Identification of mycolic acid forms using surface-enhanced Raman scattering as a fast detection method for tuberculosis

Recent Advances in Bacterial Detection Using Surface-Enhanced Raman Scattering

Rapid identification of microorganisms with a high sensitivity and selectivity is of great interest in many fields, primarily in clinical diagnosis, environmental monitoring, and the food industry. For over the past decades, a surface-enhanced Raman scattering (SERS)-based detection platform has been extensively used for bacterial detection, and the effort has been extended to clinical, environmental, and food samples. In contrast to other approaches, such as enzyme-linked immunosorbent assays and polymerase chain reaction, SERS exhibits outstanding advantages of rapid detection, being culture-free, low cost, high sensitivity, and lack of water interference. This review aims to cover the development of SERS-based methods for bacterial detection with an emphasis on the source of the signal, techniques used to improve the limit of detection and specificity, and the application of SERS in high-throughput settings and complex samples. The challenges and advancements with the implementation of artificial intelligence (AI) are also discussed.

Identification of Mycobacterium tuberculosis Resistance to Common Antibiotics: An Overview of Current Methods and Techniques

Multidrug-resistant tuberculosis (MDR-TB) is an essential cause of tuberculosis treatment failure and death of tuberculosis patients. The rapid and reliable profiling of Mycobacterium tuberculosis (MTB) drug resistance in the early stage is a critical research area for public health. Then, most traditional approaches for detecting MTB are time-consuming and costly, leading to the inappropriate therapeutic schedule resting on the ambiguous information of MTB drug resistance, increasing patient economic burden, morbidity, and mortality. Therefore, novel diagnosis methods are frequently required to meet the emerging challenges of MTB drug resistance distinguish. Considering the difficulty in treating MDR-TB, it is urgently required for the development of rapid and accurate methods in the identification of drug resistance profiles of MTB in clinical diagnosis. This review discussed recent advances in MTB drug resistance detection, focusing on developing emerging approaches and their applications in tangled clinical situations. In particular, a brief overview of antibiotic resistance to MTB was present, referred to as intrinsic bacterial resistance, consisting of cell wall barriers and efflux pumping action and acquired resistance caused by genetic mutations. Then, different drug susceptibility test (DST) methods were described, including phenotype DST, genotype DST and novel DST methods. The phenotype DST includes nitrate reductase assay, RocheTM solid ratio method, and liquid culture method and genotype DST includes fluorescent PCR, GeneXpert, PCR reverse dot hybridization, ddPCR, next-generation sequencing and gene chips. Then, novel DST methods were described, including metabolism testing, cell-free DNA probe, CRISPR assay, and spectral analysis technique. The limitations, challenges, and perspectives of different techniques for drug resistance are also discussed. These methods significantly improve the detection sensitivity and accuracy of multidrug-resistant tuberculosis (MRT) and can effectively curb the incidence of drug-resistant tuberculosis and accelerate the process of tuberculosis eradication.

Complete characterization of RNA biomarker fingerprints using a multi-modal ATR-FTIR and SERS approach for label-free early breast cancer diagnosis

Breast cancer is a prevalent form of cancer worldwide, and the current standard screening method, mammography, often requires invasive biopsy procedures for further assessment. Recent research has explored microRNAs (miRNAs) in circulating blood as potential biomarkers for early breast cancer diagnosis. In this study, we employed a multi-modal spectroscopy approach, combining attenuated total reflection Fourier transform infrared (ATR-FTIR) and surface-enhanced Raman scattering (SERS) to comprehensively characterize the full-spectrum fingerprints of RNA biomarkers in the blood serum of breast cancer patients. The sensitivity of conventional FTIR and Raman spectroscopy was enhanced by ATR-FTIR and SERS through the utilization of a diamond ATR crystal and silver-coated silicon nanopillars, respectively. Moreover, a wider measurement wavelength range was achieved with the multi-modal approach than with a single spectroscopic method alone. We have shown the results on 91 clinical samples, which comprised 44 malignant and 47 benign cases. Principal component analysis (PCA) was performed on the ATR-FTIR, SERS, and multi-modal data. From the peak analysis, we gained insights into biomolecular absorption and scattering-related features, which aid in the differentiation of malignant and benign samples. Applying 32 machine learning algorithms to the PCA results, we identified key molecular fingerprints and demonstrated that the multi-modal approach outperforms individual techniques, achieving higher average validation accuracy (95.1%), blind test accuracy (91.6%), specificity (94.7%), sensitivity (95.5%), and F-score (94.8%). The support vector machine (SVM) model showed the best area under the curve (AUC) characterization value of 0.9979, indicating excellent performance. These findings highlight the potential of the multi-modal spectroscopy approach as an accurate, reliable, and rapid method for distinguishing between malignant and benign breast tumors in women. Such a label-free approach holds promise for improving early breast cancer diagnosis and patient outcomes.

Accessing Properties of Molecular Compounds Involved in Cellular Metabolic Processes with Electron Paramagnetic Resonance, Raman Spectroscopy, and Differential Scanning Calorimetry

In this work, we review some physical methods of macroscopic experiments, which have been recently argued to be promising for the acquisition of valuable characteristics of biomolecular structures and interactions. The methods we focused on are electron paramagnetic resonance spectroscopy, Raman spectroscopy, and differential scanning calorimetry. They were chosen since it can be shown that they are able to provide a mutually complementary picture of the composition of cellular envelopes (with special attention paid to mycobacteria), transitions between their molecular patterning, and the response to biologically active substances (reactive oxygen species and their antagonists-antioxidants-as considered in our case study).

Spotlight on mycobacterial lipid exploitation using nanotechnology for diagnosis, vaccines, and treatments

Tuberculosis (TB), historically the most significant cause of human morbidity and mortality, has returned as the top infectious disease worldwide, under circumstances worsened by the COVID-19 pandemic's devastating effects on public health. Although Mycobacterium tuberculosis, the causal agent, has been known of for more than a century, the development of tools to control it has been largely neglected. With the advancement of nanotechnology, the possibility of engineering tools at the nanoscale creates unique opportunities to exploit any molecular type. However, little attention has been paid to one of the major attributes of the pathogen, represented by the atypical coat and its abundant lipids. In this review, an overview of the lipids encountered in M. tuberculosis and interest in exploiting them for the development of TB control tools are presented. Then, the amalgamation of nanotechnology with mycobacterial lipids from both reported and future works are discussed.

Tuberculosis of hand and wrist: Varied clinical presentation and functional outcome by surgical intervention in 13 cases

A prospective study of 13 cases with tuberculosis of hand and wrist was presented with mean age of patients being 42.7 years (range 18 months to 84 years). Pain, swelling and difficulty in movement of adjacent joints were the most common presenting complaints. The discharging sinus, abscess & nerve compression were also observed in some cases. Out of 13 cases, bone involvement was seen in one case, joint involvement in five cases, soft tissue involvement in five cases and two cases had both soft tissue and joint involvement. All patients had undergone operative intervention for confirmation of diagnosis and improvement in function. Surgeries like open biopsy, debridement and tenosynovectomy were performed. Depending upon drug sensitivity on culture and histopathology report, standard anti-tuberculous treatment (ATT) was commenced under supervision of Infection Disease expert. Hand function was evaluated by modified Green and O'Brian score. The mean score was 58.84 (35-70) before any intervention and it improved to 89.23 (60-100) at 6 months follow up after surgical intervention and ATT. In conclusion, surgery may help for early functional recovery and for encouraging patient to use their hand for activities of daily living.

Machine Learning Assisted Real-Time Label-Free SERS Diagnoses of Malignant Pleural Effusion due to Lung Cancer

More than half of all pleural effusions are due to malignancy of which lung cancer is the main cause. Pleural effusions can complicate the course of pneumonia, pulmonary tuberculosis, or underlying systemic disease. We explore the application of label-free surface-enhanced Raman spectroscopy (SERS) as a point of care (POC) diagnostic tool to identify if pleural effusions are due to lung cancer or to other causes (controls). Lung cancer samples showed specific SERS spectral signatures such as the position and intensity of the Raman band in different wave number region using a novel silver coated silicon nanopillar (SCSNP) as a SERS substrate. We report a classification accuracy of 85% along with a sensitivity and specificity of 87% and 83%, respectively, for the detection of lung cancer over control pleural fluid samples with a receiver operating characteristics (ROC) area under curve value of 0.93 using a PLS-DA binary classifier to distinguish between lung cancer over control subjects. We have also evaluated discriminative wavenumber bands responsible for the distinction between the two classes with the help of a variable importance in projection (VIP) score. We found that our label-free SERS platform was able to distinguish lung cancer from pleural effusions due to other causes (controls) with higher diagnostic accuracy.

Dual-Approach Electrochemical Surface-Enhanced Raman Scattering Detection of Mycobacterium tuberculosis in Patient-Derived Biological Specimens: Proof of Concept for a Generalizable Method to Detect and Identify Bacterial Pathogens

The recent surge in infectious disease-causing pathogens, resulting in global catastrophe, has merited a pivotal quest toward point-of-care (POC) diagnostics. Mycobacterium tuberculosis (MTB) is still the top bacterium-based infectious disease-causing pathogen worldwide. In a concerted effort toward simplifying and decentralizing the discriminatory screening of MTB causing pathogens, electrochemical surface-enhanced Raman scattering (EC-SERS) was adopted to create a customized screening tool. The development strategy combined five key factors, including (i) a simplified Tollens'-based chemical synthesis method for bulk supply of silver nanoparticles, (ii) the deliberate surface modification of nanoparticles with carefully selected polyelectrolytes to resemble the conditioning layer usually found on a natural substratum, (iii) uniform SERS-active films formed through simple unprogrammed assembly, (iv) the controlled manipulation of the local electric field through applied voltage using a technique that does not conform to the limitations of classical EC-SERS, and (v) the inherent specificity of the target-specific SERS vibrational signature. The EC-SERS platform was able to discriminatively detect and identify TB-derived mycobacteria, including three clinically relevant MTB strains, TB-H37Rv, TB-HN878, and TB-CDC1551. Moreover, a customized voltage stepping protocol, compatible with either the inclusion of a short preincubation step or with in situ EC-SERS is illustrated. From the obtained SERS vibrational signatures, a band indicating a mode unique to TB-derived/TB-affiliated mycobacteria and thus not observed for other bacterial types used in this study was illustrated. Furthermore, provisional investigation, done as prelude for assessing the potential for translational adaptability of the EC-SERS technique toward POC clinical settings for sputum and urine specimens, was carried out.

Recent advances in antibiotic resistance diagnosis using SERS: focus on the “Big 5” challenges

SERS for antibiotic resistance diagnosis.

A reversed phase ultra-high-performance liquid chromatography-data independent mass spectrometry method for the rapid identification of mycobacterial lipids

A rapid reversed-phase ultra-high-performance liquid chromatography-high resolution mass spectrometry based mycobacterial lipidomics approach is described. This method enables the separation of various lipid classes including lipids specific to mycobacterial, such as methoxy mycolic acid and α-mycolic acid. Lipid separation occurs during a relatively short runtime of 14 min on a charged surface hybrid C₁₈ column. A high-resolution quadrupole-time of flight mass spectrometer and a data independent acquisition mode allowed for the simultaneous acquisition of the full scan and collision induced dissociation fragmentation. The proposed method provides lipid detection results equivalent to or better than existing methods, but with a faster throughput and an overall higher sensitivity. The reversed-phase ultra-high-performance liquid chromatography-high resolution mass spectrometry method was shown to obtain structural information for lipids extracted from Mycobacterium smegmatis, but the method is applicable to the analysis of lipids from various bacterial and mammalian cell lines.

Novel Cellulose Fibre-Based Flexible Plasmonic Membrane for Point-of-Care SERS Biomarker Detection in Chronic Wound Healing

Background

Wound management is stretching the limits of health systems globally, challenging clinicians to evaluate the effectiveness of their treatments and deliver appropriate care to their patients. Visual inspection and manual measurement of wound size are subjective, often inaccurate and inconsistent. Growth factors, such as pro-inflammatory cytokines and proteases, play important roles in cutaneous wound healing. However, little is known about the point-of-care monitoring of the changes in such markers during the healing process. Here, we explore the capability of surface-enhanced Raman spectroscopy (SERS) as a viable point-of-care platform to monitor the changes of these surrogate indicators of healing status in chronic wounds.

Methods

We developed a biofunctionalized flexible, cost-effective, scalable and easy-to-fabricate plasmonic SERS substrate using cellulose fibre (CF), which is used for sensing of wound markers based on a modified immunoassay method.

Results

We evaluated and selected the reliable silver nano-island thickness that will be sputtered onto the CF-based substrate for the highest SERS enhancement. Using this biofunctionalized SERS substrate, we detected varying concentrations of MMP-9 (10–5000 ng/mL) and TNF-α (5–100 ng/mL) proteins to model the wound exudates. This SERS detection method demonstrates a linear response within biologically relevant concentrations, ranging from 10 to 500 ng/mL for MMP-9 and 5 to 25 ng/mL for TNF-α for these surrogate indicators.

Conclusion

Our SERS sensing platform achieved detection limits in the µM to sub-nM range and displayed high sensitivity and selectivity. This could result in a cheap, point-of-care device that provides a non-invasive measure of cutaneous wound healing in real time. We envision that these flexible substrates after activation may be incorporated into wound dressings in future for routine monitoring of wound healing status.

Wavelength-dependent label-free identification of isolated nontuberculous mycobacteria using surface-enhanced Raman spectroscopy

We investigated the effect of Raman excitation wavelengths on the surface-enhanced Raman spectroscopy (SERS)-based identification of isolated nontuberculous mycobacteria (NTM). The SERS spectra with 3 commonly used excitation wavelengths, 532, 638, and 785 nm, were compared across 6 representative NTM species that primarily cause human NTM infections in Korea and the United States; these species were identified. The statistical differences among NTM SERS spectra at each Raman excitation wavelength were verified using 1-way analysis of variance, and the 6 NTM species were identified using principal components-linear discriminant analysis with leave-one-out cross validation. The identification accuracies with aromatic amino acid biomarkers were 99.3%, 91.3%, and 90.7% for 532, 638, and 785 nm, respectively. We believe that the proposed SERS protocol with aromatic amino acid biomarkers at the 532-nm Raman excitation wavelength will enable fast and accurate identification of NTM compared to previous identification methods.

Towards a point-of-care SERS sensor for biomedical and agri-food analysis applications: a review of recent advancements

The growing demand for reliable and robust methodology in bio-chemical sensing calls for the continuous advancement of sensor technologies. Over the last two decades, surface-enhanced Raman spectroscopy (SERS) has emerged as one of the most promising analytical techniques for sensitive and trace analysis or detection in biomedical and agri-food applications. SERS overcomes the inherent sensitivity limitation associated with Raman spectroscopy, which provides vibrational "fingerprint" spectra of molecules that makes it unique and versatile among other spectroscopy techniques. This paper comprehensively reviews the recent advancements of SERS for biomedical, food and agricultural applications over the last 6 years, and we envision that, in the near future, some of these platforms have the potential to be translated as a point-of-care and rapid sensor for real-life end-user applications. The merits and limitations of various SERS sensor designs are analysed and discussed based on critical features such as sensitivity, specificity, usability, repeatability and reproducibility. We conclude by highlighting the opportunities and challenges in the field while stressing the technological gaps to be addressed in realizing commercially viable point-of-care SERS sensors for practical biomedical and agri-food technological applications.

Biofilms of the non-tuberculous Mycobacterium chelonae form an extracellular matrix and display distinct expression patterns

Mycobacterium chelonae is an environmental, non-tuberculous mycobacterial species, capable of causing infections in humans. Biofilm formation is a key strategy used by M. chelonae in colonising niches in the environment and in the host. We studied a water-air interface (pellicle) biofilm of M. chelonae using a wide array of approaches to outline the molecular structure and composition of the biofilm. Scanning electron micrographs showed that M. chelonae biofilms produced an extracellular matrix. Using a combination of biochemical analysis, Raman spectroscopy, and fluorescence microscopy, we showed the matrix to consist of proteins, carbohydrates, lipids and eDNA. Glucose was the predominant sugar present in the biofilm matrix, and its relative abundance decreased in late (established) biofilms. RNA-seq analysis of the biofilms showed upregulation of genes involved in redox metabolism. Additionally, genes involved in mycolic acid, other lipid and glyoxylate metabolism were also upregulated in the early biofilms.

Pediatric Tuberculosis: The Impact of "Omics" on Diagnostics Development

Tuberculosis (TB) is a major public health concern for all ages. However, the disease presents a larger challenge in pediatric populations, partially owing to the lack of reliable diagnostic standards for the early identification of infection. Currently, there are no biomarkers that have been clinically validated for use in pediatric TB diagnosis. Identification and validation of biomarkers could provide critical information on prognosis of disease, and response to treatment. In this review, we discuss how the “omics” approach has influenced biomarker discovery and the advancement of a next generation rapid point-of-care diagnostic for TB, with special emphasis on pediatric disease. Limitations of current published studies and the barriers to their implementation into the field will be thoroughly reviewed within this article in hopes of highlighting future avenues and needs for combating the problem of pediatric tuberculosis.

Tuberculosis Presenting as Isolated Wrist Swelling: A Case Report and Review of Literature

Background. Tuberculosis is a common disease entity in South East Asian countries with a significant global burden. An extra skeletal manifestation such as monoarticular TB is common, but isolated involvement of the wrist is rare. Case Summary. A 53-year-old Sri Lankan male with long-standing diabetes presented with an isolated hand swelling for a 7-month duration. His initial imaging and MRI showed multiple destructive lesions in the carpal bones, surrounding focal fluid collections and found to have caseous material intraoperatively. His histology and microbiological studies were positive for TB with no other concurrent evidence of TB elsewhere. Conclusion. Different presentations of tuberculosis should be considered when patients are presenting with atypical clinical and initial basic investigation findings in relation to monoarticular pathologies.