Cell-phone-based measurement of TSH using Mie scatter optimized lateral flow assays

Smartphone based lateral flow immunoassay quantifications

Lateral Flow Immunoassay (LFI) is a disposable tool designed to detect target substances using minimal resources. For qualitative analysis, LFI does not require a device (i.e., reader) to interpret test results. However, various studies have been conducted to implement quantitative analysis using LFI systems, incorporating LFI along with electrical/electronic readers, to overcome the limitations associated with qualitative LFI analysis. The reader used for the quantitative analysis of LFI should ensure mobility for easy on-site diagnostics and inspections, be user-friendly in operation, and have a fast processing speed until the results are obtained. Due to these requirements, smartphones are increasingly utilized as readers in quantitative analysis of LFI. Among the various components constituting a smartphone, high-performance cameras can serve as sensors converting visual signals into electrical signals. With powerful processing units, large storage capacity, and network capabilities for transmitting analysis results, smartphones are also utilized as interfaces for quantitative analysis. Absolutely, the widespread global use of smartphones is a key advantage, leading to their utilization as diagnostic devices for acquiring, analyzing, storing, and transmitting assay test results. This paper summarizes research cases where smartphones are utilized as readers for quantitative LFI systems used in confirming contamination in food or the environment, detecting drugs, and diagnosing diseases in humans or animals. The systems are classified based on the types of label particles used in the assay, and efforts to improve the quantitative analysis performance for each are examined. Cases where smartphones were used as LFI readers for the diagnosis of the 2019 Coronavirus Disease (COVID-19), which has recently caused significant global damage, have also been investigated.

Smartphone-integrated paper-based biosensor for sensitive fluorometric ethanol quantification

The development of fluorometric paper-based analytical devices (fPADs) integrated with smartphone for fluorometric quantification of ethanol in an instrument-free and portable setup is described. The NAD+-dependent alcohol dehydrogenase immobilized within chitosan modified paper substate was utilized as a bio-recognition element and enzymatically generated NADH was used as a fluorescent probe. 3D-printed imaging setup which houses a paper chip holder and UV-light emitting device (LED) was developed for rapid, accurate capture of the fluorescent images. The biocompatible chitosan layer covering the paper provides a feasible environment for enzyme immobilization and enhances the fluorescence signal. The developed fPADs exhibited high sensitivity for ethanol detection and has a linear range for ethanol detection from 17 µM to 8.75 mM (R2 =0.99). Additionally, the fPADs were applied to quantify ethanol in four different wine samples including red, white, rose, and sparkling wines successfully. Moreover, the fPADs produce reproducible signals without loss of enzyme activity for at least 14 days and ~80% activity remained till 28 days. Thus, the proposed approach can provide a facile, affordable, portable, and instrument-free tool for the onsite quantification of ethanol in real samples and is applicable for food quality controls.

New technologies and reagents in lateral flow assay (LFA) designs for enhancing accuracy and sensitivity

Lateral flow assays (LFAs) are a popular method for quick and affordable diagnostic testing because they are easy to use, portable, and user-friendly. However, LFA design has always faced challenges regarding sensitivity, accuracy, and complexity of the operation. By integrating new technologies and reagents, the sensitivity and accuracy of LFAs can be improved while minimizing the complexity and potential for false positives. Surface enhanced Raman spectroscopy (SERS), photoacoustic techniques, fluorescence resonance energy transfer (FRET), and the integration of smartphones and thermal readers can improve LFA accuracy and sensitivity. To ensure reliable and accurate results, careful assay design and validation, appropriate controls, and optimization of assay conditions are necessary. Continued innovation in LFA technology is crucial to improving the reliability and accuracy of rapid diagnostic testing and expanding its applications to various areas, such as food testing, water quality monitoring, and environmental testing.

A review of rapid food safety testing: using lateral flow assay platform to detect foodborne pathogens

The detrimental impact of foodborne pathogens on human health makes food safety a major concern at all levels of production. Conventional methods to detect foodborne pathogens, such as live culture, high-performance liquid chromatography, and molecular techniques, are relatively tedious, time-consuming, laborious, and expensive, which hinders their use for on-site applications. Recurrent outbreaks of foodborne illness have heightened the demand for rapid and simple technologies for detection of foodborne pathogens. Recently, Lateral flow assays (LFA) have drawn attention because of their ability to detect pathogens rapidly, cheaply, and on-site. Here, we reviewed the latest developments in LFAs to detect various foodborne pathogens in food samples, giving special attention to how reporters and labels have improved LFA performance. We also discussed different approaches to improve LFA sensitivity and specificity. Most importantly, due to the lack of studies on LFAs for the detection of viral foodborne pathogens in food samples, we summarized our recent research on developing LFAs for the detection of viral foodborne pathogens. Finally, we highlighted the main challenges for further development of LFA platforms. In summary, with continuing improvements, LFAs may soon offer excellent performance at point-of-care that is competitive with laboratory techniques while retaining a rapid format.

Wearable artificial intelligence biosensor networks

The demand for high-quality healthcare and well-being services is remarkably increasing due to the ageing global population and modern lifestyles. Recently, the integration of wearables and artificial intelligence (AI) has attracted extensive academic and technological attention for its powerful high-dimensional data processing of wearable biosensing networks. This work reviews the recent developments in AI-assisted wearable biosensing devices in disease diagnostics and fatigue monitoring demonstrating the trend towards personalised medicine with highly efficient, cost-effective, and accurate point-of-care diagnosis by finding hidden patterns in biosensing data and detecting abnormalities. The reliability of adaptive learning and synthetic data and data privacy still need further investigation to realise personalised medicine in the next decade. Due to the worldwide popularity of smartphones, they have been utilised for sensor readout, wireless data transfer, data processing and storage, result display, and cloud server communication leading to the development of smartphone-based biosensing systems. The recent advances have demonstrated a promising future for the healthcare system because of the increasing data processing power, transfer efficiency and storage capacity and diversifying functionalities.

A novel point-of-care device accurately measures thyrotropin in whole blood, capillary blood and serum

OBJECTIVES

Point-of-care (POC) measurement of thyrotropin (TSH) may facilitate prompt diagnosis of thyroid dysfunction. We evaluated the analytical performance of a new POC TSH assay (Wondfo).

METHODS

TSH measurements were made from 730 consecutive, unselected subjects in an outpatient setting, using Wondfo in whole blood, capillary blood and serum or automated reference equipment (serum only).

RESULTS

TSH measurements were user-independent. Total intra-and inter-assay variation (CV%) was 12.1 and 16.2%, respectively. Total CV% was 10.6-22.6% and 14.5-21.6% in serum and whole blood, respectively. Linearity was very good. Recovery rate was 97-127%. Prolongation of incubation time increased TSH results of 12% (13%) and 33% (35%) after 2 and 5 additional minutes in serum (blood), respectively. When measured simultaneously in two Wondfo devices, the slope of the regression line was 1.03 (serum) and 1.02 (blood), with Spearman's correlation of 0.99 for both. TSH measurements between Wondfo and reference correlated strongly (r=0.93-0.96), though TSH measurements were lower with Wondfo (slopes of plots of measurements made using the two devices were 0.94 [serum vs. serum]; 0.83 [whole blood vs. serum] and 0.64 [capillary blood vs. serum]). Depending on sample material, TSH in capillary blood was lower vs. whole blood (slope: 0.82) and for whole blood vs. serum (Wondfo and reference method; slope: 0.69 and 0.83). Total haemolysis, but not elevated bilirubin or lipemia, disrupted TSH measurement.

CONCLUSIONS

The Wondfo system was straightforward to use without need for specialist technicians and demonstrated analytic performance suitable for clinical use for the diagnosis of thyroid dysfunction.

Lateral flow assays for hormone detection

Endocrine diseases are the fifth most common cause of death and have a considerable impact on society given that they induce long-term morbidity in patients. For many decades, the measurement of hormones has been of great interest since this can be used to diagnose a plethora of pathological conditions. As a result, the endocrine testing market has experienced exponential growth. Several techniques have been utilised for the detection of hormones; however, they are expensive, laborious and require specialist training. Conversely, lateral flow assays (LFAs) are cheap (<£1) and rapid (<5 min) devices. LFAs typically rely on biochemical interactions between antibodies and antigens to produce coloured signals proportional to analyte concentrations, which can be visually inspected. Given their simplicity, LFAs are now considered the most attractive point-of-care device in medicine. However, the measurement of hormones in biofluids using LFAs faces many challenges including (i) the necessity for sensitive detection methods, (ii) the need for multiplexed devices for the confirmation of a diagnosis, and (iii) difficulties in sample preparation and pre-concentration. As such, most hormone LFAs remain in the research phase, and the few that have been commercialised require further optimisation before they can be employed for routine use. This review summarises the basic principles underlying lateral flow technology and provides an overview of recent advances, challenges, and potential solutions for the detection of hormone biomarkers via LFAs. Finally, hormone LFA kits available on the market are presented, with a look towards future developments and trends in the field.

Normalizing the Optical Signal Enables Robust Assays with Lateral Flow Biosensors

Lateral flow assays (LFAs) are widely adopted for fast, on-site molecular diagnostics. Obtaining high-precision assay results, however, remains challenging and often requires a dedicated optical setup to control the imaging environment. Here, we describe quick light normalization exam (qLiNE) that transforms ubiquitous smartphones into a robust LFA reader. qLiNE used a reference card, printed with geometric patterns and color standards, for real-time optical calibration: a photo of an LFA test strip was taken along with the card, and the image was processed using a smartphone app to correct shape distortion, illumination brightness, and color imbalances. This approach yielded consistent optical signal, enabling quantitative molecular analyses under different illumination conditions. We adapted qLiNE to detect cortisol, a known stress hormone, in saliva samples at point-of-use settings. The assay was fast (15 min) and sensitive (detection limit, 0.16 ng/mL). The serial qLiNE assay detected diurnal cycles of cortisol levels as well as stress-induced cortisol increase.

High-Sensitive Detection and Quantitative Analysis of Thyroid-Stimulating Hormone Using Gold-Nanoshell-Based Lateral Flow Immunoassay Device

Au nanoparticles (AuNPs) have been used as signal reporters in colorimetric lateral flow immunoassays (LFAs) for decades. However, it remains a major challenge to significantly improve the detection sensitivity of traditional LFAs due to the low brightness of AuNPs. As an alternative approach, we overcome this problem by utilizing 150 nm gold nanoshells (AuNSs) that were engineered by coating low-density silica nanoparticles with a thin layer of gold. AuNSs are dark green, have 14 times larger surface area, and are approximately 35 times brighter compared to AuNPs. In this study, we used detection of thyroid-stimulating hormone (TSH) in a proof-of-concept assay. The limit of detection (LOD) with AuNS-based LFA was 0.16 µIU/mL, which is 26 times more sensitive than the conventional colorimetric LFA that utilizes AuNP as a label. The dynamic range of the calibration curve was 0.16−9.5 µIU/mL, making it possible to diagnose both hyperthyroidism (<0.5 µIU/mL) and hypothyroidism (>5 µIU/mL) using AuNS-based LFA. Thus, the developed device has a strong potential for early screening and diagnosis of diseases related to the thyroid hormone.

Willingness of Chinese Men Who Have Sex With Men to Use Smartphone-Based Electronic Readers for HIV Self-testing: Web-Based Cross-sectional Study

BACKGROUND

The need for strategies to encourage user-initiated reporting of results after HIV self-testing (HIVST) persists. Smartphone-based electronic readers (SERs) have been shown capable of reading diagnostics results accurately in point-of-care diagnostics and could bridge the current gaps between HIVST and linkage to care.

OBJECTIVE

Our study aimed to assess the willingness of Chinese men who have sex with men (MSM) in the Jiangsu province to use an SER for HIVST through a web-based cross-sectional study.

METHODS

From February to April 2020, we conducted a convenience web-based survey among Chinese MSM by using a pretested structured questionnaire. Survey items were adapted from previous HIVST feasibility studies and modified as required. Prior to answering reader-related questions, participants watched a video showcasing a prototype SER. Statistical analysis included descriptive analysis, chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant.

RESULTS

Of 692 participants, 369 (53.3%) were aged 26-40 years, 456 (65.9%) had ever self-tested for HIV, and 493 (71.2%) were willing to use an SER for HIVST. Approximately 98% (483/493) of the willing participants, 85.3% (459/538) of ever self-tested and never self-tested, and 40% (46/115) of unwilling participants reported that SERs would increase their HIVST frequency. Engaging in unprotected anal intercourse with regular partners compared to consistently using condoms (adjusted odds ratio [AOR] 3.04, 95% CI 1.19-7.74) increased the odds of willingness to use an SER for HIVST. Participants who had ever considered HIVST at home with a partner right before sex compared to those who had not (AOR 2.99, 95% CI 1.13-7.90) were also more willing to use an SER for HIVST. Playing receptive roles during anal intercourse compared to playing insertive roles (AOR 0.05, 95% CI 0.02-0.14) was associated with decreased odds of being willing to use an SER for HIVST. The majority of the participants (447/608, 73.5%) preferred to purchase readers from local Centers of Disease Control and Prevention offices and 51.2% (311/608) of the participants were willing to pay less than US $4.70 for a reader device.

CONCLUSIONS

The majority of the Chinese MSM, especially those with high sexual risk behaviors, were willing to use an SER for HIVST. Many MSM were also willing to self-test more frequently for HIV with an SER. Further research is needed to ascertain the diagnostic and real-time data-capturing capacity of prototype SERs during HIVST.

Recurrence monitoring for ovarian cancer using a cell phone-integrated paper device to measure the ovarian cancer biomarker HE4/CRE ratio in urine

Ovarian cancer has a poor cure rate and rates of relapse are high. Current recurrence detection is limited by non-specific methods such as blood testing and ultrasound. Based on reports that human epididymis four (HE4) / creatinine (CRE) ratios found in urine are elevated in ovarian cancers, we have developed a paper-based device that combines lateral flow technology and cell phone analysis to quantitatively measure HE4/CRE. Surrogate samples were used to test the performance over clinically expected HE4/CRE ratios. For HE4/CRE ratios of 2 to 47, the percent error was found to be 16.0% on average whether measured by a flatbed scanner or cell phone. There was not a significant difference between the results from the cell phone or scanner. Based on published studies, error in this method was less than the difference required to detect recurrence. This promising new tool, with further development, could be used at home or in low-resource settings to provide timely detection of ovarian cancer recurrence.

A simple immunosensor for thyroid stimulating hormone

Determination of thyroid-stimulating hormone (TSH) level in serum or plasma is defined as a sensitive method for the diagnosis of hyperthyroidism and hypothyroidism and also in many diseases thought to be related to TSH levels. In this study, a novel simple impedimetric immunosensor based on polyamidoamine dendrimer was developed. Anti TSH antibody was immobilized on the gold electrode by using cysteamine self-assembled monolayer strategy. In constructing the immunosensor, a polyamidoamine dendrimer was used to increase the surface area in which Antı-TSH was immobilized and glutaraldehyde was used as a cross-linker. After each immobilization step, the electrode surface was monitored by electrochemical impedance spectroscopy, cyclic voltammetry, scanning electron microscopy and energy-dispersive X-ray spectroscopy techniques and optimization studies were performed. The reproducibility, repeatability, linearity and sensitivity of the immunosensor were examined. Also, the interference experiments for glucose, salts and proteins in serum were performed. The limit of detection and limit of quantification values of the proposed immunosensor were 0.026 mIUL^-1 and 0.086 mIUL^-1, respectively and it was able to detect the amount of TSH within a linear range of 0.1-0.6 mIUL^-1.

Moving toward a Handheld "Plasma" Spectrometer for Elemental Analysis, Putting the Power of the Atom (Ion) in the Palm of Your Hand

Many of the current innovations in instrument design have been focused on making them smaller, more rugged, and eventually field transportable. The ultimate application is obvious, carrying the instrument to the field for real time sample analysis without the need for a support laboratory. Real time data are priceless when screening either biological or environmental samples, as mitigation strategies can be initiated immediately upon the discovery that contaminant metals are present in a location they were not intended to be. Additionally, smaller "handheld" instruments generally require less sample for analysis, possibly increasing sensitivity, another advantage to instrument miniaturization. While many other instruments can be made smaller just by using available micro-technologies (e.g., eNose), shrinking an ICP-MS or AES to something someone might carry in a backpack or pocket is now closer to reality than in the past, and can be traced to its origins based on a component-by-component evaluation. While the optical and mass spectrometers continue to shrink in size, the ion/excitation source remains a challenge as a tradeoff exists between excitation capabilities and the power requirements for the plasma's generation. Other supporting elements have only recently become small enough for transport. A systematic review of both where the plasma spectrometer started and the evolution of technologies currently available may provide the roadmap necessary to miniaturize the spectrometer. We identify criteria on a component-by-component basis that need to be addressed in designing a miniaturized device and recognize components (e.g., source) that probably require further optimization. For example, the excitation/ionization source must be energetic enough to take a metal from a solid state to its ionic state. Previously, a plasma required a radio frequency generator or high-power DC source, but excitation can now be accomplished with non-thermal (cold) plasma sources. Sample introduction, for solids, liquids, and gasses, presents challenges for all sources in a field instrument. Next, the interface between source and a mass detector usually requires pressure reduction techniques to get an ion from plasma to the spectrometer. Currently, plasma mass spectrometers are field ready but not necessarily handheld. Optical emission spectrometers are already capable of getting photons to the detector but could eventually be connected to your phone. Inert plasma gas generation is close to field ready if nitrogen generators can be miniaturized. Many of these components are already commercially available or at least have been reported in the literature. Comparisons to other "handheld" elemental analysis devices that employ XRF, LIBS, and electrochemical methods (and their limitations) demonstrate that a "cold" plasma-based spectrometer can be more than competitive. Migrating the cold plasma from an emission only source to a mass spectrometer source, would allow both analyte identification and potentially source apportionment through isotopic fingerprinting, and may be the last major hurdle to overcome. Finally, we offer a possible design to aid in making the cold plasma source more applicable to a field deployment.

Development of a smartphone-based lateral-flow imaging system using machine-learning classifiers for detection of Salmonella spp

Salmonella spp. are a foodborne pathogen frequently found in raw meat, egg products, and milk. Salmonella is responsible for numerous outbreaks, becoming a frequent major public-health concern. Many studies have recently reported handheld and rapid devices for microbial detection. This study explored a smartphone-based lateral-flow assay analyzer which employed machine-learning algorithms to detect various concentrations of Salmonella spp. from the test line images. When cell numbers are low, a faint test line is difficult to detect, leading to misleading results. Hence, this study focused on the development of a smartphone-based lateral-flow assay (SLFA) to distinguish ambiguous concentrations of test line with higher confidence. A smartphone cradle was designed with an angled slot to maximize the intensity, and the optimal direction of the optimal incident light was found. Furthermore, the combination of color spaces and the machine-learning algorithms were applied to the SLFA for classifications. It was found that the combination of L*a*b and RGB color space with SVM and KNN classifiers achieved the high accuracy (95.56%). A blind test was conducted to evaluate the performance of devices; the results by machine-learning techniques reported less error than visual inspection. The smartphone-based lateral-flow assay provided accurate interpretation with a detection limit of 5 × 10⁴ CFU/mL commercially available lateral-flow assays.

In situ Raman enhancement strategy for highly sensitive and quantitative lateral flow assay

As a paper-based analytical platform, lateral flow assay (LFA) gets benefit from the rapid analysis, low cost, high selectivity, good stability, and user-friendliness, and thus has been widely used in rapid screening or assisted diagnosis. Nevertheless, LFA still suffers from low detection sensitivity via the naked eye, limiting its applications to qualitative and semi-quantitative tests. To enhance the signal readout, various nanoparticle signal tags have been employed to replace traditional colloidal gold nanoparticles (AuNPs), such as fluorescent nanoparticles (FNPs), magnetic nanoparticles (MNPs), and Raman reporter-labeled nanoparticles. In particular, Raman reporter-labeled nanoparticles are extremely sensitive due to remarkable signal enhancement effect on metal surface. However, the application of LFA is still hampered by the poor stability of Raman reporter-labeled nanoparticles. Herein, we developed an in situ Raman enhancement strategy to create a surface-enhanced Raman scattering (SERS) signal on the AuNPs, shortened as "i-SERS," which not only preserves the original advantages of the colloidal gold strip (AuNPs-LFA), but also realizes highly sensitive and quantitative detection. We applied the i-SERS for procalcitonin (PCT) detection. The experimental process takes only 16 min, and the limit of detection (LOD) is 0.03 ng mL^-1, far below the value using AuNPs-LFA. These results indicate that i-SERS assay was highly sensitive and suitable for the rapid detection of PCT.

FEAST of biosensors: Food, environmental and agricultural sensing technologies (FEAST) in North America

We review the challenges and opportunities for biosensor research in North America aimed to accelerate translational research. We call for platform approaches based on: i) tools that can support interoperability between food, environment and agriculture, ii) open-source tools for analytics, iii) algorithms used for data and information arbitrage, and iv) use-inspired sensor design. We summarize select mobile devices and phone-based biosensors that couple analytical systems with biosensors for improving decision support. Over 100 biosensors developed by labs in North America were analyzed, including lab-based and portable devices. The results of this literature review show that nearly one quarter of the manuscripts focused on fundamental platform development or material characterization. Among the biosensors analyzed for food (post-harvest) or environmental applications, most devices were based on optical transduction (whether a lab assay or portable device). Most biosensors for agricultural applications were based on electrochemical transduction and few utilized a mobile platform. Presently, the FEAST of biosensors has produced a wealth of opportunity but faces a famine of actionable information without a platform for analytics.

Advances in Portable Visual Detection of Pathogenic Bacteria

Food safety and regulation of consumer welfare are of great concern, so it is necessary to be able to detect pathogenic bacteria quickly and effectively. Although traditional methods of pathogen detection are reliable and widely used, the detection and analysis processes are cumbersome and time-consuming, which is not conducive to fast assays in the field. New detection strategies have emerged in recent years, especially point-of-care testing (POCT) methods, which do not rely on the laboratory and have become an important development direction for pathogen detection. Many visual detection schemes have been developed that integrate portable glucose meters (PGMs), test strips, smartphones, and other portable devices. Importantly, portable and ultrasensitive biosensors have vast promise in detecting pathogens, as they can be suitable tools for clinical diagnosis and the regulation of food safety. This Review focuses on the latest advances in portable device-based methods for visual detection of pathogens, evaluating their advantages and disadvantages.

Analysis of multiple mycotoxins-contaminated wheat by a smart analysis platform

This study describes a smart analysis platform capable of quantitative measurements using a multiplex lateral flow strip. Using the multi-mycotoxin strip, five fungal toxins were simultaneously and quantitatively detected in naturally contaminated wheat. First, a matrix-based standard curve was established for the detection of aflatoxin B1 (AFB1), fumonisin B1 (FB1), T-2, deoxynivalenol (DON), and zearalenone (ZEN). Established on an open android system, the platform is able to read 6 lines on the strip simultaneously. The platform is equipped with a Quick Response code scanning model, which reads the established standard curves, and then rapidly quantify mycotoxins in naturally contaminated wheat. All the data and sample information are stored on a central server through the platform which is linked to the cloud. The limits of detection (LOD) for AFB1, FB1, T-2, DON, and ZEN in wheat were 4, 20, 10, 200, and 40 μg/kg and the visual cut off values was 20, 1000, 200, 4000, and 400 μg/kg, separately. To validate the platform and the multi-mycotoxin detection method, 10 wheat samples were analyzed and the results were in a good agreement with those obtained by LC-MS/MS. The platform will be a powerful tool for crop monitoring services.

Label-free Mie Scattering Identification of Tumor Tissue Using an Angular Photodiode Array

Tumors differ from normal tissues in several meaningful ways including cellular size, morphology, and protein expression, which will accordingly change the refractive index and the size/morphology of cells. There are also important differences in tissue organization and unique tissue specific cell densities. Instead of time-consuming and labor-intensive histology involving the use of a benchtop microscope, a plot of Mie scattering intensities at fixed wavelength against scattering angle, which we referred to as "Mie spectrum," is suggested as an alternative to identify tumor from normal tissues. An angular photodiode array is developed to measure this Mie spectrum with three different light emitting diodes (blue, green and red) as light sources. The resulting Mie spectra show characteristic peaks for rat colonic tissues, and substantial differences can be found between tumor vs. normal tissues. Two peaks were identified at 120° and 150° scattering angles, potentially representing capillaries and colon cells, respectively. Contributions from crypts and goblet cells, represented by the scattering at 140°, were minimal. Substantial differences between tumor and normal tissues were found with 45°-70° light irradiation angles.

Nanomagnetic lateral flow assay for high-precision quantification of diagnostically relevant concentrations of serum TSH

Thyroid stimulating hormone (TSH) is the first-line marker for initial evaluation of the thyroid gland function. We present a lateral flow immunoassay based on superparamagnetic nanolabels for rapid (<25 min) quantitative determination of TSH at a point of care. The demonstrated limit of detection (LOD) of 0.017 μIU/mL in human serum is on the level of third-generation TSH laboratory tests. The wide linear dynamic range of more than 3 orders covers the whole range of clinically relevant TSH concentrations for confident quantitative diagnostics of the gland function from hyper- to hypothyroidism, and different states in-between. The attractive values of LOD and linear dynamic range are due to counting of the superparamagnetic nanolabels over the whole reaction volume by their non-linear magnetization at two frequencies of an alternating magnetic field and detecting the response at combinatorial frequencies. The developed cost-efficient and user-friendly immunoassay can be used for express in vitro diagnostics and long-term quantitative monitoring of thyroid dysfunctions, especially in distant regions, developing countries, and sparsely populated areas.

Recent progress, challenges, and prospects of fully integrated mobile and wearable point-of-care testing systems for self-testing

The rapid growth of research in the areas of chemical and biochemical sensors, lab-on-a-chip, mobile technology, and wearable electronics offers an unprecedented opportunity in the development of mobile and wearable point-of-care testing (POCT) systems for self-testing. Successful implementation of such POCT technologies leads to minimal user intervention during operation to reduce user errors; user-friendly, easy-to-use and simple detection platforms; high diagnostic sensitivity and specificity; immediate clinical assessment; and low manufacturing and consumables costs. In this review, we discuss recent developments in the field of highly integrated mobile and wearable POCT systems. In particular, aspects of sample handling platforms, recognition elements and sensing methods, and new materials for signal transducers and powering devices for integration into mobile or wearable POCT systems will be highlighted. We also summarize current challenges and future prospects for providing personal healthcare with sample-in result-out mobile and wearable POCT.

A plasmonic thermal sensing based portable device for lateral flow assay detection and quantification

Point-of-care testing (POCT) is widely used for early diagnosis and monitoring of diseases. Lateral flow assay (LFA) is a successfully commercial tool for POCT. However, LFA often suffers from a lack of quantification and analytical sensitivity. To solve these drawbacks, we have previously developed a thermal LFA using plasmonic gold nanoparticles for thermal contrast into a portable device. Although this methodology significantly improves the analytical sensitivity compared with conventional visual detection, quantification problems are still remaining. In this study, we optimized the operating conditions for the device using conduction and radiation thermal sensing modes allowing the quantification of LFA. The limit of detection of the strips merely containing nanoparticles was decreased by 5-fold (conduction mode) and 12-fold (radiation mode) compared to traditional visual detection. The effect of the ambient temperature was studied for both methods of detection showing that the radiation mode was more affected by the ambient temperature than the conduction mode. To validate the thermal sensing method, human chorionic gonadotropin (HCG) biomarker was quantified using our LFA strips, obtaining a detection limit of 2.8 mIU/mL when using the radiation method of detection.

Lateral flow biosensors based on the use of micro- and nanomaterials: a review on recent developments

This review (with 187 refs.) summarizes the progress that has been made in the design of lateral flow biosensors (LFBs) based on the use of micro- and nano-materials. Following a short introduction into the field, a first section covers features related to the design of LFBs, with subsections on strip-based, cotton thread-based and vertical flow- and syringe-based LFBs. The next chapter summarizes methods for sample pretreatment, from simple method to membrane-based methods, pretreatment by magnetic methods to device-integrated sample preparation. Advances in flow control are treated next, with subsections on cross-flow strategies, delayed and controlled release and various other strategies. Detection conditionst and mathematical modelling are briefly introduced in the following chapter. A further chapter covers methods for reliability improvement, for example by adding other validation lines or adopting different detection methods. Signal readouts are summarized next, with subsections on color-based, luminescent, smartphone-based and SERS-based methods. A concluding section summarizes the current status and addresses challenges in future perspectives. Graphical abstractRecent development and breakthrough points of lateral flow biosensors.

Developing Gold Nanoparticles-Conjugated Aflatoxin B1 Antifungal Strips

Lateral flow immunochromatographic assays are a powerful diagnostic tool for point-of-care tests, based on their simplicity, specificity, and sensitivity. In this study, a rapid and sensitive gold nanoparticle (AuNP) immunochromatographic strip is produced for detecting aflatoxin B1 (AFB1) in suspicious fungi-contaminated food samples. The 10 nm AuNPs were encompassed by bovine serum albumin (BSA) and AFB1 antibody. Thin-layer chromatography, gel electrophoresis and nuclear magnetic resonance spectroscopy were employed for analysing the chemical complexes. Various concentrations of AFB1 antigen (0-16 ng/mL) were tested with AFB1 antibody-BSA-AuNPs (conjugated AuNPs) and then analysed by scanning electron microscopy, ultraviolet-visible spectroscopy, and Zetasizer. The results showed that the AFB1 antibody was coupled to BSA by the N-hydroxysuccinimide ester method. The AuNPs application has the potential to contribute to AFB1 detection by monitoring a visible colour change from red to purple-blue, with a detection limit of 2 ng/mL in a 96-well plate. The lateral flow immunochromatographic strip tests are rapid, taking less than 10 min., and they have a detection capacity of 10 ng/g. The smartphone analysis of strips provided the results in 3 s, with a detection limit of 0.3 ng/g for AFB1 when the concentration was below 10 ng/g. Excellent agreement was found with AFB1 determination by high-performance liquid chromatography in the determination of AFB1 among 20 samples of peanuts, corn, rice, and bread.

Analyte Quantity Detection from Lateral Flow Assay Using a Smartphone

Lateral flow assay (LFA) technology has recently received interest in the biochemical field since it is simple, low-cost, and rapid, while conventional laboratory test procedures are complicated, expensive, and time-consuming. In this paper, we propose a robust smartphone-based analyte detection method that estimates the amount of analyte on an LFA strip using a smartphone camera. The proposed method can maintain high estimation accuracy under various illumination conditions without additional devices, unlike conventional methods. The robustness and simplicity of the proposed method are enabled by novel image processing and machine learning techniques. For the performance analysis, we applied the proposed method to LFA strips where the target analyte is albumin protein of human serum. We use two sets of training LFA strips and one set of testing LFA strips. Here, each set consists of five strips having different quantities of albumin—10 femtograms, 100 femtograms, 1 picogram, 10 picograms, and 100 picograms. A linear regression analysis approximates the analyte quantity, and then machine learning classifier, support vector machine (SVM), which is trained by the regression results, classifies the analyte quantity on the LFA strip in an optimal way. Experimental results show that the proposed smartphone application can detect the quantity of albumin protein on a test LFA set with 98% accuracy, on average, in real time.

A Nontoxic Battery with 3D-Printed Housing for On-Demand Operation of Microcontrollers in Microfluidic Sensors

Microcontrollers have a low energy consumption and are convenient tools for the operation and readout of small lab-on-a-chip devices. The operation of microcontrollers for data collection and analysis is key for measurements and statistics in field experiments. However, for portable lab-on-a-chip or point-of-care systems in low-resource settings, the availability of energy sources is a bottleneck. Here, we present a simple, nontoxic aluminum/air redox battery with a 3D-printed housing for on-demand operation of a sensor using a microcontroller for data collection. The battery is stored in a dry state and can be manufactured conveniently using off-the-shelf components and a simple 3D printer. It can be quickly assembled and operates a microcontroller for at least one hour in continuous operation mode. We demonstrate its performance by collecting data from a capacitive sensor capable of determining the conductivity of liquid samples. Such sensors can be used for, e.g., determining the water quality or phase formation in liquid mixtures. The sensor performance in determining different conductivities of nonconductive and conductive liquids in droplets is demonstrated.

Sensitivity enhancement in lateral flow assays: a systems perspective

Lateral flow assays (LFAs) are rapid, inexpensive, easy-to-manufacture and -use tests widely employed in medical and environmental applications, particularly in low resource settings. Historically, LFAs have been stigmatized as having limited sensitivity. However, as their global usage expands, extensive research has demonstrated that it is possible to substantially improve LFA sensitivity without sacrificing their advantages. In this critical review, we have compiled state-of-the-art approaches to LFA sensitivity enhancement. Moreover, we have organized and evaluated these approaches from a system-level perspective, as we have observed that the advantages and disadvantages of each approach have arisen from the integrated and tightly interconnected chemical, physical, and optical properties of LFAs.

Towards Lateral Flow Quantitative Assays: Detection Approaches

Point-of-care (POC) or bedside analysis is a global trend in modern diagnostics. Progress in POC testing has largely been provided by advanced manufacturing technology for lateral flow (immunochromatographic) test strips. They are widely used to rapidly and easily control a variety of biomarkers of infectious diseases and metabolic and functional disorders, as well as in consumer protection and environmental monitoring. However, traditional lateral flow tests rely on visual assessment and qualitative conclusion, which limit the objectivity and information output of the assays. Therefore, there is a need for approaches that retain the advantages of lateral flow assays and provide reliable quantitative information about the content of a target compound in a sample mixture. This review describes the main options for detecting, processing, and interpreting immunochromatographic analysis results. The possibilities of modern portable detectors that register colored, fluorescent, magnetic, and conductive labels are discussed. Prospects for further development in this direction are also examined.

Patterned plasmonic gradient for high-precision biosensing using a smartphone reader

Smartphone-compatible biosensors are believed to be one of the key techniques for improving the quality of diagnosis in remote areas. However, to date, few smartphone-compatible biosensors can reach the specifications of their conventional counterparts due to the limitations of consumer-grade detectors carried by phones. To circumvent this issue, we reported a metasurface-inspired bio-sensor, patterned plasmonic gradient (PPG), which transduces local index information into 2D patterns. By harnessing the powerful imaging and computational capability of modern smartphones, the PPG is sensitive enough to detect tiny refractive index changes induced by a submonolayer of molecules with high precision (Δn < 0.001) in a large dynamic range. It allows us to monitor the conjugation process between biotin and a trace amount of streptavidin (15 nM, 20 μL) in real-time. With high sensitivity and accuracy, the PPG provides a high performance bio-sensing solution for the places where professional equipment is inaccessible.

Pt-Ni(OH)2 nanosheets amplified two-way lateral flow immunoassays with smartphone readout for quantification of pesticides

Excessive use of herbicide and insecticide causes bioaccumulation in the environment and increases potential toxicity for people and animals. Portable systems for rapid assays of herbicide and insecticide residues have attracted prominent interests. Here, we developed a two-dimensional (2D) Pt-Ni(OH)₂ nanosheets (NSs) amplified two-way lateral flow immunoassay (LFI) with a smartphone-based readout for simultaneous detection of acetochlor and fenpropathrin. The 2D Pt-Ni(OH)₂ NSs were synthesized and used as the enhanced signal label in the immunoassay due to their high peroxidase-like activity and low migration speed. The two-way LFI was designed to eliminate potential cross-reaction between two targets. Portable detection system was developed based on a smartphone-based readout, which scans the LFI and provides the accurate testing result. The universal use of smartphones makes the developed platform suitable for cheap and on-site applications. Using the integrated platform, detection of acetochlor and fenpropathrin simultaneously was successfully achieved with the detection limits of 0.63 ng/mL and 0.24 ng/mL, respectively. To confirm the performance of the on-site application, we detected 10 non-spiked samples and 3 spiked samples. The obtained detection results were consistent with the data from gas chromatography analysis. The estimated recoveries ranged from 97.12% to 111.46%, indicating the practical reliability of our developed assay. The developed smartphone-based platform exhibits enhanced sensitivity, which provides a promising technique for on-site, multiplex, highly sensitive detection of pesticides.

Detection of chikungunya virus-specific IgM on laser-cut paper-based device using pseudo-particles as capture antigen

The incidence of arbovirus infections has increased dramatically in recent decades, affecting hundreds of millions of people each year. The Togaviridae family includes the chikungunya virus (CHIKV), which is typically transmitted by Aedes mosquitoes and causes a wide range of symptoms from flu-like fever to severe arthralgia. Although conventional diagnostic tests can provide early diagnosis of CHIKV infections, access to these tests is often limited in developing countries. Consequently, there is an urgent need to develop efficient, affordable, simple, rapid, and robust diagnostic tools that can be used in point-of-care settings. Early diagnosis is crucial to improve patient management and to reduce the risk of complications. A glass-fiber laser-cut microfluidic device (paper-based analytical device [PAD]) was designed and evaluated in a proof of principle context, for the analysis of 30 µL of patient serum. Biological raw materials used for the functionalization of the PAD were first screened by MAC-ELISA (IgM capture enzyme-linked immunosorbent assay) for CHIKV Immunoglobulin M (IgM) capture and then evaluated on the PAD using various human samples. Compared with viral lysate traditionally used for chikungunya (CHIK) serology, CHIKV pseudo-particles (PPs) have proven to be powerful antigens for specific IgM capture. The PAD was able to detect CHIKV IgM in human sera in less than 10 minutes. Results obtained in patient sera showed a sensitivity of 70.6% and a specificity of around 98%. The PAD showed few cross-reactions with other tropical viral diseases. The PAD could help health workers in the early diagnosis of tropical diseases such as CHIK, which require specific management protocols in at-risk populations.

Designing Paper-Based Immunoassays for Biomedical Applications

Paper-based sensors and assays have been highly attractive for numerous biological applications, including rapid diagnostics and assays for disease detection, food safety, and clinical care. In particular, the paper immunoassay has helped drive many applications in global health due to its low cost and simplicity of operation. This review is aimed at examining the fundamentals of the technology, as well as different implementations of paper-based assays and discuss novel strategies for improving their sensitivity, performance, or enabling new capabilities. These innovations can be categorized into using unique nanoparticle materials and structures for detection via different techniques, novel biological species for recognizing biomarkers, or innovative device design and/or architecture.

Simple geometrical modifications for substantial color intensity and detection limit enhancements in lateral-flow immunochromatographic assays

One of the ongoing challenges in lateral flow Immunochromatographic assays (LFIA), is lowering the limit of detection and enhancing their signal quality, i.e. the color intensity. There are a number of rather costly and complicated processes for this aim, such as the use of functionalized materials/membranes and additional spectroscopic readout units. Nonetheless, there are simple and easy to practice alternatives, to be uncovered by analyzing the essential parameters of immunological reactions. The color intensity of the test line is a function of analytes flow velocity and their reaction rate. Detection pad width and test line position impact the flow velocity and reaction rate kinetics, examined in this paper for the limit of detection (LOD) and test-line color intensity. Firstly, the impact of width on the LOD was examined for human chorionic gonadotropin (pregnancy biomarker). Test line color intensity was measured using five different widths of the detection pad (trapezoidal) and four different test line positions, and the trends observed were explained according to the measured evolution of the velocity along the chromatography paper. With a constant width absorbent pad, LOD was cut by half to 5 mIU/ml by using a narrowing width detection pad, which keeps the wicking velocity higher than normal strips, and compared to them, color intensity increase between 55 and 150%, depending on the concentration. Nevertheless, a widening detection pad might cut the color intensity up to 150%, compared to normal strips, due to a profound decline of the analyte to ligand ratio at the test line. In addition, adequately sending the test line away from the conjugate pad yields the highest possible color intensity, for up to 400% of increase, in lower concentrations and narrowing test pads. However, further distancing the test line downfalls the color intensity.

A smartphone readout system for gold nanoparticle-based lateral flow assays: application to monitoring of digoxigenin

For modern approaches in precision medicine, fast and easy-to-use point-of-care diagnostics (POCs) are essential. Digoxin was chosen as an example of a drug requiring close monitoring. Digoxin is a cardiac glycoside used for the treatment of tachycardia with a narrow therapeutic window of 0.5–2.0 ng·mL⁻¹, and toxic effects are common for concentrations above 2.5 ng·mL⁻¹. For monitoring of blood concentration levels and treatment of intoxication, highly selective antibodies for digoxin and its hapten, digoxigenin, are available. A smartphone readout system is described for measuring digoxigenin in human serum using a common gold nanoparticle lateral flow assay (LFA). The R-package GNSplex, which also includes a Shiny app for quantitative test interpretation based on linear models, is used for image analysis. Images of lateral flow strips were taken with an iPhone camera and a simple darkbox made from black cardboard. Sensitivity and accuracy of the quantitative smartphone system as well as analytical parameters such as limit of detection (LOD) were determined and compared to data obtained with a high resolution BioImager. The data show that the smartphone based digoxin assay yields reliable quantitative results within the clinically relevant concentration range.

Graphical abstract

Staining Traditional Colloidal Gold Test Strips with Pt Nanoshell Enables Quantitative Point-of-Care Testing with Simple and Portable Pressure Meter Readout

Traditional immunochromatographic test strips based on colloidal gold are effective devices for portable and low-cost point-of-care (POC) testing. Nevertheless, they still suffer from the limitation of qualitative or semiquantitative tests via naked-eye detection. Replacement of gold with other signal entities, such as magnetic particles or fluorescent particles, requires professional instrumentation to obtain quantitative results. A pressure-based assay with platinum nanoparticles (PtNPs) can provide quantitative results using a portable pressure meter but is also hampered by the long-term instability of PtNPs. Consequently, we developed a Pt-staining method based on test strips to create platinum nanoshells on the surface of colloidal gold. This method not only preserves the original advantages of colloidal gold with easy synthesis and decoration but also introduces PtNPs with excellent catalytic activity as signal labels to achieve sensitive quantitative detection. Myoglobin was tested as a model target, and the limit of detection was 5.47 ng/mL in 20% diluted serum samples, which satisfies the requirements for clinical monitoring of acute myocardial infarction. In addition, the two most common colloidal gold strips available in the marketplace were applied to demonstrate the compatibility of Pt-staining. Taking advantage of low cost, user-friendliness, compatibility, simplicity, and stability, colloidal gold test strips with Pt-staining are expected to satisfy the need for quantitative POC testing of biomarkers, especially in resource-limited regions.

Barcoded point-of-care bioassays

Barcoded bioassays are ready to promote bioanalysis and biomedicine toward the point of care.

From Point-of-Care Testing to eHealth Diagnostic Devices (eDiagnostics)

Point-of-care devices were originally designed to allow medical testing at or near the point of care by health-care professionals. Some point-of-care devices allow medical self-testing at home but cannot fully cover the growing diagnostic needs of eHealth systems that are under development in many countries. A number of easy-to-use, network-connected diagnostic devices for self-testing are needed to allow remote monitoring of patients' health. This Outlook highlights the essential characteristics of diagnostic devices for eHealth settings and indicates point-of-care technologies that may lead to the development of new devices. It also describes the most representative examples of simple-to-use, point-of-care devices that have been used for analysis of untreated biological samples.

An Optimized Colorimetric Readout Method for Lateral Flow Immunoassays

Despite its broad penetration of various markets, the quantitative lateral flow immunoassay (LFIA) suffers from sensitivity issues in some cases. To solve this problem, an optimized colorimetric readout method for LFIA quantification is proposed in this study. An assay reader device utilizing a color camera and an analysis method using a Bayer filtered image were developed. Spectrometric measurements of the assay test line were performed to determine the color channel that contains the test line information and effectively minimizes noise. The change in the intensity ratio with increasing concentration of the target substance in the sample was largest in the green channel. The linear range of the output curve ranged from 0 to 10 ng/mL, and the detection limit was 2 ng/mL. The suggested instrumentation and analysis methods are expected to effectively resolve the low-sensitivity problems of the former LFIA systems and to offer other prospective functionalities for LFIA quantification.