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Cepheid is an American
molecular diagnostics Molecular diagnostics is a collection of techniques used to analyze biological markers in the genome and proteome, and how their cells express their genes as proteins, applying molecular biology to medical tests, medical testing. In medicine th ...
company that is a wholly owned subsidiary of
Danaher Corporation Danaher Corporation is an American global conglomerate founded in 1984 by brothers Steven and Mitchell Rales. Headquartered in Washington, D.C., the company designs, manufactures, and markets medical, industrial, and commercial products and ...
. Its systems automate traditional
nucleic acid test A nucleic acid test (NAT) is a technique used to detect a particular nucleic acid sequence and thus usually to detect and identify a particular species or subspecies of organism, often a virus or bacterium that acts as a pathogen in blood, tissu ...
s (tests for specific sequences of
DNA Deoxyribonucleic acid (; DNA) is a polymer composed of two polynucleotide chains that coil around each other to form a double helix. The polymer carries genetic instructions for the development, functioning, growth and reproduction of al ...
or
RNA Ribonucleic acid (RNA) is a polymeric molecule that is essential for most biological functions, either by performing the function itself (non-coding RNA) or by forming a template for the production of proteins (messenger RNA). RNA and deoxyrib ...
). The tests can be used to identify and analyze
pathogens In biology, a pathogen (, "suffering", "passion" and , "producer of"), in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ. The term ...
and
genetic disorders A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosome abnormality. Although polygenic disorders are ...
. Cepheid sells clinical tests for
healthcare-associated infections A hospital-acquired infection, also known as a nosocomial infection (from the Greek , meaning "hospital"), is an infection that is acquired in a hospital or other healthcare facility. To emphasize both hospital and nonhospital settings, it is s ...
,
infectious diseases infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
,
sexual health Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive healt ...
,
oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's Etymology, etymological origin is the Greek word ὄγ ...
and
genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinians, Augustinian ...
. The cartridges used in Cepheid's testing machines are single-use and must be bought from the manufacturer. The company has been accused of profiteering, particularly in developing countries, by pricing the cartridges at many times the cost of production, and engaging in
price discrimination Price discrimination (differential pricing, equity pricing, preferential pricing, dual pricing, tiered pricing, and surveillance pricing) is a Microeconomics, microeconomic Pricing strategies, pricing strategy where identical or largely similar g ...
.


System

Cepheid owns the GeneXpert rapid molecular diagnostic system, its main product. The system was developed in the 1990s; the design remained substantially the same from the turn of the century to 2020. Similar tests have subsequently been developed by Abbott and
Roche F. Hoffmann-La Roche AG, commonly known as Roche (), is a Switzerland, Swiss multinational corporation, multinational holding healthcare company that operates worldwide under two divisions: Pharmaceuticals and Diagnostics. Its holding company, ...
. The GeneXpert system identifies organisms from their DNA. It extracts genetic material from a sample and, in the case of
RNA virus An RNA virus is a virus characterized by a ribonucleic acid (RNA) based genome. The genome can be single-stranded RNA (ssRNA) or double-stranded (Double-stranded RNA, dsRNA). Notable human diseases caused by RNA viruses include influenza, SARS, ...
es, it converts the RNA into DNA first. The GeneXpert test is basically an automated version of standard real-time PCR (polymerase chain reaction) amplification and detection. Each sample to be tested is added to a single-use GeneXpert cartridge, sold by Cepheid; after this, the tests are self-contained and fully-automated. The cartridge contains an injection-moulded series of plastic chambers, which hold the chemicals and the sample. To run the test, multiple cartridges are loaded into a desktop machine (also made by Cepheid, but reusable). The sample and chemicals are moved into the test chambers using
microfluidics Microfluidics refers to a system that manipulates a small amount of fluids (10−9 to 10−18 liters) using small channels with sizes of ten to hundreds of micrometres. It is a multidisciplinary field that involves molecular analysis, molecular bi ...
: there is a
rotary valve A rotary valve (also called rotary-motion valve) is a type of valve in which the rotation of a passage or passages in a transverse plug regulates the flow of liquid or gas through the attached pipes. The common stopcock is the simplest form of ro ...
in the center, and some small
plunger A plunger is a device driven by or against fluid pressure. In plumbing, the term plunger commonly refers to handheld tools used to clear blockages in drains and pipes. Plumbing plungers consist of a rubber suction cup attached to a stick (''sh ...
s; the plungers push the sample into the valve, the valve rotates to a new position, and the sample is then pulled out into a new chamber. The machine provides the temperature cycling needed for the PCR (much like a programmable oven). This makes many copies of DNA matching the sample (amplification). Finally, the presences or absence of the pathogen is detected using FISH probes. These are short sections of DNA which have been made to attach to a
fluorescent Fluorescence is one of two kinds of photoluminescence, the emission of light by a substance that has absorbed light or other electromagnetic radiation. When exposed to ultraviolet radiation, many substances will glow (fluoresce) with color ...
molecule. If the DNA from the sample matches the DNA of the FISH probes, the two bind, and the sample fluoresces. An optical system detects the glow, or its absence. A test for a new disease can be made by simply swapping in a FISH probe that matches the sequence of the new disease.


Tests

Tests for which a GeneXpert cartridge is sold (not exhaustive):


History

The key engineering innovations underlying GeneXpert technologies, as well as early versions of the product and field testing, were done at the
Lawrence Livermore National Laboratory Lawrence Livermore National Laboratory (LLNL) is a Federally funded research and development centers, federally funded research and development center in Livermore, California, United States. Originally established in 1952, the laboratory now i ...
at the
University of California The University of California (UC) is a public university, public Land-grant university, land-grant research university, research university system in the U.S. state of California. Headquartered in Oakland, California, Oakland, the system is co ...
. It was funded by the microelectromechanical systems (MEMS) program of the
DARPA The Defense Advanced Research Projects Agency (DARPA) is a research and development agency of the United States Department of Defense responsible for the development of emerging technologies for use by the military. Originally known as the Adva ...
and the U.S. Army, as well as through LLNL’s internal budget. Cepheid was founded in 1995 and mainly funded by the US military until the
2001 anthrax attacks The 2001 anthrax attacks, also known as Amerithrax (a portmanteau of "United States, America" and "anthrax", from its FBI case name), occurred in the United States over the course of several weeks beginning on September 18, 2001, one week after th ...
. It had received $15 million in Defense Department research and development money prior to the attacks.Emert, Carol (21 October 2001)
Detecting disease / Cepheid's stock price rises as Sunnyvale firm's device to ID anthrax gains attention
''
San Francisco Chronicle The ''San Francisco Chronicle'' is a newspaper serving primarily the San Francisco Bay Area of Northern California. It was founded in 1865 as ''The Daily Dramatic Chronicle'' by teenage brothers Charles de Young and M. H. de Young, Michael H. ...
''
During the
2001 anthrax attacks The 2001 anthrax attacks, also known as Amerithrax (a portmanteau of "United States, America" and "anthrax", from its FBI case name), occurred in the United States over the course of several weeks beginning on September 18, 2001, one week after th ...
, U.S. federal agencies contracted with Cepheid to track the anthrax. In 2003, the company put a temporary hold on some healthcare development to work with defense contractor,
Northrop Grumman Northrop Grumman Corporation is an American multinational Aerospace manufacturer, aerospace and Arms industry, defense company. With 97,000 employees and an annual revenue in excess of $40 billion, it is one of the world's largest Arms industry ...
, on a U.S. federal government contract to install anthrax detection systems at US Post Office sites nationwide. Cepheid won the 2006 Industrial Design Excellence Awards for its product, Reagent Bead Dispenser. The first clinical application for the GeneXpert System was introduced in 2006 with the U.S. FDA clearance of XpertGBS, a rapid molecular diagnostic test for Group B Streptococcus in expectant women. That same year, XpertGBS was categorized by the FDA as "Moderate Complexity" under the
Clinical Laboratory Improvement Amendments The Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research. CLIA P ...
(CLIA). It was the first amplified molecular diagnostic test using real-time PCR to receive this categorization. This allowed the test to be performed by the over 27,000 institutions registered for CLIA Moderate Complexity in addition to the approximately 7,000 institutions registered for High Complexity tests. In 2012, Cepheid won a contract with the U.S. Department of Veterans Affairs for its
MRSA Methicillin-resistant ''Staphylococcus aureus'' (MRSA) is a group of gram-positive bacteria that are genetically distinct from other strains of ''Staphylococcus aureus''. MRSA is responsible for several difficult-to-treat infections in humans. ...
reagent test kits. As of March 31, 2014, Cepheid markets 14 U.S. FDA-cleared clinical in vitro diagnostic (IVD) tests in the U.S. and 16 IVD tests internationally and has placed 6,012 GeneXpert systems globally. , there are over 23 000 GeneXpert machines globally, 7,000–10,000 of them in Africa, Latin America and South-East Asia, with over a hundred in some African countries, due to long-term investment in tuberculosis-testing infrastructure by The Global Fund, among others. During the
COVID-19 pandemic The COVID-19 pandemic (also known as the coronavirus pandemic and COVID pandemic), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began with an disease outbreak, outbreak of COVID-19 in Wuhan, China, in December ...
, Cepheid announced a partnership with Sherlock Biosciences in February 2020 to begin development of a
CRISPR CRISPR (; acronym of clustered regularly interspaced short palindromic repeats) is a family of DNA sequences found in the genomes of prokaryotic organisms such as bacteria and archaea. Each sequence within an individual prokaryotic CRISPR is d ...
-based diagnostic test for the
SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19, the respiratory illness responsible for the COVID-19 pandemic. The virus previously had the Novel coronavirus, provisional nam ...
(then called "2019-nCov") virus, to run on the same machines as Cepheid's 20-year-old GeneXpert tests, as there were machines already installed in hospitals. In March 2020, the company announced a rapid diagnostic test for SARS-CoV-2; the U.S. FDA granted an emergency use authorization for the test. The diagnostic is designed to run on any of the (over 23,000) existing Cepheid GeneXpert machines worldwide, with the standard 45 minute detection time.


Pricing controversy

There has been controversy around Cepheid's test-cartridge pricing. Since 2020, there has been a call from the public health community to reduce cartridge pricing to $5, as current prices remain a barrier to use in developing countries with high testing needs. In August 2012, a public-private partnership including the
President's Emergency Plan for AIDS Relief The United States President's Emergency Plan For AIDS Relief (PEPFAR) is the global health funding by the United States to address the global HIV/AIDS Epidemiology of HIV/AIDS, epidemic and help save the lives of those suffering from the disease ...
,
United States Agency for International Development The United States Agency for International Development (USAID) is an agency of the United States government that has been responsible for administering civilian foreign aid and development assistance. Established in 1961 and reorganized in 1998 ...
, Unitaid, and
Bill & Melinda Gates Foundation The Gates Foundation is an American private foundation founded by Bill Gates and Melinda French Gates. Based in Seattle, Washington, it was launched in 2000 and is reported to be the third largest charitable foundation in the world, holding $ ...
announced a subsidy plan that reduced the cost of GeneXpert MTB/RIF for TB testing from $16.86 to $9.98 in developing countries. It was recognized that the higher price had been impeding use of the test in low and middle-income countries. The Gates Foundation made an initial $3.5 million payment to fund the drop to start immediately.(6 August 2012)
Public-Private Partnership Announces Immediate 40 Percent Cost Reduction for Rapid TB Test
''Gates Foundation'', Retrieved 15 September 2023
(8 August 2012)
Cepheid inks deals to sell TB test in developing nations
''
Reuters Reuters ( ) is a news agency owned by Thomson Reuters. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide writing in 16 languages. Reuters is one of the largest news agencies in the world. The agency ...
''
In 2020, Cepheid announced that they would charge US$19.80 per COVID-19 test in developing countries (prices are higher in middle-income countries; for instance, GeneXpert TB tests cost $55–82 per cartridge in
Indonesia Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania, between the Indian Ocean, Indian and Pacific Ocean, Pacific oceans. Comprising over List of islands of Indonesia, 17,000 islands, including Sumatra, ...
).
Doctors Without Borders Doctor, Doctors, The Doctor or The Doctors may refer to: Titles and occupations * Physician, a medical practitioner * Doctor (title), an academic title for the holder of a doctoral-level degree ** Doctorate ** List of doctoral degrees awarded ...
stated that that price was not affordable in countries where people live on less than two dollars a day. They estimated that the cost to Cepheid of providing the test is as low as $3, and called the offered price
profiteering Profiteering is a pejorative term for the act of making a profit by methods considered unethical. Overview Business owners may be accused of profiteering when they raise prices during an emergency ( especially a war). The term is also applied to ...
, asking that Cepheid make a more moderate profit by selling the tests for US$5 each. The
Treatment Action Group Treatment Action Group (TAG) is a U.S.-based organization that has been prominent within the movement of HIV/AIDS activism. Being formed in 1991, it has possessed the goals of working with worldwide efforts to increase research on treatments for HI ...
(TAG) seconded this request, saying that the development of the tests, and their purchase and global deployment, has been done with public funds, while the owners of Cepheid (Danaher Corporation) made profits of $3 billion in 2019. They requested the same price reduction for all the tests using the same technique, including HIV, tuberculosis, and
Hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include ...
, as the costs are similar regardless of the disease (see above). They pointed out that the cartridges for testing for COVID-19 were twice the price of nearly-identical cartridges for tuberculosis, . The
International Union Against Tuberculosis and Lung Disease The International Union Against Tuberculosis and Lung Disease, or The Union, is a century old global membership based, scientific organization headquartered in Paris with the stated goals to "improve health for people in low- and middle-income Co ...
also gave public support. Some dozens of organizations worldwide had joined the “Time for $5” campaign . On September 12, 2023, a campaign was launched by author and vlogger
John Green John Michael Green (born August 24, 1977) is an American author and YouTuber. His books have more than 50 million copies in print worldwide, including ''The Fault in Our Stars'' (2012), which is one of the List of best-selling books#Bet ...
to continue the fight to lower the cost of TB cartridges to $5. One week later, Cepheid and Danaher announced a 20% price reduction for their Xpert MTB/RIF TB test cartridge, from $9.98 to $7.97 in high TB-burden countries. However, their Xpert MTB/XDR test used to diagnose for drug-resistant TB, which is the deadliest form, remained unchanged at $14.90.(19 September 2023)
MSF: TB test price reduction by Cepheid and Danaher is a step in the right direction
Doctors Without Borders


Corporate status

Cepheid was founded in March 1996 by Thomas Gutshall, Bill McMillan, Dr. Kurt Petersen, Dr. Greg Kovacs, Steven Young and Dr. Allen Northrup. The company went public in 2000. The initial public offering was June 21, 2000 at US$6 per share. Cepheid stock was listed on the
Nasdaq The Nasdaq Stock Market (; National Association of Securities Dealers Automated Quotations) is an American stock exchange based in New York City. It is the most active stock trading venue in the U.S. by volume, and ranked second on the list ...
under the ticker symbol CPHD until it was acquired by Danaher in 2016. The company's first CEO was Tom Gutshall, who held the position from 1996 to 2002. In April 2002, John L. Bishop was appointed CEO. In August 2016, the company had a
market capitalization Market capitalization, sometimes referred to as market cap, is the total value of a publicly traded company's outstanding common shares owned by stockholders. Market capitalization is equal to the market price per common share multiplied by ...
of US$2.66 billion. In late 2016, Danaher Corp. bought Cepheid for US$4 billion, citing a large base of already-installed test instruments, and a wide menu of tests that fit in them. Cepheid is headquartered in
Sunnyvale, California Sunnyvale () is a city located in the Santa Clara Valley in northwestern Santa Clara County, California, United States. Sunnyvale lies along the historic El Camino Real (California), El Camino Real and U.S. Route 101 in California, Highway 1 ...
.


See also

* GeneXpert MTB/RIF (the tuberculosis test) *
Nucleic acid test A nucleic acid test (NAT) is a technique used to detect a particular nucleic acid sequence and thus usually to detect and identify a particular species or subspecies of organism, often a virus or bacterium that acts as a pathogen in blood, tissu ...
(the technique automated by Cepheid) * Robert Guthrie (Classic case of test for PKU, developed with government funds, that was licensed to a commercial company and sold at an unaffordable price.)


Notes


References

{{reflist, 24em Companies established in 1996 2000 initial public offerings Companies formerly listed on the Nasdaq Companies associated with the COVID-19 pandemic 1996 establishments in the United States 1996 establishments in California 2016 mergers and acquisitions