This medtech startup’s paper-based system can detect bacterial and antimicrobial resistance infections in just 90 minutes

The combination of high access to antibiotics, challenges in infection prevention and control, and inappropriate prescription have proved to be dangerous, leading to rising cases of antibiotic resistance. This is particularly worrying as India has one of the highest infectious disease burdens in the world, and the irrational use of antibiotics against these diseases can lead to higher resistance. Antibiotic resistance is already increasing by 5 to 10 percent every year, and the signs are routinely visible already: as per an ICMR study, a large group of Indian patients may no longer benefit from carbapenem, a powerful antibiotic administered to treat pneumonia and septicemia.

These trends only point towards one solution - early detection of infection.

Approximately 60-80 percent of patients develop infections while staying in the hospital, such as catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. If these infections aren't detected early enough, it can lead to the incorrect prescription of antibiotics, further leading to chances of antibiotic resistance.

Ramja’s founder, Dr Pooja Goswami saw the downside of delayed infection detection rather closely in a personal capacity. A clinical scientist who completed her doctorate from AIIMS, Delhi, Dr Pooja knew she had to do something to counter delayed infection and antimicrobial resistance detection after losing her father due to these reasons while he was undergoing cancer treatement. She had noticed that diagnostic modules like the culture-based test, Polymerase Chain Reaction (PCR), Matrix-assisted laser desorption/ionization (MALDI), and sequencing are all time-consuming methods, which can be difficult to execute and take days to show results. These factors could prove to be fatal for the patient, and the only way was to develop a quick solution.

A woman’s determination

Timely detection has been a critical factor in Ramja’s journey, and the cause remains very close to Dr. Pooja’s heart. In 2014, she was treating her father, who was suffering from gastric lymphoma. But while he was on his way to recovery, he caught a sudden infection during chemotherapy. “When somebody you love the most is suffering, you want the results quickly because doctors will want to see reports before prescribing antibiotics. For my father’s culture report, I went to a private lab,” she recalled. While she had hoped to get the results quickly, it took 72 hours. And that was a long time for the doctor to change the medication. During the wait, her father passed away, leaving her shell shocked as she lost him to an infection they could not detect in time.

The shock turned to determination, and Dr Pooja set out to bridge the gap. She started reading and researching infections, and found out about a technology related to biosensors. This revelation led her to start Ramja.

What sets Ramja apart?

Launched as an ode to her father, Ramja Genosensor is a unique paper-based system that detects microbial infection and antimicrobial resistance in less than two hours. “It is world-class technology that has never been used for infection detection. For the first time, we will be providing electrochemical DNA biosensor technology, which will give you the results of any infection and antimicrobial resistance in just 90 minutes,” explained Dr Pooja who started Ramja after working in AIIMS for 16 years.

Ramja has been operational since 2019 after receiving the Biotechnology Industry Research Assistance Council (BIRAC) grant.

Through Ramja’s technology, Dr Pooja aims to benefit both patients and clinicians alike. According to Dr Pooja, the patient will be the first beneficiary as they will get the result in time and avoid being exposed to incorrect antibiotics. Secondly, doctors too will benefit from this technology because existing detection methods require well equipped lab and the time of expert scientists, or those with a Ph.D, M.D or M.Sc levels of qualification. For RAMJA's solution, all they need is a 6 feet to 6 feet room to set up a lab and a lab technician to perform the process. Comparatively, this is a simple method which requires a small setup.

Noticing that most common infections occurring all over the world are caused by six species, Ramja started working on a panel that covers 90 percent of bacterial infections. “We have already started working on the sepsis panel and we are working on the pneumonia panel,” she said, adding that they are currently also working on an AI-based panel. Through AI, Ramja will be able to predict the type of infection in less than 10 minutes.

Ramja’s technology is fast, cost-effective, portable in addition to being gene-specific and very sensitive. Dr Pooja specifies that it is a table top device which can be easily carried and technicians can perform experiments in any kind of setup. The Ramja Genosensor is also the first and only sensor-first device, where all the results will be available on the cloud. This means patients from the remotest corners of India will have access to medication from bigger hospitals. No other technology offers this facility.

Additionally, the device does not require trained professionals. To operate a culture-based test in any lab, one needs to be either an MSC or PhD student. Ramja’s novel paper-based system is so simple that someone with basic secondary education can receive the appropriate training to conduct the tests. “Our protocol is very simple - it is a five-step method which requires five training days,” added Dr Pooja.

Future roadmap

Finding the right staff, partners and funds at the right time are only some of the challenges the startup faced, whose progress was slowed down by the pandemic. But Dr Pooja revealed they overcame those by managing to supplement with her own funds and were able to sustain the company through multiple grants. “We received Rs. 2.5 crore government grant, recognition from the BIRAC, a Facebook grant, and the Pfizer intellectual property grant, among others. And we also received the Pfizer Innovation Challenge grant this year. We are also the winner of the Asia Pacific Medtech Innovator Top 10 of 2022,” she said.

Now, Ramja is looking at a market launch in three months. The company has a manufacturing unit in Okhla, where they have started their production line, for which they are working on the regulatory aspect for ISO and CDSCO approvals. In its first phase, Ramja wants to work with private diagnostics labs and hospitals. Parallelly, Dr. Pooja also wishes to work with larger government hospitals - they have already been recommended by the health ministry and have pitched their product to the National Health Innovation Program in October.

Dr Pooja believes that the mindset change may also be a challenge due to co-existing technologies in the market and set processes. It might be difficult to convince technicians and lab owners to change the norm and opt for a new technology. To counter this, Ramja’s strategy will be to pitch to the technicians, as well as lab owners and doctors. “I learned that my product is not going to be used by the doctor nor the founder; it is going to be used by a lab-technician, so we will always ensure that the technician is present in that teaching session. So they will understand why their pain point is getting resolved,” she explained.

Ramja is one of the six winners of the Pfizer INDovation Program, which was launched by Pfizer and Social Alpha to accelerate the journey of promising med-tech startups into the market. According to Dr Pooja, these companies are some of the biggest names in the country, and associating with them opens up networking avenues. Working with such big names has helped them iron out their approach, consolidate their timelines and identify other bottlenecks. She believes that Ramja can work with a realistic approach and progress continuously with a bigger platform. After all, with a story as inspiring as Dr Pooja’s, and a mission this pressing, Ramja deserves all the support they get. And through such guidance, it will be interesting to see what milestones Ramja achieves in the future.