“Globally, acute poisoning with pharmaceuticals is a public health problem. The World Drug Report estimates pharmaceutical poisoning accounting for an estimated 190,000 annual fatalities worldwide and the prevalence of non-fatal poisoning being 20-30 times higher.” 

Thus sounded Ailyn M. Yabes, MScPH, DrPH, Associate Professor at the Department of Pharmacology and Toxicology, College of Medicine, as she introduced the innovative E-Tox Point of Care Testing (POCT) device as a form of response to this problem. The E-Tox POCT device targets the detection of pharmaceuticals and selected New Psychoactive Substances (NPS). 

According to the data gathered by the UP-PGH National Poison Management and Control Center (NPMCC), pharmaceutical agents remain the most common toxicants, accounting for 35.5% of in-patient referrals. 

“Paracetamol is the main cause of poisoning, not only accidentally but also non-accidentally or deliberately.” Dr. Yabes pointed out that paracetamol poisoning is a significant issue not only in the Philippines but also in the region.

Based on the United Nations Office for Drugs and Crime (UNODC), NPS are defined as “substances of abuse, either in a pure form or a preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but which may pose a public health threat. These substances are designed to mimic the effects of established illicit drugs like cannabis, cocaine, ecstasy, and LSD.

While current data from the Philippines indicates that out of 74 samples for NPS poisoning, 41 cases involved NPS, with cathinones being the predominant class.

Addressing Gaps in Toxicology Testing

Dr. Yabes started her presentation by citing a critical patient case which highlighted the need for the E-Tox POCT device. “In this case, the delayed diagnosis and management of a 22-year-old female patient who had taken a paracetamol overdose could have been avoided if a point-of-care testing device was available at the emergency room.”

She underscored the importance of timely acute management in poisoning cases. “It is widely recognized that prompt acute management of poisoning cases will significantly enhance the overall patient outcomes of these poison patients. Although certain toxidromes may narrow down the differential diagnosis, especially in a known pharmaceutical poisoning, having a diagnostic test that would indicate the presence of a certain pharmaceutical or a certain drug would definitely aid in either ruling in or ruling out the offending agent.”

Dr. Yabes discussed that existing testing platforms for pharmaceuticals and NPS are often lab-based, costly, and require hazardous chemicals, making them inaccessible and impractical for emergency or bedside toxicology; thus, there is a need for a portable, user-friendly, and cost-effective point-of-care testing device in emergency settings.

“The drugs of abuse test kits currently available in the Philippines do not include NPS,” Yabes added. She asserted that the E-Tox POCT device fills these gaps. “The E-Tox can detect seven new psychoactive substances, part of those identified in the Philippines.”

The E-Tox Innovation

The E-Tox POCT device is available in two models: the E-Tox-NPS, designed to detect New Psychoactive Substances such as ketamine, synthetic cannabinoids, and synthetic cathinones; and the E-Tox-PHX, which focuses on detecting pharmaceuticals such as paracetamol, isoniazid, and salicylate poisoning.

Both models have undergone validation and demonstrated acceptable performance characteristics in terms of limit of detection, accuracy, precision, sensitivity, specificity, and predictive values as per UNODC, CLSI, and ISO 5725-1:2023 standards.

The device was developed by Dr. Yabes as the Principal Investigator; Prof. Noel Quiming, Department of Physical Sciences and Mathematics, UP Manila CAS as Co-Investigator; Ass. Prof. Sarah Johnson, Department of Physical Sciences and Mathematics, CAS, UP Manila as Co-Investigator; Gabrielle Pagjunasan, University Researcher I, UP Manila; Greg Andrew Octa, University Researcher I, UP Manila; and Jessa Turreda, University Research Associate, UP Manila, as Project Staff.

The development of the E-Tox POCT device has been supported by various funding agencies, including the Dangerous Drugs Board, the Department of Science and Technology – Philippine Council for Health Research and Development (DOST-PCHRD), and the UP-PGH 1st Director’s Innovation Grant. The clinical validation of E-Tox-NPS is expected to conclude by October 2024, while E-Tox-PHX is currently partially funded and in progress.

Call for Partners

Dr. Yabes concluded her presentation by discussing the validation and readiness of the E-Tox devices. “This POCT device passed the validation parameters and were all within acceptable ranges based on international guidelines for POCT devices,” she stated. “Currently, both E-Tox NPS and E-Tox PHS are at technology readiness level five, and a patent has been applied to IPOPHIL with the assistance of UP Manila TTBDO.”

Looking ahead, Dr. Yabes expressed optimism about introducing the E-Tox POCT device to the healthcare market as a solution for early diagnosis and management of poisoned patients. She hopes to advance the E-Tox POCT device to Technology Readiness Levels (TRL) 6 and 7. “We are now looking for industry partners to collaborate with us in the pre-commercial stage and subsequently in manufacturing and commercialization.” #

Text by: Charmaine A. Lingdas