A multiplexed three-dimensional paper-based electrochemical impedance device for simultaneous label-free affinity sensing of total and glycated haemoglobin: The potential of using a specific single-frequency value for analysis

Trends in Quantification of HbA1c Using Electrochemical and Point-of-Care Analyzers

Glycated hemoglobin (HbA1c), one of the many variants of hemoglobin (Hb), serves as a standard biomarker of diabetes, as it assesses the long-term glycemic status of the individual for the previous 90-120 days. HbA1c levels in blood are stable and do not fluctuate when compared to the random blood glucose levels. The normal level of HbA1c is 4-6.0%, while concentrations > 6.5% denote diabetes. Conventionally, HbA1c is measured using techniques such as chromatography, spectroscopy, immunoassays, capillary electrophoresis, fluorometry, etc., that are time-consuming, expensive, and involve complex procedures and skilled personnel. These limitations have spurred development of sensors incorporating nanostructured materials that can aid in specific and accurate quantification of HbA1c. Various chemical and biological sensing elements with and without nanoparticle interfaces have been explored for HbA1c detection. Attempts are underway to improve the detection speed, increase accuracy, and reduce sample volumes and detection costs through different combinations of nanomaterials, interfaces, capture elements, and measurement techniques. This review elaborates on the recent advances in the realm of electrochemical detection for HbA1c detection. It also discusses the emerging trends and challenges in the fabrication of effective, accurate, and cost-effective point-of-care (PoC) devices for HbA1c and the potential way forward.

Paper-Based Electrochemical Biosensors for Food Safety Analysis

Nowadays, foodborne pathogens and other food contaminants are among the major contributors to human illnesses and even deaths worldwide. There is a growing need for improvements in food safety globally. However, it is a challenge to detect and identify these harmful analytes in a rapid, sensitive, portable, and user-friendly manner. Recently, researchers have paid attention to the development of paper-based electrochemical biosensors due to their features and promising potential for food safety analysis. The use of paper in electrochemical biosensors offers several advantages such as device miniaturization, low sample consumption, inexpensive mass production, capillary force-driven fluid flow, and capability to store reagents within the pores of the paper substrate. Various paper-based electrochemical biosensors have been developed to enable the detection of foodborne pathogens and other contaminants that pose health hazards to humans. In this review, we discussed several aspects of the biosensors including different device designs (e.g., 2D and 3D devices), fabrication techniques, and electrode modification approaches that are often optimized to generate measurable signals for sensitive detection of analytes. The utilization of different nanomaterials for the modification of electrode surface to improve the detection of analytes via enzyme-, antigen/antibody-, DNA-, aptamer-, and cell-based bioassays is also described. Next, we discussed the current applications of the sensors to detect food contaminants such as foodborne pathogens, pesticides, veterinary drug residues, allergens, and heavy metals. Most of the electrochemical paper analytical devices (e-PADs) reviewed are small and portable, and therefore are suitable for field applications. Lastly, e-PADs are an excellent platform for food safety analysis owing to their user-friendliness, low cost, sensitivity, and a high potential for customization to meet certain analytical needs.

Fabrication of a Disposable Electrochemical Immunosensor Based on Nanochannel Array Modified Electrodes and Gated Electrochemical Signals for Sensitive Determination of C-Reactive Protein

Sensitive determination of C-reactive protein (CRP) is of great significance because it is an early indicator of inflammation in cardiovascular disease and acute myocardial infarction. A disposable electrode with an integrated three-electrode system (working, reference, and counter electrodes) has great potential in the detection of biomarkers. In this work, an electrochemical immunosensing platform was fabricated on disposable and integrated screen-printed carbon electrode (SPCE) by introducing nanochannel arrays and gated electrochemical signals, which can achieve the sensitive detection of CRP in serum. To introduce active reactive groups for the fabrication of immuno-recognitive interface, vertically-ordered mesoporous silica-nanochannel film (VMSF) with rich amino groups (NH₂-VMSF) was rapidly grown by electrochemical assisted self-assembly (EASA). The electrochemically reduced graphene oxide (ErGO) synthesized in situ during the growth of NH₂-VMSF was used as a conductive adhesive glue to achieve stable bonding of the nanochannel array (NH₂-VMSF/ErGO/SPCE). After the amino group on the outer surface of NH₂-VMSF reacted with bifunctional glutaraldehyde (GA/NH₂-VMSF/ErGO/SPCE), the converted aldehyde surface was applied for covalent immobilization of the recognitive antibody (Ab) followed with the blocking of the non-specific sites. The fabricated immunosensor, Ab/GA/NH₂-VMSF/ErGO/SPCE, enables sensitive detection of CRP in the range from 10 pg/mL to 100 ng/mL with low limit of detection (LOD, 8 pg/mL, S/N = 3). The immunosensor possessed high selectivity and can realize reliable determination of CRP in human serum.

Glycated Hemoglobin Electrochemical Immunosensor Based on Screen-Printed Electrode

An electrochemical HbA1c sensor with high sensitivity and good specificity is proposed based on the electrochemical immune principle. The reproducibility and conductivity of the electrode are improved by depositing gold nanoparticles (AuNPs) on the surface of the screen-printed electrode (SPE). The HbA1c antibodies are immobilized on the surface of the modified electrode by adsorption to capture the HbA1c in the sample. The hindering effect of HbA1c on the electrode transfer reaction was exploited as the HbA1c detection mechanism. The electrode's properties were characterized by electrochemical impedance spectroscopy (EIS), and the measurement properties of the electrode were analyzed using differential pulse voltammetry (DPV) and cyclic voltammetry (CV). The experimental results show that the peak current signal of the electrochemical immunosensor produced a linear response to HbA1c in the concentration range of 20-200 μg/mL, a linear relationship coefficient of 0.9812, a detection limit of 15.5 µg/mL, and a sensitivity of 0.0938 µA/µg·mL^-1. The sensor delivered satisfactory repeatability, stability, and anti-interference performance. Due to its small size, high sensitivity, and wide linear detection range, it is expected to play a significant role in managing diabetes at home.

A Review of Electrochemical Sensors for the Detection of Glycated Hemoglobin

Glycated hemoglobin (HbA1c) is the gold standard for measuring glucose levels in the diagnosis of diabetes due to the excellent stability and reliability of this biomarker. HbA1c is a stable glycated protein formed by the reaction of glucose with hemoglobin (Hb) in red blood cells, which reflects average glucose levels over a period of two to three months without suffering from the disturbance of the outside environment. A number of simple, high-efficiency, and sensitive electrochemical sensors have been developed for the detection of HbA1c. This review aims to highlight current methods and trends in electrochemistry for HbA1c monitoring. The target analytes of electrochemical HbA1c sensors are usually HbA1c or fructosyl valine/fructosyl valine histidine (FV/FVH, the hydrolyzed product of HbA1c). When HbA1c is the target analyte, a sensor works to selectively bind to specific HbA1c regions and then determines the concentration of HbA1c through the quantitative transformation of weak electrical signals such as current, potential, and impedance. When FV/FVH is the target analyte, a sensor is used to indirectly determine HbA1c by detecting FV/FVH when it is hydrolyzed by fructosyl amino acid oxidase (FAO), fructosyl peptide oxidase (FPOX), or a molecularly imprinted catalyst (MIC). Then, a current proportional to the concentration of HbA1c can be produced. In this paper, we review a variety of representative electrochemical HbA1c sensors developed in recent years and elaborate on their operational principles, performance, and promising future clinical applications.

Current Challenges and Future Trends of Enzymatic Paper-Based Point-of-Care Testing for Diabetes Mellitus Type 2

A point-of-care (POC) can be defined as an in vitro diagnostic test that can provide results within minutes. It has gained enormous attention as a promising tool for biomarkers detection and diagnosis, as well as for screening of chronic noncommunicable diseases such as diabetes mellitus. Diabetes mellitus type 2 is one of the metabolic disorders that has grown exponentially in recent years, becoming one of the greatest challenges to health systems. Early detection and accurate diagnosis of this disorder are essential to provide adequate treatments. However, efforts to reduce incidence should remain not only in these stages but in developing continuous monitoring strategies. Diabetes-monitoring tools must be accessible and affordable; thus, POC platforms are attractive, especially paper-based ones. Paper-based POCs are simple and portable, can use different matrixes, do not require highly trained staff, and are less expensive than other platforms. These advantages enhance the viability of its application in low-income countries and hard-to-reach zones. This review aims to present a critical summary of the main components required to create a sensitive and affordable enzymatic paper-based POC, as well as an oriented analysis to highlight the main limitations and challenges of current POC devices for diabetes type 2 monitoring and future research opportunities in the field.

Hand-drawn electrode based disposable paper chip for artificial sweat analysis using impedance spectroscopy

Low cost, disposable paper based electrical sensor to examine the analyte concentration in an extremely small volume of sample solution is essential for environmental and healthcare applications. For the development of paper based devices, sophisticated instruments are essential to pattern electrode on the top surface of the paper. In most cases, such fabricated device results in direct contact with the analyte solution on the surface of the electrode during electrical detection and leads to high electrical double layer capacitance. In this work, we have focused to reduce the double layer capacitance by fabricating hand drawn electrode paper sensor utilising the reverse side of the paper. This design acts as a sample storage and facilitate impedimetric sensing of ionic concentration of analyte solution using a few microlitre. Droplet formation at the bottom of the paper in the confined area is visually monitored to reduce sample wastage. The interaction between two different electrode materials (graphite and silver) on the paper substrate with the different volume and concentration of the electrolyte is analysed to improve the robustness and sensitivity of the measurement. Simultaneously, we observed a reduction in the electrical double layer effect on the low sample volumes. The proposed paper based sensor shows the enhanced impedance stability on silver electrode patterned paper chip than graphite electrode paper chip to detect the different ionic concentration of artificial sweat sample. Finally, it demonstrates that paper chip has great potential as a disposable diagnostics sensor in healthcare applications.

Recent advances in lab-on-paper diagnostic devices using blood samples

Lab-on-paper, or microfluidic paper-based analytical devices (μPADs), use paper as a substrate material, and are patterned with a system of microchannels, reaction zones and sensing elements to perform analysis and detection. The sample transfer in such devices is performed by capillary action. As a result, external driving forces are not required, and hence the size and cost of the device are significantly reduced. Lab-on-paper devices have thus attracted significant attention for point-of-care medical diagnostic purposes in recent years, particularly in less-developed regions of the world lacking medical resources and infrastructures. This review discusses the major advances in lab-on-paper technology for blood analysis and diagnosis in the past five years. The review focuses particularly on the many clinical applications of lab-on-paper devices, including diabetes diagnosis, acute myocardial infarction (AMI) detection, kidney function diagnosis, liver function diagnosis, cholesterol and triglyceride (TG) analysis, sickle-cell disease (SCD) and phenylketonuria (PKU) analysis, virus analysis, C-reactive protein (CRP) analysis, blood ion analysis, cancer factor analysis, and drug analysis. The review commences by introducing the basic transmission principles, fabrication methods, structural characteristics, detection techniques, and sample pretreatment process of modern lab-on-paper devices. A comprehensive review of the most recent applications of lab-on-paper devices to the diagnosis of common human diseases using blood samples is then presented. The review concludes with a brief summary of the main challenges and opportunities facing the lab-on-paper technology field in the coming years.

Paper-based sensors for the application of biological compound detection

This chapter describes the importance of PADs for biomarker detection. The screening of disease markers and other biomolecules that related to health conditions have play important roles for an indication of the risk from infections and other diseases. Paper-based analytical devices (PADs) is an excellent option for applications of biomarker detection because it contains all advantages which arise from the paper material. Moreover, the uncomplicated techniques including electrochemistry and colorimetry can be easily applied on PADs for the analytical detection. The detection method can be categorized into three main topics: enzymatic methods, immunoassays, and DNA sensors. Following the main context, other interesting applications also present in this chapter.

Recent advances in and potential utilities of paper-based electrochemical sensors: beyond qualitative analysis

Paper based electrochemical sensors (PESs) are simple, low-cost, portable and disposable analytical sensing platforms that can be applied in clinical diagnostics, food quality control and environmental monitoring.

Trends in Paper-based Electrochemical Biosensors: From Design to Application

Electrochemical bio-sensing using paper-based detection systems is the main focus of this review. The different existing designs of 2-dimensional and 3-dimensional sensors, and fabrication techniques are discussed. This review highlights the effect of adopting different sensor designs, distinct fabrication techniques, as well as different modification methods, in order to produce reliable and reproducible reading. The use of various nanomaterials have been demonstrated in order to modify the surface of electrodes during fabrication to further enhance the signal for subsequent analysis. The reviewed sensors were classified into categories based on their applications, such as diagnostics, environmental and food testing. One of the major advantages of using paper-based electrochemical sensors is the potential for miniaturization, which only requires relatively small amount of samples, and the low cost for the purpose of mass production. Additionally, most of the devices reviewed were made to be portable, making them well-suited for on-site detection. Finally, paper-based detection is an ideal platform to fabricate cost-effective, user-friendly and sensitive electrochemical biosensors, with large capacity for customization depending on functional needs.

Direct Measurement of a Biomarker's Native Optimal Frequency with Physical Adsorption Based Immobilization

The optimal frequency (OF) of a biomarker in electrochemical impedance spectroscopy (EIS) is the frequency at which the EIS response best reflects the binding of the biomarker to its molecular recognition element. Commonly, biosensors rely on complicated immobilization chemistry to attach biological molecules to the sensor surface, making the direct study of a biomarker's native OF a challenge. Physical adsorption presents a simple immobilization strategy to study the native biomarker's OF, but its utility is often discouraged due to a loss in biological activity. To directly study a biomarker's native OF and investigate the potential of OF to overcome the limitations of physical adsorption, a combination of EIS and glutaraldehyde-mediated physical adsorption was explored. The experimental sensing platform was prepared by immobilizing either anti-lactoferrin (Lfn) IgG or anti-immunoglobulin E (IgE) onto screen printed carbon electrodes. After characterizing the native OFs of both biomarkers, investigation of the platform's specificity, stability, and performance in complex medium was found to be sufficient. Finally, a paper-based tear sampling component was integrated to transform the testing platform into a prototypical point-of-care dry eye diagnostic. The investigation of native OFs revealed a correlation between the native OFs (57.44 and 371.1 Hz for Lfn and IgE, respectively) and the molecular weight of the antibody-antigen complex. Impedance responses at the native OFs have enabled detection limits of 0.05 mg/mL and 40 ng/mL for Lfn and IgE, respectively, covering the clinically relevant ranges. The native OFs were found to be robust across various testing mediums and conditions.

New Titanium Dioxide-Based Heterojunction Nanohybrid for Highly Selective Photoelectrochemical-Electrochemical Dual-Mode Sensors

A new titanium dioxide (TiO₂)-based heterojunction nanohybrid (HJNH) composed of TiO₂, graphene (G), poly[3-aminophenylboronic acid] (PAPBA), and gold nanoparticles (Au NPs) was synthesized and designated as TiO₂(G) NW@PAPBA-Au HJNH. The TiO₂(G) NW@PAPBA-Au HJNH possesses dual-mode signal photoelectrochemical (PEC) and electrochemical transduction capabilities to sense glucose and glycated hemoglobin (HbA1c) independently. The synthesis of the HJNH material involved two sequential stages: (i) simple electrospinning synthesis of G-embedded TiO₂ nanowires [TiO₂(G) NWs] and (ii) one-step synthesis of Au NP-dispersed PAPBA nanocomposite (NC) in the presence of TiO₂(G) NWs. The as-synthesized TiO₂(G) NW@PAPBA-Au HJNH was characterized by field emission scanning electron microscopy, field emission transmission electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy, Fourier transform infrared, thermogravimetric analysis, and UV-visible diffuse reflectance spectroscopy. A PEC platform was developed with TiO₂(G) NW@PAPBA-Au HJNH for the selective detection of glucose without any enzyme auxiliary. The PEC glucose sensor presents an acceptable linear range (from 0.5 to 28 mM), good sensitivity (549.58 μA mM^-1 cm^-2), and low detection limit (0.11 mM), which are suited for diabetes glucose monitoring. Besides, the boronic acid groups in PAPBA were utilized as a host to capture HbA1c. We fabricated the electrochemical HbA1c sensor based on monitoring the electrocatalytic reduction current of hydrogen peroxide produced by HbA1c tethered to the sensor probe. The amperometric electrochemical sensor for HbA1c exhibited linear responses to HbA1c levels from 2.0 to 10% (with a detection limit of 0.17%). Notably, the performances of the fabricated glucose and HbA1c sensors are superior in the dual-signal transduction modes as compared to the literature, suggesting the significance of the newly designed bifunctional TiO₂(G) NW@PAPBA-Au HJNH.

Current Status of HbA1c Biosensors

Glycated hemoglobin (HbA1c) is formed via non-enzymatic glycosylation reactions at the α–amino group of βVal1 residues in the tetrameric Hb, and it can reflect the ambient glycemic level over the past two to three months. A variety of HbA1c detection methods, including chromatography, immunoassay, enzymatic measurement, electrochemical sensor and capillary electrophoresis have been developed and used in research laboratories and in clinics as well. In this review, we summarize the current status of HbA1c biosensors based on the recognition of the sugar moiety on the protein and also their applications in the whole blood sample measurements.

Paper based diagnostics for personalized health care: Emerging technologies and commercial aspects

Personalized health care (PHC) is being appreciated globally to combat clinical complexities underlying various metabolic or infectious disorders including diabetes, cardiovascular, communicable diseases etc. Effective diagnoses majorly depend on initial identification of the causes which are nowadays being practiced in disease-oriented approach, where personal health profile is often overlooked. The adoption of PHC has shown significantly improved diagnoses in various conditions including emergency, ambulatory, and remote area. PHC includes personalized health monitoring (PHM), which is its integral part and may provide valuable information's on various clinical conditions. In PHC, bio-fluids are analyzed using various diagnostic devices including lab based equipment and biosensors. Among all types of biosensing systems, paper based biosensors are commercially attracted due to its portability, easy availability, cheaper manufacturing cost, and transportability. Not only these, various intrinsic properties of paper has facilitated the development of paper based miniaturized sensors, which has recently gained ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment free, Deliverable to all end-users) status for point of care diagnosis in miniaturized settings. In this review, importance of paper based biosensors and their compatibility for affordable and low cost diagnostics has been elaborated with various examples. Limitations and strategies to overcome the challenges of paper biosensor have also been discussed. We have provided elaborated tables which describe the types, model specifications, sensing mechanisms, target biomarkers, and analytical performance of the paper biosensors with their respective applications in real sample matrices. Different commercial aspects of paper biosensor have also been explained using SWOT (Strength, Weakness, Opportunities, Threats) analysis.