Non-faradaic electrochemical impedimetric profiling of procalcitonin and C-reactive protein as a dual marker biosensor for early sepsis detection

Advances in Bioelectrode Design for Developing Electrochemical Biosensors

The critical performance factors such as selectivity, sensitivity, operational and storage stability, and response time of electrochemical biosensors are governed mainly by the function of their key component, the bioelectrode. Suitable design and fabrication strategies of the bioelectrode interface are essential for realizing the requisite performance of the biosensors for their practical utility. A multifaceted attempt to achieve this goal is visible from the vast literature exploring effective strategies for preparing, immobilizing, and stabilizing biorecognition elements on the electrode surface and efficient transduction of biochemical signals into electrical ones (i.e., current, voltage, and impedance) through the bioelectrode interface with the aid of advanced materials and techniques. The commercial success of biosensors in modern society is also increasingly influenced by their size (and hence portability), multiplexing capability, and coupling in the interface of the wireless communication technology, which facilitates quick data transfer and linked decision-making processes in real-time in different areas such as healthcare, agriculture, food, and environmental applications. Therefore, fabrication of the bioelectrode involves careful selection and control of several parameters, including biorecognition elements, electrode materials, shape and size of the electrode, detection principles, and various fabrication strategies, including microscale and printing technologies. This review discusses recent trends in bioelectrode designs and fabrications for developing electrochemical biosensors. The discussions have been delineated into the types of biorecognition elements and their immobilization strategies, signal transduction approaches, commonly used advanced materials for electrode fabrication and techniques for fabricating the bioelectrodes, and device integration with modern electronic communication technology for developing electrochemical biosensors of commercial interest.

Advancement in biomarker based effective diagnosis of neonatal sepsis

Neonatal sepsis is considered as alarming medical emergency and becomes the common global reason of neonatal mortality. Non-specific symptoms and limitations of conventional diagnostic methods for neonatal sepsis mandate fast and reliable method to diagnose disease for point of care application. Recently, disease specific biomarkers have gained interest for rapid diagnosis that led to the development of electrochemical biosensor with enhanced specificity, sensitivity, cost-effectiveness and user-friendliness. Other than conventional biomarker C-reactive protein to diagnose neonatal sepsis, several potential biomarkers including Procalcitonin (PCT), Serum amyloid A (SAA) and other candidates are extensively investigated. The present review provides insights on advancements and diagnostic abilities of protein and nucleotide based biomarkers with their incorporation in developing electrochemical biosensors by employing novel fabrication strategies. This review provides an overview of most promising biomarker and its capability for neonatal sepsis diagnosis to fulfil future demand to develop electrochemical biosensor for point-of-care applications.

Advancing chirality analysis through enhanced enantiomer characterization and quantification via fast Fourier transform capacitance voltammetry

The exploration of the chiral configurations of enantiomers represents a highly intriguing realm of scientific inquiry due to the distinct roles played by each enantiomer (D and L) in chemical reactions and their practical utilities. This study introduces a pioneering analytical methodology, termed fast Fourier transform capacitance voltammetry (FFT-CPV), in conjunction with principal component analysis (PCA), for the identification and quantification of the chiral forms of tartaric acid (TA), serving as a representative model system for materials exhibiting pronounced chiral characteristics. The proposed methodology relies on the principle of chirality, wherein the capacitance signal generated by the adsorption of D-TA and L-TA onto the surface of a platinum electrode (Pt-electrode) in an acidic solution is harnessed. The capacitance voltammograms were meticulously recorded under optimized experimental conditions. To compile the final dataset for the analyte, the average of the FFT capacitance voltammograms of the acidic solution (without the presence of the analyte) was subtracted from those containing the analyte. A distinct arrangement was obtained by employing PCA as a linear data transformation method, representing D-TA and L-TA in a two/three-dimensional space. The outcomes of the study reveal the successful detection of the two chiral forms of TA with a considerable degree of precision and reproducibility. Moreover, the proposed method facilitated the establishment of two linear response ranges for the concentration values of each enantiomer, spanning from 1 to 20 µM, and 50 to 500 µM. The respective detection limits were also determined to be 0.4 µM for L-TA and 1.3 µM for D-TA. These findings underscore the satisfactory sensitivity and efficiency of the proposed method in both qualitative and quantitative assessments of the chiral forms of TA.

Ultrasensitive Photoelectrochemical Immunoassay Strategy Based on Bi2S3/Ag2S for the Detection of the Inflammation Marker Procalcitonin

As an inflammatory marker, procalcitonin (PCT) is more representative than other traditional inflammatory markers. In this work, a highly efficient photoelectrochemical (PEC) immunosensor was constructed based on the photoactive material Bi₂S₃/Ag₂S to realize the sensitive detection of PCT. Bi₂S₃ was prepared by a hydrothermal method, and Ag₂S quantum dots were deposited on the ITO/Bi₂S₃ surface via in situ reduction. Bi₂S₃ is a kind of admirable photoelectric semiconductor nanomaterial on account of its moderate bandgap width and low binding rate of photogenerated electron holes, which can effectively convert light energy into electrical energy. Therefore, based on the energy level matching principle of Bi₂S₃ and Ag₂S, a labeled Bi₂S₃/Ag₂S PEC immunosensor was constructed, and the sensitive detection of PCT was successfully established. The linear detection range of the PEC immunosensor was 0.50 pg∙mL^-1 to 50 ng∙mL^-1, and the minimum detection limit was 0.18 pg∙mL^-1. Compared with the traditional PEC strategy, the proposed PEC immunosensor is simple, convenient, and has good anti-interference, sensitivity, and specificity, which could provide a meaningful theoretical basis and reference value for the clinical detection of PCT.

Investigating the Electric Field Lysis of Exosomes Immobilized on the Screen-Printed Electrode and Electrochemical Sensing of the Lysed-Exosome-Derived Protein

It is important to isolate exosomes (<150 nm) from biofluid for diagnosis or prognosis purposes, followed by sensing of exosomal proteins. In the present work, exosomes are isolated from human serum by immobilizing on a Screen-Printed Electrode (SPE) followed by electric field lysis and electrochemical impedance spectroscopy (EIS)-based sensing of relevant exosomal proteins (HSP70 and HER2). Upon immobilization of exosomes on the surface, the role of different electrical signals (sinusoidal and square wave) in the lysis of exosomes was studied by varying the frequency and voltage. HSP70 was used for EIS to determine the optimal voltage and frequency for lysing the exosomes. It was observed that the low frequencies and, specifically, sinusoidal signals are ideal for lysing exosomes as compared to square signals. The relative quantity of HSP70 obtained by lysing with different voltages (sinusoidal waveform) was compared using Western blotting. After electric field lysis of the exosome with an optimized signal, HER2, a breast cancer biomarker, was detected successfully from serum by EIS. In the proposed technique, 3.5 × 10⁸ exosomes/mL were isolated from serum. With the limit of detection of 10 pg, the designed cell showed a linear detection of HER2 from 0.1 ng to 1 µg. It was observed from the results that the electric field lysis of exosomes not only plays a significant role in releasing the cargo protein but also improves the sensing of surface proteins associated with exosomes.

Highly Sensitive Readout Interface for Real-Time Differential Precision Measurements with Impedance Biosensors

Field deployment is critical to developing numerous sensitive impedance transducers. Precise, cost-effective, and real-time readout units are being sought to interface these sensitive impedance transducers for various clinical or environmental applications. This paper presents a general readout method with a detailed design procedure for interfacing impedance transducers that generate small fractional changes in the impedance characteristics after detection. The emphasis of the design is obtaining a target response resolution considering the accuracy in real-time. An entire readout unit with amplification/filtering and real-time data acquisition and processing using a single microcontroller is proposed. Most important design parameters, such as the signal-to-noise ratio (SNR), common-mode-to-differential conversion, digitization configuration/speed, and the data processing method are discussed here. The studied process can be used as a general guideline to design custom readout units to interface with various developed transducers in the laboratory and verify the performance for field deployment and commercialization. A single frequency readout unit with a target 8-bit resolution to interface differentially placed transducers (e.g., bridge configuration) is designed and implemented. A single MCU is programmed for real-time data acquisition and sine fitting. The 8-bit resolution is achieved even at low SNR levels of roughly 7 dB by setting the component values and fitting algorithm parameters with the given methods.

Design and Preparation of Sensing Surfaces for Capacitive Biodetection

Despite their high sensitivity and their suitability for miniaturization, biosensors are still limited for clinical applications due to the lack of reproducibility and specificity of their detection performance. The design and preparation of sensing surfaces are suspected to be a cause of these limitations. Here, we first present an updated overview of the current state of use of capacitive biosensors in a medical context. Then, we summarize the encountered strategies for the fabrication of capacitive biosensing surfaces. Finally, we describe the characteristics which govern the performance of the sensing surfaces, along with recent developments that were suggested to overcome their main current limitations.

A Proof-of-Concept Electrochemical Skin Sensor for Simultaneous Measurement of Glial Fibrillary Acidic Protein (GFAP) and Interleukin-6 (IL-6) for Management of Traumatic Brain Injuries

This work demonstrates the use of a noninvasive, sweat-based dual biomarker electrochemical sensor for continuous, prognostic monitoring of a Traumatic Brain Injury (TBI) with the aim of enhancing patient outcomes and reducing the time to treatment after injury. A multiplexed SWEATSENSER was used for noninvasive continuous monitoring of glial fibrillary acidic protein (GFAP) and Interleukin-6 (IL-6) in a human sweat analog and in human sweat. Electrochemical impedance spectroscopy (EIS) and chronoamperometry (CA) were used to measure the sensor response. The assay chemistry was characterized using Fourier Transform Infrared Spectroscopy (FTIR). The SWEATSENSER was able to detect GFAP and IL-6 in sweat over a dynamic range of 3 log orders for GFAP and 2 log orders for IL-6. The limit of detection (LOD) for GFAP detection in the sweat analog was estimated to be 14 pg/mL using EIS and the LOD for IL-6 was estimated to be 10 pg/mL using EIS. An interference study was performed where the specific signal was significantly higher than the non-specific signal. Finally, the SWEATSENSER was able to distinguish between GFAP and IL-6 in simulated conditions of a TBI in human sweat. This work demonstrates the first proof-of-feasibility of a multiplexed TBI marker combined with cytokine and inflammatory marker detection in passively expressed sweat in a wearable form-factor that can be utilized toward better management of TBIs. This is the first step toward demonstrating a noninvasive enabling technology that can enable baseline tracking of an inflammatory response.

Emerging Biosensing Technologies towards Early Sepsis Diagnosis and Management

Sepsis is defined as a systemic inflammatory dysfunction strictly associated with infectious diseases, which represents an important health issue whose incidence is continuously increasing worldwide. Nowadays, sepsis is considered as one of the main causes of death that mainly affects critically ill patients in clinical settings, with a higher prevalence in low-income countries. Currently, sepsis management still represents an important challenge, since the use of traditional techniques for the diagnosis does not provide a rapid response, which is crucial for an effective infection management. Biosensing systems represent a valid alternative due to their characteristics such as low cost, portability, low response time, ease of use and suitability for point of care/need applications. This review provides an overview of the infectious agents associated with the development of sepsis and the host biomarkers suitable for diagnosis and prognosis. Special focus is given to the new emerging biosensing technologies using electrochemical and optical transduction techniques for sepsis diagnosis and management.

An Electrochemical Immunosensor for the Determination of Procalcitonin Using the Gold-Graphene Interdigitated Electrode

Procalcitonin (PCT) is considered a sepsis and infection biomarker. Herein, an interdigitated electrochemical immunosensor for the determination of PCT has been developed. The interdigitated electrode was made of the laser-engraved graphene electrode decorated with gold (LEGE/Aunano). The scanning electron microscopy indicated the LEGE/Aunano has been fabricated successfully. After that, the anti-PTC antibodies were immobilized on the surface of the electrode by using 3-mercaptopropionic acid. The electrochemical performance of the fabricated immunosensor was studied using electrochemical impedance spectroscopy (EIS). The EIS method was used for the determination of PCT in the concentration range of 2.5–800 pg/mL with a limit of detection of 0.36 pg/mL. The effect of several interfering agents such as the C reactive protein (CRP), immunoglobulin G (IgG), and human serum albumin (HSA) was also studied. The fabricated immunosensor had a good selectivity to the PCT. The stability of the immunosensor was also studied for 1 month. The relative standard deviation (RSD) was obtained to be 5.2%.

Detection of COVID-19-related biomarkers by electrochemical biosensors and potential for diagnosis, prognosis, and prediction of the course of the disease in the context of personalized medicine

As a more efficient and effective way to address disease diagnosis and intervention, cutting-edge technologies, devices, therapeutic approaches, and practices have emerged within the personalized medicine concept depending on the particular patient's biology and the molecular basis of the disease. Personalized medicine is expected to play a pivotal role in assessing disease risk or predicting response to treatment, understanding a person's health status, and, therefore, health care decision-making. This work discusses electrochemical biosensors for monitoring multiparametric biomarkers at different molecular levels and their potential to elucidate the health status of an individual in a personalized manner. In particular, and as an illustration, we discuss several aspects of the infection produced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a current health care concern worldwide. This includes SARS-CoV-2 structure, mechanism of infection, biomarkers, and electrochemical biosensors most commonly explored for diagnostics, prognostics, and potentially assessing the risk of complications in patients in the context of personalized medicine. Finally, some concluding remarks and perspectives hint at the use of electrochemical biosensors in the frame of other cutting-edge converging/emerging technologies toward the inauguration of a new paradigm of personalized medicine.

Simultaneous detection of sepsis host response biomarkers in whole blood using electrochemical biosensor

Sepsis is a silent killer, caused by a syndromic reaction of the body's immune system to an infection that is typically the ultimate pathway to mortality due to numerous infectious diseases, including COVID‐19 across the world. In the United States alone, sepsis claims 220,000 lives, with a dangerously high fatality rate between 25% and 50%. Early detection and treatment can avert 80% of sepsis mortality which is currently unavailable in most healthcare institutions. The novelty in this work is the ability to simultaneously detect eight (IL‐6, IL‐8, IL‐10, IP‐10, TRAIL, d‐dimer, CRP, and G‐CSF) heterogeneous immune response biomarkers directly in whole blood without the need for dilution or sample processing. The DETecT sepsis (Direct Electrochemical Technique Targeting Sepsis) 2.0 sensor device leverages electrochemical impedance spectroscopy as a technique to detect subtle binding interactions at the metal/semi‐conductor sensor interface and reports results within 5 min using only two drops (~100 μl) of blood. The device positively (r >0.87) correlated with lab reference standard LUMINEX for clinical translation using 40 patient samples. The developed device showed diagnostic accuracy greater than 80% (AUC >0.8) establishing excellent specific and sensitive response. Portable handheld user‐friendly feature coupled with precise quantification of immune biomarkers makes the device amenable in a versatile setting providing insights on patient's immune response. This work highlights an innovative solution of enhancing sepsis care and management in the absence of a decision support device in the continuum of sepsis care.

Portable Pesticide Electrochem-sensor: A Label-Free Detection of Glyphosate in Human Urine

The toxicity levels of and exposure to glyphosate, a widely used herbicide and desiccant, are significant public health issues. In this study, we aim to design a highly sensitive, label-free, portable sensor for the direct detection of glyphosate in human urine. The sensor platform consists of a portable, printed circuit board circular platform with gold working and reference electrodes to enable nonfaradic electrochemical impedance spectroscopy. The sensing platform was an immunoassay-based, gold electrode surface immobilized with a monolayer of dithiobis(succinimidyl propionate) (DSP), a thiol-based cross-linker, which was then modified with a glyphosate antibody (Glyp-Ab) through the bonding of the ester group of DSP with the amide of the antibody (Glyp-Ab). The sensor was tested electrochemically, first using the laboratory-based benchtop method for the glyphosate-spiked urine samples, resulting in a dynamic response in the concentration range of 0.1-72 ng/mL with a limit of detection of 0.1 ng/mL. The platform showed high selectivity in the presence of major interfering analytes in urine [malathion (Mal), 3-phenoxybenzoic acid (PBA), and chlorpyrifos (Chlp)] and high reproducibility. The sensing platform was then translated into a portable device that showed a performance correlation (r = 0.994) with the benchtop (laboratory method). This developed portable sensing approach can be a highly reliable alternate sensor platform for the direct detection of pesticides in human bodily fluids.

Cerebrospinal Fluid Leak Detection with a Carbon Nanotube-Based Field-Effect Transistor Biosensing Platform

Cerebrospinal fluid (CSF) leakage may lead to life-threatening complications if not detected promptly. However, gel electrophoresis, the gold-standard test for confirming CSF leakage by detecting beta2-transferrin (β2-Tf), requires 3-6 h and is labor-intensive. We developed a new β2-Tf detection platform for rapid identification of CSF leakage. The three-step design, which includes two steps of affinity chromatography and a rapid sensing step using a semiconductor-enriched single-walled carbon nanotube field-effect transistor (FET) sensor, circumvented the lack of selectivity that antitransferrin antibody exhibits for transferrin isoforms and markedly shortened the detection time. Furthermore, three different sensing configurations for the FET sensor were investigated for obtaining the optimal β2-Tf sensing results. Finally, body fluid (CSF and serum) tests employing our three-step strategy demonstrated high sensitivity, suggesting its potential to be used as a rapid diagnostic tool for CSF leakage.

Novel approaches for rapid detection of COVID-19 during the pandemic: A review

The rapid spread of the SARS-CoV-2 virus that caused the COVID-19 disease, has highlighted our urgent need for sensitive, fast and accurate diagnostic technologies. In fact, one of the main challenges for flatting COVID-19 spread charts is the ability to accurately and rapidly identify asymptomatic cases that result in spreading the virus to close contacts. SARS-CoV-2 virus mutation is also relatively rapid, which makes the detection of COVID-19 diseases still crucial even after the vaccination. Conventional techniques, which are commercially available have focused on clinical manifestation, along with molecular and serological detection tools that can identify the SARS-CoV-2 virus however, owing to various disadvantages including low specificity and sensitivity, a quick, low cost and easy approach is needed for diagnosis of COVID-19. Scientists are now showing extensive interest in an effective portable and simple detection method to diagnose COVID-19. There are several novel methods and approaches that are considered viable advanced systems that can meet the demands. This study reviews the new approaches and sensing technologies that work on COVID-19 diagnosis for easy and successful detection of SARS-CoV-2 virus.

Rapid Detection of Sepsis: Recent Advances in Biomarker Sensing Platforms

Sepsis is a major cause of mortality among hospitalized patients worldwide. Rapid diagnosis is critical as early treatments have been demonstrated to improve survival. Despite the importance of early detection, current technologies and clinical methods are often insufficient due to their lack of the necessary speed, selectivity, or sensitivity. The development of rapid sensing platforms that target sepsis-related biomarkers could significantly improve the outcomes of patients. This Mini-Review focuses on the recent advances in rapid diagnosis of soluble biomarkers in blood with the emphasis on different configurations of point-of-care (POC) instruments. Specifically, it first describes the commonly targeted biomarkers and the mechanisms by which they are detected. Then, it highlights the recently developed sensors that aim to reduce the total time of diagnosis without sacrificing selectivity and limit of detection. These sensors are categorized based on their distinct sensing and transduction mechanisms. Finally, it concludes with a brief outlook over future developments of multiplexed sensors.

Targeted On-Demand Screening of Pesticide Panel in Soil Runoff

Using pesticides is a common agricultural and horticultural practice to serve as a control against weeds, fungi, and insects in plant systems. The application of these chemical agents is usually by spraying them on the crop or plant. However, this methodology is not highly directional, and so only a fraction of the pesticide actually adsorbs onto the plant, and the rest seeps through into the soil base contaminating its composition and eventually leaching into groundwater sources. Electrochemical sensors which are more practical for in situ analysis used for pesticide detection in soil runoff systems are still in dearth, while the ones published in the literature are attributed with complex sensor modification/functionalization and preprocessing of samples. Hence, in this work, we present a highly intuitive electroanalytical sensor approach toward rapid (10 min), on-demand screening of commonly used pesticides-glyphosate and atrazine-in soil runoff. The proposed sensor functions based on the affinity biosensing mechanism driven via thiol cross-linker and antibody receptors that holistically behaves as a recognition immunoassay stack that is specific and sensitive to track test pesticide analytes. Then, this developed sensor is integrated further to create a pesticide-sensing ecosystem using a front-end field-deployable smart device. The method put forward in this work is compared and validated against a standard laboratory potentiostat instrument to determine efficacy, feasibility, and robustness for a point-of-use (PoU) setting yielding LoD levels of 0.001 ng/ml for atrazine and 1 ng/ml for glyphosate. Also, the ML model integration resulted in an accurate prediction rate of ≈80% in real soil samples. Therefore, a universal pesticide screening analytical device is designed, fabricated, and tested for pesticide assessment in real soil runoff samples.

Label Free, Lateral Flow Prostaglandin E2 Electrochemical Immunosensor for Urinary Tract Infection Diagnosis

A label-free, rapid, and easy-to-use lateral flow electrochemical biosensor was developed for urinary tract infection (UTI) diagnosis in resource challenged areas. The sensor operates in non-faradaic mode and utilizes Electrochemical Impedance Spectroscopy for quantification of Prostaglandin E2, a diagnostic and prognostic urinary biomarker for UTI and recurrent UTI. To achieve high sensitivity in low microliter volumes of neat, unprocessed urine, nanoconfinement of assay biomolecules was achieved by developing a three-electrode planar gold microelectrode system on top of a lateral flow nanoporous membrane. The sensor is capable of giving readouts within 5 min and has a wide dynamic range of 100–4000 pg/mL for urinary PGE2. The sensor is capable of discriminating between low and high levels of PGE2 and hence is capable of threshold classification of urine samples as UTI positive and UTI negative. The sensor through its immunological response (directly related to host immune response) is superior to the commercially available point-of-care UTI dipsticks which are qualitative, have poor specificity for UTI, and have high false-positive rates. The developed sensor shows promise for rapid, easy and cost-effective UTI diagnosis for both clinical and home-based settings. More accurate point-of-care UTI diagnosis will improve patient outcomes and allow for timely and appropriate prescription of antibiotics which can subsequently increase treatment success rates and reduce costs.

Temporal profiling of cytokines in passively expressed sweat for detection of infection using wearable device

This work presents the viability of passive eccrine sweat as a functional biofluid toward tracking the human body's inflammatory response. Cytokines are biomarkers that orchestrate the manifestation and progression of an infection/inflammatory event. Hence, noninvasive, real-time monitoring of cytokines can be pivotal in assessing the progression of infection/inflammatory event, which may be feasible through monitoring of host immune markers in eccrine sweat. This work is the first experimental proof demonstrating the ability to detect inflammation/infection such as fever, FLU directly from passively expressed sweat in human subjects using a wearable "SWEATSENSER" device. The developed SWEATSENSER device demonstrates stable, real-time monitoring of inflammatory cytokines in passive sweat. An accuracy of >90% and specificity >95% was achieved using SWEATSENSER for a panel of cytokines (interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α) over an analytical range of 0.2-200 pg mL-1. The SWEATSENSER demonstrated a correlation of Pearson's r > 0.98 for the study biomarkers in a cohort of 26 subjects when correlated with standard reference method. Comparable IL-8 levels (2-15 pg mL-1) between systemic circulation (serum) and eccrine sweat through clinical studies in a cohort of 15 subjects, and the ability to distinguish healthy and sick (infection) cohort using inflammatory cytokines in sweat provides pioneering evidence of the SWEATSENSER technology for noninvasive tracking of host immune response biomarkers. Such a wearable device can offer significant strides in improving prognosis and provide personalized therapeutic treatment for several inflammatory/infectious diseases.

An approach to rapidly assess sepsis through multi-biomarker host response using machine learning algorithm

Sepsis is a life-threatening condition and understanding the disease pathophysiology through the use of host immune response biomarkers is critical for patient stratification. Lack of accurate sepsis endotyping impedes clinicians from making timely decisions alongside insufficiencies in appropriate sepsis management. This work aims to demonstrate the potential feasibility of a data-driven validation model for supporting clinical decisions to predict sepsis host-immune response. Herein, we used a machine learning approach to determine the predictive potential of identifying sepsis host immune response for patient stratification by combining multiple biomarker measurements from a single plasma sample. Results were obtained using the following cytokines and chemokines IL-6, IL-8, IL-10, IP-10 and TRAIL where the test dataset was 70%. Supervised machine learning algorithm naïve Bayes and decision tree algorithm showed good accuracy of 96.64% and 94.64%. These promising findings indicate the proposed AI approach could be a valuable testing resource for promoting clinical decision making.

Electrochemical Immunosensors for Quantification of Procalcitonin: Progress and Prospects

Human procalcitonin (PCT) is a peptide precursor of the calcium-regulating hormone calcitonin. Traditionally, PCT has been used as a biomarker for severe bacterial infections and sepsis. It has also been recently identified as a potential marker for COVID-19. Normally, serum PCT is intracellularly cleaved to calcitonin, which lowers the levels of PCT (<0.01 ng/mL). In severe infectious diseases and sepsis, serum PCT levels increase above 100 ng/mL in response to pro-inflammatory stimulation. Development of sensors for specific quantification of PCT has resulted in considerable improvement in the sensitivity, linear range and rapid response. Among the various sensing strategies, electrochemical platforms have been extensively investigated owing to their cost-effectiveness, ease of fabrication and portability. Sandwich-type electrochemical immunoassays based on the specific antigen–antibody interactions with an electrochemical transducer and use of nanointerfaces has augmented the electrochemical response of the sensors towards PCT. Identification of a superior combination of electrode material and nanointerface, and translation of the sensing platform into flexible and disposable substrates are under active investigation towards development of a point-of-care device for PCT detection. This review provides an overview of the existing detection strategies and limitations of PCT electrochemical immunosensors, and the emerging directions to address these lacunae.

Infection-Mediated Clinical Biomarkers for a COVID-19 Electrical Biosensing Platform

The race towards the development of user-friendly, portable, fast-detection, and low-cost devices for healthcare systems has become the focus of effective screening efforts since the pandemic attack in December 2019, which is known as the coronavirus disease 2019 (COVID-19) pandemic. Currently existing techniques such as RT-PCR, antigen-antibody-based detection, and CT scans are prompt solutions for diagnosing infected patients. However, the limitations of currently available indicators have enticed researchers to search for adjunct or additional solutions for COVID-19 diagnosis. Meanwhile, identifying biomarkers or indicators is necessary for understanding the severity of the disease and aids in developing efficient drugs and vaccines. Therefore, clinical studies on infected patients revealed that infection-mediated clinical biomarkers, especially pro-inflammatory cytokines and acute phase proteins, are highly associated with COVID-19. These biomarkers are undermined or overlooked in the context of diagnosis and prognosis evaluation of infected patients. Hence, this review discusses the potential implementation of these biomarkers for COVID-19 electrical biosensing platforms. The secretion range for each biomarker is reviewed based on clinical studies. Currently available electrical biosensors comprising electrochemical and electronic biosensors associated with these biomarkers are discussed, and insights into the use of infection-mediated clinical biomarkers as prognostic and adjunct diagnostic indicators in developing an electrical-based COVID-19 biosensor are provided.

Longitudinal Zeolite-Iron Oxide Nanocomposite Deposited Capacitance Biosensor for Interleukin-3 in Sepsis Detection

Sepsis is an extreme condition involving a physical response to severe microbial infection and causes fatal and life-threatening issues. Sepsis generates during the chemicals release with the immune system into the bloodstream for fighting against an infection, which causes the inflammation and leads to the medical emergency. A complexed longitudinal zeolite and iron oxide nanocomposite was extracted from coal mine fly ash and utilized to improve the surface characteristics of the capacitance biosensor to identify sepsis attacks. Anti-interleukin-3 (anti-IL-3) antibody was attached to the zeolite- and iron oxide-complexed capacitance electrode surface through an amine linker to interact with the sepsis biomarker IL-3. The morphological and chemical components of the nanocomplex were investigated by FESEM, FETEM, and EDX analyses. At approximately 30 nm, the longitudinal zeolite and iron oxide nanocomposite aided in attaining the limit of IL-3 detection of 3 pg/mL on the linear curve, with a regression coefficient (R2) of 0.9673 [y = 1.638x - 1.1847]. A lower detection limit was achieved in the dose-dependent range (3-100 pg/mL) due to the higher amount of antibody immobilization on the sensing surface due to the nanomaterials and the improved surface current. Furthermore, control experiments with relevant biomolecules did not show capacitance changes, and spiked IL-3 in human serum increased capacitance, indicating the specific and selective detection of IL-3. This study identifies and quantifies IL-3 via potentially useful methods and helps in diagnosing sepsis attack.

Sensitive silica-alumina modified capacitive non-Faradaic glucose sensor for gestational diabetes

A highly sensitive silica-alumina (Si-Al)-modified capacitive non-Faradaic glucose biosensor was introduced to monitor gestational diabetes. Glucose oxidase (GOx) was attached to the Si-Al electrode surface as the probe through amine-modification followed by glutaraldehyde premixed GOx as aldehyde-amine chemistry. This Si-Al (∼50 nm) modified electrode surface has increased the current flow upon binding of GOx with glucose. Capacitance values were increased by increasing the glucose concentrations. A mean capacitance value was plotted and the detection limit was found as 0.03 mg/mL with the regression coefficient value, R² = 0.9782 [y = 0.8391x + 1.338] on the linear range between 0.03 and 1 mg/mL. Further, a biofouling experiment with fructose and galactose did not increase the capacitance, indicating the specific glucose detection. This Si-Al-modified capacitance sensor detects a lower level of glucose presence and helps in monitoring gestational diabetes.

Electrochemical Impedance Spectroscopy Biosensor Enabling Kinetic Monitoring of Fucosyltransferase Activity

Monitoring glycosyltransferases on biosensors is of great interest for pathogen and cancer diagnostics. As a proof of concept, we here demonstrate the layer-by-layer immobilization of a multivalent neoglycoprotein (NGP) as a substrate for a bacterial fucosyltransferase (FucT) and the subsequent binding of the fucose-specific Aleuria aurantia lectin (AAL) on an electrochemical impedance spectroscopy (EIS) sensor. We report for the first time the binding kinetics of a glycosyltransferase in real-time. Highly stable EIS measurements are obtained by the modification of counter and reference electrodes with polypyrrole: polystyrene sulfonate (PPy:PSS). In detail, the N-acetyllactosamine (LacNAc)-carrying NGP was covalently immobilized on the gold working electrode and served as a substrate for the FucT-catalyzed reaction. The LacNAc epitopes were converted to Lewis^x (Le^x) and detected by AAL. AAL binding to the Le^x epitope was further confirmed in a lectin displacement and a competitive lectin binding inhibition experiment. We monitored the individual kinetic processes via EIS. The time constant for covalent immobilization of the NGP was 653 s. The FucT kinetics was the slowest process with a time constant of 1121 s. In contrast, a short time constant of 11.8 s was determined for the interaction of AAL with the modified NGPs. When this process was competed by 400 mM fucose, the binding was significantly slowed down, as indicated by a time constant of 978 s. The kinetics for the displacement of bound AAL by free fucose was observed with a time constant of 424 s. We conclude that this novel EIS biosensor and the applied workflow has the potential to detect FucT and other GT activities in general and further monitor protein-glycan interactions, which may be useful for the detection of pathogenic bacteria and cancer cells in future biomedical applications.

Development of an Interdigitated Electrode-Based Disposable Enzyme Sensor Strip for Glycated Albumin Measurement

Glycated albumin (GA) is an important glycemic control marker for diabetes mellitus. This study aimed to develop a highly sensitive disposable enzyme sensor strip for GA measurement by using an interdigitated electrode (IDE) as an electrode platform. The superior characteristics of IDE were demonstrated using one microelectrode of the IDE pair as the working electrode (WE) and the other as the counter electrode, and by measuring ferrocyanide/ferricyanide redox couple. The oxidation current was immediately reached at the steady state when the oxidation potential was applied to the WE. Then, an IDE enzyme sensor strip for GA measurement was prepared. The measurement of fructosyl lysine, the protease digestion product of GA, exhibited a high, steady current immediately after potential application, revealing the highly reproducible measurement. The sensitivity (2.8 nA µM⁻¹) and the limit of detection (1.2 µM) obtained with IDE enzyme sensor strip were superior compared with our previously reported sensor using screen printed electrode. Two GA samples, 15 or 30% GA, corresponding to healthy and diabetic levels, respectively, were measured after protease digestion with high resolution. This study demonstrated that the application of an IDE will realize the development of highly sensitive disposable-type amperometric enzyme sensors with high reproducibility.

Handheld pH meter-assisted immunoassay for C-reactive protein using glucose oxidase-conjugated dendrimer loaded with platinum nanozymes

A simple and feasible pH meter-based immunoassay is reported for detection of C-reactive protein (CRP) using glucose oxidase (GOD)-conjugated dendrimer loaded with platinum nanozyme. Initially, platinum nanozymes were loaded into the dendrimers through an in situ synthetic method. Then, GOD and monoclonal anti-CRP antibody with a high molar ratio were covalently conjugated onto carboxylated dendrimers via typical carbodiimide coupling. The immunoreaction was carried out with a competitive mode in a CRP-coated microplate. Along with formation of immunocomplex, the added glucose was oxidized into gluconic acid and hydrogen peroxide by GOD, and the latter was further decomposed by platinum nanozyme, thus accelerating chemical reaction in the positive direction. The produced gluconic acid changed the pH of detection solution, which was determined using a handheld pH meter. Under optimum conditions, the pH meter-based immunoassay gave a good signal toward target CRP from 0.01 to 100 ng mL-1. The limit of detection was 5.9 pg mL-1. An intermediate precision ≤ 11.2% was acquired with batch-to-batch identification. No nonspecific adsorption was observed during a series of procedures to detect target CRP, and the cross-reaction against other biomarkers was very low. Importantly, our system gave well-matched results for analysis of human serum samples relative to a referenced ELISA kit.Graphical abstract.

Advancement in biosensors for inflammatory biomarkers of SARS-CoV-2 during 2019-2020

COVID-19 pandemic has affected everyone throughout the world and has resulted in the loss of lives of many souls. Due to the restless efforts of the researchers working hard day and night, some success has been gained for the detection of virus. As on date, the traditional polymerized chain reactions (PCR), lateral flow devices (LFID) and enzyme linked immunosorbent assays (ELISA) are being adapted for the detection of this deadly virus. However, a more exciting avenue is the detection of certain biomarkers associated with this viral infection which can be done by simply re-purposing our existing infrastructure. SARS-CoV-2 viral infection triggers various inflammatory, biochemical and hematological biomarkers. Because of the infection route that the virus follows, it causes significant inflammatory response. As a result, various inflammatory markers have been reported to be closely associated with this infection such as C-reactive proteins, interleukin-6, procalcitonin and ferritin. Sensing of these biomarkers can simultaneously help in understanding the illness level of the affected patient. Also, by monitoring these biomarkers, we can predict the viral infections in those patients who have low SARS-CoV-2 RNA and hence are missed by traditional tests. This can give more targets to the researchers and scientists, working in the area of drug development and provide better prognosis. In this review, we propose to highlight the conventional as well as the non-conventional methods for the detection of these inflammatory biomarkers which can act as a single platform of knowledge for the researchers and scientists working for the treatment of COVID-19.

Multiplexed cytokine detection using electrochemical point-of-care sensing device towards rapid sepsis endotyping

The implementation of endotype-driven effective intervention strategies is now considered as an essential component for sepsis management. Rapid screening and frequent monitoring of immune responses are critical for evidence-based informed decisions in the early hours of patient arrival. Current technologies focus on pathogen identification that lack rapid testing of the patient immune response, impeding clinicians from providing appropriate sepsis treatment. Herein, we demonstrate a first-of-its-kind novel point-of-care device that uses a unique approach by directly monitoring a panel of five cytokine biomarkers (IL-6, IL-8, IL-10, TRAIL & IP-10), that is attributed as a sign of the body's host immune response to sepsis. The developed point-of-care device encompasses a disposable sensor cartridge attached to an electrochemical reader. High sensitivity is achieved owing to the unique sensor design with an array of nanofilm semiconducting/metal electrode interface, functionalized with specific capture probes to measure target biomarkers simultaneously using non-faradaic electrochemical impedance spectroscopy. The sensor has a detection limit of ~1 pg/mL and provides results in less than five minutes from a single drop of undiluted plasma sample. Furthermore, the sensor demonstrates an excellent correlation (Pearson's r > 0.90) with the reference method for a total n = 40 clinical samples, and the sensor's performance is ~30 times faster compared to the standard reference technique. We have demonstrated the sensor's effectiveness to enhance diagnosis with a mechanistic biomarker-guided approach that can help disease endotypying for effective clinical management of sepsis at the patient bedside.

Establish pre-clinical diagnostic efficacy for parathyroid hormone as a point-of-surgery-testing-device (POST)

Measuring the Parathyroid hormone (PTH) levels assists in the investigation and management of patients with parathyroid disorders. Rapid PTH monitoring is a valid tool for accurate assessment intraoperatively. Rapid Electro-Analytical Device (READ) is a point-of-care device that uses impedance change between target and capture probe to assess the PTH concentration in undiluted patient plasma samples. The aim of this work focuses on evaluating the analytical performance of READ platform to Roche analyzer as a prospective clinical validation method. The coefficient of variation (CV) for intra-assay imprecision was < 5% and inter-assay imprecision CV was < 10% for high (942 pg/mL) and low (38.2 pg/mL) PTH concentration. Functional sensitivity defined at 15% CV was 1.9 pg/mL. Results obtained from READ platform correlated well (r = 0.99) with commercially available clinical laboratory method (Roche Diagnostics) to measure PTH concentrations with a turn-around time of less than 15 min. Furthermore, the mean bias of 7.6 pg/mL determined by Bland–Altman analysis, showed good agreement between the two methods. We envision such a sensing system would allow medical practitioners to facilitate targeted interventions, thereby, offering an immediate prognostic approach as the cornerstone to delivering successful treatment for patients suffering from primary hyperparathyroidism.

Design and Electrochemical Characterization of Spiral Electrochemical Notification Coupled Electrode (SENCE) Platform for Biosensing Application

C-reactive protein (CRP) is considered to be an important biomarker associated with many diseases. During any physiological inflammation, the level of CRP reaches its peak at 48 h, whereas its half-life is around 19 h. Hence, the detection of low-level CRP is an important task for the prognostic management of diseases like cancer, stress, metabolic disorders, cardiovascular diseases, and so on. There are various techniques available in the market to detect low-level CRP like ELISA, Western blot, etc. An electrochemical biosensor is one of the important miniaturized platforms which provides sensitivity along with ease of operation. The most important element of an electrochemical biosensor platform is the electrode which, upon functionalization with a probe, captures the selective antibody-antigen interaction and produces a digital signal in the form of potential/current. Optimization of the electrode design can increase the sensitivity of the sensor by 5-10-fold. Herein, we come up with a new sensor design called the spiral electrochemical notification coupled electrode (SENCE) where the working electrode (WE) is concentric in nature, which shows better response than the market-available standard screen-printed electrode. The sensor is thoroughly characterized using a standard Ferro/Ferri couple. The sensing performance of the fabricated platform is also characterized by the detection of standard H2O2 using a diffusion-driven technique, and a low detection limit of 15 µM was achieved. Furthermore, we utilized the platform to detect a low level (100 ng/mL) of CRP in synthetic sweat. The manuscript provides emphasis on the design of a sensor that can offer good sensitivity in electrochemical biosensing applications.