# Facile screening for esophageal cancer in LMICs

> **NIH NIH UH3** · JOHNS HOPKINS UNIVERSITY · 2021 · $936,336

## Abstract

Esophageal squamous cell carcinoma (ESCC) ranks sixth among all cancers worldwide, with 450,000 new
cases diagnosed per year and a very poor prognosis. Low-cost, minimally invasive point-of-care population
screening for ESCC is badly needed, particularly in LMICs, where 5-year ESCC survival is less than 10%.
Altered methylation occurs frequently in human malignancies, including EC, constituting an early event that
can serve as an early cancer detection biomarker. However, for DNA methylation to be used in this manner,
we need cost-effective, user-friendly and robust tests that permit clinical translation in LMICs. We propose an
early ESCC diagnostic strategy comprising a single-use, swallowable sponge to collect esophageal specimens
coupled with a smartphone-manipulated microfluidic chip for automated sample processing and methylation
detection. This strategy does not require endoscopy (EGD), can be administered by healthcare workers
without medical degrees, and uses an on-phone analytic app. The sponge is cheaper (approximately $30
each), less invasive, and easier to perform than EGD ($1500 total cost, including facility fees); there are no
room charges, unlike EGD. The microchip integrates DNA extraction, bisulfite DNA conversion, and
methylation analysis into a single device. In addition, the microchip interfaces with a cellphone, for both device
control and methylation detection and analysis. The integrated device enables detection of DNA methylation
from crude samples in a “sample-to-answer” manner, without the need for sending data back to an analytic
center off-site. Thus, the proposed platform promises a cost-effective and user-friendly POC strategy for early
ESCC detection that is implementable in LMICs. We have also assembled a talented interdisciplinary,
intercontinental team to execute this strategy. Our task will be achieved in 2 phases via the following Aims:
UG3 PHASE: Aim 1: To assess a streamlined protocol for sample collection, processing and methylation
detection. Aim 2: To implement DNA sample processing and methylation detection into a mobile phone-
manipulated microfluidic chip system. Aim 3: To test a prototype ESCC diagnostic strategy integrating the DNA
methylation detection system with the swallowable sponge for sample collection. UH3 PHASE: Aim 1: To
improve the cost-effectiveness and robustness of the methylation diagnostic system for use in LMICs. Aim 2:
To develop a method for ambient chip storage and perform on-chip QC tests to verify assay functionality. Aim
3: To conduct an ESCC diagnostic trial in Uganda using our point-of-care strategy.

## Key facts

- **NIH application ID:** 10238011
- **Project number:** 5UH3CA211457-05
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Stephen J Meltzer
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $936,336
- **Award type:** 5
- **Project period:** 2017-05-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10238011

## Citation

> US National Institutes of Health, RePORTER application 10238011, Facile screening for esophageal cancer in LMICs (5UH3CA211457-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10238011. Licensed CC0.

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