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Schobesberger S, Thumfart H, Selinger F, Schlimp CJ, Zipperle J, Ertl P. Development of a Paper-based Hematocrit Test and a Lateral Flow Assay to Detect Critical Fibrinogen Concentrations Using a Bottom-Up Pyramid Workflow Approach. ACS OMEGA 2024; 9:8533-8542. [PMID: 38405462 PMCID: PMC10882670 DOI: 10.1021/acsomega.3c10045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
Fibrinogen is a coagulation factor in human blood and the first one to reach critical levels in major bleeding. Hypofibrinogenemia (a too low fibrinogen concentration in blood) poses great challenges to first responders, clinicians, and healthcare providers since it represents a risk factor for exsanguination and massive transfusion requirements. Thus, the rapid assessment of the fibrinogen concentration at the point of care has gained considerable importance in preventing and managing major blood loss. However, in whole blood measurements, hematocrit variations affect the amount (volume fraction) of plasma that passes the detection zone. In an attempt to accurately determine realistic critical levels of fibrinogen (<1.5 mg/mL) in patients needing immediate treatment and medical interventions, we have developed novel diagnostic systems capable of estimating hematocrit and critical fibrinogen concentrations. A lateral flow assay (LFA) for the detection of fibrinogen has been developed by establishing a workflow employing rapid characterization methods to streamline LFA development. The integration of two detection lines enables (i) the identification of fibrinogen (first line) present in the sample and (ii) the determination of the clinically critical fibrinogen concentrations below 1.5 mg/mL (second line). Furthermore, the paper-based separation of blood cells from plasma provides a semiquantitative estimate of the hematocrit by analyzing the fractions. Initial validation of the point-of-care (PoC) hematocrit test revealed good comparability to a standard laboratory method. The developed diagnostic systems have the ability to accelerate decision-making in cases with major bleeding.
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Affiliation(s)
| | - Helena Thumfart
- Faculty of Technical Chemistry, TU Wien, Getreidemarkt 9, 1060 Vienna, Austria
| | - Florian Selinger
- Faculty of Technical Chemistry, TU Wien, Getreidemarkt 9, 1060 Vienna, Austria
| | - Christoph J Schlimp
- Ludwig-Boltzmann-Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria
- Department of Anaesthesiology and Intensive Care, AUVA Trauma Center Linz, Garnisonstraße 7, 4010 Linz, Austria
| | - Johannes Zipperle
- Ludwig-Boltzmann-Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria
| | - Peter Ertl
- Faculty of Technical Chemistry, TU Wien, Getreidemarkt 9, 1060 Vienna, Austria
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Saidykhan J, Selevic L, Cinti S, May JE, Killard AJ. Paper-Based Lateral Flow Device for the Sustainable Measurement of Human Plasma Fibrinogen in Low-Resource Settings. Anal Chem 2021; 93:14007-14013. [PMID: 34615344 PMCID: PMC8529579 DOI: 10.1021/acs.analchem.1c03665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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Fibrinogen
concentration is a major determinant of both clotting
and bleeding risk. Clotting and bleeding disorders cause extensive
morbidity and mortality, particularly in resource-poor and emergency
settings. This is exacerbated by a lack of timely intervention informed
by measurement of fibrinogen levels under conditions such as thrombosis
or postpartum haemorrhage. There is an absence of simple, rapid, low-cost,
and sustainable diagnostic devices for fibrinogen measurement that
can be deployed in such environments. Paper-based analytical devices
are of significant interest due to their potential for low-cost production,
ease of use, and environmental sustainability. In this work, a device
for measuring blood plasma fibrinogen using chromatography paper was
developed. Wax printing was used to create hydrophobic structures
to define the test channel and sample application zone. Test strips
were modified with bovine thrombin. Plasma samples (22 μL) were
applied, and the flow rate was monitored over 5 min. As the sample
traversed the strip, clotting was induced by the conversion of soluble
fibrinogen to insoluble fibrin. The flow rate and distance travelled
by the sample were dependent on fibrinogen concentration. The device
was able to measure fibrinogen concentration in the range of 0.5–7.0
± 0.3 mg/mL (p < 0.05, n = 24) and had excellent correlation with laboratory coagulometry
in artificial samples (r2 = 0.9582, n = 60). Devices were also stable at 4–6 °C
for up to 3 weeks.
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Affiliation(s)
- Jerro Saidykhan
- Centre for Research in Biosciences (CRIB), Department of Applied Sciences, University of the West of England, Coldhar-bour Lane, Bristol BS16 1QY, U.K
| | - Laura Selevic
- Centre for Research in Biosciences (CRIB), Department of Applied Sciences, University of the West of England, Coldhar-bour Lane, Bristol BS16 1QY, U.K
| | - Stefano Cinti
- Department of Pharmacy, University of Naples "Federico II", Via Domenico Montesano 49, Napoli 80131, Italy
| | - Jennifer E May
- Centre for Research in Biosciences (CRIB), Department of Applied Sciences, University of the West of England, Coldhar-bour Lane, Bristol BS16 1QY, U.K
| | - Anthony J Killard
- Centre for Research in Biosciences (CRIB), Department of Applied Sciences, University of the West of England, Coldhar-bour Lane, Bristol BS16 1QY, U.K
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Shu C, Li TF, Li D, Li ZQ, Xia XH. Barcode signal amplifying strategy for sensitive and accurate protein detection on LC-MS/MS. Analyst 2021; 146:1725-1733. [PMID: 33459316 DOI: 10.1039/d0an01948h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Protein drugs showing strong pharmaceutical activity, high specificity, and low toxicity and side effects have drawn extensive attention in the field of life sciences and medicine. Precise evaluation of the function of these drugs requires accurate and sensitive detection methods. Here, we report a novel chromatography-tandem mass spectrometry (LC-MS/MS) method for sensitive and selective detection of protein drugs. Magnetic nanoparticles (Apt29@MNPs) were functionalized by thrombin aptamers, and quantum dots (Apt15@ss@QDs) were dual-functionalized with quantitative thrombin aptamers and small molecules with high ionization efficiency as the mass barcode. After Apt29@MNPs specifically purify and enrich thrombin from biological samples, they can form a nano "sandwich structure" when Apt15@ss@QDs are added, resulting in the release of the mass barcode for LC-MS/MS analysis via the cutting of the disulfide bond. Since there is a higher quantitative molecular ratio of mass barcode to thrombin in the nano-"sandwich structure", quantitative detection of thrombin with high sensitivity and selectivity can be achieved via the LC-MS/MS detection of the mass barcode with high ionization efficiency rather than thrombin, which effectively avoids the disadvantages of direct protein detection by mass spectrometry. The established method for thrombin detection shows a good linear relationship in a concentration range of 0.00115-1.15 nM with a limit of detection (LOD) of 0.0007 nM. The present work provides a new approach for the effective and sensitive quantitative analysis of protein drugs and would be of great significance in promoting the development of protein drugs and clinical applications.
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Affiliation(s)
- Chang Shu
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, China. and Department of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Teng-Fei Li
- School of Pharmacy, Department of Clinical Pharmacology, Sir Run Hospital, Nanjing Medical University, Nanjing 211166, China
| | - Duo Li
- Department of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Zhong-Qiu Li
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, China.
| | - Xing-Hua Xia
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, China.
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Bialkower M, Manderson CA, McLiesh H, Tabor RF, Garnier G. Paper Diagnostic for Direct Measurement of Fibrinogen Concentration in Whole Blood. ACS Sens 2020; 5:3627-3638. [PMID: 33095567 DOI: 10.1021/acssensors.0c01937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The ability to diagnose and treat critically bleeding patients can save more than 2 million lives a year. Diagnosing hypofibrinogenemia is essential in these patients. Recently, with the development of new handheld diagnostics, fibrinogen concentration can be measured rapidly at the point of care. However, these diagnostics can only work with plasma and hence need blood cells to be separated before use. In this study, we demonstrate a handheld fibrinogen diagnostic that works with whole blood. The test works by (1) forming a premixed droplet of a whole blood sample and thrombin solution on a solid surface, (2) allowing it to clot, and (3) dropping a paper strip on top. The further that blood moves down the strip, the lower the fibrinogen concentration. The diagnostic can easily measure plasma fibrinogen concentrations below 1.6 g/L for blood samples with hematocrits between 40 and 50%. Furthermore, diluting blood samples not only increases the test's sensitivity but also eliminates the effect of hematocrit and thrombin inhibitors. The test can be completed in 3-4 min, making it suitable for diagnosing early hypofibrinogenemia and allowing for fibrinogen replacement therapy in critically bleeding patients.
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Affiliation(s)
- Marek Bialkower
- BioPRIA and Department of Chemical Engineering, Monash University, Clayton, VIC 3800, Australia
| | - Clare A. Manderson
- BioPRIA and Department of Chemical Engineering, Monash University, Clayton, VIC 3800, Australia
| | - Heather McLiesh
- BioPRIA and Department of Chemical Engineering, Monash University, Clayton, VIC 3800, Australia
| | - Rico F. Tabor
- School of Chemistry, Monash University, Clayton, VIC 3800, Australia
| | - Gil Garnier
- BioPRIA and Department of Chemical Engineering, Monash University, Clayton, VIC 3800, Australia
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Abstract
Fibrinogen is one of the first factors to fall to critically low levels in the blood in many coagulopathic events. Patients with hypofibrinogenemia are at a significantly greater risk of major hemorrhage and death. The rapid replacement of fibrinogen early on in hypofibrinogenemia may significantly improve outcomes for patients. Fibrinogen is present at concentrations between 2 and 4 g/L in the plasma of healthy people. However, hypofibrinogenemia is diagnosed when the fibrinogen level drops below 1.5-2 g/L. This review analyses different types of fibrinogen assays that can be used for diagnosing hypofibrinogenemia. The scientific mechanisms and limitations behind these tests are then presented. Additionally, the current state of clinical major hemorrhage protocols (MHPs) is presented and the structure, function and physiological role of fibrinogen is summarized.
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Affiliation(s)
- Marek Bialkower
- BioPRIA and Department of Chemical Engineering, Monash University, Clayton, Australia
| | - Gil Garnier
- BioPRIA and Department of Chemical Engineering, Monash University, Clayton, Australia
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