A quantitative electrochemical assay for liver injury

Current trends in electrochemical approaches for liver biomarker detection: a mini-review

Aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and albumin are well-established liver biomarkers with significant physiological functions. Alterations in these liver function tests can be indicative of the presence and progression of acute and chronic liver conditions such as liver cirrhosis, non-alcoholic fatty liver disease, biliary disease, and liver failure. Therefore, accurate and quantitative detection of these biomarkers is crucial for diagnosing and monitoring liver disease. There are several commercially available chemistry analyzers capable of simultaneously detecting all these biomarkers, as well as numerous biosensors designed for individual detection. Various techniques have been employed, including colorimetry, surface-enhanced Raman spectroscopy (SERS), electrochemiluminescence (ECL), fluorescence-based techniques, and electrochemical methods. Among these, electrochemical detection stands out due to its simplicity, cost-effectiveness, low sample volume requirement, label-free detection, high sensitivity, fast response times, miniaturization, and portability. Information on recently developed electrochemical biosensors is summarized through detailed tables and is intended to guide future research and development efforts in this area.

Alanine aminotransferase electrochemical sensor based on graphene@MXene composite nanomaterials

Graphene@MXene composite nanomaterials were utilized to construct an electrochemical sensor for alanine aminotransferase (ALT) detection. The combination of graphene nanosheets with MXene avoids the self-stacking of MXene and graphene, and broadens the charge transfer channel. In addition, the composite nanomaterial provides increased loading sites for pyruvate oxidase. The principle of ALT detection is a two-step enzymatic reaction. L-Alanine was initially transferred to pyruvate catalyzed by ALT. The formed pyruvate was then oxidized by pyruvate oxidase, generating H2O2. Through the detection of the generated H2O2, ALT activity was measured. The linear range of the sensor to ALT was from 5 to 400 U·L-1 with a detection limit of 0.16 U·L-1 (S/N = 3). For real sample analysis, the spiked recovery test results of ALT in serum samples were between 96.89 and 103.93% with RSD < 5%, confirming the reliability of the sensor testing results and potential clinical application of the sensor.

Portable dual-channel blood enzyme analyzer for point-of-care liver function detection

Because the liver is an important metabolic center in the human body, the reliability and timeliness of chronic liver disease diagnosis are particularly important. Alanine aminotransferase and aspartate transaminase are the two most important liver function indicators, and their test results are crucial in the diagnosis of liver diseases. However, the simultaneous detection of these two indicators is currently restricted by the need for expensive equipment and complicated detection processes. This study proposes a portable dual-channel blood enzyme analyzer (BEA) for point-of-care-testing. The device uses photometric reflectance to quantify the enzyme concentration by evaluating the reflected light intensity. The BEA also precisely controls and maintains the temperature at 37 °C ± 0.1 °C in the dual-channel assay. We assessed the responses of this system within a clinically relevant range by testing blood samples from a local hospital. The test verified that BEA for ALT and AST achieved a detection limit of 3.5 U L-1 and 4 U L-1, detection range of 4-350 U L-1 and 4-250 U L-1, coefficients of variation (CV) that were both less than 10%, and a linear correlation coefficient of 0.9827 and 0.9714 compared with a high-precision clinical biochemistry analyzer (Roche Cobas C702), respectively. We realized remote data analysis and storage through connection with smartphones, which can be applied to remote diagnostics and preventative personal disease management. Therefore, BEA has broad application prospects in the future internet of medical things.

Self-template sacrifice and in situ oxidation of a constructed hollow MnO2 nanozymes for smartphone-assisted colorimetric detection of liver function biomarkers

Liver function tests play a vital role in accurately diagnosing liver diseases, monitoring treatment outcomes, and assessing liver damage severity. Here, we introduce a novel approach to develop a smartphone-assisted portable colorimetric sensor for rapid detection of three liver function biomarkers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). This sensor is based on the inherent enzyme-like activities of hollow MnO2 (H-MnO2). The H-MnO2 is synthesized via a self-template sacrifice and in situ oxidation strategy, utilizing a manganese-based Prussian blue analogue (Mn-PBA) as a sacrificial template. The resulting H-MnO2 exhibits a polycrystalline structure with a large specific surface area. By encapsulating the H-MnO2 in sodium alginate, we construct a portable sensing platform facilitating specific and rapid colorimetric detection of the three liver function biomarkers with the assistance of a smartphone. The developed sensor demonstrates outstanding sensitivity and stability, achieving detection limits of 4.9 U L-1, 3.6 U L-1, and 0.99 U L-1 for AST, ALT, and ALP, respectively. Importantly, this work introduces an innovative in situ oxidation method for fabricating hollow nanozymes, offering a cost-effective and convenient assay for liver function biomarkers detection.

A dry chemistry-based electrochemiluminescence device for point-of-care testing of alanine transaminase

Liver disease causes serious public health problems because of its high prevalence, particularly affecting low- and middle-income countries. Alanine transaminase (ALT) is considered to be one of the most sensitive indicators for diagnosing liver disease. Although many strategies have been reported for ALT detection, few of them have solved the problem of automatic detection. In this work, for the first time, a dry chemistry-based electrochemiluminescence (DC-ECL) device is developed for point-of-care testing (POCT) of ALT, achieving real sample-to-answer detection. The proposed DC-ECL device consists of the following two components: (a) a DC-ECL chip consisting of the outer shell (including the top cap and pedestal) and detection layer (including the baseplate, electrode pad and carrier pad) and (b) an automatic ECL analyzer mainly including the data processing and instrument control unit, imaging detection unit, electrochemical reaction excitation unit, open detection window unit and rechargeable power supply. Under optimized conditions, the device had a wide detection range (0-1000 U/L), the ECL intensity linearly increased with ALT concentration (5-50 U/L) and logarithmic ALT concentration (50-1000 U/L), and the limit of detection was calculated to be 1.702 U/L. In addition, the DC-ECL device had the ability to measure ALT levels in human serum samples and showed acceptable selectivity, stability and repeatability. These results reveal that the DC-ECL device can overcome the disadvantages of traditional methods for ALT detection (such as high cost and requirement of professional technicians) and potentially opens the door to the development of similar POCT analyzers.

Optical assay using B-doped core-shell Fe@BC nanozyme for determination of alanine aminotransferase

B-doped core-shell Fe@BC nanozyme was synthesized. The peroxidase (POD) like activity of Fe@BC nanozyme was studied and utilized for detecting the activity of alanine aminotransferase (ALT). In the presence of ALT as well as ALT co-substrates L-alanine and α-ketoglutarate, L-glutamate is generated. The following catalytic oxidation of L-glutamate by glutamate oxidase leads to the generation of H₂O₂. The POD-like activity of Fe@BC can oxidize 3,3',5,5'-tetramethylbenzidine (TMB) to oxTMB in the presence of H₂O₂, generating a blue-colored compound. Through the detection of the amount of H₂O₂ generated, ALT activity can be determined through measuring the absorbance intensity variation at 450 nm. The limit of detection of the assay is 4 U/L, with a linear range from 10 to 1000 U/L. For human serum samples, the ALT levels determined by our assay are comparable to those determined by the hospital with a correlation coefficient of 0.991, demonstrating the reliability of our assay results.

A low-cost compact blood enzyme analyzer based on optical sensing for point-of-care liver function testing

Serum alanine aminotransferase (ALT) is the most sensitive indicator of liver function; therefore, in clinical practice, its detection has diagnostic significance.

Dye-functionalized metal-organic frameworks with the uniform dispersion of MnO2 nanosheets for visualized fluorescence detection of alanine aminotransferase

The wide applications of metal-organic framework (MOF) luminescent materials in the field of optics have attracted the general attention of researchers. Therefore, the development of simple and multifunctional MOF light-emitting platforms have become a research hotspot. The composites (MnO2@ZIF-8-luminol) were prepared by an in situ synthesis method and room-temperature covalent reaction. The composites and o-phenylenediamine (OPD) constitute a dual emission sensor for detecting alanine aminotransferase (ALT). OPD can be oxidized by MnO₂ to 2,3-diaminophenazine (DAP) with yellow fluorescence emission, which inhibits the blue emission of luminol through fluorescence resonance energy transfer (FRET). The presence of tiopronin (TP) will destroy the FRET process, extinguishing the yellow fluorescence emission and restoring the blue fluorescence emission. The special effect between ALT and TP will further reverse the changes in the two fluorescent signals. Moreover, in the detection process, when the blue and yellow fluorescence energies in the system are within a certain range, a new white light emission will be generated, which causes the sensing of ALT to present ternary visualization. In addition, a high-security anti-counterfeiting platform is constructed by using the prepared materials and agarose hydrogels. The anti-counterfeiting platform can encrypt information on demand according to the luminous characteristics of different materials. This study not only provides a typical case of ternary visualization sensing by MOF-based materials but also develops a possible method for the construction of a MOF-based hydrogel anti-counterfeiting platform.

Economic Evaluation of Screening Interventions for Drug-induced Liver Injury

BACKGROUND

Human immunodeficiency virus (HIV)/AIDS and tuberculosis (TB) continue to be a significant global burden, disproportionately affecting low- and middle-income countries (LMICs). While much progress has been made in treating these epidemics, this has led to a rise in liver complications, as patients on ARTs and anti-TBs are at an increased risk of drug-induced liver injury (DILI). Therefore, patients on these medicines require consistent screening of liver function. Due to logistical barriers, gold standard DILI screening fails to be executed at the point-of-care in LMICs. For this reason, we used cost-effectiveness analysis to gauge the efficacy of a paper-test that could be implemented in these settings.

METHODS

We used a Markov Model to simulate HIV and TB coinfected patient care in LMICs using both publicly available data and data from Village Health Works in Burundi. We compared the cost-effectiveness of two screening interventions for liver function monitoring: 1. paper-based point-of-care testing, and 2. gold-standard laboratory testing. These interventions were compared against baseline clinical monitoring.

RESULTS

The paper test showed a 56% increase in efficacy over clinical monitoring alone. The paper-test is more cost-effective than the gold-standard method, at a ceiling cost of $1.60 per test.

CONCLUSIONS

With this information, policy makers can be informed as to the large potential value of paper-based tests when gold standard monitoring is not achievable. Scientists and engineers should also keep these analyses in mind and while in development limit the cost of an ALT screening test to $1.60.

Towards better diagnostic tools for liver injury in low-income and middle-income countries

Liver disease is a significant public health burden in both high-income and low-income countries, accounting for over 2 million annual, global deaths. Despite the significant mortality burden, liver diseases are historically a neglected problem due to a lack of accurate incidence and prevalence statistics, as well as national and international programmes targeting these diseases. A large portion of deaths due to liver diseases can be treated (eg, chronic hepatitis B), cured (eg, chronic hepatitis C) or prevented (eg, acute liver failure due to medications) if prompt diagnosis is made, but currently diagnostic methods fall short. Therefore, there is a critical need to fund the development of prompt, effective diagnostics for liver function, specifically in low-income and middle-income countries where the landscape for this testing is sparse. Here, we review and compare available and currently emerging diagnostic methods for liver injury in low-income and middle-income settings, while highlighting the opportunities and challenges that exist in the field.