Electrochemical bioaffinity sensors for salivary biomarkers detection

Saliva-Sensing Dental Floss: An Innovative Tool for Assessing Stress via On-Demand Salivary Cortisol Measurement with Molecularly Imprinted Polymer and Thread Microfluidics Integration

On-demand dental-floss-based point-of-care platform is developed for the noninvasive and real-time quantification of salivary cortisol utilizing redox-molecule embedded molecularly imprinted polymer structures and thread microfluidics. Herein, we explore the high-surface-area graphene-based electrode substrate for electrochemically synthesizing selective cortisol MIPs and integrate it with thread microfluidics to build a highly sensitive cortisol-sensing platform for stress monitoring. This platform uses flossing to collect and transport saliva to a flexible electrochemical sensor via capillary microfluidics, where cortisol, a stress biomarker, is measured. This strategy allowed us to detect cortisol as low as 0.048 pg mL-1 in real-time with a detection range of 0.10-10,000 pg mL-1 (R2 = 0.9916). The saliva-sensing dental floss provides results within 11-12 min. The thread-based microfluidic design minimizes interference and ensures consistent repeatability when testing both artificial and actual human saliva samples, yielding 98.64-102.4% recoveries with a relative standard deviation of 5.01%, demonstrating high accuracy and precision. For the human saliva sample (as part of the stress study), the platform showed a high correlation (r = 0.9910) against conventional ELISA assays. Combined with a wireless readout, this saliva floss offers a convenient way to monitor daily stress levels. It can be extended to detect other critical salivary biomarkers with high sensitivity and selectivity in complex environments.

Advancing transistor-based point-of-care (POC) biosensors: additive manufacturing technologies and device integration strategies for real-life sensing

Infectious pathogens pose a significant threat to public health and healthcare systems, making the development of a point-of-care (POC) detection platform for their early identification a key focus in recent decades. Among the numerous biosensors developed over the years, transistor-based biosensors, particularly those incorporating nanomaterials, have emerged as promising candidates for POC detection, given their unique electronic characteristics, compact size, broad dynamic range, and real-time biological detection capabilities with limits of detection (LODs) down to zeptomolar levels. However, the translation of laboratory-based biosensors into practical applications faces two primary challenges: the cost-effective and scalable fabrication of high-quality transistor sensors and functional device integration. This review is structured into two main parts. The first part examines recent advancements in additive manufacturing technologies-namely in screen printing, inkjet printing, aerosol jet printing, and digital light processing-and evaluates their applications in the mass production of transistor-based biosensors. While additive manufacturing offers significant advantages, such as high quality, cost-effectiveness, rapid prototyping, less instrument reliance, less material waste, and adaptability to diverse surfaces, challenges related to uniformity and yield remain to be addressed before these technologies can be widely adopted for large-scale production. The second part focuses on various functional integration strategies to enhance the practical applicability of these biosensors, which is essential for their successful translation from laboratory research to commercialization. Specifically, it provides a comprehensive review of current miniaturized lab-on-a-chip systems, microfluidic manipulation, simultaneous sampling and detection, wearable implementation, and integration with the Internet of Things (IoT).

Development of an AI-derived, non-invasive, label-free 3D-printed microfluidic SERS biosensor platform utilizing Cu@Ag/carbon nanofibers for the detection of salivary biomarkers in mass screening of oral cancer

Developing a non-invasive and reliable tool for the highly sensitive detection of oral cancer is essential for its mass screening and early diagnosis, and improving treatment efficacy. Herein, we utilized a label-free surface enhanced Raman spectroscopy (SERS)-based biosensor composed of Cu@Ag core-shell nanoparticle anchored carbon nanofibers (Cu@Ag/CNFs) for highly sensitive salivary biomarker detection in oral cancer mass screening. This SERS substrate provided a Raman signal enhancement of up to 107 and a detection limit as low as 10-12 M for rhodamine 6G molecules. Finite-difference time-domain (FDTD) simulation studies on Cu@Ag/CNFs indicated an E-field intensity enhancement factor (|E|2/|E0|2) of 250 at the plasmonic hotspot induced between two adjacent Cu@Ag nanoparticles. The interaction of this strong E-field along with the chemical enhancement effects was responsible for such huge enhancement in the Raman signals. To realize the real capability of the developed biosensor in practical scenarios, it was further utilized for the detection of oral cancer biomarkers such as nitrate, nitrite, thiocyanate, proteins, and amino acids with a micro-molar concentration in saliva samples. The integration of SERS substrates with a 3D-printed 12-channel microfluidic platform significantly enhanced the reproducibility and statistical robustness of the analytical process. Moreover, AI-driven techniques were employed to improve the diagnostic accuracy in differentiating the salivary profiles of oral cancer patients (n1 = 56) from those of healthy controls (n2 = 60). Principal component analysis (PCA) was utilized for dimensionality reduction, followed by classification using a random forest (RF) algorithm, yielding a robust classification accuracy of 87.5%, with a specificity of 92% and sensitivity of 88%. These experimental and theoretical findings emphasize the real-world functionality of the present non-invasive diagnostic tool in paving the way for more accurate and early-stage detection of oral cancer in clinical settings.

Artificial-Intelligence Bio-Inspired Peptide for Salivary Detection of SARS-CoV-2 in Electrochemical Biosensor Integrated with Machine Learning Algorithms

Developing affordable, rapid, and accurate biosensors is essential for SARS-CoV-2 surveillance and early detection. We created a bio-inspired peptide, using the SAGAPEP AI platform, for COVID-19 salivary diagnostics via a portable electrochemical device coupled to Machine Learning algorithms. SAGAPEP enabled molecular docking simulations against the SARS-CoV-2 Spike protein's RBD, leading to the synthesis of Bio-Inspired Artificial Intelligence Peptide 1 (BIAI1). Molecular docking was used to confirm interactions between BIAI1 and SARS-CoV-2, and BIAI1 was functionalized on rhodamine-modified electrodes. Cyclic voltammetry (CV) using a [Fe(CN)6]3-/4 solution detected virus levels in saliva samples with and without SARS-CoV-2. Support vector machine (SVM)-based machine learning analyzed electrochemical data, enhancing sensitivity and specificity. Molecular docking revealed stable hydrogen bonds and electrostatic interactions with RBD, showing an average affinity of -250 kcal/mol. Our biosensor achieved 100% sensitivity, 80% specificity, and 90% accuracy for 1.8 × 10⁴ focus-forming units in infected saliva. Validation with COVID-19-positive and -negative samples using a neural network showed 90% sensitivity, specificity, and accuracy. This BIAI1-based electrochemical biosensor, integrated with machine learning, demonstrates a promising non-invasive, portable solution for COVID-19 screening and detection in saliva.

Advancing amyotrophic lateral sclerosis disease diagnosis: A lab-on-chip electrochemical immunosensor for ultra-sensitive TDP-43 protein detection and monitoring in serum patients'

The global increase in population aging has led to a rise in neurodegenerative diseases (NDs), posing significant challenges to public health. Developing selective and specific biomarkers for early diagnosis and drug development is crucial addressing the growing burden of NDs. In this context, the RNA-binding protein TDP-43 has emerged as a promising biomarker for amyotrophic lateral sclerosis (ALS), frontotemporal lobar degeneration (FTLD), and TDP-43-associated proteinopathies. However, existing detection methods suffer from limitations such as cost, complexity, and operator dependence. Here, we present a novel electrochemical biosensor integrated into a lab-on-chip (LoC) platform to detect TDP-43. The sensor utilizes electrosynthesized polypyrrole derivatives with carboxylic groups for transducer functionalization, enabling targeted immobilization of TDP-43 antibodies. Differential pulsed voltammetry (DPV) is used for the indirect detection and quantification of TDP-43. The chip exhibits rapid response, good reproducibility, a linear detection range, and sensitivity from 0.01 ng/mL to 25 ng/mL of TDP-43 protein concentration with a LOD = 10 pg/mL. Furthermore, successful TDP-43 detection in complex matrices like serum of ALS patients and healthy individuals demonstrates its potential as a point-of-care diagnostic device. This electrochemical biosensor integrated into a chip offers good sensitivity, rapid response, and robust performance, providing a promising avenue for advancing neurodegenerative disease diagnostics and therapeutic development.

Field effect transistor based wearable biosensors for healthcare monitoring

The rapid advancement of wearable biosensors has revolutionized healthcare monitoring by screening in a non-invasive and continuous manner. Among various sensing techniques, field-effect transistor (FET)-based wearable biosensors attract increasing attention due to their advantages such as label-free detection, fast response, easy operation, and capability of integration. This review explores the innovative developments and applications of FET-based wearable biosensors for healthcare monitoring. Beginning with an introduction to the significance of wearable biosensors, the paper gives an overview of structural and operational principles of FETs, providing insights into their diverse classifications. Next, the paper discusses the fabrication methods, semiconductor surface modification techniques and gate surface functionalization strategies. This background lays the foundation for exploring specific FET-based biosensor designs, including enzyme, antibody and nanobody, aptamer, as well as ion-sensitive membrane sensors. Subsequently, the paper investigates the incorporation of FET-based biosensors in monitoring biomarkers present in physiological fluids such as sweat, tears, saliva, and skin interstitial fluid (ISF). Finally, we address challenges, technical issues, and opportunities related to FET-based biosensor applications. This comprehensive review underscores the transformative potential of FET-based wearable biosensors in healthcare monitoring. By offering a multidimensional perspective on device design, fabrication, functionalization and applications, this paper aims to serve as a valuable resource for researchers in the field of biosensing technology and personalized healthcare.

Artificial intelligence-driven electrochemical immunosensing biochips in multi-component detection

Electrochemical Immunosensing (EI) combines electrochemical analysis and immunology principles and is characterized by its simplicity, rapid detection, high sensitivity, and specificity. EI has become an important approach in various fields, such as clinical diagnosis, disease prevention and treatment, environmental monitoring, and food safety. However, EI multi-component detection still faces two major bottlenecks: first, the lack of cost-effective and portable detection platforms; second, the difficulty in eliminating batch differences and accurately decoupling signals from multiple analytes. With the gradual maturation of biochip technology, high-throughput analysis and portable detection utilizing the advantages of miniaturized chips, high sensitivity, and low cost have become possible. Meanwhile, Artificial Intelligence (AI) enables accurate decoupling of signals and enhances the sensitivity and specificity of multi-component detection. We believe that by evaluating and analyzing the characteristics, benefits, and linkages of EI, biochip, and AI technologies, we may considerably accelerate the development of EI multi-component detection. Therefore, we propose three specific prospects: first, AI can enhance and optimize the performance of the EI biochips, addressing the issue of multi-component detection for portable platforms. Second, the AI-enhanced EI biochips can be widely applied in home care, medical healthcare, and other areas. Third, the cross-fusion and innovation of EI, biochip, and AI technologies will effectively solve key bottlenecks in biochip detection, promoting interdisciplinary development. However, challenges may arise from AI algorithms that are difficult to explain and limited data access. Nevertheless, we believe that with technological advances and further research, there will be more methods and technologies to overcome these challenges.

Skin-Interfaced Wearable Sweat Sensors for Precision Medicine

Wearable sensors hold great potential in empowering personalized health monitoring, predictive analytics, and timely intervention toward personalized healthcare. Advances in flexible electronics, materials science, and electrochemistry have spurred the development of wearable sweat sensors that enable the continuous and noninvasive screening of analytes indicative of health status. Existing major challenges in wearable sensors include: improving the sweat extraction and sweat sensing capabilities, improving the form factor of the wearable device for minimal discomfort and reliable measurements when worn, and understanding the clinical value of sweat analytes toward biomarker discovery. This review provides a comprehensive review of wearable sweat sensors and outlines state-of-the-art technologies and research that strive to bridge these gaps. The physiology of sweat, materials, biosensing mechanisms and advances, and approaches for sweat induction and sampling are introduced. Additionally, design considerations for the system-level development of wearable sweat sensing devices, spanning from strategies for prolonged sweat extraction to efficient powering of wearables, are discussed. Furthermore, the applications, data analytics, commercialization efforts, challenges, and prospects of wearable sweat sensors for precision medicine are discussed.

Disposable solar microcell array-based addressable photoelectrochemical sensor for high-throughput and multiplexed analysis of salivary metabolites

The high-throughput detection of multiple metabolites in saliva by electrochemical sensors is usually a challenge, which however is essential to the comprehensive evaluation of health status or screening of diseases. Here, a light-addressable and paper-based hydrogen peroxide (H₂O₂) photoelectrochemical (PEC) sensor for the high-throughput detection of multiple salivary metabolites is reported. This sensor has a unique solar microcell array structure with a silver nanowires/fullerene-Congo red (AgNWs/C₆₀-CR) disc working electrode (WE) and a single-walled carbon nanotubes/platinum nanowires (SWCNTs/PtNWs) ring reference/counter electrode (RE/CE) in each microcell. Enzymes of different metabolites are immobilized on different separated microcells of a cover slide over the sensor, from which enzymatically produced H₂O₂ can react with p-hydroxyphenyl boric acid (4-HPBA) on the WE of the sensor to generate hydroquinone (HQ) for photocurrent responses. Based on this strategy, a disposable PEC sensor of saliva was developed, which allows the multiplexed detection of uric acid (UA), glucose (GLU) and lactate (LA) in diluted human saliva with high sensitivity and selectivity. Moreover, the detection throughput and application field of the sensor can be easily extended by connecting a series of sensors in parallel or varying the enzymes. The present work thus establishes a cost-effective approach to the scalable construction of versatile biosensing platforms with tunable throughput and varied analytes.

Biosensors for saliva biomarkers

The analysis of salivary biomarkers has gained interest and is advantageous for simple, safe, and non-invasive testing in diagnosis as well as treatment. This chapter explores the importance of saliva biomarkers and summarizes recent advances in biosensor fabrication. The identification of diagnostic, prognostic and therapeutic markers in this matrix enables more rapid and frequent testing when combined with the use of biosensor technology. Challenges and future goals are highlighted and examined.

Detection of COVID-19-related biomarkers by electrochemical biosensors and potential for diagnosis, prognosis, and prediction of the course of the disease in the context of personalized medicine

As a more efficient and effective way to address disease diagnosis and intervention, cutting-edge technologies, devices, therapeutic approaches, and practices have emerged within the personalized medicine concept depending on the particular patient's biology and the molecular basis of the disease. Personalized medicine is expected to play a pivotal role in assessing disease risk or predicting response to treatment, understanding a person's health status, and, therefore, health care decision-making. This work discusses electrochemical biosensors for monitoring multiparametric biomarkers at different molecular levels and their potential to elucidate the health status of an individual in a personalized manner. In particular, and as an illustration, we discuss several aspects of the infection produced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a current health care concern worldwide. This includes SARS-CoV-2 structure, mechanism of infection, biomarkers, and electrochemical biosensors most commonly explored for diagnostics, prognostics, and potentially assessing the risk of complications in patients in the context of personalized medicine. Finally, some concluding remarks and perspectives hint at the use of electrochemical biosensors in the frame of other cutting-edge converging/emerging technologies toward the inauguration of a new paradigm of personalized medicine.

Advances in Electrochemical Biosensors Based on Nanomaterials for Protein Biomarker Detection in Saliva

The focus on precise medicine enhances the need for timely diagnosis and frequent monitoring of chronic diseases. Moreover, the recent pandemic of severe acute respiratory syndrome coronavirus 2 poses a great demand for rapid detection and surveillance of viral infections. The detection of protein biomarkers and antigens in the saliva allows rapid identification of diseases or disease changes in scenarios where and when the test response at the point of care is mandated. While traditional methods of protein testing fail to provide the desired fast results, electrochemical biosensors based on nanomaterials hold perfect characteristics for the detection of biomarkers in point-of-care settings. The recent advances in electrochemical sensors for salivary protein detection are critically reviewed in this work, with emphasis on the role of nanomaterials to boost the biosensor analytical performance and increase the reliability of the test in human saliva samples. Furthermore, this work identifies the critical factors for further modernization of the nanomaterial-based electrochemical sensors, envisaging the development and implementation of next-generation sample-in-answer-out systems.

Point-of-Care Diagnostic Biosensors to Monitor Anti-SARS-CoV-2 Neutralizing IgG/sIgA Antibodies and Antioxidant Activity in Saliva

Monitoring biomarkers is a great way to assess daily physical condition, and using saliva instead of blood samples is more advantageous as the process is simple and allows individuals to test themselves. In the present study, we analyzed the titers of neutralizing antibodies, IgG and secretory IgA (sIgA), in response to the SARS-CoV-2 vaccine, in saliva. A total of 19 saliva and serum samples were collected over a 10-month period 3 weeks after the first vaccine, 8 months after the second vaccine, and 1 month after the third vaccine. The ranges of antibody concentrations post-vaccination were: serum IgG: 81-15,000 U/mL, salivary IgG: 3.4-330 U/mL, and salivary IgA: 58-870 ng/mL. A sharp increase in salivary IgG levels was observed after the second vaccination. sIgA levels also showed an increasing trend. A correlation with trends in serum IgG levels was observed, indicating the possibility of using saliva to routinely assess vaccine efficacy. The electrochemical immunosensor assay developed in this study based on the gold-linked electrochemical immunoassay, and the antioxidant activity measurement based on luminol electrochemiluminescence (ECL), can be performed using portable devices, which would prove useful for individual-based diagnosis using saliva samples.

Super-Slippery Poly(Dimethylsiloxane) Brush Surfaces: From Fabrication to Practical Application

Superwetting surfaces with special slippery performances have been the focus of practical applications and basic research for decades. Compared to superhydrophobic/superoleophobic and slippery liquid-infused porous surfaces (SLIPS), liquid-like covalently attached poly(dimethylsiloxane) (PDMS) brush surfaces have no trouble in constructing the micro/nanostructure and the loss of infused lubricant, meanwhile, it can also provide lots of new advantages, such as smooth, transparent, pressure- and temperature-resistant, and low contact angle hysteresis (CAH) to diverse liquids. This paper focuses on the relationship between the wetting performance and practical functional application of PDMS brush surfaces. Recent progress of the preparation of PDMS brush surfaces and their super-slippery performances, with a special focus on diverse functional applications were summarized. Finally, perspectives on future research directions are also discussed.

The Roadmap of Graphene-Based Sensors: Electrochemical Methods for Bioanalytical Applications

Graphene (GR) has engrossed immense research attention as an emerging carbon material owing to its enthralling electrochemical (EC) and physical properties. Herein, we debate the role of GR-based nanomaterials (NMs) in refining EC sensing performance toward bioanalytes detection. Following the introduction, we briefly discuss the GR fabrication, properties, application as electrode materials, the principle of EC sensing system, and the importance of bioanalytes detection in early disease diagnosis. Along with the brief description of GR-derivatives, simulation, and doping, classification of GR-based EC sensors such as cancer biomarkers, neurotransmitters, DNA sensors, immunosensors, and various other bioanalytes detection is provided. The working mechanism of topical GR-based EC sensors, advantages, and real-time analysis of these along with details of analytical merit of figures for EC sensors are discussed. Last, we have concluded the review by providing some suggestions to overcome the existing downsides of GR-based sensors and future outlook. The advancement of electrochemistry, nanotechnology, and point-of-care (POC) devices could offer the next generation of precise, sensitive, and reliable EC sensors.

Next generation sequencing-based salivary biomarkers in oral squamous cell carcinoma

Selection of potential disease-specific biomarkers from saliva or epithelial tissues through next generation sequencing (NGS)-based protein studies has recently become possible. The early diagnosis of oral squamous cell carcinoma (OSCC) has been difficult, if not impossible, until now due to the lack of an effective OSCC biomarker and efficient molecular validation method. The aim of this study was to summarize the advances in the application of NGS in cancer research and to propose potential proteomic and genomic saliva biomarkers for NGS-based study in OSCC screening and diagnosis programs. We have reviewed four categories including definitions and use of NGS, salivary biomarkers and OSCC, current biomarkers using the NGS-based technique, and potential salivary biomarker candidates in OSCC using NGS.

Enzymatic Methods for Salivary Biomarkers Detection: Overview and Current Challenges

Early detection is a key factor in patient fate. Currently, multiple biomolecules have been recognized as biomarkers. Nevertheless, their identification is only the starting line on the way to their implementation in disease diagnosis. Although blood is the biofluid par excellence for the quantification of biomarkers, its extraction is uncomfortable and painful for many patients. In this sense, there is a gap in which saliva emerges as a non-invasive and valuable source of information, as it contains many of the biomarkers found in blood. Recent technological advances have made it possible to detect and quantify biomarkers in saliva samples. However, there are opportunity areas in terms of cost and complexity, which could be solved using simpler methodologies such as those based on enzymes. Many reviews have focused on presenting the state-of-the-art in identifying biomarkers in saliva samples. However, just a few of them provide critical analysis of technical elements for biomarker quantification in enzymatic methods for large-scale clinical applications. Thus, this review proposes enzymatic assays as a cost-effective alternative to overcome the limitations of current methods for the quantification of biomarkers in saliva, highlighting the technical and operational considerations necessary for sampling, method development, optimization, and validation.

Liquid-like Polymer Coating as a Promising Candidate for Reducing Electrode Contamination and Noise in Complex Biofluids

Biosensors that can automatically and continuously track fluctuations in biomarker levels over time are essential for real-time sensing in biomedical and environmental applications. Although many electrochemical sensors have been developed to quickly and sensitively monitor biomarkers, their sensing stability in complex biofluids is disturbed by unavoidable nonspecific adhesion of proteins or bacteria. Recently, various substrate surface modification techniques have been developed to resist biofouling, yet functionalization of electrodes in sensors to be anti-biofouling is rarely achieved. Here, we report an integrated three-electrode system (ITES) modified with a "liquid-like" polydimethylsiloxane (PDMS) brush that can continuously and stably monitor reactive oxygen species (ROS) in complex fluids. Based on the slippery "liquid-like" coating, the modified ITES surface could prevent the adhesion of various liquids as well as the adhesion of proteins and bacteria. The "liquid-like" coating does not significantly affect the sensitivity of the electrode in detecting ROS, while the sensing performance could remain stable and free of bacterial attack even after 3 days of incubation with bacteria. In addition, the PDMS brush-modified ITES (PMITES) could continuously record ROS levels in bacterial-rich fluids with excellent stability over 24 h due to the reduced bacterial contamination on the electrode surface. This technique offers new opportunities for continuous and real-time monitoring of biomarkers that will facilitate the development of advanced sensors for biomedical and environmental applications.

Recent advances in graphene-based nanobiosensors for salivary biomarker detection

As biosensing research is rapidly advancing due to significant developments in materials, chemistry, and electronics, researchers strive to build cutting-edge biomedical devices capable of detecting health-monitoring biomarkers with high sensitivity and specificity. Biosensors using nanomaterials are highly promising because of the wide detection range, fast response time, system miniaturization, and enhanced sensitivity. In the recent development of biosensors and electronics, graphene has rapidly gained popularity due to its superior electrical, biochemical, and mechanical properties. For biomarker detection, human saliva offers easy access with a large variety of analytes, making it a promising candidate for its use in point-of-care (POC) devices. Here, we report a comprehensive review that summarizes the most recent graphene-based nanobiosensors and oral bioelectronics for salivary biomarker detection. We discuss the details of structural designs of graphene electronics, use cases of salivary biomarkers, the performance of existing sensors, and applications in health monitoring. This review also describes current challenges in materials and systems and future directions of the graphene bioelectronics for clinical POC applications. Collectively, the main contribution of this paper is to deliver an extensive review of the graphene-enabled biosensors and oral electronics and their successful applications in human salivary biomarker detection.

Simultaneous Quantification of Antioxidants Paraxanthine and Caffeine in Human Saliva by Electrochemical Sensing for CYP1A2 Phenotyping

The enzyme CYP1A2 is responsible for the metabolism of numerous antioxidants in the body, including caffeine, which is transformed into paraxanthine, its main primary metabolite. Both molecules are known for their antioxidant and pro-oxidant characteristics, and the paraxanthine-to-caffeine molar ratio is a widely accepted metric for CYP1A2 phenotyping, to optimize dose–response effects in individual patients. We developed a simple, cheap and fast electrochemical based method for the simultaneous quantification of paraxanthine and caffeine in human saliva, by differential pulse voltammetry, using an anodically pretreated glassy carbon electrode. Cyclic voltammetry experiments revealed for the first time that the oxidation of paraxanthine is diffusion controlled with an irreversible peak at ca. +1.24 V (vs. Ag/AgCl) in a 0.1 M H₂SO₄ solution, and that the mechanism occurs via the transfer of two electrons and two protons. The simultaneous quantification of paraxanthine and caffeine was demonstrated in 0.1 M H₂SO₄ and spiked human saliva samples. In the latter case, limits of detection of 2.89 μM for paraxanthine and 5.80 μM for caffeine were obtained, respectively. The sensor is reliable, providing a relative standard deviation within 7% (n = 6). Potential applicability of the sensing platform was demonstrated by running a small scale trial on five healthy volunteers, with simultaneous quantification by differential pulse voltammetry (DPV) of paraxanthine and caffeine in saliva samples collected at 1, 3 and 6 h postdose administration. The results were validated by ultra-high pressure liquid chromatography and shown to have a high correlation factor (r = 0.994).

COVID-19 Pandemic and Role of Human Saliva as a Testing Biofluid in Point-of-Care Technology

Novel coronavirus disease 2019 (COVID-19) outbreak has termed as a controllable pandemic, and the entire world has come to a standstill trying to mitigate the disease with health systems. Health care providers, around the globe, are fighting day and night. Currently, rapid testing is taking place with the help of nasopharyngeal, oropharyngeal swab, bronchoalveolar lavage, sputum, urine, and blood. All these approaches are invasive or embarrassing to the infected person. It is observed that salivary glands are hosting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) because of angiotensin-converting enzyme 2 and the detection of high viral loads in the saliva and is playing a crucial role in virus transmission, especially from individuals showing absolutely no symptoms. Saliva is proving to be a promising noninvasive sample specimen for the diagnosis of COVID-19, thus helping to monitor the infection and prevent it from further spreading by prompt isolation.

Non-Invasive Electrochemical Biosensors Operating in Human Physiological Fluids

Non-invasive healthcare technologies are an important part of research and development nowadays due to the low cost and convenience offered to both healthcare receivers and providers. This work overviews the recent advances in the field of non-invasive electrochemical biosensors operating in secreted human physiological fluids, viz. tears, sweat, saliva, and urine. Described electrochemical devices are based on different electrochemical techniques, viz. amperometry, coulometry, cyclic voltammetry, and impedance spectroscopy. Challenges that confront researchers in this exciting area and key requirements for biodevices are discussed. It is concluded that the field of non-invasive sensing of biomarkers in bodily fluid is highly convoluted. Nonetheless, if the drawbacks are appropriately addressed, and the pitfalls are adroitly circumvented, the approach will most certainly disrupt current clinical and self-monitoring practices.

Implantable Nanosensors for Human Steroid Hormone Sensing In Vivo Using a Self-Templating Corona Phase Molecular Recognition

Dynamic measurements of steroid hormones in vivo are critical, but steroid sensing is currently limited by the availability of specific molecular recognition elements due to the chemical similarity of these hormones. In this work, a new, self-templating synthetic approach is applied using corona phase molecular recognition (CoPhMoRe) targeting the steroid family of molecules to produce near infrared fluorescent, implantable sensors. A key limitation of CoPhMoRe has been its reliance on library generation for sensor screening. This problem is addressed with a self-templating strategy of polymer design, using the examples of progesterone and cortisol sensing based on a styrene and acrylic acid copolymer library augmented with an acrylated steroid. The pendant steroid attached to the corona backbone is shown to self-template the phase, providing a unique CoPhMoRE design strategy with high efficacy. The resulting sensors exhibit excellent stability and reversibility upon repeated analyte cycling. It is shown that molecular recognition using such constructs is viable even in vivo after sensor implantation into a murine model by employing a poly (ethylene glycol) diacrylate (PEGDA) hydrogel and porous cellulose interface to limit nonspecific absorption. The results demonstrate that CoPhMoRe templating is sufficiently robust to enable a new class of continuous, in vivo biosensors.

Multisensor Systems and Arrays for Medical Applications Employing Naturally-Occurring Compounds and Materials

The significant improvement of quality of life achieved over the last decades has stimulated the development of new approaches in medicine to take into account the personal needs of each patient. Precision medicine, providing healthcare customization, opens new horizons in the diagnosis, treatment and prevention of numerous diseases. As a consequence, there is a growing demand for novel analytical devices and methods capable of addressing the challenges of precision medicine. For example, various types of sensors or their arrays are highly suitable for simultaneous monitoring of multiple analytes in complex biological media in order to obtain more information about the health status of a patient or to follow the treatment process. Besides, the development of sustainable sensors based on natural chemicals allows reducing their environmental impact. This review is concerned with the application of such analytical platforms in various areas of medicine: analysis of body fluids, wearable sensors, drug manufacturing and screening. The importance and role of naturally-occurring compounds in the development of electrochemical multisensor systems and arrays are discussed.

Low-Fouling Substrates for Plasmonic Sensing of Circulating Biomarkers in Biological Fluids

The monitoring of biomarkers in body fluids provides valuable prognostic information regarding disease onset and progression. Most biosensing approaches use noninvasive screening tools and are conducted in order to improve early clinical diagnosis. However, biofouling of the sensing surface may disturb the quantification of circulating biomarkers in complex biological fluids. Thus, there is a great need for antifouling interfaces to be designed in order to reduce nonspecific adsorption and prevent inactivation of biological receptors and loss of sensitivity. To address these limitations and enable their application in clinical practice, a variety of plasmonic platforms have been recently developed for biomarker analysis in easily accessible biological fluids. This review presents an overview of the latest advances in the design of antifouling strategies for the detection of clinically relevant biomarkers on the basis of the characteristics of biological samples. The impact of nanoplasmonic biosensors as point-of-care devices has been examined for a wide range of biomarkers associated with cancer, inflammatory, infectious and neurodegenerative diseases. Clinical applications in readily obtainable biofluids such as blood, saliva, urine, tears and cerebrospinal and synovial fluids, covering almost the whole range of plasmonic applications, from surface plasmon resonance (SPR) to surface-enhanced Raman scattering (SERS), are also discussed.

Electrochemical immunosensor for the determination of the cytokine interferon gamma (IFN-γ) in saliva

A simple, fast and sensitive amperometric immunosensing method for the determination of the clinically relevant cytokine interferon gamma (IFN-γ) in saliva complying the requirements demanded for this kind of sample is reported. The target analyte was sandwiched between a specific capture antibody covalently immobilized on a screen-printed electrode functionalized by the diazonium salt grafting of p-aminobenzoic acid, and a biotinylated detector antibody labeled with a streptavidin-horseradish peroxidase conjugate. The amperometric responses measured at - 0.20 V vs Ag pseudo-reference electrode upon addition of hydrogen peroxide in the presence of hydroquinone as the redox mediator allowed a calibration plot with a linear range between 2.5 and 2000 pg mL^-1 and a low limit of detection (1.6 pg mL^-1) to be obtained. In addition, a good selectivity against other non-target proteins was achieved. The developed method was validated by analyzing a WHO 1st International Standard for IFN-γ. In addition, the immunosensor was used for the determination of the endogenous IFN-γ in saliva with results in excellent agreement with those obtained by a commercial ELISA kit.

Pushing the limits of electrochemistry toward challenging applications in clinical diagnosis, prognosis, and therapeutic action

Constant progress in the identification of biomarkers at different molecular levels in samples of different natures, and the need to conduct routine analyses, even in limited-resource settings involving simple and short protocols, are examples of the growing current clinical demands not satisfied by conventional available techniques. In this context, the unique features offered by electrochemical biosensors, including affordability, real-time and reagentless monitoring, simple handling and portability, and versatility, make them especially interesting for adaptation to the increasingly challenging requirements of current clinical and point-of-care (POC) diagnostics. This has allowed the continuous development of strategies with improved performance in the clinical field that were unthinkable just a few years ago. After a brief introduction to the types and characteristics of clinically relevant biomarkers/samples, requirements for their analysis, and currently available methodologies, this review article provides a critical discussion of the most important developments and relevant applications involving electrochemical biosensors reported in the last five years in response to the demands of current diagnostic, prognostic, and therapeutic actions related to high prevalence and high mortality diseases and disorders. Special attention is paid to the rational design of surface chemistry and the use/modification of state-of-the-art nanomaterials to construct electrochemical bioscaffolds with antifouling properties that can be applied to the single or multiplex determination of biomarkers of accepted or emerging clinical relevance in particularly complex clinical samples, such as undiluted liquid biopsies, whole cells, and paraffin-embedded tissues, which have scarcely been explored using conventional techniques or electrochemical biosensing. Key points guiding future development, challenges to be addressed to further push the limits of electrochemical biosensors towards new challenging applications, and their introduction to the market are also discussed.

Wearable biosensors for healthcare monitoring

Wearable biosensors are garnering substantial interest due to their potential to provide continuous, real-time physiological information via dynamic, noninvasive measurements of biochemical markers in biofluids, such as sweat, tears, saliva and interstitial fluid. Recent developments have focused on electrochemical and optical biosensors, together with advances in the noninvasive monitoring of biomarkers including metabolites, bacteria and hormones. A combination of multiplexed biosensing, microfluidic sampling and transport systems have been integrated, miniaturized and combined with flexible materials for improved wearability and ease of operation. Although wearable biosensors hold promise, a better understanding of the correlations between analyte concentrations in the blood and noninvasive biofluids is needed to improve reliability. An expanded set of on-body bioaffinity assays and more sensing strategies are needed to make more biomarkers accessible to monitoring. Large-cohort validation studies of wearable biosensor performance will be needed to underpin clinical acceptance. Accurate and reliable real-time sensing of physiological information using wearable biosensor technologies would have a broad impact on our daily lives.

Electrochemical cardiovascular platforms: Current state of the art and beyond

Cardiovascular diseases (CVD) remain the leading cause of death within industrialized nations as well as an increasing cause of mortality and morbidity in many developing countries. Smoking, alcohol consumption and increased level of blood cholesterol are the main CVD risk factors. Other factors, such as the prevalence of overweight/obesity and diabetes, have increased considerably in recent decades and are indirect causes of CVD. Among CVDs, the acute coronary syndrome (ACS) represents the most common cause of emergency hospital admission. Since the prognosis of ACS is directly associated with timely initiation of revascularization, missed, misdiagnosis or late diagnosis have unfavorable medical implications. Early ACS diagnosis can reduce complications and risk of recurrence, finally decreasing the economic burden posed on the health care system as a whole. To decrease the risk of ACS and related CVDs and to reduce associated costs to healthcare systems, a fast management of patients with chest pain has become crucial and urgent. Despite great efforts, biochemical diagnostic approaches of CVDs remain difficult and controversial medical challenges as cardiac biomarkers should be rapidly released into the blood at the time of ischemia and persistent for a sufficient length of time to allow diagnostics, with tests that should be rapid, easy to perform and relatively inexpensive. Early biomarker assessments have involved testing for the total enzyme activity of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK), which cardiac troponins being the main accepted biomarkers for diagnosing myocardial injury and acute myocardial infarction (AMI). To allow rapid diagnosis, it is necessary to replace the traditional biochemical assays by cardiac biosensor platforms. Among the numerous of possibilities existing today, electrochemical biosensors are important players as they have many of the required characteristics for point-of-care tests. Electrochemical based cardiac biosensors are highly adapted for monitoring the onset and progress of cardiovascular diseases in a fast and accurate manner, while being cheap and scalable devices. This review outlines the state of the art in the development of cardiac electrochemical sensors for the detection of different cardiac biomarkers ranging from troponin to BNP, N-terminal proBNP, and others.

Bioassay of saliva proteins: The best alternative for conventional methods in non-invasive diagnosis of cancer

Non-invasive diagnosis of cancer is often the key to effective treatment and patient survival. Saliva as a multi-constituent oral fluid comprises various disease signaling biomarkers, holds great potential for early-stage cancer diagnostics with cost-effective and easy collection, storage, transport and processing. Therefore, detection of biomarkers and proteins in the saliva samples is highly demand. The current review was performed using reliable internet database (mainly PubMed) to provide an overview of the most recent developments on non-invasive diagnosis of cancers in saliva and highlights main challenges and future prospects in sensing of the salivary biomarkers. The conventional detection methods of cancer biomarkers in saliva is discussed in the paper, however, the main focus is on non-invasive diagnosis of cancers in saliva using immunosensing (electrochemical, optical, piezoelectric), DNA based sensors, aptasensors and peptide based bio-assays The reviewed literature revealed that non-invasive cancer detection methods using the mentioned biosensors and without any processing of saliva sample offers a quick, sensitive, specific and cost effective analytical tool. Besides, salivary based detection methods can be used for simultaneous detection of panels of disease specific biomarkers in a real time manner or as home testing kits in near future.

Determination of progesterone in saliva using an electrochemical immunosensor and a COTS-based portable potentiostat

This paper describes the reliable determination of progesterone (P4) in undiluted saliva making use of a disposable amperometric immunosensors implemented on low-cost and portable device/potentiostat constructed with commercial-off-the-shelf (COTS) components. The immunosensor allows the fast (45 min), selective and sensitive determination (5 pg mL^-1 LOD) of P4 using amperometry in stirred solutions. The immunosensor was coupled to the COTS-based potentiostat and amperometry was made into drops of quiescent solutions. No significant differences were apparent between the analytical performance achieved with the immunosensor for P4 using both a conventional and the COST-based potentiostats. The practical applicability of the immunosensor coupled with the COTS-based potentiostat was demonstrated by determining the endogenous P4 content in different undiluted saliva samples with highly variable endogenous contents of the target hormone. The obtained results were in good agreement with those provided by the conventional ELISA methodology and with the contents reported in the literature for samples with similar characteristics. This validated the combined device for the reliable and minimally invasive determination of the target hormone involving a very simple protocol and taking only 45 min.

An impedimetric immunosensor for highly sensitive detection of IL-8 in human serum and saliva samples: A new surface modification method by 6-phosphonohexanoic acid for biosensing applications

In this study, we fabricated a sensitive and label-free impedimetric immunosensor based on 6-phosphonohexanoic acid (PHA) modified ITO electrode for detection of interleukin-8 (IL-8) in human serum and saliva. PHA was first employed to cancer biomarker sensing platform. Anti-IL-8 antibody was used as a biorecognition element and the detection principle of this immunosensor was based on monitoring specific interaction between anti-IL-8 antibody and IL-8 antigen. The morphological characterization of each electrode modification step was analyzed by scanning electron microscopy (SEM), SEM-energy dispersive X-ray spectroscopy (EDX) and atomic force microscopy (AFM) while electrochemical characterization was performed by electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV) and single frequency impedance (SFI) techniques. Moreover, the antibody immobilization on the electrode surface was proved Fourier-transform infrared spectroscopy (FTIR) and Raman Spectroscopy. This proposed impedimetric immunosensor exhibited good performances with a wide linear in the range from 0.02 pg/mL to 3 pg/mL as well as a relative low detection limit of 6 fg/mL. The impedimetric immunosensor had a good specificity, stability and reproducibility. This study proved that PHA was a suitable interface material to fabricate an electrochemical biosensor.

Nafion®-coated mesoporous Pd film toward remarkably enhanced detection of lactic acid

Mesoporous metal films can detect biomarkers with high sensitivity. Further coating the mesoporous metal with polymers enhances sensing selectivity by favoring specific biomarkers against other interferents. In the present study, we report the fabrication of a Nafion®-coated mesoporous Pd film to filtrate interferents present in sweat during non-invasive biosensing. By using a Nafion®-coated mesoporous Pd film, lactic acid, a metabolite present in sweat, can be successfully detected with high sensitivity.

Electrochemical immunosensors - A powerful tool for analytical applications

Immunosensors are biosensors based on interactions between an antibody and antigen on a transducer surface. Either antibody or antigen can be the species immobilized on the transducer to detect antigen or antibody, respectively. Because of the strong binding forces between these biomolecules, immunosensors present high selectivity and very high sensitivity, making them very attractive for many applications in different science fields. Electrochemical immunosensors explore measurements of an electrical signal produced on an electrochemical transductor. This signal can be voltammetric, potentiometric, conductometric or impedimetric. Immunosensors utilizing electrochemical detection have been explored in several analyses since they are specific, simple, portable, and generally disposable and can carry out in situ or automated detection. This review addresses the potential of immunosensors destined for application in food and environmental analysis, and cancer biomarker diagnosis. Emphasis is given to the approaches that have been used for construction of electrochemical immunosensors. Additionally, the fundamentals of immunosensors, technology of transducers and nanomaterials and a general overview of the possible applications of electrochemical immunosensors to the food, environmental and diseases analysis fields are described.

Recent Advances in Electrochemical Immunosensors

Immunosensors have experienced a very significant growth in recent years, driven by the need for fast, sensitive, portable and easy-to-use devices to detect biomarkers for clinical diagnosis or to monitor organic pollutants in natural or industrial environments. Advances in the field of signal amplification using enzymatic reactions, nanomaterials such as carbon nanotubes, graphene and graphene derivatives, metallic nanoparticles (gold, silver, various oxides or metal complexes), or magnetic beads show how it is possible to improve collection, binding or transduction performances and reach the requirements for realistic clinical diagnostic or environmental control. This review presents these most recent advances; it focuses first on classical electrode substrates, then moves to carbon-based nanostructured ones including carbon nanotubes, graphene and other carbon materials, metal or metal-oxide nanoparticles, magnetic nanoparticles, dendrimers and, to finish, explore the use of ionic liquids. Analytical performances are systematically covered and compared, depending on the detection principle, but also from a chronological perspective, from 2012 to 2016 and early 2017.

Diagnostics Strategies with Electrochemical Affinity Biosensors Using Carbon Nanomaterials as Electrode Modifiers

Early diagnosis is often the key to successful patient treatment and survival. The identification of various disease signaling biomarkers which reliably reflect normal and disease states in humans in biological fluids explain the burgeoning research field in developing new methodologies able to determine the target biomarkers in complex biological samples with the required sensitivity and selectivity and in a simple and rapid way. The unique advantages offered by electrochemical sensors together with the availability of high affinity and specific bioreceptors and their great capabilities in terms of sensitivity and stability imparted by nanostructuring the electrode surface with different carbon nanomaterials have led to the development of new electrochemical biosensing strategies that have flourished as interesting alternatives to conventional methodologies for clinical diagnostics. This paper briefly reviews the advantages of using carbon nanostructures and their hybrid nanocomposites as electrode modifiers to construct efficient electrochemical sensing platforms for diagnosis. The review provides an updated overview of some selected examples involving attractive amplification and biosensing approaches which have been applied to the determination of relevant genetic and protein diagnostics biomarkers.