Paper-based CRP Monitoring Devices

Paper-Based Biosensors for COVID-19: A Review of Innovative Tools for Controlling the Pandemic

The appearance and quick spread of the new severe acute respiratory syndrome coronavirus disease, COVID-19, brought major societal challenges. Importantly, suitable medical diagnosis procedures and smooth clinical management of the disease are an emergent need, which must be anchored on novel diagnostic methods and devices. Novel molecular diagnostic tools relying on nucleic acid amplification testing have emerged globally and are the current gold standard in COVID-19 diagnosis. However, the need for widespread testing methodologies for fast, effective testing in multiple epidemiological scenarios remains a crucial step in the fight against the COVID-19 pandemic. Biosensors have previously shown the potential for cost-effective and accessible diagnostics, finding applications in settings where conventional, laboratorial techniques may not be readily employed. Paper- and cellulose-based biosensors can be particularly relevant in pandemic times, for the renewability, possibility of mass production with sustainable methodologies, and safe environmental disposal. In this review, paper-based devices and platforms targeting SARS-CoV-2 are showcased and discussed, as a means to achieve quick and low-cost PoC diagnosis, including detection methodologies for viral genomic material, viral antigen detection, and serological antibody testing. Devices targeting inflammatory markers relevant for COVID-19 are also discussed, as fast, reliable bedside diagnostic tools for patient treatment and follow-up.

A Paper-Based IL-6 Test Strip Coupled With a Spectrum-Based Optical Reader for Differentiating Influenza Severity in Children

Influenza virus infection is a major worldwide public health problem. Influenza virus infections are associated with a high hospitalization rate in children between the ages of 5 and 14. The predominant reason for poor influenza prognosis is the lack of any effective means for early diagnosis. Early diagnosis of severe illness is critical to improving patient outcome, and could be especially useful in areas with limited medical resources. Accurate, inexpensive, and easy-to-use diagnostic tools could improve early diagnosis and patient outcome, and reduce overall healthcare costs. We developed an interleukin-6 paper-based test strip that used colloidal gold-conjugated antibodies to detect human interleukin-6 protein. These complexes were captured on a paper-based test strip patterned with perpendicular T lines that were pre-coated with anti-human interleukin-6 antibodies. Applied serum samples interacted with these antibodies and presented as colored bands that could be read using a spectrum-based optical reader. The full-spectrum of the reflected light interleukin-6 protein signal could be obtained from the spectral optics module, and the standard could be used to quantitatively analyze interleukin 6 level in serum. We retrospectively evaluated 10 children (23 serum samples) with severe influenza virus infections, 26 children (26 serum samples) with mild influenza virus infections, and 10 healthy children (10 serum samples). Our system, the combined use of a paper-based test strip and a spectrum-based optical reader, provided both qualitative and quantitative information. When used with the optical reader, the detection limit was improved from a qualitative, naked-eye level of 400 pg/ml to a quantitative, optical reader level of 76.85 pg/ml. After monitoring serum interleukin-6 level via our system, we found a high correlation between our system results and those obtainable using a conventional sandwich enzyme-linked immunosorbent assay method (Rho = 0.706, p < 0.001). The sensitivity and specificity for differentiating between severe and mild influenza using our combined method (test strip coupled with optical reader) were 78.3 and 50.0%, respectively. When interleukin-6 was combined with serum C-reaction protein, the sensitivity and specificity were 85.7 and 95.5%, and the receiver operating characteristic area-under-the-curve was quite high (AUC = 0.911, p < 0.001). The potential advantages of our system, i.e., a paper-based test strip coupled with a spectrum-based optical reader, are as follows: 1) simple user operation; 2) rapid turnaround times–within 20 min; 3) high detection performance; and, 4) low-cost fabrication.

Sink/Float Magnetic Immunoassays for In-Field Bioassays

Analytical tests/devices that are used outside laboratory settings are required to have a very simple analytical protocol to get clearance by regulatory authorities. This study describes sink/float magnetic immunoassays, a new type of rapid, mix-and-observe, instrument-free tests for the detection of biomarkers in untreated biological samples that are very simple and might meet the simple-to-use criterion of authorities to be used in the field. These tests can tell whether an analyte is above or below a predetermined level within 25-45 minutes based on the sinking or floating of a mm-sized sphere on the surface of which an immunoassay that uses reporter antibodies conjugated to superparamagnetic nanoparticles is performed. This manuscript describes the theory and proof-of-concept applications of sink/float magnetic immunoassays for the detection of C-Reactive Protein, anti-Treponema pallidum antibodies and E. coli bacteria.

The Role of Dendritic Mesoporous Silica Nanoparticles' Size for Quantum Dots Enrichment and Lateral Flow Immunoassay Performance

Using dendritic mesoporous silica nanoparticles (DMSNs) for quantum dots (QDs) enrichment and signal amplification is an emerging strategy for improving the detection sensitivity of lateral flow immunoassay (LFIA). In this study, a new and convenient approach is developed to prepare water-dispersible DMSNs-QDs. A series of DMSNs with various diameters (138, 251, 368, and 471 nm) are studied for loading QDs and LFIA applications. The resultant water-dispersible DMSNs-QDs exhibit a high fluorescence retention of 81.8%. The increase in particle size from 138 to 471 nm results in an increase in loading capacity of QDs and a decrease in binding quantity of the DMSNs-QDs in the test line of LFIA. This trade-off leads to an optimal DMSNs-QDs size of 368 nm with a limit of detection reaching 10 pg mL^-1 (equivalent to 9.0 × 10^-14 m) for the detection of C-reactive protein, which is nearly an order of magnitude more sensitive than the literature. To the best of the authors' knowledge, this study is the first to demonstrate the distinctive role of DMSN's size for QDs enrichment and LFIA. The strategy developed from this work is useful for the rational design of high-quality QDs-based nanoparticles for ultrasensitive detection.

Paper-based human neutrophil elastase detection device for clinical wound monitoring

Paper-based diagnostic devices have been widely applied to assess the presence and status of a variety of clinical diseases by analyzing samples such as urine or blood. Due to their low cost, user-friendliness, and convenience, they have been used as point-of-care (POC) devices in countries lacking resources or energy. Despite wide-ranging research and implementation, paper-based devices have not previously been developed for wound analysis. Here, we discuss the successful development of such a tool to facilitate simple and rapid wound status assessment. The purpose of this study was to develop a paper-based elastase detection device (PEDD) for clinical wound assessment that specifically examines human neutrophil elastase (HNE), one of the most abundant serine proteases found in chronic wounds. The first step in this study was an examination of different paper substrate types (i.e., chromatography paper and filter paper) to determine which provided the best protease immobilization and colorimetric response. We then used a wax printing approach to create hydrophobic and hydrophilic regions and designated test zones created on both chromatography and filter papers. This allowed us to physically immobilize both substrate and protease within the desired test zone regions. This PEDD which demonstrated good sensitivity (0.631 μg mL^-1, in a wound fluid system) can be used to monitor protease activity expressed in wounds. After developing this device, we examined samples from 9 patients presenting a total of 7 acute and 4 chronic wounds to determine wound HNE concentration. We believe that this study may be widely applicable in both academic and commercial sciences, including the development of practical POC detection devices.

Zinc oxide nanoparticles decorated fluorescent and antibacterial glass fiber pre-filter paper

Zinc oxide nanoparticles (ZnO–NPs) were synthesized and decorated simultaneously onto the glass fiber pre-filter paper (GF paper) by the sonochemical method without using any additional reagents (a ‘Green’ synthesis approach). ZnO–NPs decorated GF paper was characterized by electron, confocal laser scanning and atomic force microscopy, fourier transform infrared and atomic emission spectroscopy, X-ray diffraction, and thermogravimetric analysis etc. Due to the massive void volume space, exceptional dimensional stability, large thickness (790 μm) of the GF paper (unlike other paper materials) and ultrasonic irradiation effects, ZnO–NPs were decorated in the enormous amount (96 mg per paper) without causing any adverse effects on the GF paper. Such a huge amount decoration onto GF paper makes it multifunctional, fluorescencet (orange-pink color, 535–624 nm) under ultra-violet light (360 nm) and antibacterial. The antibacterial activity of the ZnO–NPs decorated GF paper was examined against Gram-positive bacteria Bacillus subtilis 168 and Staphylococcus aureus (MCC 2043, pathogenic). The outcomes from the antibacterial experiments revealed ∼99% (2 log) reduction in the survival of the filtered bacteria (B. subtilis) on the ZnO–NPs decorated GF paper due to the toxicity of ZnO–NPs on bacterial cells like cell shrinkage, cytoplasmic leakage, cell burst, etc. Multifunctional, ZnO–NPs decorated GF paper could be used for fluorescencet and antibacterial paper-based applications.

Integration of Mobile Devices and Point-Of-Care Diagnostic Devices-The Case of C-Reactive Protein Diagnosis

In recent years, the misuse and overuse of antibiotics has promoted antibiotic resistance, which has now become a global public health concern [...].

Multifunctional Paper-Based Analytical Device for In Situ Cultivation and Screening of Escherichia coli Infections

Point-of-care testing (POCT) for uropathogen detection and chemical screening has great benefits for the diagnosis of urinary tract infections (UTIs). The goal of this study was to develop a portable and inexpensive paper-based analytical device (PAD) for cultivating bacteria in situ and rapidly testing for nitrite on the same device. The PAD was fabricated using a wax printing technique to create a pattern on Whatman No. 1 filter paper, which was then combined with a cotton sheet to support bacterial growth. Nitrite detection was based on the principle of the Griess reaction, and a linear detection range of 0-1.6 mg/dL (R² = 0.989) was obtained. Scanning electron microscopy (SEM) analysis demonstrated that the bacteria were able to grow and formed a cluster on the cellulose fibres within 2 hours. The enzyme β-glucuronidase, which is specifically produced by Escherichia coli, was able to convert the pre-immobilized 5-bromo-4-chloro-3-indolyl-β-D-glucuronide sodium salt (X-GlcA), a colourless substrate, generating a blue colour. Under optimum conditions, the proposed device allowed bacterial concentrations in the range of 10⁴-10⁷ colony forming units (CFU)/mL to be quantified within 6 hours. Moreover, the use of this device enables the identification of E. coli pathogens with selectivity in real urine samples. In conclusion, the PAD developed in this study for UTI screening provides a rapid, cost-effective diagnostic method for use in remote areas.

From Point-of-Care Testing to eHealth Diagnostic Devices (eDiagnostics)

Point-of-care devices were originally designed to allow medical testing at or near the point of care by health-care professionals. Some point-of-care devices allow medical self-testing at home but cannot fully cover the growing diagnostic needs of eHealth systems that are under development in many countries. A number of easy-to-use, network-connected diagnostic devices for self-testing are needed to allow remote monitoring of patients' health. This Outlook highlights the essential characteristics of diagnostic devices for eHealth settings and indicates point-of-care technologies that may lead to the development of new devices. It also describes the most representative examples of simple-to-use, point-of-care devices that have been used for analysis of untreated biological samples.

A hook effect-free immunochromatographic assay (HEF-ICA) for measuring the C-reactive protein concentration in one drop of human serum

The immunochromatographic (ICA) assay is a highly promising platform for rapid and simple detection of C-reactive protein (CRP) which is an indicator of the different phases of various diseases, as well as of inflammation and infection. However, the hook effect in the ICA assay limits the quantification of CRP levels at high CRP concentrations. Methods: In this study, we developed a hook effect-free immunochromatographic assay (HEF-ICA) to detect CRP over a wide concentration range. The hook effect results from the simultaneous reaction of an excess target antigens with both immobilized and labeled antibodies respectively. To reduce the potential occurrence of this simultaneous reaction, we separated the migration of the target antigen and gold nanoparticle (AuNP)-labeled antibodies on a nitrocellulose membrane and analyzed the time profiles by modifying the ICA structure. Results: The signal intensity of HEF-ICA was saturated at high CRP concentrations, without decreasing. The titration curve of HEF-ICA was adjusted with the Hill equation, and HEF-ICA was performed with the following parameters: limit of detection, 43 ng mL^-1; dynamic range, 119 ng mL^-1 to 100 µg mL^-1. The accuracy of the newly developed assay was evaluated using 33 clinical samples via comparison with a clinical chemistry analyzer. Conclusion: HEF-ICA enabled the measurement of a wide range of CRP concentrations without the hook effect, and was suitable for point-of-care testing with fingertip blood sampling, as only a minute sample volume (2.5 µL) was required.

Paper-based inkjet bioprinting to detect fluorescence resonance energy transfer for the assessment of anti-inflammatory activity

For the first time, a paper-based fluorescence resonance energy transfer (FRET) determination with cyclic AMP (cAMP)-specific phosphodiesterase 4B (PDE4B) inhibitory assay using an inkjet-printing technique is proposed. Non-fabricated parchment paper is found to constitute a unique substrate to measure fluorescent energy transfer, due to its insignificant self-absorption, and enables efficient sample interaction. Here, we report the responsive FRET signals generated on paper, upon sequentially printing reaction components on parchment paper using a conventional inkjet printer equipped with four cartridges. After printing, the energy emitted by Eu chelate was transferred by FRET to ULight molecule on paper, detected at 665 nm. In the absence of free cAMP, a maximum FRET signal was achieved on paper, while a decrease in FRET signals was recorded when free cAMP produced by PDE4B inhibitors compete with Eu-cAMP, binding with ULight-mAb. The IM₅₀ value was determined as 2.46 × 10⁻¹³ mole for roliparm and 1.86 × 10⁻¹³ mole for roflumilast, to effectively inhibit PDE4B activity. Inkjet printing-based FRET signal determination utilizes components that are less than the femtomole range, which was four-orders less than the standard assay method. The methodology reported here constitutes an innovative approach towards the determination of FRET signals generated on paper.

The Role of Nanoparticle Design in Determining Analytical Performance of Lateral Flow Immunoassays

Rapid, simple, and cost-effective diagnostics are needed to improve healthcare at the point of care (POC). However, the most widely used POC diagnostic, the lateral flow immunoassay (LFA), is ∼1000-times less sensitive and has a smaller analytical range than laboratory tests, requiring a confirmatory test to establish truly negative results. Here, a rational and systematic strategy is used to design the LFA contrast label (i.e., gold nanoparticles) to improve the analytical sensitivity, analytical detection range, and antigen quantification of LFAs. Specifically, we discovered that the size (30, 60, or 100 nm) of the gold nanoparticles is a main contributor to the LFA analytical performance through both the degree of receptor interaction and the ultimate visual or thermal contrast signals. Using the optimal LFA design, we demonstrated the ability to improve the analytical sensitivity by 256-fold and expand the analytical detection range from 3 log10 to 6 log10 for diagnosing patients with inflammatory conditions by measuring C-reactive protein. This work demonstrates that, with appropriate design of the contrast label, a simple and commonly used diagnostic technology can compete with more expensive state-of-the-art laboratory tests.

Rapid, Self-driven Liquid Mixing on Open-Surface Microfluidic Platforms

Self-driven surface micromixers (SDSM) relying on patterned-wettability technology provide an elegant solution for low-cost, point-of-care (POC) devices and lab-on-a-chip (LOC) applications. We present a SDSM fabricated by strategically patterning three wettable wedge-shaped tracks onto a non-wettable, flat surface. This SDSM operates by harnessing the wettability contrast and the geometry of the patterns to promote mixing of small liquid volumes (µL droplets) through a combination of coalescence and Laplace pressure-driven flow. Liquid droplets dispensed on two juxtaposed branches are transported to a coalescence station, where they merge after the accumulated volumes exceed a threshold. Further mixing occurs during capillary-driven, advective transport of the combined liquid over the third wettable track. Planar, non-wettable “islands” of different shapes are also laid on this third track to alter the flow in such a way that mixing is augmented. Several SDSM designs, each with a unique combination of island shapes and positions, are tested, providing a greater understanding of the different mixing regimes on these surfaces. The study offers design insights for developing low-cost surface microfluidic mixing devices on open substrates.