Recent advances in graphene-based nanobiosensors for salivary biomarker detection

Towards sustainable and humane dairy farming: A low-cost electrochemical sensor for on-site diagnosis of milk fever

Milk fever is a metabolic disorder that predominantly affects dairy animals during the periparturient period and within four weeks of calving. Milk fever is primarily attributed to a decrease in the animal's serum Ca2+ levels. Clinical milk fever occurs when Ca2+ concentration drops below 1.5 mM (6 mg/dL). Without prompt intervention, clinical milk fever leads to noticeable physical symptoms and health complications including coma and fatality. Subclinical milk fever is characterized by Ca2+ levels between 1.5 and 2.12 mM (6-8.48 mg/dL). Approximately 50% of multiparous dairy cows suffer from subclinical milk fever during the transition to lactation. The economic impact of milk fever, both direct and indirect, is substantial, posing challenges for farmers. To address this issue, we developed a low-cost electrochemical sensor that can measure bovine serum calcium levels on-site, providing an opportunity for early detection of subclinical and clinical milk fever and early intervention. This calcium sensor is a scalable solid contact ion sensing platform that incorporates a polymeric calcium-selective membrane and ionic liquid-based reference membrane into laser-induced graphene (LIG) electrodes. Our sensing platform demonstrates a sensitivity close to the theoretical Nernstian value (29.6 mV/dec) with a limit of detection of 15.6 μM and selectivity against the species in bovine serum. Moreover, our sensor can detect Ca2+ in bovine serum with 91% recovery.

Active site-tuned high peroxidase-like activity nanozyme for on-the-spot detection of saliva total antioxidant capacity using smartphone devices

Metal-Organic Framework (MOF) based nanozymes with clear structure are beneficial for exploration of structural-performance and exhibit broad prospects in improving activity. In this study, the prepared bimetallic Fe3Ni-MOF nanozyme was superior to single metal MOF in the peroxidase-like activity. Subsequently, a derivative nanozyme (Fe3Ni-MOF-Ar) was prepared by pyrolysis using Fe3Ni-MOF as the precursor in argon atomoshere with controlled temperature. The investigated of Fe3Ni-MOF-Ar revealed that the irregular macroporous state and the presence of heterovalent FeIII/FeII sites of Fe3Ni-MOF-Ar enable the retention, exposure, and electronic structure regulation of active sites, promoting the dual mechanism (the generation of •OH and electron transfer mechanism) and significantly increasing the peroxidase-like activity. Fe3Ni-MOF-Ar exhibited a strong affinity for substrate H2O2, which is higher than horseradish peroxidase. Ascorbic acid and cysteine are typical substances of antioxidants. Fe3Ni-MOF-Ar was used for sensitive colorimetric detection of ascorbic acid and cysteine, and the detection limit was as low as 150 and 60 nM. In addition, the smartphone devices was used to detection of antioxidant equivalent ascorbic acid, with a detection range of 0.5-120 μM. Fe3Ni-MOF-Ar nanozyme is feasible for sensitive detection of saliva total antioxidant capacity.

A review of biocompatible polymer-functionalized two-dimensional materials: Emerging contenders for biosensors and bioelectronics applications

Bioelectronics, a field pivotal in monitoring and stimulating biological processes, demands innovative nanomaterials as detection platforms. Two-dimensional (2D) materials, with their thin structures and exceptional physicochemical properties, have emerged as critical substances in this research. However, these materials face challenges in biomedical applications due to issues related to their biological compatibility, adaptability, functionality, and nano-bio surface characteristics. This review examines surface modifications using covalent and non-covalent-based polymer-functionalization strategies to overcome these limitations by enhancing the biological compatibility, adaptability, and functionality of 2D nanomaterials. These surface modifications aim to create stable and long-lasting therapeutic effects, significantly paving the way for the practical application of polymer-functionalized 2D materials in biosensors and bioelectronics. The review paper critically summarizes the surface functionalization of 2D nanomaterials with biocompatible polymers, including g-C3N4, graphene family, MXene, BP, MOF, and TMDCs, highlighting their current state, physicochemical structures, synthesis methods, material characteristics, and applications in biosensors and bioelectronics. The paper concludes with a discussion of prospects, challenges, and numerous opportunities in the evolving field of bioelectronics.

Realizing the clinical utility of saliva for monitoring oral diseases

In the era of personalized/precision health care, additional effort is being expended to understand the biology and molecular mechanisms of disease processes. How these mechanisms are affected by individual genetics, environmental exposures, and behavioral choices will encompass an expanding role in the future of optimally preventing and treating diseases. Considering saliva as an important biological fluid for analysis to inform oral disease detection/description continues to expand. This review provides an overview of saliva as a diagnostic fluid and the features of various biomarkers that have been reported. We emphasize the use of salivary biomarkers in periodontitis and transport the reader through extant literature, gaps in knowledge, and a structured approach toward validating and determine the utility of biomarkers in periodontitis. A summation of the findings support the likelihood that a panel of biomarkers including both host molecules and specific microorganisms will be required to most effectively identify risk for early transition to disease, ongoing disease activity, progression, and likelihood of response to standard periodontal therapy. The goals would be to develop predictive algorithms that serve as adjunctive diagnostic tools which provide the clinician and patient important information for making informed clinical decisions.

Development of a selective electrochemical microsensor based on molecularly imprinted polydopamine/ZIF-67/laser-induced graphene for point-of-care determination of 3-nitrotyrosine

3-nitrotyrosine (3-NT) is a biomarker closely associated with the early diagnosis of oxidative stress-related disorders. The development of an accurate, cost-effective, point-of-care 3-NT sensor holds significant importance for self-monitoring and clinical treatment. In this study, a selective, sensitive, and portable molecularly imprinted electrochemical sensor was developed. ZIF-67 with strong adsorption capacity was facilely modified on an electrochemically active laser-induced graphene (LIG) substrate (formed ZIF-67/LIG). Subsequently, biocompatible dopamine was chosen as the functional monomer, and interference-free ʟ-tyrosine was used as the dummy template to create molecularly imprinted polydopamine (MIPDA) on the ZIF-67/LIG, endowing the sensor with selectivity. The morphologies, electrochemical properties, and detection performance of the sensor were comprehensively investigated using scanning electron microscopy, cyclic voltammetry, electrochemical impedance spectroscopy, and differential pulse voltammetry. To achieve the best performance, several parameters were optimized, including the number of polymerization cycles (15), elution time (60 min), incubation time (7 min), and pH of the buffer solution (6). The turnaround time for this sensor is 10 min. Benefiting from the alliance of MIPDA, ZIF-67, and LIG, the sensor exhibited excellent sensitivity with a detection limit of 6.71 nM, and distinguished selectivity against 11 interfering substances. To enable convenient clinical diagnosis, a customized electrochemical microsensor with MIPDA/ZIF-67/LIG was designed, showcasing excellent reliability and convenience in detecting biological samples without pretreatment. The proposed microsensor will not only facilitate clinical diagnosis and improve patient care, but also provide inspiration for the development of other portable and accurate electrochemical biosensors.

Biomedical applications of graphene-based nanomaterials: recent progress, challenges, and prospects in highly sensitive biosensors

Graphene-based nanomaterials (graphene, graphene oxide, reduced graphene oxide, graphene quantum dots, graphene-based nanocomposites, etc.) are emerging as an extremely important class of nanomaterials primarily because of their unique and advantageous physical, chemical, biological, and optoelectronic aspects. These features have resulted in uses across diverse areas of scientific research. Among all other applications, they are found to be particularly useful in designing highly sensitive biosensors. Numerous studies have established their efficacy in sensing pathogens and other biomolecules allowing for the rapid diagnosis of various diseases. Considering the growing importance and popularity of graphene-based materials for biosensing applications, this review aims to provide the readers with a summary of the recent progress in the concerned domain and highlights the challenges associated with the synthesis and application of these multifunctional materials.

Progress in Procalcitonin Detection Based on Immunoassay

Procalcitonin (PCT) serves as a crucial biomarker utilized in diverse clinical contexts, including sepsis diagnosis and emergency departments. Its applications extend to identifying pathogens, assessing infection severity, guiding drug administration, and implementing theranostic strategies. However, current clinical deployed methods cannot meet the needs for accurate or real-time quantitative monitoring of PCT. This review aims to introduce these emerging PCT immunoassay technologies, focusing on analyzing their advantages in improving detection performances, such as easy operation and high precision. The fundamental principles and characteristics of state-of-the-art methods are first introduced, including chemiluminescence, immunofluorescence, latex-enhanced turbidity, enzyme-linked immunosorbent, colloidal gold immunochromatography, and radioimmunoassay. Then, improved methods using new materials and new technologies are briefly described, for instance, the combination with responsive nanomaterials, Raman spectroscopy, and digital microfluidics. Finally, the detection performance parameters of these methods and the clinical importance of PCT detection are also discussed.

Disease diagnosis and application analysis of molecularly imprinted polymers (MIPs) in saliva detection

Saliva has significantly evolved as a diagnostic fluid in recent years, giving a non-invasive alternative to blood analysis. A high protein concentration in saliva is delivered directly from the bloodstream, making it a "human mirror" that reflects the body's physiological state. It plays an essential role in detecting diseases in biomedical and fitness monitoring. Molecularly imprinted polymers (MIPs) are biomimetic materials with custom-designed synthetic recognition sites that imitate biological counterparts renowned for sensitive analyte detection. This paper reviews the progress made in research about MIP biosensors for detecting saliva biomarkers. Specifically, we investigate the link between saliva biomarkers and various diseases, providing detailed insights into the corresponding biosensors. Furthermore, we discuss the principles of molecular imprinting for disease diagnostics and application analysis, including recent advances in integrated MIP-sensor technologies for high-affinity analyte detection in saliva. Notably, these biosensors exhibit high discrimination, allowing for the detection of saliva biomarkers linked explicitly to chronic stress disorders, diabetes, cancer, bacterial or viral-induced illnesses, and exposure to illicit toxic substances or tobacco smoke. Our findings indicate that MIP-based biosensors match and perhaps surpass their counterparts featuring integrated natural antibodies in terms of stability, signal-to-noise ratios, and detection limits. Additionally, we highlight the design of MIP coatings, strategies for synthesizing polymers, and the integration of advanced biodevices. These tailored biodevices, designed to assess various salivary biomarkers, are emerging as promising screening or diagnostic tools for real-time monitoring and self-health management, improving quality of life.

Implications of graphene-based materials in dentistry: present and future

Since the advent of nanoscience, nanobiomaterials have been applied in the dental industry. Graphene and its derivatives have attracted the most interest of all of them due to their exceptional look, biocompatibility, multiplication differential, and antibacterial capabilities. We outlined the most recent developments about their applications to dentistry in our review. There is discussion of the synthesis processes, architectures, and characteristics of materials based on graphene. The implications of graphene and its counterparts are then meticulously gathered and described. Finally, in an effort to inspire more excellent research, this paper explores the obstacles and potential of graphene-based nanomaterials for dental aspects.

Advances in Electrochemical Biosensors for the Detection of Common Oral Diseases

Limiting and preventing oral diseases remains a major challenge to the health of populations around the world, so finding ways to detect early-stage diseases (e.g., caries, periodontal disease, and oral cancer) and aiding in their prevention has always been an important clinical treatment concept. The development and application of electrochemical detection technology can provide important support for the early detection and non-invasive diagnosis of oral diseases and make up for the shortcomings of traditional diagnostic methods, which are highly sensitive, non-invasive, cost-effective, and less labor-intensive. It detects specific disease markers in body fluids through electrochemical reactions, discovers early warning signals of diseases, and realizes rapid and reliable diagnosis. This paper comprehensively summarizes the development and application of electrochemical biosensors in the detection and diagnosis of common oral diseases in terms of application platforms, sensing types, and disease detection, and discusses the challenges faced by electrochemical biosensors in the detection of oral diseases as well as the great prospects for future applications, in the hope of providing important insights for the future development of electrochemical biosensors for the early detection of oral diseases.

A Review on Graphene Analytical Sensors for Biomarker-based Detection of Cancer

The engineering of nanoscale materials has broadened the scope of nanotechnology in a restricted functional system. Today, significant priority is given to immediate health diagnosis and monitoring tools for point-of-care testing and patient care. Graphene, as a one-atom carbon compound, has the potential to detect cancer biomarkers and its derivatives. The atom-wide graphene layer specialises in physicochemical characteristics, such as improved electrical and thermal conductivity, optical transparency, and increased chemical and mechanical strength, thus making it the best material for cancer biomarker detection. The outstanding mechanical, electrical, electrochemical, and optical properties of two-dimensional graphene can fulfil the scientific goal of any biosensor development, which is to develop a more compact and portable point-of-care device for quick and early cancer diagnosis. The bio-functionalisation of recognised biomarkers can be improved by oxygenated graphene layers and their composites. The significance of graphene that gleans its missing data for its high expertise to be evaluated, including the variety in surface modification and analytical reports. This review provides critical insights into graphene to inspire research that would address the current and remaining hurdles in cancer diagnosis.

Development of enzyme-inorganic hybrid nanoflower-modified electrodes and a smartphone-controlled electrochemical analyzer for point-of-care testing of salivary amylase in saliva

Quantitation of salivary alpha-amylase (sAA) plays a significant role in not only theoretical studies but also clinical practice. This study reports a quantitative point-of-care testing (POCT) system for sAA quantitation anywhere, anytime and by anyone, which consists of customized electrodes and a smartphone-controlled electrochemical analyzer. Organic-inorganic hybrid nanoflowers (NFs) encapsulating α-glucosidase (AG) and glucose dehydrogenase (GDH) have been synthesized and modified onto screen-printed electrodes (SPCEs) to fabricate the customized electrodes. The SPCEs integrated with the smartphone-controlled electrochemical analyzer exhibit good analytical performance for sAA with a low detection limit of 5.02 U mL-1 and a wide dynamic range of 100-2000 U mL-1 using chronoamperometry. The reported POCT system has been successfully demonstrated for quantitation of sAA in clinical saliva samples, and the quantitation results correlated well with those of the Bernfeld method which is extensively used in clinics. More importantly, this study reveals the great potential of sAA as an early warning indicator of abnormal glucose metabolism in obese individuals. Considering the non-invasive saliva sampling process as well as the easy-to-use and cost-effectiveness features of this quantitative POCT system, quantitation of salivary sAA at home by laypersons might become an appealing choice for obese individuals to monitor their glucose metabolism status anytime.

Label-Free SERS and MD Analysis of Biomarkers for Rapid Point-of-Care Sensors Detecting Head and Neck Cancer and Infections

For the progress of point-of-care medicine, where individual health status can be easily and quickly monitored using a handheld sensor, saliva serves as one of the best-suited body fluids thanks to its availability and abundance of physiological indicators. Salivary biomarkers, combined with rapid and highly sensitive detection tools, may pave the way to new real-time health monitoring and personalized preventative therapy branches using saliva as a target matrix. Saliva is increasing in importance in liquid biopsy, a non-invasive approach that helps physicians diagnose and characterize specific diseases in patients. Here, we propose a proof-of-concept study combining the unique specificity in biomolecular recognition provided by surface-enhanced Raman spectroscopy (SERS) in combination with molecular dynamics (MD) simulations, which give leave to explore the biomolecular absorption mechanism on nanoparticle surfaces, in order to verify the traceability of two validated salivary indicators, i.e., interleukin-8 (IL-8) and lysozyme (LYZ), implicated in oropharyngeal squamous cell carcinoma (OSCC) and oral infection. This strategy simultaneously assures the detection and interpretation of protein biomarkers in saliva, ultimately opening a new route for the evolution of fast and accurate point-of-care SERS-based sensors of interest in precision medicine diagnostics.

Sensors for in situ monitoring of oral and dental health parameters in saliva

OBJECTIVES

The oral cavity is an easily accessible unique environment and open system which is influenced by the oral fluids, microbiota, and nutrition. Little is known about the kinetics and dynamics of metabolic processes at the intraoral surfaces. Real-time monitoring of salivary biomarkers, e.g., glucose, lactate, fluoride, calcium, phosphate, and pH with intraoral sensors is therefore of major interest. The aim of this review is to overview the existing literature for intraoral saliva sensors.

MATERIALS AND METHODS

A comprehensive literature search was performed to review the most relevant studies on intraoral saliva sensor technology.

RESULTS

There is limited literature about the in situ saliva monitoring of salivary biomarkers. Bioadhesion and biofouling processes at the intraoral surfaces limit the performances of the sensors. Real-time, long-term, and continuous intraoral measurement of salivary metabolites remains challenging and needs further investigation as only few well-functioning sensors have been developed until today. Until now, there is no sensor that measures reliably beyond hours for any analyte other than glucose.

CONCLUSIONS

Saliva's complex and dynamic structure as well as bioadhesion are key challenges and should be addressed in the future developments. Consequently, more studies that focus particularly on biofouling processes and interferential effects of the salivary matrix components on sensor surfaces are required.

CLINICAL RELEVANCE

By monitoring fluids in the oral cavity, as the entrance to the digestive system, extensive information can be obtained regarding the effects of foods and preventive agents on the oral microbiota and the tooth surfaces. This may lead to a better understanding of strategies to modulate oral and general health.

Fabricating process-electrochemical property correlation of laser-scribed graphene and smartphone-based electrochemical platform for portable and sensitive biosensing

Laser-scribed graphene (LSG), a promising electrode material has attracted special research interest in recent years. Here, the fabricating process-electrochemical property correlation of laser-scribed graphene (LSG) devices was discussed emphatically and a pertinent optimization was performed to achieve better electroanalytical performance. Experiment results indicated that the laser scribing technique possessed great process latitude and reducing laser power and scribing speed facilitated fabricating high-quality graphene electrodes. Benefiting from its binder-free 3D porous network structure and high active/geometric area ratio, the optimized LSG electrode was superior to the screen-printed carbon electrode (SPCE) on electrochemical performance in the [Fe(CN)6]3-/4- redox system. Integrating the LSG electrode with a homemade hand-held detector, a portable electrochemical sensing platform with smartphone readout was developed. It realized a specific detection of H2O2 (linear range: 0.02-3.4 mM, sensitivity: 24.56 μA mM-1 cm-2), glucose (linear range: 0.04-4.0 mM, sensitivity: 16.35 μA mM-1 cm-2) by directly decorating biological enzymes without artificial redox mediator and featured a satisfactory comprehensive performance. The constructed immunosensor for tumor necrosis factor-α exhibited a wide linear range (2-500 pg mL-1) and a 4.3-fold enhancement in sensitivity compared with that of SPCE. With satisfactory selectivity, reproducibility, and sensitivity, the developed smartphone-based electrochemical sensing platform held great promise in accurate detection on the spot. This work also provided a significant reference for tailoring binder-free carbonaceous electrode materials toward the desired application.

Salivary biomarkers: novel noninvasive tools to diagnose chronic inflammation

Several chronic disorders including type 2 diabetes (T2D), obesity, heart disease and cancer are preceded by a state of chronic low-grade inflammation. Biomarkers for the early assessment of chronic disorders encompass acute phase proteins (APP), cytokines and chemokines, pro-inflammatory enzymes, lipids and oxidative stress mediators. These substances enter saliva through the blood flow and, in some cases, there is a close relation between their salivary and serum concentration. Saliva can be easily collected and stored with non-invasive and cost-saving procedures, and it is emerging the concept to use it for the detection of inflammatory biomarkers. To this purpose, the present review aims to discuss the advantages and challenges of using standard and cutting-edge techniques to discover salivary biomarkers which may be used in diagnosis/therapy of several chronic diseases with inflammatory consequences with the pursuit to possibly replace conventional paths with detectable soluble mediators in saliva. Specifically, the review describes the procedures used for saliva collection, the standard approaches for the measurement of salivary biomarkers and the novel methodological strategies such as biosensors to improve the quality of care for chronically affected patients.

Quality-by-Design R&D of a Novel Nanozyme-Based Sensor for Saliva Antioxidant Capacity Evaluation

Oxidative stress is one of the main causes of cell damage, leading to the onset of several diseases, and antioxidants represent a barrier against the production of reactive species. Saliva is receiving increasing interest as a promising biofluid to study the onset of diseases and assess the overall health status of an individual. The antioxidant capacity of saliva can be a useful indicator of the health status of the oral cavity, and it is nowadays evaluated mainly through spectroscopic methods that rely on benchtop machines and liquid reagents. We developed a low-cost screen-printed sensor based on cerium oxide nanoparticles that can be used to assess the antioxidant capacity of biofluids as an alternative to traditional methods. The sensor development process was investigated via a quality-by-design approach to identify the most critical parameters of the process for further optimization. The sensor was tested in the detection of ascorbic acid, which is used as an equivalent in the assessment of overall antioxidant capacity. The LoDs ranged from 0.1147 to 0.3528 mM, while the recoveries varied from 80% to 121.1%, being therefore comparable with those of the golden standard SAT test, whose recovery value was 96.3%. Therefore, the sensor achieved a satisfactory sensitivity and linearity in the range of clinical interest for saliva and was validated against the state-of-the-art equipment for antioxidant capacity evaluation.

Reshaping healthcare with wearable biosensors

Wearable health sensors could monitor the wearer's health and surrounding environment in real-time. With the development of sensor and operating system hardware technology, the functions of wearable devices have been gradually enriched with more diversified forms and more accurate physiological indicators. These sensors are moving towards high precision, continuity, and comfort, making great contributions to improving personalized health care. At the same time, in the context of the rapid development of the Internet of Things, the ubiquitous regulatory capabilities have been released. Some sensor chips are equipped with data readout and signal conditioning circuits, and a wireless communication module for transmitting data to computer equipment. At the same time, for data analysis of wearable health sensors, most companies use artificial neural networks (ANN). In addition, artificial neural networks could help users effectively get relevant health feedback. Through the physiological response of the human body, various sensors worn could effectively transmit data to the control unit, which analyzes the data and provides feedback of the health value to the user through the computer. This is the working principle of wearable sensors for health. This article focuses on wearable biosensors used for healthcare monitoring in different situations, as well as the development, technology, business, ethics, and future of wearable sensors for health monitoring.

Biosensors for saliva biomarkers

The analysis of salivary biomarkers has gained interest and is advantageous for simple, safe, and non-invasive testing in diagnosis as well as treatment. This chapter explores the importance of saliva biomarkers and summarizes recent advances in biosensor fabrication. The identification of diagnostic, prognostic and therapeutic markers in this matrix enables more rapid and frequent testing when combined with the use of biosensor technology. Challenges and future goals are highlighted and examined.

Functionalized graphene-based electrochemical array sensors for the identification of distinct conformational states of Amyloid Beta in Alzheimer's disease

Aβ oligomers have been widely accepted as significant biomarkers for Alzheimer's disease (AD) detection, monitoring, and therapy since they are highly correlated with AD development. In this work, an electrochemical array-based sensing platform was successfully built using a group of functionalized graphene with different physicochemical features. Since the electro-insulated Aβ peptide species severely interfered with the electron transport on the electrode surface, the presence of Aβ led to a significant change in the electrochemical impedance signal. The resulting variety of the impedance was then classified and processed by linear discriminant analysis. The constructed sensing platform can discriminate different Aβ forms, the mixture of various Aβ forms, and different ratios of Aβ42 to Aβ40 with 100% accuracy by only the combination of dual probes. Furthermore, it also exhibited excellent performance for screening Aβ inhibitors and metal chelators. The strategy utilizes the infinitesimal general discrepancy instead of specific biomarker recognition, exhibiting the advantage of no requirement to know the exact information about the specific ligand and receptor in advance, which is promising to be widened for the other biosensing detection fields.

Salivary Diagnostics in Pediatrics and the Status of Saliva-Based Biosensors

Salivary biomarkers are increasingly being used as an alternative to diagnose and monitor the progression of various diseases due to their ease of use, on site application, non-invasiveness, and most likely improved patient compliance. Here, we highlight the role of salivary biosensors in the general population, followed by the application of saliva as a diagnostic tool in the pediatric population. We searched the literature for pediatric applications of salivary biomarkers, more specifically, in children from 0 to 18 years old. The use of those biomarkers spans autoimmune, developmental disorders, oncology, neuropsychiatry, respiratory illnesses, gastrointestinal disorders, and oral diseases. Four major applications of salivary proteins as biomarkers are: (1) dental health (caries, stress from orthodontic appliances, and gingivitis); (2) gastrointestinal conditions (eosinophilic esophagitis, acid reflux, appendicitis); (3) metabolic conditions (obesity, diabetes); and (4) respiratory conditions (asthma, allergic rhinitis, small airway inflammation, pneumonia). Genomics, metabolomics, microbiomics, proteomics, and transcriptomics, are various other classifications for biosensing based on the type of biomarkers used and reviewed here. Lastly, we describe the recent advances in pediatric biosensing applications using saliva. This work guides scientists in fabricating saliva-based biosensors by comprehensively overviewing the potential markers and techniques that can be employed.

Two birds with one stone: integrating exfoliation and immunoaffinity properties in multi-walled carbon nanotubes by non-covalent functionalization with human immunoglobulin G

An innovative strategy is proposed to simultaneously exfoliate multi-walled carbon nanotubes (MWCNTs) and generate MWCNTs with immunoaffinity properties. This strategy was based on the non-covalent functionalization of MWCNTs with human immunoglobulin G (IgG) by sonicating 2.5 mg mL^-1 MWCNTs in 2.0 mg mL^-1 IgG for 15 min with sonicator bath. Impedimetric experiments performed at glassy carbon electrodes (GCE) modified with the resulting MWCNT-IgG nanohybrid in the presence of anti-human immunoglobulin G antibody (Anti-IgG) demonstrated that the immunoglobulin retains their biorecognition properties even after the treatment during the MWCNT functionalization. We proposed, as proof-of-concept, two model electrochemical sensors, a voltammetric one for uric acid quantification by taking advantages of the exfoliated MWCNTs electroactivity (linear range, 5.0 × 10^-7 M - 5.0 × 10^-6 M; detection limit, 165 nM) and an impedimetric immunosensor for the detection of Anti-IgG through the use of the bioaffinity properties of the IgG present in the nanohybrid (linear range, 5-50 µg mL^-1; detection limit, 2 µg mL^-1).

Saliva diagnostics: emerging techniques and biomarkers for salivaomics in cancer detection

INTRODUCTION

The pursuit of easy-to-use, non-invasive and inexpensive diagnostics is an urgent task for clinicians and scientists. Saliva is an important component of body fluid with regular changes of contents under various pathophysiological conditions, and the biomarkers identified from saliva shows high application potentials and values in disease diagnostics. This review introduces the latest developments in saliva research, with an emphasis on the detection and application of salivary biomarkers in cancer detection.

AREAS COVERED

Detection of disease-specific biomarkers in saliva samples by existing salivaomic methods can be used to diagnose various human pathological conditions and was introduced in details. This review also covers the saliva collection methods, the analytical techniques as well as the corresponding commercial products, with an aim to describe an holistic process for saliva-based diagnostics.

EXPERT OPINION

Saliva, as a non-invasive and collectable body fluid, can reflect the pathophysiological changes of the human body to a certain extent. Identification of reliable saliva biomarkers can provide a convenient way for cancer detection in clinical applications.

Noble Metal Nanoparticles for Point-of-Care Testing: Recent Advancements and Social Impacts

Point-of-care (POC) tests for the diagnosis of diseases are critical to the improvement of the standard of living, especially for resource-limited areas or countries. In recent years, nanobiosensors based on noble metal nanoparticles (NM NPs) have emerged as a class of effective and versatile POC testing technology. The unique features of NM NPs ensure great performance of associated POC nanobiosensors. In particular, NM NPs offer various signal transduction principles, such as plasmonics, catalysis, photothermal effect, and so on. Significantly, the detectable signal from NM NPs can be tuned and optimized by controlling the physicochemical parameters (e.g., size, shape, and elemental composition) of NPs. In this article, we introduce the inherent merits of NM NPs that make them attractive for POC testing, discuss recent advancement of NM NPs-based POC tests, highlight their social impacts, and provide perspectives on challenges and opportunities in the field. We hope the review and insights provided in this article can inspire new fundamental and applied research in this emerging field.

Effect of Recombinant Antibodies and MIP Nanoparticles on the Electrical Behavior of Impedimetric Biorecognition Surfaces for SARS-CoV-2 Spike Glycoprotein: A Short Report

Electrochemical immunosensors are often described as innovative strategies to tackle urgent epidemiological needs, such as the detection of SARS-CoV-2 main biomarker, the spike glycoprotein. Nevertheless, there is a great variety of receptors, especially recombinant antibodies, that can be used to develop these biosensing platforms, and very few reports compare their suitability in analytical device design and their sensing performances. Therefore, this short report targeted a brief and straightforward investigation of the performance of different impedimetric biorecognition surfaces (BioS) for SARS-CoV-2, which were crafted from three commonly reported recombinant antibodies and molecularly-imprinted polymer (MIP) nanoparticles (nanoMIP). The selected NanoMIP were chosen due to their reported selectivity to the receptor binding domain (RBD) of SARS-CoV-2 spike glycoprotein. Results showed that the surface modification protocol based on MUDA and crosslinking with EDC/NHS was successful for the anchoring of each tested receptor, as the semicircle diameter of the Nyquist plots of EIS increased upon each modification, which suggests the increase of Rct due to the binding of dielectric materials on the conductive surface. Furthermore, the type of monoclonal antibody used to craft the BioS and the artificial receptors led to very distinct responses, being the RBD5305 and the NanoMIP-based BioS the ones that showcased the highest increment of signal in the conditions herein reported, which suggests their adequacy in the development of impedimetric immunosensors for SARS-CoV-2 spike glycoprotein.

Conversion of Carbon Dioxide into Chemical Vapor Deposited Graphene with Controllable Number of Layers via Hydrogen Plasma Pre-Treatment

In this work, we report the conversion of carbon dioxide (CO₂) gas into graphene on copper foil by using a thermal chemical vapor deposition (CVD) method assisted by hydrogen (H₂) plasma pre-treatment. The synthesized graphene has been characterized by Raman spectroscopy, X-ray diffraction, scanning electron microscopy, and transmission electron microscopy. The results show the controllable number of layers (two to six layers) of high-quality graphene by adjusting H₂ plasma pre-treatment powers (100-400 W). The number of layers is reduced with increasing H₂ plasma pre-treatment powers due to the direct modification of metal catalyst surfaces. Bilayer graphene can be well grown with H₂ plasma pre-treatment powers of 400 W while few-layer graphene has been successfully formed under H₂ plasma pre-treatment powers ranging from 100 to 300 W. The formation mechanism is highlighted.

Graphene Quantum-Dot-Based Nanophotonic Approach for Targeted Detection of Long Noncoding RNAs in Circulation

Recent progress in the field of nanophotonics has opened up novel avenues for developing nanomaterial-based biosensing systems, which can detect various disease-specific biomarkers, including long noncoding RNAs (lncRNAs) known to circulate in biological fluids. Herein, we designed and developed a nanophotonic approach for rapid and specific capture of lncRNAs using oligonucleotide-conjugated graphene quantum-dot-nanoconjugates. The method offers accurate identification of the target lncRNAs with high selectivity, despite the presence of other molecules in the given sample. The observations also pointed toward the high feasibility and simplicity of the method in the selective determination of lncRNAs. Overall, the approach has the potential of assessing lncRNA expression as a function of disease initiation and progression.

Role of Förster Resonance Energy Transfer in Graphene-Based Nanomaterials for Sensing

Förster resonance energy transfer (FRET)-based fluorescence sensing of various target analytes has been of growing interest in the environmental, bioimaging, and diagnosis fields. Graphene-based zero- (0D) to two-dimensional (2D) nanomaterials, such as graphene quantum dots (GQDs), graphene oxide (GO), reduced graphene oxide (rGO), and graphdiyne (GD), can potentially be employed as donors/acceptors in FRET-based sensing approaches because of their unique electronic and photoluminescent properties. In this review, we discuss the basics of FRET, as well as the role of graphene-based nanomaterials (GQDs, GO, rGO, and GD) for sensing various analytes, including cations, amino acids, explosives, pesticides, biomolecules, bacteria, and viruses. In addition, the graphene-based nanomaterial sensing strategy could be applied in environmental sample analyses, and the reason for the lower detection ranges (micro- to pico-molar concentration) could also be explained in detail. Challenges and future directions for designing nanomaterials with a new sensing approach and better sensing performance will also be highlighted.

The era of nano-bionic: 2D materials for wearable and implantable body sensors

Nano-bionics have the potential of revolutionizing modern medicine. Among nano-bionic devices, body sensors allow to monitor in real-time the health of patients, to achieve personalized medicine, and even to restore or enhance human functions. The advent of two-dimensional (2D) materials is facilitating the manufacturing of miniaturized and ultrathin bioelectronics, that can be easily integrated in the human body. Their unique electronic properties allow to efficiently transduce physical and chemical stimuli into electric current. Their flexibility and nanometric thickness facilitate the adaption and adhesion to human body. The low opacity permits to obtain transparent devices. The good cellular adhesion and reduced cytotoxicity are advantageous for the integration of the devices in vivo. Herein we review the latest and more significant examples of 2D material-based sensors for health monitoring, describing their architectures, sensing mechanisms, advantages and, as well, the challenges and drawbacks that hampers their translation into commercial clinical devices.

An insight into polyscopoletin electrosynthesis by a quality-by-design approach

Scopoletin (SP) as a functional monomer for electropolymerization has recently been investigated in the context of molecularly imprinted polymers for biosensing applications. Herein we describe an in-depth analysis of the mechanisms involved in the electropolymerization of SP toward the optimization of the experimental conditions for applications in sensor studies. PolySP films have been in situ synthesized on a standard glassy carbon electrodes by varying three independent experimental parameters, and the output of the analysis has been evaluated in terms of the resulting electroactive area and surface coverage. A quality-by-design approach including design-of-experiments principles and response surface methodology produced unbiased observations on the most relevant parameters to be controlled during the electropolymerization of SP. By combining the output of electroactive area and surface overage, we highlighted a strong dependence on the monomer concentration and scan rate. Thus, an appropriate selection of these two parameters should be sought to have an optimal electropolymerization process, leading to uniform films and homogeneous surface behavior. This study shows that the application of multi-factorial analysis in a comprehensive design of experiments allows the systematic study of polymer electrosynthesis. Therefore, this research is expected to guide further efforts in the electropolymerization of several functional monomers.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10853-022-07349-8.

Advanced wearable biosensors for the detection of body fluids and exhaled breath by graphene

Given the huge economic burden caused by chronic and acute diseases on human beings, it is an urgent requirement of a cost-effective diagnosis and monitoring process to treat and cure the disease in their preliminary stage to avoid severe complications. Wearable biosensors have been developed by using numerous materials for non-invasive, wireless, and consistent human health monitoring. Graphene, a 2D nanomaterial, has received considerable attention for the development of wearable biosensors due to its outstanding physical, chemical, and structural properties. Moreover, the extremely flexible, foldable, and biocompatible nature of graphene provide a wide scope for developing wearable biosensor devices. Therefore, graphene and its derivatives could be trending materials to fabricate wearable biosensor devices for remote human health management in the near future. Various biofluids and exhaled breath contain many relevant biomarkers which can be exploited by wearable biosensors non-invasively to identify diseases. In this article, we have discussed various methodologies and strategies for synthesizing and pattering graphene. Furthermore, general sensing mechanism of biosensors, and graphene-based biosensing devices for tear, sweat, interstitial fluid (ISF), saliva, and exhaled breath have also been explored and discussed thoroughly. Finally, current challenges and future prospective of graphene-based wearable biosensors have been evaluated with conclusion. Graphene is a promising 2D material for the development of wearable sensors. Various biofluids (sweat, tears, saliva and ISF) and exhaled breath contains many relevant biomarkers which facilitate in identify diseases. Biosensor is made up of biological recognition element such as enzyme, antibody, nucleic acid, hormone, organelle, or complete cell and physical (transducer, amplifier), provide fast response without causing organ harm.

An ultrasensitive electrochemical sensing platform based on silver nanoparticle-anchored 3D reduced graphene oxide for rifampicin detection

A facile strategy has been reported to anchor silver nanoparticles (Ag NPs) onto three-dimensional reduced graphene oxide (3D rGO) via a green and simple method. An accurate and reliable electrochemical sensing platform based on Ag NPs/3D rGO was designed for the ultrasensitive detection of rifampicin (RIF). The morphology and features of Ag NPs/3D rGO were characterized by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), Raman spectroscopy and electrochemical measurements. The interface of the modified electrode presented effective electrical activity for the analysis of RIF due to the large electrochemically active surface area and excellent electron transport ability. The sensor exhibited a good linear relationship in the range of 0.01 nM-45 μM and a low detection limit of 0.810 nM (S/N = 3). Crucially, the fabricated Ag NPs/3D rGO sensor was successfully utilized to assess RIF in human blood, drug and aquatic product samples. This sensing platform exhibited outstanding electrochemical performance for RIF detection and showed great potential application in clinical diagnosis, pharmaceutical and food-related fields.

Salivary biomarkers of neurodegenerative and demyelinating diseases and biosensors for their detection

Salivary analysis is gaining increasing interest as a novel and promising field of research for the diagnosis of neurodegenerative and demyelinating diseases related to aging. The collection of saliva offers several advantages, being noninvasive, stress-free, and repeatable. Moreover, the detection of biomarkers directly in saliva could allow an early diagnosis of the disease, leading to timely treatments. The aim of this manuscript is to highlight the most relevant researchers' findings relatively to salivary biomarkers of neurodegenerative and demyelinating diseases, and to describe innovative and advanced biosensing strategies for the detection of salivary biomarkers. This review is focused on five relevant aging-related neurodegenerative disorders (Alzheimer's disease, Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Multiple Sclerosis) and the salivary biomarkers most commonly associated with them. Advanced biosensors enabling molecular diagnostics for the detection of salivary biomarkers are presented, in order to stimulate future research in this direction and pave the way for their clinical application.

Graphene-Based Nanomaterials for Dental Applications: Principles, Current Advances, and Future Outlook

With the development of nanotechnology, nanomaterials have been used in dental fields over the past years. Among them, graphene and its derivatives have attracted great attentions, owing to their excellent physicochemical property, morphology, biocompatibility, multi-differentiation activity, and antimicrobial activity. In our review, we summarized the recent progress about their applications on the dentistry. The synthesis methods, structures, and properties of graphene-based materials are discussed. Then, the dental applications of graphene-based materials are emphatically collected and described. Finally, the challenges and outlooks of graphene-based nanomaterials on the dental applications are discussed in this paper, aiming at inspiring more excellent studies.

Nanoarchitectonics for Abused-Drug Biosensors

Rapid, accessible, and highly accurate biosensors for the detection of addictive and abused drugs are needed to reduce the adverse personal and societal impacts of addiction. Modern sensors that utilize next-generation technologies, e.g., nanobiotechnology and nanoarchitectonics, have triggered revolutionary progress in the field as they allow accurate detection and tracking of trace levels of major classes of drugs. This paper reviews advances in the field of biosensors for the detection of commonly abused drugs, both prescribed such as codeine and morphine, and illegal narcotics like cocaine.

An electrochemical amplification strategy based on the ferrocene functionalized cuprous oxide superparticles for the detection of NSE

A sandwich-type electrochemical immunosensor was designed utilizing ferrocene-functionalized cuprous oxide superparticles (Au/Fc@Cu_xO SPs) as the signal label and graphene supported by hollow carbon balls (HCNs-GR) as the substrate. The Cu_xO SPs possess a superparticle structure with synergistic properties of isotropy and promising catalytic activity. Ferrocene (Fc) was deposited on the Cu_xO SPs to act as the electronic transmission medium. The Au/Fc@Cu_xO SPs played a pivotal role in improving the sensitivity of the immunosensor. The graphene supported by hollow carbon balls (HCNs-GR) was used to modify the electrode surface. The embedding of hollow carbon nanospheres (HCNs) reduced the decrease of the effective surface area caused by the stacking of graphene nanotubes. Meanwhile, the load of carbon balls further increases the surface area of graphene, enabled HCNs-GR to immobilize antibodies more effectively, improved the sensitivity of the immunosensor. The proposed immunosensor showed a linear range from 500 fg/mL to 100 ng/mL, with the detection limit to 25.7 fg/mL.

Sensitive electrochemical detection of metabisulphite in gastrointestinal fluids

Electrochemical detection of metabisulphite in simulated gastrointestinal fluids.

Engineered red blood cell membrane for sensitive and precise electrochemical detection of salivary exosomes

As a kind of promising non-invasive biomarker, exosomes naturally occurring in saliva have recently attracted considerable attention in view of their potential use in the diagnosis of oral diseases. Herein, we propose a new electrochemical method for the sensitive and precise detection of salivary exosomes. A red blood cell membrane (RBCM) engineered with CD63 aptamer is the core element of the method and is used to camouflage a gold electrode, thus giving the electrode superior antifouling and targeting ability. Target exosomes presented in saliva are recognized and captured by the highly specific interaction between the exosomal CD63 and the aptamers engineered in RBCM. Then, silver nanoparticles modified with CD63 aptamers are recruited onto the electrode surface to generate significant electrochemical signals, which enables the sensitive detection of target exosomes. By using human oral squamous cell carcinoma CAL27 cell-derived exosomes as a model, the method allows target salivary exosome detection in a wide linear range from 5 × 10² to 1 × 10⁶ particles per mL and a low detection limit of 2.07 × 10² particles per mL. Moreover, the method displays good reproducibility and is feasible for detecting target exosomes with high precision in saliva samples. Overall, the method may provide a useful tool for salivary exosome detection and may have great potential for practical use in the clinical diagnosis of oral diseases.

Graphene Biodevices for Early Disease Diagnosis Based on Biomarker Detection

The early diagnosis of diseases plays a vital role in healthcare and the extension of human life. Graphene-based biosensors have boosted the early diagnosis of diseases by detecting and monitoring related biomarkers, providing a better understanding of various physiological and pathological processes. They have generated tremendous interest, made significant advances, and offered promising application prospects. In this paper, we discuss the background of graphene and biosensors, including the properties and functionalization of graphene and biosensors. Second, the significant technologies adopted by biosensors are discussed, such as field-effect transistors and electrochemical and optical methods. Subsequently, we highlight biosensors for detecting various biomarkers, including ions, small molecules, macromolecules, viruses, bacteria, and living human cells. Finally, the opportunities and challenges of graphene-based biosensors and related broad research interests are discussed.

Saliva testing as a means to monitor therapeutic lithium levels in patients with psychiatric disorders: Identification of clinical and environmental covariates, and their incorporation into a prediction model

OBJECTIVE

The narrow therapeutic window of lithium medications necessitates frequent serum monitoring, which can be expensive and inconvenient for the patient. Compared to blood, saliva collection is easier, non-invasive, requires less processing, and can be done without the need for trained personnel. This study investigated the utility of longitudinal salivary lithium level monitoring.

METHODS

We measured salivary lithium levels using ICP-OES in n = 169 passive drool samples, collected both as single observations and longitudinally for up to 18 months, from a multi-center cohort of n = 75 patients with bipolar disorder or other psychiatric conditions.

RESULTS

Saliva and serum lithium levels were highly correlated. Adjustment for daily lithium dose, diabetes, and smoking improved this relationship (r = 0.77). Using the adjusted intersubject equation and a patient's salivary lithium value, we observed a strong correlation between the predicted vs. observed serum lithium levels (r = 0.70). Most patients had highly stable saliva/serum ratios across multiple visits, with longitudinal variability significantly greater with age. Use of the intrasubject saliva/serum ratio from a single prior observation had similar predictive power to the use of the adjusted intersubject equation. However, the use of the mean intrasubject ratio from three prior observations could robustly predict serum lithium levels (predicted vs. observed r = 0.90).

CONCLUSIONS

These findings strongly suggest that saliva could be used for lithium monitoring, and open the door for the development and implementation of a point-of-care salivary lithium device for use at home or the clinic. We propose that the use of saliva will dramatically improve treatment opportunities for patients with mood disorders.

Advances in Microsensors and Wearable Bioelectronics for Digital Stethoscopes in Health Monitoring and Disease Diagnosis

Acoustic stethoscopes have demonstrated beneficial factors aiding diagnosis from the doctors with accurate body sounds. Still, the conventional acoustic stethoscopes require a substantial amount of clinical experience and hearing skills for the physicians to accurately diagnose symptoms from abnormal sounds. Especially for cardiopulmonary systems, it is crucial to collect sounds with precision since they contain valuable information in specific frequency ranges for various sounds. This review paper summarizes recent advances and technical developments in microsensors, circuits, chips, and integrated electronics for fabricating different digital stethoscopes that offer portable detection of body sounds. They solve the limitations of conventional stethoscopes, aiming for wireless auscultation in digitized medicine. Overall, this comprehensive review will help researchers design and develop new wearable electronics and digital stethoscopes for advancing human healthcare, continuous monitoring, and better diagnosis.

Malignancies and Biosensors: A Focus on Oral Cancer Detection through Salivary Biomarkers

Oral cancer is among the deadliest types of malignancy due to the late stage at which it is usually diagnosed, leaving the patient with an average five-year survival rate of less than 50%. The booming field of biosensing and point of care diagnostics can, in this regard, play a major role in the early detection of oral cancer. Saliva is gaining interest as an alternative biofluid for non-invasive diagnostics, and many salivary biomarkers of oral cancer have been proposed. While these findings are promising for the application of salivaomics tools in routine practice, studies on larger cohorts are still needed for clinical validation. This review aims to summarize the most recent development in the field of biosensing related to the detection of salivary biomarkers commonly associated with oral cancer. An introduction to oral cancer diagnosis, prognosis and treatment is given to define the clinical problem clearly, then saliva as an alternative biofluid is presented, along with its advantages, disadvantages, and collection procedures. Finally, a brief paragraph on the most promising salivary biomarkers introduces the sensing technologies commonly exploited to detect oral cancer markers in saliva. Hence this review provides a comprehensive overview of both the clinical and technological advantages and challenges associated with oral cancer detection through salivary biomarkers.

A graphene oxide-based fluorescent nanosensor to identify antiviral agents via a drug repurposing screen

Currently, there are no approved therapeutics for Dengue virus (DENV) infection, even though it can cause fatal complications. Understanding DENV infection and its propagation process in host cells is necessary to develop specific antiviral therapeutics. Here, we developed a graphene oxide-based fluorescent system (Graphene Oxide-based Viral RNA Analysis system, GOViRA) that enables sensitive and quantitative real-time monitoring of the intracellular viral RNA level in living cells. The GOViRA system consists of a fluorescent dye-labeled peptide nucleic acid (PNA) with a complementary sequence to the DENV genome and a dextran-coated reduced graphene oxide nanocolloid (DRGON). When the dye labeled PNA is adsorbed onto DRGON, the fluorescence of the dye is effectively quenched. The quenched fluorescence signal is recovered when the dye labeled PNA forms interaction with intracellular viral RNA in DENV infected host cells. We demonstrated the successful use of the GOViRA platform for high-throughput screening to discover novel antiviral compounds. Through a cell-based high-throughput screening of FDA-approved small-molecule drugs, we identified ulipristal, a selective progesterone receptor modulator (SPRM), as a potent inhibitor against DENV infection. The anti-DENV activity of ulipristal was confirmed both in vitro and in vivo. Moreover, we suggest that the mode of action of ulipristal is mediated by inhibiting viral entry into the host cells.

Development of Flexible Ion-Selective Electrodes for Saliva Sodium Detection

Saliva can be used for health monitoring with non-invasive wearable systems. Such devices, including electrochemical sensors, may provide a safe, fast, and cost-efficient way of detecting target ions. Although salivary ions are known to reflect those in blood, no available clinical device can detect essential ions directly from saliva. Here, we introduce an all-solid-state, flexible film sensor that allows highly accurate detection of sodium levels in saliva, comparable to those in blood. The wireless film sensor system can successfully measure sodium ions from a small volume of infants' saliva (<400 µL), demonstrating its potential as a continuous health monitor. This study includes the structural characterization and error analysis of a carbon/elastomer-based ion-selective electrode and a reference electrode to confirm the signal reliability. The sensor, composed of a pair of the electrodes, shows good sensitivity (58.9 mV/decade) and selectivity (log K = -2.68 for potassium), along with a broad detection range of 5 × 10^-5 ≈ 1 M with a low detection limit of 4.27 × 10^-5 M. The simultaneous comparison between the film sensor and a commercial electrochemical sensor demonstrates the accuracy of the flexible sensor and a positive correlation in saliva-to-blood sodium levels. Collectively, the presented study shows the potential of the wireless ion-selective sensor system for a non-invasive, early disease diagnosis with saliva.

Current strategies with sensing technologies to eliminate stress cardiomyopathy

Stress cardiomyopathy refers weakening of heart muscle due to the continuous stress. Generally, the severe status of stress cardiomyopathy has been revealed after damaging the muscles and measured by the physical changes in the heart system. To overcome this issue, biosensor can be used, which could eliminate the late identification stress cardiomyopathy. With biosensors, different stress markers such as epinephrine, dopamine, catecholamine, α-amylase, norepinephrine, serotonin and cortisol have been identified by a wide range of developments. These biosensors are available from laboratory to industry at the ranges of nano to macrodevices. To merge with the identification of stress cardiomyopathy, the above strategies might be utilized properly and can aid to reduce the stress-related problems. This overview gleaned the currently available biosensing methods and the associated biomarkers at various stages of the developments and implementations of stress cardiomyopathy.