Current and Potential Developments of Cortisol Aptasensing towards Point-of-Care Diagnostics (POTC)

Quantifying the variability in the assessment of reproductive hormone levels

OBJECTIVE

To quantify how representative a single measure of reproductive hormone level is of the daily hormonal profile using data from detailed hormonal sampling in the saline placebo-treated arm conducted over several hours.

DESIGN

Retrospective analysis of data from previous interventional research studies evaluating reproductive hormones.

SETTING

Clinical Research Facility at a tertiary reproductive endocrinology centre at Imperial College Hospital NHS Foundation Trust.

PATIENTS

Overall, 266 individuals, including healthy men and women (n = 142) and those with reproductive disorders and states (n = 124 [11 with functional hypothalamic amenorrhoea, 6 with polycystic ovary syndrome, 62 women and 32 men with hypoactive sexual desire disorder, and 13 postmenopausal women]), were included in the analysis.

INTERVENTIONS

Data from 266 individuals who had undergone detailed hormonal sampling in the saline placebo-treated arms of previous research studies was used to quantify the variability in reproductive hormones because of pulsatile secretion, diurnal variation, and feeding using coefficient of variation (CV) and entropy.

MAIN OUTCOME MEASURES

The ability of a single measure of reproductive hormone level to quantify the variability in reproductive hormone levels because of pulsatile secretion, diurnal variation, and nutrient intake.

RESULTS

The initial morning value of reproductive hormone levels was typically higher than the mean value throughout the day (percentage decrease from initial morning measure to daily mean: luteinizing hormone level 18.4%, follicle-stimulating hormone level 9.7%, testosterone level 9.2%, and estradiol level 2.1%). Luteinizing hormone level was the most variable (CV 28%), followed by sex-steroid hormone levels (testosterone level 12% and estradiol level 13%), whereas follicle-stimulating hormone level was the least variable reproductive hormone (CV 8%). In healthy men, testosterone levels fell between 9:00 am and 5:00 pm by 14.9% (95% confidence interval 4.2, 25.5%), although morning levels correlated with (and could be predicted from) late afternoon levels in the same individual (r2 = 0.53, P<.0001). Testosterone levels were reduced more after a mixed meal (by 34.3%) than during ad libitum feeding (9.5%), after an oral glucose load (6.0%), or an intravenous glucose load (7.4%).

CONCLUSION

Quantification of the variability of a single measure of reproductive hormone levels informs the reliability of reproductive hormone assessment.

Aptasensors: employing molecular probes for precise medical diagnostics and drug monitoring

Accurate detection and monitoring of therapeutic drug levels are vital for effective patient care and treatment management. Aptamers, composed of single-stranded DNA or RNA molecules, are integral components of biosensors designed for both qualitative and quantitative detection of biological samples. Aptasensors play crucial roles in target identification, validation, detection of drug-target interactions and screening potential of drug candidates. This review focuses on the pivotal role of aptasensors in early disease detection, particularly in identifying biomarkers associated with various diseases such as cancer, infectious diseases and cardiovascular disorders. Aptasensors have demonstrated exceptional potential in enhancing disease diagnostics and monitoring therapeutic drug levels. Aptamer-based biosensors represent a transformative technology in the field of healthcare, enabling precise diagnostics, drug monitoring and disease detection.

Recent developments in wearable & non-wearable point-of-care biosensors for cortisol detection

INTRODUCTION

Cortisol is one of the most prominent biomarkers used for the detection of psychological stress and related disorders. It plays an important role in many physiological processes including immunomodulation and fat metabolism. Thus, monitoring of cortisol levels can be used to indicate different pathological conditions including stress disorders. There has been a gradual rise in the development of point of care (PoC) biosensors for continuous cortisol monitoring.

AREAS COVERED

This review discusses recent breakthroughs toward the development of PoC sensors (wearable and non wearable) for cortisol monitoring. Challenges associated with them have also been summarized.

EXPERT OPINION

Electrochemical PoC devices have recently emerged as a powerful tools for continuous monitoring of cortisol that can be utilized for stress management and treatment of related disorders. However, there are many challenges that should be addressed before such devices can be deployed at mass level, such as inter-individual variability, changing the device calibration with the circadian rhythm, interference from other endocrine moieties, etc. [Figure: see text].

A dual-color plasmonic immunosensor for salivary cortisol measurement

Lifestyle-related disorders are a public health problem worldwide and their early diagnosis represents the key to successful therapies. In this framework, rapid point-of-care (POC) tests are one of the most promising diagnostic techniques. In particular, the use of saliva is raising increasing interest as a noninvasive biological fluid in POC systems, although the low concentration of salivary biomarkers typically requires strong advances to improve the device sensitivity. In this study, the plasmonic properties of two differently shaped gold nanoparticles (i.e., nanospheres and nanostars) were combined to develop an efficient paper-based immunosensor for the naked-eye evaluation of salivary cortisol, known as one of the main stress-related biomarkers. Notably, the dual-color system facilitated an immediate and easy evaluation of cortisol levels, based on a blue-to-pink color change of the detection zone. Furthermore, the implemented strategy showed potential applicability as a rapid and portable monitoring system, allowing discriminating different target concentrations.

Nanomaterials for Cortisol Sensing

Space represents one of the most dangerous environments for humans, which can be affected by high stress levels. This can lead to severe physiological problems, such as headaches, gastrointestinal disorders, anxiety, hypertension, depression, and coronary heart diseases. During a stress condition, the human body produces specific hormones, such as dopamine, adrenaline, noradrenaline, and cortisol. In particular, the control of cortisol levels can be related to the stress level of an astronaut, particularly during a long-term space mission. The common analytical methods (HPLC, GC-MS) cannot be used in an extreme environment, such as a space station, due to the steric hindrance of the instruments and the absence of gravity. For these reasons, the development of smart sensing devices with a facile and fast analytical protocol can be extremely useful for space applications. This review summarizes the recent (from 2011) miniaturized sensoristic devices based on nanomaterials (gold and carbon nanoparticles, nanotubes, nanowires, nano-electrodes), which allow rapid and real-time analyses of cortisol levels in biological samples (such as saliva, urine, sweat, and plasma), to monitor the health conditions of humans under extreme stress conditions.

Development of a Redox-Label-Doped Molecularly Imprinted Polymer on β-Cyclodextrin/Reduced Graphene Oxide for Electrochemical Detection of a Stress Biomarker

Cortisol is a major stress biomarker involved in the regulation of metabolic and immune responses. Readily accessible assays with sufficient quantitative and temporal resolution can assist in prevention, early diagnosis, and management of chronic diseases. Whereas conventional assays are costly in terms of time, labor, and capital, an electrochemical approach offers the possibility of miniaturization and detection at the point-of-care. Here, we investigate the biosensor application of molecularly imprinted polypyrrole (PPy) doped with hexacyanoferrate (HCF) and coupled to reduced graphene oxide functionalized with β-cyclodextrin (β-CD). β-CD provides an inclusion site for lipophilic cortisol and was electrochemically grafted simultaneous with reduction of GO. Next, PPy was electrochemically deposited in presence of cortisol template with HCF dopant ions serving as intrinsic redox probe. Thus, the sensor response was evaluated via changes of redox peak current in cyclic voltammetry and demonstrated a broad logarithmic detection range (5 pg/mL to 5000 ng/mL, R ² = 0.995), with a sensitivity of 8.809 μA log^-1 (ng/mL) cm^-2 and LOD of 19.3 pM. The sensor was shown to be specific toward cortisol in reference to salivary cortisol concentration in saliva over structural analogues. The sensor was exhibited to determine cortisol in artificial saliva at normal and elevated levels. The good performance and facile electrochemical fabrication of this antibody- and external label-free interface are promising for the development of affordable point-of-care biosensors.

Genotoxicity and Gene Expression in the Rat Lung Tissue following Instillation and Inhalation of Different Variants of Amorphous Silica Nanomaterials (aSiO2 NM)

Several reports on amorphous silica nanomaterial (aSiO2 NM) toxicity have been questioning their safety. Herein, we investigated the in vivo pulmonary toxicity of four variants of aSiO2 NM: SiO2_15_Unmod, SiO2_15_Amino, SiO2_7 and SiO2_40. We focused on alterations in lung DNA and protein integrity, and gene expression following single intratracheal instillation in rats. Additionally, a short-term inhalation study (STIS) was carried out for SiO2_7, using TiO2_NM105 as a benchmark NM. In the instillation study, a significant but slight increase in oxidative DNA damage in rats exposed to the highest instilled dose (0.36 mg/rat) of SiO2_15_Amino was observed in the recovery (R) group. Exposure to SiO2_7 or SiO2_40 markedly increased oxidative DNA lesions in rat lung cells of the exposure (E) group at every tested dose. This damage seems to be repaired, since no changes compared to controls were observed in the R groups. In STIS, a significant increase in DNA strand breaks of the lung cells exposed to 0.5 mg/m3 of SiO2_7 or 50 mg/m3 of TiO2_NM105 was observed in both groups. The detected gene expression changes suggest that oxidative stress and/or inflammation pathways are likely implicated in the induction of (oxidative) DNA damage. Overall, all tested aSiO2 NM were not associated with marked in vivo toxicity following instillation or STIS. The genotoxicity findings for SiO2_7 from instillation and STIS are concordant; however, changes in STIS animals were more permanent/difficult to revert.

Highly Sensitive Colorimetric Assay of Cortisol Using Cortisol Antibody and Aptamer Sandwich Assay

In this study, cortisol, which is a key stress hormone, could be detected sensitively via the colorimetric assay of a polycarbonate (PC) and glass substrate by the sandwich assay of cortisol monoclonal antibody (c-Mab) and cortisol specific binding aptamer (c-SBA). A highly sensitive change in colorimetry with a limit of detection (LOD) of cortisol of 100 fM could be attained on the optically transparent substrate using the antibody aptamer sandwich (AAS) assay by corresponding stacks of 5 nm gold nanoparticles (Au NPs). The Au NPs were conjugated by the c-SBA and the c-Mab was tethered on the PC and glass substrates. For the AAS method, a simple UV-Vis spectrophotometer was adopted to quantify the cortisol concentrations at an absorbance wavelength of 520 nm. Therefore, this study demonstrates the versatility of the AAS method to measure very low concentrations of cortisol in diagnostic applications.

Autonomous, Real-Time Monitoring Electrochemical Aptasensor for Circadian Tracking of Cortisol Hormone in Sub-microliter Volumes of Passively Eluted Human Sweat

The proposed work involves the development of an autonomous, label-free electrochemical sensor for real-time monitoring of cortisol levels expressed naturally in sub-microliter sweat volumes, for prolonged sensing periods of ∼8 h. Highly specific single-stranded DNA (ssDNA) aptamer is used for affinity capture of cortisol hormone eluted in sweat dynamically. The cortisol present in sweat binds to the aptamer capture probe that changes conformation and modulates electrochemical properties at the electrode-buffer interface, which was studied using dynamic light scattering studies for the entire physiological sweat pH. Attenuated total reflectance-Fourier transform infrared spectroscopy and UV-vis spectroscopy were used to optimize the binding chemistry of the elements of the sensor stack. Nonfaradaic electrochemical impedance spectroscopy was used to calibrate the sensor for a dynamic range of 1-256 ng/mL. An R² of 0.97 with an output signal range of 20-50% was obtained. Dynamic cortisol level variation tracking was studied using continuous dosing experiments to calibrate the sensor for temporal variation. The sensor did not show significant susceptibility to noise due to cross-reactive interferents and nonspecific buffer constituents. The performance of the developed aptasensor was compared with the previously established cortisol immunosensor in terms of surface charge behavior and nonfaradaic biosensing. The aptamer sensor shows a higher signal-to-noise ratio, better resolution, and has a larger output range for the same input range as the cortisol immunosensor. The feasibility of deploying the developed aptasensing scheme as continuous lifestyle and performance monitors was validated through human subject studies.

Aptasensors for Point-of-Care Detection of Small Molecules

Aptamers, a group of nucleic acids which can specifically bind to a target molecule, have drawn extensive interest over the past few decades. For analytics, aptamers represent a viable alternative to gold-standard antibodies due to their oligonucleic nature combined with advantageous properties, including higher stability in harsh environments and longer shelf-life. Indeed, over the last decade, aptamers have been used in numerous bioanalytical assays and in various point-of-care testing (POCT) platforms. The latter allows for rapid on-site testing and can be performed outside a laboratory by unskilled labor. Aptamer technology for POCT is not limited just to medical diagnostics; it can be used for a range of applications, including environmental monitoring and quality control. In this review, we critically examine the use of aptamers in POCT with an emphasis on their advantages and limitations. We also examine the recent success of aptasensor technology and how these findings pave the way for the analysis of small molecules in POCT and other health-related applications. Finally, the current major limitations of aptamers are discussed, and possible approaches for overcoming these challenges are presented.

Label-Free Sensitive Detection of Steroid Hormone Cortisol Based on Target-Induced Fluorescence Quenching of Quantum Dots

We discovered that several types of steroid hormones quench the fluorescence of quantum dots (QDs) at close proximity. Inspired by the finding, we developed a new type of biosensor for the sensitive detection of cortisol via direct fluorescence quenching of functionalized QD probes directly induced by the capture of target cortisol without additional reporter reagents. The detection selectivity was provided by cortisol-selective aptamers or anticortisol antibodies conjugated on the QD surfaces. With the magnetic nanoparticle labeling, the new sensing method enabled rapid cortisol sensing at physiologically relevant concentrations and yielded the detection limit of ∼1 nM for aptamer-based sensors and ∼100 pM for antibody-based sensors. We also evaluated the new detection method using saliva samples with an optimized sample preparation process under the assistance of magnetic manipulation. The result showed a satisfying recovery rate for spiked saliva tests. The facile sensing technology offers an appealing approach for the detection of steroid hormones in point-of-care settings.

A sensitive chemiluminescence based immunoassay for the detection of cortisol and cortisone as stress biomarkers

An electrochemically based antibody immobilization was used to perform environmentally and clinically relevant immunoassays for stress hormones biomarkers (cortisol and cortisone) using chemiluminescence (CL) detection. To achieve CL detection, the ferrocene tag on the antibodies was first oxidised, and this then acted as a catalyst for the luminol and hydrogen peroxide CL reaction. The conditions were optimised and measurements were made with an incubation time of 30 min. Using this approach limits of detection were obtained of 0.47 pg ml−1and 0.34 pg ml−1alsoR20.9912 and 0.9902 for cortisol and cortisone respectively with a linear concentration from 0 to 50 ng ml−1. The method was then applied to Zebrafish whole body and artificial saliva samples. For the Zebrafish sample recoveries of 91.0% and 90.0% were obtained with samples spiked with cortisol and cortisone, for artificial saliva the recoveries were 92.59% and 90.73% respectively. Interference studies showed only minor effects on the measurement of the analyte. A comparison between this procedure and the standard enzyme-linked immunosorbent assay (ELISA) procedure gave approximately the sameR2values.

Highly sensitive immunodiagnostics at the point of care employing alternative recognition elements and smartphones: hype, trend, or revolution?

Immunodiagnostic tests performed at the point of care (POC) today usually employ antibodies for biorecognition and are read out either visually or with specialized equipment. Availability of alternative biorecognition elements with promising features as well as smartphone-based approaches for signal readout, however, challenge the described established configuration in terms of analytical performance and practicability. Assessing these developments' clinical relevance and their impact on POC immunodiagnostics is demanding. The first part of this review will therefore give an overview on suitable diagnostic biosensors based on alternative recognition elements (such as nucleic acid-based aptamers or engineered binding proteins) and exemplify advantages and drawbacks of these biomolecules on the base of selected assays. The second part of the review then focuses on smartphone-connected diagnostics and discusses the indispensable considerations required for successful future clinical POCT implementation. Together, the joint depiction of two of the most innovative and exciting developments in the field will enable the reader to cast a glance into the distant future of POC immunodiagnostics.

Measuring cortisol, the major stress hormone in fishes

Stress in teleosts is an increasingly studied topic because of its interaction with growth, reproduction, immune system and ultimately fitness of the animal. Whether it is for evaluating welfare in aquaculture, adaptive capacities in fish ecology, or to investigate effects of human-induced rapid environmental change, new experimental methods to describe stress physiology in captive or wild fish have flourished. Cortisol has proven to be a reliable indicator of stress and is considered the major stress hormone. Initially principally measured in blood, cortisol measurement methods are now evolving towards lower invasiveness and to allow repeated measurements over time. We present an overview of recent achievements in the field of cortisol measurement in fishes, discussing new alternatives to blood, whole body and eggs as matrices for cortisol measurement, notably mucus, faeces, water, scales and fins. In parallel, new analytical tools are being developed to increase specificity, sensitivity and automation of the measure. The review provides the founding principles of these techniques and introduces their potential as continuous monitoring tools. Finally, we consider promising avenues of research that could be prioritised in the field of stress physiology of fishes.

Open Source 3D-printed focussing mechanism for cellphone-based cellular microscopy

The need to improve access to microscopes in low-resource and educational settings coupled with the global proliferation of camera-enabled cellphones has recently led to an explosion in new developments in portable, low-cost microscopy. The availability of accurate ball lenses has resulted in many variants of van Leeuwenhoek-like microscopes. Combined with cellphones, they have the potential for use as portable microscopes in education and clinics. The need for reproducibility in such applications implies that control over focus is critical. Here, we describe a 3D-printed focussing mechanism based on a rack and pinion mechanism, coupled to a ball lens- based microscope. We quantify the time-stability of the focussing mechanism through an edge-based contrast measure used in autofocus cameras and apply it to 'thin smear' blood sample infected with Plasmodium as well as onion skin cells. We show that stability of the z-focus is in the micrometre range. This development could, we believe, serve to further enhance the utility of a low-cost and robust microscope and encourage further developments in field microscopes based on the Open Source principle. LAY DESCRIPTION: The wide spread of cellphones with cameras makes them an attractive platform for digital microscopy. Such microscopes could help improve microscope access in clinics and classrooms in the form of 'field microscopes', if they could be adapted for imaging cells. We integrate a 3D printed focussing mechanism made with recyclable plastic with ball-lens microscope of the Leeuwenhoek type. We demonstrate how the device can help stabilise to a focal plane for acquiring movies of a thin-smear of blood infected with Plasmodium and onion skin cells using a cellphone. The stability of focus is expectedly less precise as compared to research-grade microscopes, but is of the range of a few micrometers. We believe, the focussing device demonstrates it is possible to obtain reliable and reproducible images of typical samples used in clinics and classrooms. By making the design files of this device open-source we believe it could serve as a small step in improved, affordable and accurate 'field microscopes'.

High-Affinity Nucleic-Acid-Based Receptors for Steroids

Artificial receptors for hydrophobic molecules usually have moderate affinities and limited selectivities. We describe three new classes of high affinity hydrophobic receptors for nonaromatic steroids based on deoxyribonucleotides, obtained through five high stringency selections coupled with tailored counter-selections. The isolation of multiple classes of high affinity steroid receptors demonstrates the surprising breadth of moderately sized hydrophobic binding motifs (<40 nucleotides) available to natural nucleic acids. Studies of interactions with analogs indicate that two classes, four-way junctions and 4XG_N motifs, comprise receptors with shapes that prevent binding of specific steroid conjugates used in counter-selections. Furthermore, they strongly prefer nonhydroxylated steroid cores, which is typical for hydrophobic receptors. The third new class accommodates hydroxyl groups in high-affinity, high-selectivity binding pockets, thus reversing the preferences of the first two classes. The high-affinity binding of aptamers to targets efficiently inhibits double-helix formation in the presence of the complementary oligonucleotides. The high affinity of some of these receptors and tailored elimination of binding through counter-selections ensures that these new aptamers will enable clinical chemistry applications.