Bioactive paper provides a low-cost platform for diagnostics

Fully inkjet-printed distance-based paper microfluidic devices for colorimetric calcium determination using ion-selective optodes

Although the determination of calcium ions (Ca²⁺) is of high importance to monitor water hardness, currently available devices for on-site analysis suffer from a lack of user-friendliness and sensitivity. This work demonstrates fully inkjet-printed and low-cost microfluidic paper-based analytical devices (μPADs) for the simple naked-eye colorimetric determination of calcium ions (Ca²⁺) in drinking and tap water samples. The quantification of Ca²⁺ relies on visual readout of the length of a colour-changed detection channel modified with ionophore-doped ion-selective optode nanospheres (nano-optodes), eliminating the requirement of a scanner or a camera. All fabrication steps for deposition of assay reagents have been performed by means of a simple desktop thermal inkjet printer, which is expected to contribute to highly batch-to-batch reproducible device preparation. The detectable Ca²⁺ concentrations between 0.05 mmol L^-1 and 5 mmol L^-1 cover the range recommended by the International Organization for Standardization (0.05-2.5 mmol L^-1) and the World Health Organization (WHO) guideline for Ca²⁺ quantification in drinking water (less than 5 mmol L^-1). The lowest concentration of Ca²⁺ detectable by the naked eye was found to be 0.05 mmol L^-1, which is below the value achieved with previously reported paper-based devices. μPAD quantified Ca²⁺ concentrations in tap or drinking waters were within 15% error of the results obtained with a classical complexometric titration. Hence, distance-based μPADs relying on nano-optodes are sensitive and reproducible tools for equipment-free on-site assaying of Ca²⁺ in real samples.

Paper-Based Origami Photoelectrochemical Sensing Platform with TiO2/Bi4NbO8Cl/Co-Pi Cascade Structure Enabling of Bidirectional Modulation of Charge Carrier Separation

A bidirectional modulation of photoinduced charge carrier separation strategy based on TiO₂/Bi₄NbO₈Cl/Co-Pi was proposed in microfluidic paper based photoelectrochemical analytical device (μ-POAD). Perovskite Bi₄NbO₈Cl with high charge carrier mobility was employed as visible light absorber, sandwiching between electron transporting material (ETM) and hole transporting material (HTM). Paper based TiO₂ nanosheet arrays (PTNAs) serve as the ETM to provide a direct pathway for electron transport and Co-Pi works as the HTM to extract holes. Driven by a built-in electric field, the generated electrons of Bi₄NbO₈Cl are extracted by PTNAs, while holes are drawn toward Co-Pi, achieving efficient carrier separation. Remarkably, it is the first time that the HTM was introduced into μ-POAD to efficiently output holes and enhance the sensitivity. With the aid of ETM and HTM, 2.59 and 14.6 times higher photocurrent density was obtained compared with PTNAs/Bi₄NbO₈Cl and Bi₄NbO₈Cl photoelectrode, respectively. Benefiting from this dramatic photocurrent signal, ultrasensitive detection of β human chorionic gonadotrophin is realized with the linear range of 0.01-3000 IU L^-1 and detection limitation of 0.005 IU L^-1. This work demonstrates the importance of efficient carrier separation to the sensitivity of μ-POAD and paves the way for developing a high-performance analytical device.

Single step and mask-free 3D wax printing of microfluidic paper-based analytical devices for glucose and nitrite assays

Microfluidic paper-based analytical devices (μPADs) have recently emerged as a simple, portable, user-friendly, and affordable alternative to more instrument-intensive analytical approaches for point-of-care testing (POCT), food safety analysis, and environmental monitoring. However, most of the existing methods for the fabrication of μPADs still face a great challenge because of different trade-offs among cost, convenience, and the pattern resolution. In this work, we report a facile one-step approach to prepare a μPAD using an affordable, easy-to-build 3D printer to generate patterns of solid wax on laboratory filter paper. The presented wax printing method did not require the use of predesigned masks and an external heat source to form complete hydrophobic wax barrier through the use of a custom-made extruder. The results revealed a strong linear relationship (R² = 0.985) between the nominal and the printed widths of the wax barriers. The achievable resolution of the wax barrier printed on filter paper was 468 ± 72 µm, which was lower than previously reported minimum barrier feature sizes achieved by wax printing and other wax patterning techniques, such as stamping and screen-printing. The analytical utility of the fabricated μPADs was evaluated for colorimetric nitrite and glucose detection in artificial solutions. It was found that the fabricated μPADs provided adequate accuracy and reproducibility for quantitative determination of nitrite and glucose within concentration ranges relevant to the disease detection in human saliva and urine. The wax printing approach reported here provides a simple, rapid, and cost-effective fabrication method for paper-based microfluidics and may bring benefits to medical diagnostics in the developing world.

Versatile and Robust Integrated Sensors To Locally Assess Humidity Changes in Fully Enclosed Paper-Based Devices

The synergic combination of materials and interfaces to create novel functional devices is a crucial approach for various applications, including low-cost paper-based point-of-care systems. In this work, we demonstrate the implementation of surface-modified polypyrrole (PPy) structures, monolithically integrated into a three-dimensional multilayered paper-based microfluidic device, to locally assess humidity changes. The fabrication and integration of the system include the deterministic incorporation of PPy into the paper-based structure by gas-phase polymerization and the modification of the polymer properties to allow local humidity monitoring. The functionalization of PPy changes both the wettability and the chemical composition of the interface, what is of fundamental importance for the sensor's operation. The PPy structure has excellent mechanical stability, enduring at least 600 bending cycles, what is of relevance on flexible electronics. The electrical resistance correlates with the local relative humidity (RH) inside of the sealed microfluidic system, and the sensor response is fully reversible. The integrated system capable of locally monitoring the RH allowed us to verify that inside the microfluidic channel, water molecules can diffuse across the wax barriers-a possibility disregarded so far. Our results attest that RH variations of 5-10% can affect the flow of extended channels (>5 cm) even when they are fully enclosed.

Paper-Based Analytical Methods for Smartphone Sensing with Functional Nanoparticles: Bridges from Smart Surfaces to Global Health

In this Feature, the most recent developments as well as "pros and cons" in smartphone sensing, which have been developed using various functional nanoparticles in paper-based sensing systems, will be discussed. Additionally, smart phone sensing and POC combination as a potential tool that opens a gate for knowledge flow "from lab scale data to public use" will be evaluated.

Paper-Based Sensors: Emerging Themes and Applications

Paper is a versatile, flexible, porous, and eco-friendly substrate that is utilized in the fabrication of low-cost devices and biosensors for rapid detection of analytes of interest. Paper-based sensors provide affordable platforms for simple, accurate, and rapid detection of diseases, in addition to monitoring food quality, environmental and sun exposure, and detection of pathogens. Paper-based devices provide an inexpensive technology for fabrication of simple and portable diagnostic systems that can be immensely useful in resource-limited settings, such as in developing countries or austere environments, where fully-equipped facilities and highly trained medical staff are absent. In this work, we present the different types of paper that are currently utilized in fabrication of paper-based sensors, and common fabrication techniques ranging from wax printing to origami- and kirigami-based approaches. In addition, we present different detection techniques that are employed in paper-based sensors such as colorimetric, electrochemical, and fluorescence detection, chemiluminescence, and electrochemiluminescence, as well as their applications including disease diagnostics, cell cultures, monitoring sun exposure, and analysis of environmental reagents including pollutants. Furthermore, main advantages and disadvantages of different types of paper and future trends for paper-based sensors are discussed.

Self-Assembled Functional DNA Superstructures as High-Density and Versatile Recognition Elements for Printed Paper Sensors

Micrometer-sized functional nucleic acid (FNA) superstructures (denoted as 3D DNA) were examined as a unique class of biorecognition elements to produce highly functional bioactive paper surfaces. 3D DNA containing repeating sequences of either a DNA aptamer or DNAzyme was created from long-chain products of rolling circle amplification followed by salt aging. The resulting 3D DNA retained its original spherical shape upon inkjet printing and adhered strongly to the paper surface via physisorption. 3D DNA paper sensors showed resistance to degradation by nucleases, suppressed nonspecific protein adsorption, and provided a much higher surface density of functional DNA relative to monomeric FNAs, making such species ideally suited for development of paper-based biosensors.

Electrochemical impedance-based DNA sensor using pyrrolidinyl peptide nucleic acids for tuberculosis detection

A label-free electrochemical DNA sensor based on pyrrolidinyl peptide nucleic acid (acpcPNA)-immobilized on a paper-based analytical device (PAD) was developed. Unlike previous PNA-based electrochemical PAD (ePAD) sensors where the capture element was placed directly on the electrode, acpcPNA was covalently immobilized onto partially oxidized cellulose paper allowing regeneration by simple PAD replacement. As an example application, a sensor probe was designed for Mycobacterium tuberculosis (MTB) detection. The ePAD DNA sensor was used to determine a synthetic 15-base oligonucleotide of MTB by measuring the fractional change in the charge transfer resistance (R_ct) obtained from electrochemical impedance spectroscopy (EIS). The R_ct of [Fe(CN)₆]^3-/4- before and after hybridization with the target DNA could be clearly distinguished. Cyclic voltammetry (CV) was used to verify the EIS results, and showed an increase in peak potential splitting in a similar stepwise manner for each immobilization step. Under optimal conditions, a linear calibration curve in the range of 2-200 nM and the limit of detection 1.24 nM were measured. The acpcPNA probe exhibited very high selectivity for complementary oligonucleotides over single-base-mismatch, two-base-mismatch and non-complementary DNA targets due to the conformationally constrained structure of the acpcPNA. Moreover, the ePAD DNA sensor platform was successfully applied to detect PCR-amplified MTB DNA extracted from clinical samples. The proposed paper-based electrochemical DNA sensor has potential to be an alternative device for low-cost, simple, label-free, sensitive and selective DNA sensor.

Editable TiO2 Nanomaterial-Modified Paper in Situ for Highly Efficient Detection of Carcinoembryonic Antigen by Photoelectrochemical Method

In this work, a versatile photoelectrochemical paper-based sensor based on N-carbon dots/TiO₂-Pt-modified paper in situ is developed for sensitive detection of carcinoembryonic antigen (CEA) in clinical serum samples. Interconnected cellulose fibers on paper provide a porous, 3D, and flexible substrate for photoelectrochemical sensing. In situ modification of N-carbon dots/TiO₂-Pt with editable structures on paper significantly increases the conductivity, widens the adsorption range, and enhances the photoelectrochemical ability, which enables the higher sensitivity and flexibility compared with traditional rigid sensors. On the basis of this novel protocol, a miniaturized and portable origami device realizes the CEA determination with a low detection limit of 1.0 pg mL^-1 and a wide linear range from 0.002 to 200 ng mL^-1. Thanks to the good biocompatibility, the paper-based device provides a new avenue for the detection of CEA on the cell surface which is promising for portable diagnostics in early tumor warning.

A Paper Sensor Printed with Multifunctional Bio/Nano Materials

We report a paper-based aptasensor platform that uses two reaction zones and a connecting bridge along with printed multifunctional bio/nano materials to achieve molecular recognition and signal amplification. Upon addition of analyte to the first zone, a fluorescently labelled DNA or RNA aptamer is desorbed from printed graphene oxide, rapidly producing an initial fluorescence signal. The released aptamer then flows to the second zone where it reacts with printed reagents to initiate rolling circle amplification, generating DNA amplicons containing a peroxidase-mimicking DNAzyme, which produces a colorimetric readout that can be read in an equipment-free manner or with a smartphone. The sensor was demonstrated using an RNA aptamer for adenosine triphosphate (a bacterial marker) and a DNA aptamer for glutamate dehydrogenase (Clostridium difficile marker) with excellent sensitivity and specificity. These targets could be detected in spiked serum or feacal samples, demonstrating the potential for testing clinical samples.

Recent Advances in Modified Cellulose for Tissue Culture Applications

Tissue engineering is a rapidly advancing field in regenerative medicine, with much research directed towards the production of new biomaterial scaffolds with tailored properties to generate functional tissue for specific applications. Recently, principles of sustainability, eco-efficiency and green chemistry have begun to guide the development of a new generation of materials, such as cellulose, as an alternative to conventional polymers based on conversion of fossil carbon (e.g., oil) and finding technologies to reduce the use of animal and human derived biomolecules (e.g., foetal bovine serum). Much of this focus on cellulose is due to it possessing the necessary properties for tissue engineering scaffolds, including biocompatibility, and the relative ease with which its characteristics can be tuned through chemical modification to adjust mechanical properties and to introduce various surface modifications. In addition, the sustainability of producing and manufacturing materials from cellulose, as well as its modest cost, makes cellulose an economically viable feedstock. This review focusses specifically on the use of modified cellulose materials for tissue culturing applications. We will investigate recent techniques used to promote scaffold function through physical, biochemical and chemical scaffold modifications, and describe how these have been utilised to reduce reliance on the addition of matrix ligands such as foetal bovine serum.

Detecting Chemical Hazards in Foods Using Microfluidic Paper-Based Analytical Devices (μPADs): The Real-World Application

Food safety remains one of the most important issues in most countries and the detection of food hazards plays a key role in the systematic approach to ensuring food safety. Rapid, easy-to-use and low-cost analytical tools are required to detect chemical hazards in foods. As a promising candidate, microfluidic paper-based analytical devices (μPADs) have been rarely applied to real food samples for testing chemical hazards, although numerous papers have been published in this field in the last decade. This review discusses the current status and concerns of the μPAD applications in the detection of chemical hazards in foods from the perspective of food scientists, mainly for an audience with a background in mechanical and chemical engineering who may have interests in exploring the potential of μPAD to address real-world food safety issues.

Low-cost Paper Analytical Devices for Environmental and Biomedical Sensing Applications

Over the last decade, the fabrication of analytical devices utilizing microfluidic structures and lab-on-a-chip platforms has shown breakthrough advancements, both for environmental and biological applications. The ASSURED criteria (affordable, sensitive, specific, user-friendly, robust, equipment-free, delivered), developed by the WHO for diagnostics devices, point towards the need of paper-based analytical devices (PAD) for diagnostics. On the other hand, cost-effective PADs owing the great advantage of affordable applicability in both resource-rich and -limited settings are recently employed for on-site environmental monitoring. In this book chapter, we will discuss about the brief history of paper analytical devices, fabrications, need, and its environmental and biomedical applications.

Modulating cell response on cellulose surfaces; tunable attachment and scaffold mechanics

Combining surface chemical modification of cellulose to introduce positively charged trimethylammonium groups by reaction with glycidyltrimethylammonium chloride (GTMAC) allowed for direct attachment of mammalian MG-63 cells, without addition of protein modifiers, or ligands. Very small increases in the surface charge resulted in significant increases in cell attachment: at a degree of substitution (DS) of only 1.4%, MG-63 cell attachment was > 90% compared to tissue culture plastic, whereas minimal attachment occurred on unmodified cellulose. Cell attachment plateaued above DS of ca. 1.85% reflecting a similar trend in surface charge, as determined from ζ-potential measurements and capacitance coupling (electric force microscopy). Cellulose film stiffness was modulated by cross linking with glyoxal (0.3-2.6% degree of crosslinking) to produce a range of materials with surface shear moduli from 76 to 448 kPa (measured using atomic force microscopy). Cell morphology on these materials could be regulated by tuning the stiffness of the scaffolds. Thus, we report tailored functionalised biomaterials based on cationic cellulose that can be tuned through surface reaction and glyoxal crosslinkin+g, to influence the attachment and morphology of cells. These scaffolds are the first steps towards materials designed to support cells and to regulate cell morphology on implanted biomaterials using only scaffold and cells, i.e. without added adhesion promoters.

Challenges of the Nano-Bio Interface in Lateral Flow and Dipstick Immunoassays

Lateral flow assays (LFAs) are highly attractive for point-of-care (POC) diagnostics for infectious disease, food safety, and many other medical uses. The unique optical, electronic, and chemical properties that arise from the nanostructured and material characteristics of nanoparticles provide an opportunity to increase LFA sensitivity and impart novel capabilities. However, interfacing to nanomaterials in complex biological environments is challenging and can result in undesirable side effects such as non-specific adsorption, protein denaturation, and steric hindrance. These issues are even more acute in LFAs where there are many different types of inorganic-biological interfaces, often of a complex nature. Therefore, the unique properties of nanomaterials for LFAs must be exploited in a way that addresses these interface challenges.

Quantitative evaluation of analyte transport on microfluidic paper-based analytical devices (μPADs)

The transport efficiency during capillary flow-driven sample transport on microfluidic paper-based analytical devices (μPADs) made from filter paper has been investigated for a selection of model analytes (Ni²⁺, Zn²⁺, Cu²⁺, PO₄^3-, bovine serum albumin, sulforhodamine B, amaranth) representing metal cations, complex anions, proteins and anionic molecules. For the first time, the transport of the analytical target compounds rather than the sample liquid, has been quantitatively evaluated by means of colorimetry and absorption spectrometry-based methods. The experiments have revealed that small paperfluidic channel dimensions, additional user operation steps (e.g. control of sample volume, sample dilution, washing step) as well as the introduction of sample liquid wicking areas allow to increase analyte transport efficiency. It is also shown that the interaction of analytes with the negatively charged cellulosic paper substrate surface is strongly influenced by the physico-chemical properties of the model analyte and can in some cases (Cu²⁺) result in nearly complete analyte depletion during sample transport. The quantitative information gained through these experiments is expected to contribute to the development of more sensitive μPADs.

Engineered Paper-Based Cell Culture Platforms

Paper is used in various applications in biomedical research including diagnostics, separations, and cell cultures. Paper can be conveniently engineered due to its tunable and flexible nature, and is amenable to high-throughput sample preparation and analysis. Paper-based platforms are used to culture primary cells, tumor cells, patient biopsies, stem cells, fibroblasts, osteoblasts, immune cells, bacteria, fungi, and plant cells. These platforms are compatible with standard analytical assays that are typically used to monitor cell behavior. Due to its thickness and porous nature, there are no mass transport limitations to/from the cells in paper scaffolds. It is possible to pattern paper in different scales (micrometer to centimeter), generate modular configurations in 3D, fabricate multicellular and compartmentalized tissue mimetics for clinical applications, and recover cells from the scaffolds for further analysis. 3D paper constructs can provide physiologically relevant tissue models for personalized medicine. Layer-by layer strategies to assemble tissue-like structures from low-cost and biocompatible paper-based materials offer unique opportunities that include understanding fundamental biology, developing disease models, and assembling different tissues for organ-on-paper applications. Paper-based platforms can also be used for origami-inspired tissue engineering. This work provides an overview of recent progress in engineered paper-based biomaterials and platforms to culture and analyze cells.

Rethinking the Design of Low-Cost Point-of-Care Diagnostic Devices

Reducing the global diseases burden requires effective diagnosis and treatment. In the developing world, accurate diagnosis can be the most expensive and time-consuming aspect of health care. Healthcare cost can, however, be reduced by use of affordable rapid diagnostic tests (RDTs). In the developed world, low-cost RDTs are being developed in many research laboratories; however, they are not being equally adopted in the developing countries. This disconnect points to a gap in the design philosophy, where parameterization of design variables ignores the most critical component of the system, the point-of-use stakeholders (e.g., doctors, nurses and patients). Herein, we demonstrated that a general focus on reducing cost (i.e., "low-cost"), rather than efficiency and reliability is misguided by the assumption that poverty reduces the value individuals place on their well-being. A case study of clinicians in Kenya showed that "zero-cost" is a low-weight parameter for point-of-use stakeholders, while reliability and standardization are crucial. We therefore argue that a user-driven, value-addition systems-engineering approach is needed for the design of RDTs to enhance adoption and translation into the field.

A Printed Multicomponent Paper Sensor for Bacterial Detection

We present a simple all-in-one paper-based sensor for E. coli detection using a composite ink made of a fluorogenic DNAzyme probe for bacterial recognition and signal generation, lysozyme that lyses whole bacterial cells, and pullulan/trehalose sugars that stabilize printed bioactive molecules. The paper sensor is capable of producing a fluorescence signal as a readout within 5 minutes upon contacting E. coli, can achieve a limit of detection of 100 cells/mL, in a variety of sample matrixes, without sample enrichment, and remains stable for at least 6 months when stored at ambient temperature. Therefore, this simple paper sensor provides rapid bacterial testing on site, and can be shipped and stored under ambient conditions to benefit users living in resource-limited regions.

Print to detect: a rapid and ultrasensitive phage-based dipstick assay for foodborne pathogens

Foodborne pathogens are a burden to the economy and a constant threat to public health. The ability to rapidly detect the presence of foodborne pathogens is a vital component of any strategy towards establishing a safe and secure food supply chain. Bacteriophages (phages) are viruses capable of infecting and replicating within bacteria in a strain-specific manner. The ubiquitous and selective nature of phages makes them ideal for the detection and biocontrol of bacteria. Therefore, the objective of this research was to develop and test a phage-based paper dipstick biosensor for the detection of various foodborne pathogens in food matrices. The first step was to identify the best method for immobilizing phages on paper such that their biological activity (infectivity) was preserved. It was found that piezoelectric inkjet printing resulted in lower loss of phage infectivity when compared with other printing methods (namely gravure and blade coating) and that ColorLok paper was ideally suited to create functional sensors. The phage-based bioactive papers developed with use of piezoelectric inkjet printing actively lysed their target bacteria and retained this antibacterial activity for up to 1 week when stored at room temperature and 80% relative humidity. These bioactive paper strips in combination with quantitative real-time PCR were used for quantitative determination of target bacteria in broth and food matrices. A phage dipstick was used to capture and infect Escherichia coli O157:H7, E. coli O45:H2, and Salmonella Newport in spinach, ground beef and chicken homogenates, respectively, and quantitative real-time PCR was used to detect the progeny phages. A detection limit of 10-50 colony-forming units per millilitre was demonstrated with a total assay time of 8 h, which was the duration of a typical work shift in an industrial setting. This detection method is rapid and cost-effective, and may potentially be applied to a broad range of bacterial foodborne pathogens. Graphical abstract ᅟ.

Stabilization of T4 bacteriophage at acidic and basic pH by adsorption on paper

Bacteriophages find applications in agriculture, medicine, and food safety. Many of these applications can expose bacteriophages to stresses that inactivate them including acidic and basic pH. Bacteriophages can be stabilized against these stresses by materials including paper, a common material in packaging and consumer products. Combining paper and bacteriophages creates antibacterial materials, which can reduce the use of antibiotics. Here we show that adsorption on paper protects T4, T5, and T7 bacteriophage from acidic and basic pH. We added bacteriophages to filter paper functionalized with carboxylic acid (carboxyl methyl cellulose) or amine (chitosan) groups, and exposed them to pH from 5.6 to 14. We determined the number of infective bacteriophages after exposure directly on the paper. All papers extended the lifetime of infective bacteriophage by at least a factor of four with some papers stabilizing bacteriophages for up to one week. The degree of stabilization depended on five main factors (i) the family of the bacteriophage, (ii) the charge of the paper and bacteriophages, (iii) the location of the bacteriophages within the paper, (iv) the ability of the paper to prevent bacteriophage-bacteriophage aggregation, and (v) the sensitivity of the bacteriophage proteins to the tested pH. Even when adsorbed on paper the bacteriophages were able to remove E. coli in milk. Choosing the right paper modification or material will protect bacteriophages adsorbed on that material against detrimental pH and other environmental challenges increasing the range of applications of bacteriophages on materials.

Paper-based assays for urine analysis

A transformation of the healthcare industry is necessary and imminent: hospital-centered, reactive care will soon give way to proactive, person-centered care which focuses on individuals' well-being. However, this transition will only be made possible through scientific innovation. Next-generation technologies will be the key to developing affordable and accessible care, while also lowering the costs of healthcare. A promising solution to this challenge is low-cost continuous health monitoring; this approach allows for effective screening, analysis, and diagnosis and facilitates proactive medical intervention. Urine has great promise for being a key resource for health monitoring; unlike blood, it can be collected effortlessly on a daily basis without pain or the need for special equipment. Unfortunately, the commercial rapid urine analysis tests that exist today can only go so far-this is where the promise of microfluidic devices lies. Microfluidic devices have a proven record of being effective analytical devices, capable of controlling the flow of fluid samples, containing reaction and detection zones, and displaying results, all within a compact footprint. Moving past traditional glass- and polymer-based microfluidics, paper-based microfluidic devices possess the same diagnostic ability, with the added benefits of facile manufacturing, low-cost implementation, and disposability. Hence, we review the recent progress in the application of paper-based microfluidics to urine analysis as a solution to providing continuous health monitoring for proactive care. First, we present important considerations for point-of-care diagnostic devices. We then discuss what urine is and how paper functions as the substrate for urine analysis. Next, we cover the current commercial rapid tests that exist and thereby demonstrate where paper-based microfluidic urine analysis devices may fit into the commercial market in the future. Afterward, we discuss various fabrication techniques that have been recently developed for paper-based microfluidic devices. Transitioning from fabrication to implementation, we present some of the clinically implemented urine assays and their importance in healthcare and clinical diagnosis, with a focus on paper-based microfluidic assays. We then conclude by providing an overview of select biomarker research tailored towards urine diagnostics. This review will demonstrate the applicability of paper-based assays for urine analysis and where they may fit into the commercial healthcare market.

Materials for Microfluidic Immunoassays: A Review

Conventional immunoassays suffer from at least one of these following limitations: long processing time, high costs, poor user-friendliness, technical complexity, poor sensitivity and specificity. Microfluidics, a technology characterized by the engineered manipulation of fluids in channels with characteristic lengthscale of tens of micrometers, has shown considerable promise for improving immunoassays that could overcome these limitations in medical diagnostics and biology research. The combination of microfluidics and immunoassay can detect biomarkers with faster assay time, reduced volumes of reagents, lower power requirements, and higher levels of integration and automation compared to traditional approaches. This review focuses on the materials-related aspects of the recent advances in microfluidics-based immunoassays for point-of-care (POC) diagnostics of biomarkers. We compare the materials for microfluidic chips fabrication in five aspects: fabrication, integration, function, modification and cost, and describe their advantages and drawbacks. In addition, we review materials for modifying antibodies to improve the performance of the reaction of immunoassay. We also review the state of the art in microfluidic immunoassays POC platforms, from the laboratory to routine clinical practice, and also commercial products in the market. Finally, we discuss the current challenges and future developments in microfluidic immunoassays.

Functionality of Immunoglobulin G and Immunoglobulin M Antibody Physisorbed on Cellulosic Films

The functionality and aging mechanism of antibodies physisorbed onto cellulosic films was investigated. Blood grouping antibodies immunoglobulin G (IgG) and immunoglobulin M (IgM) were adsorbed onto smooth cellulose acetate (CAF) and regenerated cellulose (RCF) films. Cellulose films and adsorbed IgG layers were characterized at the air and liquid interface by X-ray and neutron reflectivity (NR), respectively. Cellulose film 208 Å thick (in air) swell to 386 Å once equilibrated in water. IgG adsorbs from solution onto cellulose as a partial layer 62 Å thick. IgG and IgM antibodies were adsorbed onto cellulose and cellulose acetate films, air dried, and aged at room temperature for periods up to 20 days. Antibody functionality and surface hydrophobicity were measured everyday with the size of red blood cell (RBC) agglutinates (using RBC specific to IgG/IgM) and the water droplet contact angle, respectively. The functionality of the aged IgG/IgM decreases faster if physisorbed on cellulose than on cellulose acetate and correlates to surface hydrophobicity. IgG physisorbed on RCF or CAF age better and remain functional longer than physisorbed IgM. We found a correlation between antibody stability and hydrogen bond formation ability of the system, evaluated from antibody carbonyl concentration and cellulosic surface hydroxyl concentration. Antibody physisorbs on cellulose by weak dipole forces and hydrogen bonds. Strong hydrogen bonding contributes to the physisorption of antibody on cellulose into a non-functional configuration in which the molecule relaxes by rotation of hydophobic groups toward the air interface.

Paper microfluidics for nucleic acid amplification testing (NAAT) of infectious diseases

The diagnosis of infectious diseases is entering a new and interesting phase. Technologies based on paper microfluidics, coupled to developments in isothermal amplification of Nucleic Acids (NAs) raise opportunities for bringing the methods of molecular biology in the field, in a low setting environment. A lot of work has been performed in the domain over the last few years and the landscape of contributions is rich and diverse. Most often, the level of sample preparation differs, along with the sample nature, the amplification and detection methods, and the design of the device, among other features. In this review, we attempt to offer a structured description of the state of the art. The domain is not mature and there exist bottlenecks that hamper the realization of Nucleic Acid Amplification Tests (NAATs) complying with the constraints of the field in low and middle income countries. In this domain however, the pace of progress is impressively fast. This review is written for a broad Lab on a Chip audience.

Heat release at the wetting front during capillary filling of cellulosic micro-substrates

Spontaneous imbibition in cellulosic materials is an expanding field of research due to the direct applicability in paper-based microfluidics. Here, we show experimentally, using simultaneous thermal and optical imaging that the temperature at the wetting front during capillary filling of paper is temporarily increased, even if the imbibed fluid and the cellulosic substrate are initially at isothermal conditions. Several liquids and two types of filter paper, characterised by scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis, were investigated demonstrating a significant temperature rise at the wetting front that cannot be neglected form the process. The temperature rise is found to be related to the energetics of imbibition compounds, including acid-base contributions, that result in electrostatic attractions as the liquid molecules are adhered on the fiber surfaces upon capillary contact.

Preparation of Linear Cryogel Arrays as a Microfluidic Platform for Immunochromatographic Assays

We describe a new microfluidic platform to perform immunochromatographic assays. The platform consists of a linear assembly of small, porous cryogel monoliths functionalized with various biomolecules. The cryogels are anchored in an optically transparent capillary, which serves as the microfluidic carrier. This assembly enables fluid flow by capillary action and simple optical detection. Using an in situ preparation method, individual compartments are generated from small plugs of polymer solutions that are transformed into small individually functionalized cryogel monoliths through a photoinduced cross-linking reaction. In the same reaction step, the monoliths are firmly anchored to the surface of the capillary. As proof-of-concept, a prototype platform is successfully used for the detection of the inflammatory marker interleukin 6 via a sandwich immunoassay. We observe excellent assay performance metrics that include high sensitivity, good linearity, and low variation. We also demonstrate fluid transport solely by passive means, which is a critical attribute for point-of-care diagnostics.

Filaments with Affinity Binding and Wet Strength Can Be Achieved by Spinning Bifunctional Cellulose Nanofibrils

We demonstrate benzophenone (BP) conjugation via amine-reactive esters onto oxidized cellulosic fibers that were used as precursors, after microfluidization, of photoactive cellulose nanofibrils (CNF). From these fibrils, cellulose I filaments were synthesized by hydrogel spinning in an antisolvent followed by fast biradical UV cross-linking. As a result, the wet BP-CNF filaments retained extensively the original dry strength (a remarkable ∼80% retention). Thus, the principal limitation of these emerging materials was overcome (the wet tensile strength is typically <0.5% of the value measured in dry conditions). Subsequently, antihuman hemoglobin (anti-Hb) antibodies were conjugated onto residual surface carboxyl groups, making the filaments bifunctional for their active groups and properties (wet strength and bioactivity). Optical (surface plasmon resonance) and electroacoustic (quartz crystal microgravimetry) measurements conducted with the bifunctional CNF indicated effective anti-Hb conjugation (2.4 mg m^-2), endowing an excellent sensitivity toward Hb targets (1.7 ± 0.12 mg m^-2) and negligible nonspecific binding. Thus, the anti-Hb biointerface was deployed on filaments that captured Hb efficiently from aqueous matrices (confocal laser microscopy of FITC-labeled antibodies). Significantly, the anti-Hb biointerface was suitable for regeneration, while its sensitivity and selectivity in affinity binding can be tailored by application of blocking copolymers. The developed bifunctional filaments based on nanocellulose offer great promise in detection and affinity binding built upon 1D systems, which can be engineered into other structures for rational use of material and space.

Paper-based RNA detection and multiplexed analysis for Ebola virus diagnostics

The most performing techniques enabling early diagnosis of infectious diseases rely on nucleic acid detection. Today, because of their high technicality and cost, nucleic acid amplification tests (NAAT) are of benefit only to a small fraction of developing countries population. By reducing costs, simplifying procedures and enabling multiplexing, paper microfluidics has the potential to considerably facilitate their accessibility. However, most of the studies performed in this area have not quit the lab. This letter brings NAAT on paper closer to the field, by using clinical samples and operating in a resource-limited setting. We first performed isothermal reverse transcription and Recombinase Polymerase Amplification (RT-RPA) of synthetic Ribonucleic Acid (RNA) of Ebola virus using paper microfluidics devices. We further applied this method in Guinea to detect the presence of Ebola virus in human sample RNA extracts, with minimal facilities (carry-on detection device and freeze-dried reagents on paper). RT-RPA results were available in few minutes and demonstrate a sensitivity of 90.0% compared to the gold-standard RT-PCR on a set of 43 patient samples. Furthermore, the realization of a nine-spot multilayered device achieving the parallel detection of three distinct RNA sequences opens a route toward the detection of multiple viral strains or pathogens.

Beyond Wicking: Expanding the Role of Patterned Paper as the Foundation for an Analytical Platform

While a number of assays for soluble analytes have been developed using paper-based microfluidic devices, the detection and analysis of blood cells has remained an outstanding challenge. In this Feature, we discuss how the properties of paper determine the performance of paper-based microfluidic devices and permit the design of cellular assays, which can ultimately impact disparities in healthcare that exist in limited-resource settings.

Paper-based analytical devices for clinical diagnosis: recent advances in the fabrication techniques and sensing mechanisms

INTRODUCTION

There is a significant interest in developing inexpensive portable biosensing platforms for various applications including disease diagnostics, environmental monitoring, food safety, and water testing at the point-of-care (POC) settings. Current diagnostic assays available in the developed world require sophisticated laboratory infrastructure and expensive reagents. Hence, they are not suitable for resource-constrained settings with limited financial resources, basic health infrastructure, and few trained technicians. Cellulose and flexible transparency paper-based analytical devices have demonstrated enormous potential for developing robust, inexpensive and portable devices for disease diagnostics. These devices offer promising solutions to disease management in resource-constrained settings where the vast majority of the population cannot afford expensive and highly sophisticated treatment options. Areas covered: In this review, the authors describe currently developed cellulose and flexible transparency paper-based microfluidic devices, device fabrication techniques, and sensing technologies that are integrated with these devices. The authors also discuss the limitations and challenges associated with these devices and their potential in clinical settings. Expert commentary: In recent years, cellulose and flexible transparency paper-based microfluidic devices have demonstrated the potential to become future healthcare options despite a few limitations such as low sensitivity and reproducibility.

Toward practical application of paper-based microfluidics for medical diagnostics: state-of-the-art and challenges

Microfluidic paper-based analytical devices (μPADs) have emerged as a promising diagnostic platform a decade ago. In contrast to highly active academic developments, their entry into real-life applications is still very limited. This discrepancy is attributed to the gap between research developments and their practical utility, particularly in the aspects of operational simplicity, long-term stability of devices, and associated equipment. On the basis of these backgrounds, this review attempts to: 1) identify the reasons for success of paper-based devices already in the market, 2) describe the current status and remaining issues of μPADs in terms of operational complexity, signal interpretation approaches, and storage stability, and 3) discuss the possibility of mass production based on established manufacturing technologies. Finally, the state-of-the-art in commercialisation of μPADs is discussed, and the "upgrades" required from a laboratory-based prototype to an end user device are demonstrated on a specific example.

Technical aspects and challenges of colorimetric detection with microfluidic paper-based analytical devices (μPADs) - A review

Paper-based devices are a leading alternative among the main analytical tools for point-of-care testing, due to their portability, low-cost, and ease-of-use. Colorimetric readouts are the most common method of detection in these microfluidic devices, enabling qualitative, semi-quantitative and fully quantitative analysis of multiple analytes. There is a multitude of ways to obtain a colorimetric output in such devices, including nanoparticles, dyes, redox and pH indicators, and each has unique drawbacks and benefits. There are also multiple variables that impact the analysis of colorimetric reactions in microfluidic paper-based systems, including color homogeneity, image capture methods, and the data handling itself. Here, we present a critical review of recent developments and challenges of colorimetric detection on microfluidic paper-based analytical devices (μPADs), and present thoughts and insights towards future perspectives in the area to improve the use of colorimetric readouts in conjunction with μPADs.

A paper-based platform for detection of viral RNA

Viral detection presents a host of challenges for even the most sensitive analytical techniques, and the complexity of common detection platforms typically preclude portability. With these considerations in mind, we designed a paper microzone plate-based virus detection system for the detection of viral genetic material that can be performed with simple instruments. The sensing system can detect viral cDNA reverse-transcribed from total RNA extraction by utilizing a biotinylated capture probe and an Alexa Fluor® 647-labeled reporter probe. The biotinylated capture probe was linked to the paper surface via NeutrAvidin® that was physically adsorbed on the paper. After addition of reverse-transcribed sample and reporter probe in sequence, the reverse-transcribed target captured the reporter probe and tethered it to the capture probe in a bridged format. Fluorescence intensity was imaged using a Western blot imaging system, and higher target concentration was visible by the increased emission intensity from Alexa Fluor® 647. By utilizing paper, this detection setup could also serve as a sample concentration method via evaporation, which could remarkably lower the detection limit if needed. This detection platform used Epstein-Barr virus (EBV) RNA as a proof-of-concept by sensing cDNA resulting from reverse transcription and can be further expanded as a general method for other pathogens. EBV is a well-known human tumor virus, which has also recently been linked to the development of cervical cancer. The assay was accomplished within two hours including the room-temperature RNA extraction and reverse transcription steps. Also, this paper microzone plate-based platform can potentially be applicable for the development of point-of-care (POC) detection kits or devices due to its robust design, convenient interface, and easy portability. The experiment could be stopped after each step, and continued at a later time. The shelf-life of the modified paper plate setup was at least 3 months without a discernible change in signal, and the result from day 1 could be read at 3 months - both of which are important criteria for POC analytical testing tools, especially in resource-poor settings. All of the required assay steps could potentially be performed without any significant equipment using inexpensive paper microzone plates, which will be ideal for further development of POC testing devices. Although, this platform is not at the stage where it can be directly used in a point-of-care setting, it does have fundamental characteristics such as a stable platform, a simple detection method, and relatively common reagents that align closely with a POC system.

Immunosensors for C-Reactive Protein Based on Ultrathin Films of Carboxylated Cellulose Nanofibrils

C-reactive protein (CRP) is an acute phase protein that has been widely used as a predictor of cardiovascular diseases. We report herein the synthesis of immunosensors based on carboxylated cellulose nanofibrils (CNF) for CRP detection, as demonstrated by quartz crystal microgravimetry (QCM). QCM sensors carrying ultrathin films of carboxylated CNF were prepared by using two protocols: (i) spin coating of CNF on the sensors followed by carboxylation via in situ oxidation with 2,2,6,6-tetramethylpiperidine 1-oxyl and (ii) carboxymethylation of CNF in aqueous dispersion followed by spin coating deposition on the sensors. Protein A was conjugated to the carboxylated CNF via N-(3-(Dimethylamino)propyl)-N'-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide and used as a ligand for oriented immobilization of anti C-reactive protein (anti-CRP). The different carboxyl group density of the two oxidized CNF surfaces influenced Protein A binding and, subsequently, the available immobilized anti-CRP molecules. The detection efficiency for CRP, specificity, and concentration range displayed by the carboxylated CNF-based immunosensors coupled with oriented and unoriented anti-CRP were determined and compared.