinical diagnostic accuracy study to validate the earlier results and if necessary refine assay design to improve accuracy further. This clinical study and assay development is being funded via the MRC DPFS award with financial and in kind support from Fast Track Diagnostics Ltd, Luxembourg. |
Type | Diagnostic Tool - Non-Imaging |
Current Stage Of Development | Initial development |
Year Development Stage Completed | 2019 |
Development Status | Under active development/distribution |
Impact | To our knowledge, this is one of the first host transcript based tests for improving diagnosis of bacterial meningitis being developed in partnership between a University and Industry. The collaboration has resulted in knowledge exchange around novel design concepts between partners. |
Description | Presentation at ESCV Annual Conference |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Invited to give presentations on the TRIM study and the potential advantages / disadvantages of host based diagnostic to detect bacterial meningitis compared to current practice and potential future alternative approaches. Audience was mainly clinicians and clinical researchers with a focus on virologists and infectious diseases. Audience also included members of biotechnology industry. Questions were around strength / weakness of this novel approach. Others asked about study participation. |
Year(s) Of Engagement Activity | 2019 |
Description | Presentations at ECCMID Annual Conference |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Invited to give presentations on the TRIM study and the potential advantages / disadvantages of host based diagnostic to detect bacterial meningitis compared to current practice and potential future alternative approaches. Audience was mainly clinicians and clinical researchers with a focus on microbiologists and infectious diseases. Audience also included members of biotechnology industry. Questions were around strength / weakness of this novel approach. Others asked about study participation. |
Year(s) Of Engagement Activity | 2019,2020 |