Recent advances in cardiac biomarkers detection: From commercial devices to emerging technologies

Emerging Biomarkers and Electrochemical Biosensors for Early Detection of Premature Coronary Artery Disease

Coronary artery disease (CAD) is one of the primary causes of morbidity and death worldwide. Premature CAD (pCAD) is the term used to describe the 3-10% of CAD occurrences that occur in people under 45 worldwide. Diagnostic difficulties arise from the different risk factor profiles of pCAD and late-onset CAD. Better cardiovascular risk prediction in younger populations has been made possible by the development of biomarker detection tools. This can be applied to a diagnostic tool, including electrochemical biosensors, which have been predicted to be instrumental because of their adaptability for point-of-care applications for quicker diagnoses. These biosensors provide efficient, scalable, and reasonably priced solutions for the quick identification and tracking of CAD. Multiplex biomarker detection has been adopted as a viable approach for early diagnosis and risk assessment due to the constraints of using a single biomarker for pCAD diagnosis. Thus, this study looks at current developments in biosensing technology and discusses established and new cardiac biomarker panels for pCAD identification.

An integrated magnetoimpedance biosensor microfluidic magnetic platform for the evaluation of the cardiac marker cTnI

An integrated magnetoimpedance (MI) biosensor microfluidic magnetic platform was proposed for the evaluation of the cardiac marker, cardiac troponin I (cTnI). This bioanalyte evaluation platform mainly comprised three external permanent magnets (PMs), one MI element, two peelable SiO2 film units and a microfluidic chip (MFC). The MI element was made of micro-electro-mechanical system (MEMS)-based multilayered [Ti (6 nm)/FeNi (100 nm)]5/Cu (400 nm)/[Ti (6 nm)/FeNi (100 nm)]5 thin films and designed as meander structures with closed magnetic flux. The MFC was fabricated using 3D printing and inverted molding techniques, designed with a solution by mixing the reaction region, magnetic separation region and detection region. Peelable SiO2 film units with the same size as the MI sensing element were used as the immunoreactivity interface of the bioanalytes. Two large PMs were placed directly below the MI sensing unit to provide a bias magnetic field, and the smaller PM was embedded in MCF for magnetic separation function. Different concentrations of the biological target (cTnI antigen)-, PBS buffer-, and Dynabeads-labeled polyclonal cTnI antibody solution were injected sequentially into the MCF. After immunoreactivity and magnetic separation, a classical sandwich immunoreaction process occurred on the surface of the monoclonal antibody-modified SiO2 film via self-assembling process in the reaction region of the MFC. The fundamental principle for evaluation of cTnI was based on variations of the MI signal under different concentrations of the biological target coupled with different numbers of Dynabeads. It was demonstrated that the mentioned MI-based magnetic platform could perform quantitative detection analyses over a range of cTnI concentrations (lowest concentration = 0.1 ng mL-1 and highest concentration = 100 ng mL-1). The proposed MI-based magnetic platform provides a sensitive, reliable, stable and reusable bioanalytical platform, and it has potential in future biomedical applications.

Electrochemical Determination of B-Type Natriuretic Peptide with an Epitope-Imprinted Polymer-Based Sensor

B-type natriuretic peptides (BNP) are produced and secreted by the myocardium to reduce blood pressure and cardiac load. They cause vasodilation, natriuresis, growth suppression, and inhibition of the sympathetic nervous system and the renin-angiotensin-aldosterone system. The measurement of plasma BNP levels provides clinically useful information concerning the diagnosis and management of left ventricular dysfunction and heart failure, complementing other diagnostic testing procedures. In this work, three epitopes from the N-terminal (BNPnt), C-terminal (BNPct), and the cystine-bridged cyclic peptides (BNPr) of B-type natriuretic peptides were synthesized as templates for molecular imprinting. These peptides were doped into aniline (AN) and m-aminobenzenesulfonic acid (MSAN) for electropolymerization, thus forming epitope-imprinted poly(AN-co-MSAN) conductive films (EIPs). The monomer ratio was optimized using the electrochemical signals during polymerization. The optimized films were then characterized using a scanning electron microscope (SEM), atomic force microscope (AFM), and AC impedance. The electrochemical response of the films to the target peptides and to BNP was then measured. The sensing range of the EIPs-coated electrodes was from 0.001 to 1000 pg/mL for BNP. Finally, the BNP concentration in diluted serum samples was measured with the BNPrIP-coated electrode, giving 3.15 ± 0.07 pg/mL. By spiking the sample with known BNP concentrations, the accuracy was determined to be better than ±5%.

A Plasmonic Nanoledge Array Sensor for Selective Detection of Cardiovascular Disease Biomarkers in Human Whole Blood

Optical sensors face challenges when detecting ultralow amounts of analytes in whole blood, including signal quenching due to optical absorption and false positives due to nonspecific binding. This study introduces gold nanoscale array features termed nanoledges (NLs), which interact with incident white light to produce a transmitted surface plasmon resonance (tSPR) signal. This extraordinary optical transmission (EOT) spectrum occurs in the near-infrared (NIR) region, thereby minimizing signal quenching caused by visible-light absorption from blood proteins and pigments. To develop a sensitive, selective, and label-free optical biosensor for detecting various levels of cardiac troponin I (cTnI) in very small volumes of whole blood samples, DNA aptamers are tethered to the NL surface, specifically binding to the cTnI biomarker. This biological binding activity alters the refractive index at the NL surface, causing a peak shift in the EOT spectrum and enabling quantification of cTnI levels. The NL array chip demonstrated high sensitivity for cTnI detection in buffer, human serum (HS), and human whole blood (HB), with detection limits of 0.079, 0.084, and 0.097 ng/mL, respectively. Control measurements using blank target mediums and those containing up to 125 ng/mL of other proteins, such as myoglobin, creatine kinase, and heparin, showed minimal interference and high specificity. The NL plasmonic array's performance in biosensing underscores its promise for clinical analysis and its potential development as a point-of-care platform for early cardiovascular disease (CVD) diagnostics.

Multi-omic analysis of dysregulated pathways in triple negative breast cancer

The aggressive characteristics of triple-negative breast cancer (TNBC) and the absence of targeted medicines make TNBC a challenging clinical case. The molecular landscape of TNBC has been well-understood thanks to recent developments in multi-omic analysis, which have also revealed dysregulated pathways and possible treatment targets. This review summarizes the utilization of multi-omic approaches in elucidating TNBC's complex biology and therapeutic avenues. Dysregulated pathways including cell cycle progression, immunological modulation, and DNA damage response have been uncovered in TNBC by multi-omic investigations that integrate genomes, transcriptomics, proteomics, and metabolomics data. Methods like this pave the door for the discovery of new therapeutic targets, such as the EGFR, PARP, and mTOR pathways, which in turn direct the creation of more precise treatments. Recent developments in TNBC treatment strategies, including immunotherapy, PARP inhibitors, and antibody-drug conjugates, show promise in clinical trials. Emerging biomarkers like MUC1, YB-1, and immune-related markers offer insights into personalized treatment approaches and prognosis prediction. Despite the strengths of multi-omic analysis in offering a more comprehensive view and personalized treatment strategies, challenges exist. Large sample sizes and ensuring high-quality data remain crucial for reliable findings. Multi-omic analysis has revolutionized TNBC research, shedding light on dysregulated pathways, potential targets, and emerging biomarkers. Continued research efforts are imperative to translate these insights into improved outcomes for TNBC patients.

AlphaLISA-Based Immunoassay for Detection of Troponin T in Serum of Patients with Acute Myocardial Infarction

Survival and prognosis of patients with acute myocardial infarction (AMI) are highly dependent on rapid and accurate diagnosis of myocardial damage. Troponin T is the primary diagnostic biomarker and is widely used in clinical practice. Amplified luminescent proximity homogeneous assay (AlphaLISA) may provide a solution to rapidly detect a small amount of analyte through molecular interactions between special luminescent donor beads and acceptor bead. Here, a double-antibody sandwich assay was introduced into AlphaLISA for rapid detection for early diagnosis of AMI and disease staging evaluation. The performance of the assay was evaluated. The study found that the cTnT assay has a linear range of 48.66 to 20,000 ng/L with a limit of detection of 48.66 ng/L. In addition, the assay showed no cross-reactivity with other classic biomarkers of myocardial infarction and was highly reproducible with intra- and inter-batch coefficients of variation of less than 10%, notably, only 3 min was taken, which is particularly suitable for clinical diagnosis. These results suggest that our method can be conveniently applied in the clinic to determine the severity of the patient's condition.

Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review

Heart failure (HF) represents a significant global health challenge, characterized by a variety of symptoms resulting from cardiac dysfunction. This dysfunction often leads to systemic and pulmonary congestion. The pathophysiology of HF is complex, involving stimulation of the sympathetic nervous system, which is insufficiently balanced by the release of natriuretic peptide. This imbalance leads to progressive hypertrophy and dilatation of the heart's chambers, impairing its pumping efficiency and increasing the risk of arrhythmias and conduction disorders. The prevalence of HF is exceptionally high in industrialized nations and is expected to increase owing to an aging population and advancements in diagnostic methods. This study emphasizes the critical role of early diagnosis in reducing morbidity and mortality associated with HF, focusing specifically on the evolving importance of biomarkers in managing this condition. Biomarkers have played a key role in transforming the diagnosis and treatment of HF. Traditional biomarkers such as b-type natriuretic peptide and N-terminal pro-b-type natriuretic peptide have been widely adopted for their cost-effectiveness and ease of access. However, the rise of novel biomarkers such as growth differentiation factor 15 and adrenomedullin has shown promising results, offering superior sensitivity and specificity. These new biomarkers enhance diagnostic accuracy, risk stratification, and prognostic evaluation in HF patients. Despite these advancements, challenges remain, such as limited availability, high costs, and the need for further validation in diverse patient populations. Through a comprehensive literature review across databases such as PubMed, Google Scholar, and the Cochrane Library, this study compiles and analyzes data from 18 relevant studies, offering a detailed understanding of the current state of HF biomarkers. The study examines both traditional and emerging biomarkers such as galectin-3 and soluble suppression of tumorigenicity 2 in HF, exploring their clinical roles and impact on patient outcomes.

A multiplexed immunochemical microarray for the determination of cardiovascular disease biomarkers

A fluorescence antibody microarray has been developed for the determination of relevant cardiovascular disease biomarkers for the analysis of human plasma samples. Recording characteristic protein molecular fingerprints to assess individual's states of health could allow diagnosis to go beyond the simple identification of the disease, providing information on its stage or prognosis. Precisely, cardiovascular diseases (CVDs) are complex disorders which involve different degenerative processes encompassing a collection of biomarkers related to disease progression or stage. The novel approach that we propose is a fluorescent microarray chip has been developed accomplishing simultaneous determination of the most significant cardiac biomarkers in plasma aiming to determine the CVD status stage of the patient. As proof of concept, we have chosen five relevant biomarkers, C-reactive protein (CRP) as biomarker of inflammation, cystatin C (CysC) as biomarker of renal failure that is directly related with heart failure, cardiac troponin I (cTnI) as already established biomarker for cardiac damage, heart fatty acid binding protein as biomarker of ischemia (H-FABP), and finally, NT-proBNP (N-terminal pro-brain natriuretic peptide), a well-established heart failure biomarker. After the optimization of the multiplexed microarray, the assay allowed the simultaneous determination of 5 biomarkers in a buffer solution reaching LODs of 15 ± 5, 3 ± 1, 24 ± 3, 25 ± 3, and 3 ± 1 ng mL-1, for CRP, CysC, H-FABP, cTnI, and NT-proBNP, respectively. After solving the matrix effect, and demonstrating the accuracy for each biomarker, the chip was able to determine 24 samples per microarray chip. Then, the microarray has been used on a small pilot clinical study with 29 plasma samples from clinical patients which suffered different CVD and other related disorders. Results show the superior capability of the chip to provide clinical information related to the disease in terms of turnaround time (1 h 30 min total assay and measurement) and amount of information delivered in respect to reference technologies used in hospital laboratories (clinical analyzers). Despite the failure to detect c-TnI at the reported threshold, the microarray technology could be a powerful approach to diagnose the cardiovascular disease at early stage, monitor its progress, and eventually providing information about an eminent potential risk of suffering a myocardial infarction. The microarray chip here reported could be the starting point for achieving powerful multiplexed diagnostic technologies for the diagnosis of CVDs or any other pathology for which biomarkers have been identified at different stages of the disease.

Progress in the Optical Sensing of Cardiac Biomarkers

Biomarkers play key roles in the diagnosis, risk assessment, treatment and supervision of cardiovascular diseases (CVD). Optical biosensors and assays are valuable analytical tools answering the need for fast and reliable measurements of biomarker levels. This review presents a survey of recent literature with a focus on the past 5 years. The data indicate continuing trends towards multiplexed, simpler, cheaper, faster and innovative sensing while newer tendencies concern minimizing the sample volume or using alternative sampling matrices such as saliva for less invasive assays. Utilizing the enzyme-mimicking activity of nanomaterials gained ground in comparison to their more traditional roles as signaling probes, immobilization supports for biomolecules and for signal amplification. The growing use of aptamers as replacements for antibodies prompted emerging applications of DNA amplification and editing techniques. Optical biosensors and assays were tested with larger sets of clinical samples and compared with the current standard methods. The ambitious goals on the horizon for CVD testing include the discovery and determination of relevant biomarkers with the help of artificial intelligence, more stable specific recognition elements for biomarkers and fast, cheap readers and disposable tests to facilitate rapid testing at home. As the field is progressing at an impressive pace, the opportunities for biosensors in the optical sensing of CVD biomarkers remain significant.

Simultaneous Electrochemical Detection of LDL and MDA-LDL Using Antibody-Ferrocene or Anthraquinone Conjugates Coated Magnetic Beads

The simultaneous detection of atherosclerotic cardiovascular disease (ACSVD) biomarkers was recently of great scientific interest. In this work, magnetic beads-based immunosensors for the simultaneous detection of low density lipoprotein (LDL) and malondialdehyde-modified low density lipoprotein (MDA-LDL) were presented. The approach proposed was based on the formation of two types of specific immunoconjugates consisting of monoclonal antibodies: anti-LDL or anti-MDA-LDL, together with redox active molecules: ferrocene and anthraquinone, respectively, coated on magnetic beads (MBs). The decrease in redox agent current in the concentration range: 0.001-1.0 ng/mL for LDL and 0.01-10.0 ng/mL for MDA-LDL, registered by square wave voltammetry (SWV), was observed upon the creation of complex between LDL or MDA-LDL and appropriate immunoconjugates. The detection limits of 0.2 ng/mL for LDL and 0.1 ng/mL for MDA-LDL were estimated. Moreover, the results of selectivity against the possible interferents were good, as human serum albumin (HSA) and high density lipoprotein (HDL), stability and recovery studies demonstrated the potential of platform proposed for early prognosis and diagnosis of ASCVD.

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina

Objective:

The present study seeks to find a way to quickly and correctly differentiate myocardial infarction from unstable angina by measuring the creatine kinase-MB/creatine phosphokinase ratio and comparing in non-ST elevation myocardial infarction patients with unstable angina at different time intervals, to improve the health quality of patients with coronary artery disease.

Methods:

The present study is a retrospective epidemiological analysis of 260 patients with non-ST elevation myocardial infarction and 260 patients with unstable angina, including age, sex, creatine kinase-MB, and creatine phosphokinase biomarkers at two-time intervals, including referral (4–8 h from the onset of pain) as the first interval, and 8 h after the first sampling was extracted as the second interval. Moreover, the delta of the creatine kinase-MB/creatine phosphokinase ratio during two interval times was measured.

Results:

In non-ST elevation myocardial infarction patients in the first and second intervals, creatine kinase-MB/creatine phosphokinase ratio was 32.7 and 33.8% higher than the normal laboratory cutoff (positive), respectively, and in the group of unstable angina patients, this index was positive in 31.9 and 30.4% of patients, respectively. There was no significant difference between the mean creatine kinase-MB to creatine phosphokinase index between the patients with non-ST elevation myocardial infarction and unstable angina (p = 0.507). In the first interval, the sensitivity and specificity of this index in differentiating non-ST elevation myocardial infarction from unstable angina were 51.5 and 57.3% (area under the curve = 0.518), respectively. While in the second interval, the sensitivity and specificity of this index were 17.7 and 87.8% (area under the curve = 0.519), respectively. The creatine kinase-MB/creatine phosphokinase delta in the non-ST elevation myocardial infarction group was significantly higher than in patients with unstable angina during different time intervals (p = 0.01).

Conclusion:

According to our results, creatine kinase-MB/creatine phosphokinase index cannot help differentiate the two groups of non-ST elevation myocardial infarction and unstable angina. However, the findings show that higher levels of creatine kinase-MB enzyme and creatine kinase-MB/creatine phosphokinase delta in the early hours, 4–16 h after the onset of pain in non-ST elevation myocardial infarction patients, can be used to differentiate between non-ST elevation myocardial infarction and unstable angina.

Biosensors for the Rapid Detection of Cardiovascular Biomarkers of Vital Interest: Needs, Analysis and Perspectives

We have previously surveyed a panel of 508 physicians from around the world about which biomarkers would be relevant if obtained in a very short time frame, corresponding to emergency situations (life-threatening or not). The biomarkers that emerged from this study were markers of cardiovascular disease: troponin, D-dimers, and brain natriuretic peptide (BNP). Cardiovascular disease is a group of disorders affecting the heart and blood vessels. At the intersection of medicine, basic research and engineering, biosensors that address the need for rapid biological analysis could find a place of choice in the hospital or primary care ecosystem. Rapid, reliable, and inexpensive analysis with a multi-marker approach, including machine learning analysis for patient risk analysis, could meet the demand of medical teams. The objective of this opinion review, proposed by a multidisciplinary team of experts (physicians, biologists, market access experts, and engineers), is to present cases where a rapid biological response is indeed valuable, to provide a short overview of current biosensor technologies for cardiac biomarkers designed for a short result time, and to discuss existing market access issues.

Ruthenium and Nickel Molybdate-Decorated 2D Porous Graphitic Carbon Nitrides for Highly Sensitive Cardiac Troponin Biosensor

Two-dimensional (2D) layered materials functionalized with monometallic or bimetallic dopants are excellent materials to fabricate clinically useful biosensors. Herein, we report the synthesis of ruthenium nanoparticles (RuNPs) and nickel molybdate nanorods (NiMoO₄ NRs) functionalized porous graphitic carbon nitrides (PCN) for the fabrication of sensitive and selective biosensors for cardiac troponin I (cTn-I). A wet chemical synthesis route was designed to synthesize PCN-RuNPs and PCN-NiMoO₄ NRs. Morphological, elemental, spectroscopic, and electrochemical investigations confirmed the successful formation of these materials. PCN-RuNPs and PCN-NiMoO₄ NRs interfaces showed significantly enhanced electrochemically active surface areas, abundant sites for immobilizing bioreceptors, porosity, and excellent aptamer capturing capacity. Both PCN-RuNPs and PCN-NiMoO₄ NRs materials were used to develop cTn-I sensitive biosensors, which showed a working range of 0.1–10,000 ng/mL and LODs of 70.0 pg/mL and 50.0 pg/mL, respectively. In addition, the biosensors were highly selective and practically applicable. The functionalized 2D PCN materials are thus potential candidates to develop biosensors for detecting acute myocardial infractions.

A versatile and automated microfluidic platform for a quantitative magnetic bead based protocol: application to gluten detection

A microfluidic platform for the integration of multi-step biological assays has been developed. The presented system is a unique instrument compatible with microfluidic chips for various applications based on bead manipulation. Two examples of microfluidic cartridges are presented here. The first one contains two rows of eight chambers (40 and 80 μL), six reagent inlets, eight testing solution (calibrators and samples) inlets and eight outlets to reproduce precisely each step of a biological assay. This configuration is versatile enough to integrate many different biological assays and save a lot of development time. The second architecture is dedicated to one specific protocol and is completely automated from the standard and sample dilutions to the optical detection. Linear dilutions have been integrated to prepare automatically a range of standard concentrations and outlets have been modified for integrated colorimetric detection. The technology uses pneumatically collapsible chambers to perform all the fluidic operations for a fully automated protocol such as volume calibrations, fluid transport, mixing, and washing steps. A programmable instrument with a software interface has been developed to adapt rapidly a protocol to this cartridge. As an example, these new microfluidic cartridges have been used to successfully perform an immunoassay for gluten detection in the dynamic range of 10-30 ppm with good sensitivity (2 ppm) and specificity.

An Immunocolorimetric Sensing System for Highly Sensitive and High-Throughput Detection of BNP with Carbon-Gold Nanocomposites Amplification

Conventional immunocolorimetric sensing of biomolecules continues to be challenged with low sensitivity although its wide application as a diagnostic tool in medicine and biotechnology. Herein, we present a multifunctional immunocolorimetric sensing system for sensitive and high-throughput detection of B-type natriuretic peptide (BNP) with carbon-gold nanocomposite (CGNs) amplification. Using a “green” strategy, monodisperse carbon nanospheres (CNs) were successfully synthesized by glucose carbonization. A simple and efficient hydrothermal method was developed to assemble abundant gold nanoparticles (AuNPs) onto the surfaces of CNs. The resulting CGNs were characterized and utilized for biomarker detection with superior properties of easy manufacturing, good biocompatibility, satisfactory chemical stability, and high loading capacity for biomolecules. As a proof of concept, the as-prepared CGNs were conjugated with horseradish peroxidase-labeled antibody against BNP (CGNs@AntiBNP-HRP) functioning as the carrier, signal amplifier, and detector for the sensitive detection of BNP. Under optimal conditions, the established CGNs@AntiBNP-HRP immunoprobe remarkably enhanced the detection performance of BNP, achieving signal amplification of more than 9 times compared to the conventional method. Based on our self-developed bionic electronic eye (e-Eye) and CGNs@AntiBNP-HRP immunoprobe, the multifunctional sensing system displayed a wide dynamic linear range of 3.9–500 ng/mL and a LOD of 0.640 ng/mL for BNP detection with high specificity, good accuracy and reproducibility. This portable sensing system with enhanced performance demonstrates great potential for BNP detection in point of care applications, and offers a universal and reliable platform for in vitro biomarker detection.

N, Adigal S, Lukose J, Kartha VB, Chidangil S. Cardiovascular biomarkers in body fluids: progress and prospects in optical sensors

Cardiovascular diseases (CVD) are the major causative factors for high mortality and morbidity in developing and developed nations. The biomarker detection plays a crucial role in the early diagnosis of several non-infectious and life-threatening diseases like CVD and many cancers, which in turn will help in more successful therapy, reducing the mortality rate. Biomarkers have diagnostic, prognostic and therapeutic significances. The search for novel biomarkers using proteomics, bio-sensing, micro-fluidics, and spectroscopic techniques with good sensitivity and specificity for CVD is progressing rapidly at present, in addition to the use of gold standard biomarkers like troponin. This review is dealing with the current progress and prospects in biomarker research for the diagnosis of cardiovascular diseases. Expert opinion. Fast diagnosis of cardiovascular diseases (CVDs) can help to provide rapid medical intervention, which can affect the patient's short and long-term health. Identification and detection of proper biomarkers for early diagnosis are crucial for successful therapy and prognosis of CVDs. The present review discusses the analysis of clinical samples such as whole blood, blood serum, and other body fluids using techniques like high-performance liquid chromatography-LASER/LED-induced fluorescence, Raman spectroscopy, mainly, optical methods, combined with nanotechnology and micro-fluidic technologies, to probe patterns of multiple markers (marker signatures) as compared to conventional techniques.