Microfluidic platform towards point-of-care diagnostics in infectious diseases

A dry chemistry-based self-enhanced electrochemiluminescence lateral flow immunoassay sensor for accurate sample-to-answer detection of luteinizing hormone

BACKGROUND

Colorimetric lateral flow immunoassay (LFIA) is a widely used point-of-care testing (POCT) technology, while it has entered a bottleneck period because of low detection sensitivity, expensive preparation materials, and incapable quantitative detection. Therefore, it is necessary to develop a novel POCT method that is ultrasensitive, simple, portable, and capable of accurately detecting biomarkers in biofluids daily, particularly for pregnancy preparation and early screening of diseases.

RESULT

In this work, a novel dry chemistry-based self-enhanced electrochemiluminescence (DC-SE-ECL) LFIA sensor is introduced for accurate POCT of luteinizing hormone (LH). The proposed DC-SE-ECL immunosensor significantly improves the detection sensitivity through the Poly-l-Lysine (PLL)-based SE-ECL probe and cathode modification of closed bipolar electrode (C-BPE). Additionally, a new type of C-BPE configuration is designed for easily performing the LFIA. And, two standalone absorbent pads are symmetrically arranged below the reporting channel of the electrode pad to decease useless residues on the detection pad, which further improves the detection performance. Under optimized conditions, the proposed LFIA sensor has a low limit of detection (9.274 μIU mL-1) and a wide linear dynamic range (0.01-100 mIU mL-1), together with good selectivity, repeatability and storage stability.

SIGNIFICANCE

These results indicate that the proposed DC-SE-ECL method has the potential as a new tool for detecting biomarkers in clinical samples.

Open and closed microfluidics for biosensing

Biosensing is vital for many areas like disease diagnosis, infectious disease prevention, and point-of-care monitoring. Microfluidics has been evidenced to be a powerful tool for biosensing via integrating biological detection processes into a palm-size chip. Based on the chip structure, microfluidics has two subdivision types: open microfluidics and closed microfluidics, whose operation methods would be diverse. In this review, we summarize fundamentals, liquid control methods, and applications of open and closed microfluidics separately, point out the bottlenecks, and propose potential directions of microfluidics-based biosensing.

Recent advances in smart wearable sensors for continuous human health monitoring

In recent years, the biochemical and biological research areas have shown great interest in a smart wearable sensor because of its increasing prevalence and high potential to monitor human health in a non-invasive manner by continuous screening of biomarkers dispersed throughout the biological analytes, as well as real-time diagnostic tools and time-sensitive information compared to conventional hospital-centered system. These smart wearable sensors offer an innovative option for evaluating and investigating human health by incorporating a portion of recent advances in technology and engineering that can enhance real-time point-of-care-testing capabilities. Smart wearable sensors have emerged progressively with a mixture of multiplexed biosensing, microfluidic sampling, and data acquisition systems incorporated with flexible substrate and bodily attachments for enhanced wearability, portability, and reliability. There is a good chance that smart wearable sensors will be relevant to the early detection and diagnosis of disease management and control. Therefore, pioneering smart wearable sensors into reality seems extremely promising despite possible challenges in this cutting-edge technology for a better future in the healthcare domain. This review presents critical viewpoints on recent developments in wearable sensors in the upcoming smart digital health monitoring in real-time scenarios. In addition, there have been proactive discussions in recent years on materials selection, design optimization, efficient fabrication tools, and data processing units, as well as their continuous monitoring and tracking strategy with system-level integration such as internet-of-things, cyber-physical systems, and machine learning algorithms.

Microfluidics for personalized drug delivery

This review highlights the transformative impact of microfluidic technology on personalized drug delivery. Microfluidics addresses issues in traditional drug synthesis, providing precise control and scalability in nanoparticle fabrication, and microfluidic platforms show high potential for versatility, offering patient-specific dosing and real-time monitoring capabilities, all integrated into wearable technology. Covalent conjugation of antibodies to nanoparticles improves bioactivity, driving innovations in drug targeting. The integration of microfluidics with sensor technologies and artificial intelligence facilitates real-time feedback and autonomous adaptation in drug delivery systems. Key challenges, such as droplet polydispersity and fluidic handling, along with future directions focusing on scalability and reliability, are essential considerations in advancing microfluidics for personalized drug delivery.

Microfluidics as diagnostic tools

The challenges in the management of human diseases are largely determined by the precision, speed and ease of diagnostic procedures available. Developments in biomedical engineering technologies have greatly helped in transforming human health care, especially for disease diagnosis which in turn lead to better patient outcomes. One such development is in the form of microfluidic chip technology which has transformed various aspects of human health care. We present in this review, a comprehensive account on the utility of microfluidic chip technologies for the diagnosis of autoimmune disorders, cardiovascular diseases (CVDs), infectious diseases, and neurodegenerative conditions. We have included the diseases posing global threat such as rheumatoid arthritis, diabetes, pernicious anemia, tuberculosis, COVID-19, influenza, alzheimer's, multiple sclerosis, and epilepsy. Apart from discussing the ways of microfluidic chip in diagnosis, we included a section presenting electrochemical, electrical, optical, and acoustic detection technologies for the precise diagnosis of CVDs. Microfluidics platforms have thus revolutionized novel capabilities in addressing the requirements of point-of-care diagnostics enabling miniaturization by integrating multiple laboratory functions into a single chip resulting in "one flow - one solution" systems. Hence, the precision and early diagnoses of diseases are now possible due to the advancements of microfluidics-based technology.

Microfluidics-Based Nanobiosensors for Healthcare Monitoring

Efficient healthcare management demands prompt decision-making based on fast diagnostics tools, astute data analysis, and informatics analysis. The rapid detection of analytes at the point of care is ensured using microfluidics in synergy with nanotechnology and biotechnology. The nanobiosensors use nanotechnology for testing, rapid disease diagnosis, monitoring, and management. In essence, nanobiosensors detect biomolecules through bioreceptors by modulating the physicochemical signals generating an optical and electrical signal as an outcome of the binding of a biomolecule with the help of a transducer. The nanobiosensors are sensitive and selective and play a significant role in the early identification of diseases. This article reviews the detection method used with the microfluidics platform for nanobiosensors and illustrates the benefits of combining microfluidics and nanobiosensing techniques by various examples. The fundamental aspects, and their application are discussed to illustrate the advancement in the development of microfluidics-based nanobiosensors and the current trends of these nano-sized sensors for point-of-care diagnosis of various diseases and their function in healthcare monitoring.

Trends and challenges in microfluidic methods for protein manipulation-A review

Proteins are important molecules involved in an immensely large number of biological processes. Being capable of manipulating proteins is critical for developing reliable and affordable techniques to analyze and/or detect them. Such techniques would enable the production of therapeutic agents for the treatment of diseases or other biotechnological applications (e.g., bioreactors or biocatalysis). Microfluidic technology represents a potential solution to protein manipulation challenges because of the diverse phenomena that can be exploited to achieve micro- and nanoparticle manipulation. In this review, we discuss recent contributions made in the field of protein manipulation in microfluidic systems using different physicochemical principles and techniques, some of which are miniaturized versions of already established macro-scale techniques.

Paper-Based Microfluidic Chips for Food Hazard Factor Detection: Fabrication, Modification, and Application

Food safety and quality are paramount concerns for ensuring the preservation of human life and well-being. As the field of food processing continues to advance, there is a growing interest in the development of fast, instant, cost-effective, and convenient methods for detecting food safety issues. In this context, the utilization of paper-based microfluidic chips has emerged as a promising platform for enabling rapid detection, owing to their compact size, high throughput capabilities, affordability, and low resource consumption, among other advantages. To shed light on this topic, this review article focuses on the functionalization of paper-based microfluidic surfaces and provides an overview of the latest research and applications to colorimetric analysis, fluorescence analysis, surface-enhanced Raman spectroscopy, as well as their integration with paper-based microfluidic platforms for achieving swift and reliable food safety detection. Lastly, the article deliberates on the challenges these analytical methods and presents insights into their future development prospects in facilitating rapid food safety assessment.

A review of current effective COVID-19 testing methods and quality control

COVID-19 is a highly infectious disease caused by the SARS-CoV-2 virus, which primarily affects the respiratory system and can lead to severe illness. The virus is extremely contagious, early and accurate diagnosis of SARS-CoV-2 is crucial to contain its spread, to provide prompt treatment, and to prevent complications. Currently, the reverse transcriptase polymerase chain reaction (RT-PCR) is considered to be the gold standard for detecting COVID-19 in its early stages. In addition, loop-mediated isothermal amplification (LMAP), clustering rule interval short palindromic repeats (CRISPR), colloidal gold immunochromatographic assay (GICA), computed tomography (CT), and electrochemical sensors are also common tests. However, these different methods vary greatly in terms of their detection efficiency, specificity, accuracy, sensitivity, cost, and throughput. Besides, most of the current detection methods are conducted in central hospitals and laboratories, which is a great challenge for remote and underdeveloped areas. Therefore, it is essential to review the advantages and disadvantages of different COVID-19 detection methods, as well as the technology that can enhance detection efficiency and improve detection quality in greater details.

Mini-thermal platform integrated with microfluidic device with on-site detection for real-time DNA amplification

The recent cases of COVID-19 have brought the prospect of and requirement for point-of-care diagnostic devices into the limelight. Despite all the advances in point-of-care devices, there is still a huge requirement for a rapid, accurate, easy-to-use, low-cost, field-deployable and miniaturized PCR assay device to amplify and detect genetic material. This work aims to develop an Internet-of-Things automated, integrated, miniaturized and cost-effective microfluidic continuous flow-based PCR device capable of on-site detection. As a proof of application, the 594-bp GAPDH gene was successfully amplified and detected on a single system. The presented mini thermal platform with an integrated microfluidic device has the potential to be used for the detection of several infectious diseases.

Advances in point-of-care genetic testing for personalized medicine applications

Breakthroughs within the fields of genomics and bioinformatics have enabled the identification of numerous genetic biomarkers that reflect an individual's disease susceptibility, disease progression, and therapy responsiveness. The personalized medicine paradigm capitalizes on these breakthroughs by utilizing an individual's genetic profile to guide treatment selection, dosing, and preventative care. However, integration of personalized medicine into routine clinical practice has been limited-in part-by a dearth of widely deployable, timely, and cost-effective genetic analysis tools. Fortunately, the last several decades have been characterized by tremendous progress with respect to the development of molecular point-of-care tests (POCTs). Advances in microfluidic technologies, accompanied by improvements and innovations in amplification methods, have opened new doors to health monitoring at the point-of-care. While many of these technologies were developed with rapid infectious disease diagnostics in mind, they are well-suited for deployment as genetic testing platforms for personalized medicine applications. In the coming years, we expect that these innovations in molecular POCT technology will play a critical role in enabling widespread adoption of personalized medicine methods. In this work, we review the current and emerging generations of point-of-care molecular testing platforms and assess their applicability toward accelerating the personalized medicine paradigm.

Multiplexed Ultrasensitive Sample-to-Answer RT-LAMP Chip for the Identification of SARS-CoV-2 and Influenza Viruses

Prompt on-site diagnosis of SARS-CoV-2 with other respiratory infections will have minimized the global impact of the COVID-19 pandemic through rapid, effective management. However, no such multiplex point-of-care (POC) chip has satisfied a suitable sensitivity of gold-standard nucleic acid amplification tests (NAATs). Here, a rapid multiplexed ultrasensitive sample-to-answer loop-mediated isothermal amplification (MUSAL) chip operated by simple LED-driven photothermal amplification to detect six targets from single-swab sampling is presented. First, the MUSAL chip allows ultrafast on-chip sample preparation with ≈500-fold preconcentration at a rate of 1.2 mL min^-1 . Second, the chip enables contamination-free amplification using autonomous target elution into on-chip reagents by photothermal activation. Finally, the chip accomplishes multiplexed on-chip diagnostics of SARS-CoV-2 and influenza viruses with a limit of detection (LoD) of 0.5 copies µL^-1 . The rapid, ultrasensitive, cost-effective sample-to-answer chip with a multiplex capability will allow timely management of various pandemics situations that may be faced shortly.

Magnetically localized and wash-free fluorescence immunoassay (MLFIA): proof of concept and clinical applications

Immunoassays are used for many applications in various markets, from clinical diagnostics to the food industry, generally relying on gold-standard ELISAs that are sensitive, robust, and cheap but also time-consuming and labour intensive. As an alternative, we propose here the magnetically localized and wash-free fluorescence immunoassay (MLFIA): a no-wash assay to directly measure a biomolecule concentration, without mixing nor washing steps. To do so, a fluorescence no-wash measurement is performed to generate a detectable signal. It consists of a differential measurement between the fluorescence of fluorophores bound to magnetic nanoparticles specifically captured by micro-magnets against the residual background fluorescence of unbound fluorophores. Targeted biomolecules (antibodies or antigens) are locally concentrated on micro-magnet lines, with the number of captured biomolecules quantitatively measured without any washing step. The performance of the MLFIA platform is assessed and its use is demonstrated with several biological models as well as clinical blood samples for HIV, HCV and HBV detection, with benchmarking to standard analyzers of healthcare laboratories. Thus, we demonstrated for the first time the versatility of the innovative MLFIA platform. We highlighted promising performances with the successful quantitative detection of various targets (antigens and antibodies), in different biological samples (serum and plasma), for different clinical tests (HCV, HBV, HIV).

Application of a novel rectangular filtering microfluidic device for microfilarial detection

The rectangular filtering microfluidic chip was invented using microfluidics device fabrication technology and can separate living microfilariae from blood samples without a syringe pump. The diagnostic results are highly effective. The device is based on the principle of separating millions of blood cells from microfilariae using a rectangular filter structure. It disperses fluid evenly into the flow-passage channel, and its rectangular filter structure is the key to success in reducing the pressure and separating blood cells from microfilariae effectively. The flow rate and blood cell concentration were optimized in our study. The chip is intended to be a point-of-care device that can reduce the use of superfluous instrumentation in the field. The technology is designed to be rapid, accurate, and easy-to-use for all users, especially those in remote areas.

CRISPR-Cas-mediated diagnostics

An ideal molecular diagnostic method should be sensitive, specific, low cost, rapid, portable, and easy to operate. Traditional nucleic acid detection methods based mainly on PCR technology have not only high sensitivity and specificity, but also some limitations, such as the need for expensive equipment and skilled technicians, being both time and labor intensive, and difficult to implement in some regions. However, with the continuous development of CRISPR-Cas technology and its application in molecular diagnosis, new approaches have been used for the construction of molecular diagnostic systems. In this review, we discuss recent advances in CRISPR-based molecular diagnostic technologies and highlight the revolution they bring to the field of molecular diagnostics.

Microfluidics-Based POCT for SARS-CoV-2 Diagnostics

A microfluidic chip is a tiny reactor that can confine and flow a specific amount of fluid into channels of tens to thousands of microns as needed and can precisely control fluid flow, pressure, temperature, etc. Point-of-care testing (POCT) requires small equipment, has short testing cycles, and controls the process, allowing single or multiple laboratory facilities to simultaneously analyze biological samples and diagnose infectious diseases. In general, rapid detection and stage assessment of viral epidemics are essential to overcome pandemic situations and diagnose promptly. Therefore, combining microfluidic devices with POCT improves detection efficiency and convenience for viral disease SARS-CoV-2. At the same time, the POCT of microfluidic chips increases user accessibility, improves accuracy and sensitivity, shortens detection time, etc., which are beneficial in detecting SARS-CoV-2. This review shares recent advances in POCT-based testing for COVID-19 and how it is better suited to help diagnose in response to the ongoing pandemic.

Asymmetric stem-loop–mediated isothermal amplification of nucleic acids for DNA diagnostic assays by simple modification of canonical PCR primers

Nucleic acid–based assays have been adopted as mainstream tools for clinical diagnostics, food safety, and environment monitoring with the merits of accuracy, rapidity, and sensitivity. Loop-mediated isothermal amplification (LAMP) is a well-established method to rapidly identify nucleic acids and has gained recognition and been developed for clinical applications in resource-limited areas. However, the needs for specifically designed primer sets and non-specific amplification hinder the development of LAMP-based nucleic acid tests. Here, a promoted method, termed asymmetric stem-loop–mediated isothermal amplification (ASLAMP) by simple modification of canonical PCR primers, was developed to attempt to overcome those drawbacks. The two primers in the ASLAMP reaction can be easily obtained by adding a stem-loop sequence part to one PCR primer at 5′-ends to get the folding primer (FP), then adding the same primer to the counter canonical PCR primer at 5′-ends to get the turn-back primer (TP). The ASLAMP method was demonstrated in detecting the H1N1 gene fragment with merits of simple primer design, short target sequence, and high amplification efficiency. In addition, the ASLAMP method showed similar efficacy compared with LAMP targeting at the same H1N1 gene sequence. Furthermore, Shigella detection monitored by real-time fluorescence and endpoint colorimetric approaches were taken as examples for evaluation of the practical application of the ASLAMP method, both offered 100% sensitivity and specificity. In conclusion, the novel ASLAMP method with simplicity of primer design, low requirement of equipment, efficiency, and rapidity has exhibited its great prospect for establishment of DNA isothermal amplification in point of care application.

Diagnosis of disease relevant nucleic acid biomarkers with off-the-shelf devices

Changes in the level of nucleic acids in blood may be correlated with some clinical disorders like cancer, stroke, trauma and autoimmune diseases, and thus, nucleic acids can serve as potential biomarkers for pathological processes. The requirement of technical equipment and operator expertise in effective information readout of modern molecular diagnostic technologies significantly restricted application outside clinical laboratories. The ability to detect nucleic acid biomarkers with off-the-shelf devices, which have the advantages of portability, simplicity, low cost and short response time, is critical to provide a prompt clinical result in circumstances where the laboratory instruments are not available. This review throws light on the current strategies and challenges for nucleic acid diagnosis with commercial portable devices, indicating the future prospect of portable diagnostic devices and making a great difference in improving the healthcare and disease surveillance in resource-limited areas.

Microfluidic technology and its application in the point-of-care testing field

Since the outbreak of the coronavirus disease 2019 (COVID-19), countries around the world have suffered heavy losses of life and property. The global pandemic poses a challenge to the global public health system, and public health organizations around the world are actively looking for ways to quickly and efficiently screen for viruses. Point-of-care testing (POCT), as a fast, portable, and instant detection method, is of great significance in infectious disease detection, disease screening, pre-disease prevention, postoperative treatment, and other fields. Microfluidic technology is a comprehensive technology that involves various interdisciplinary disciplines. It is also known as a lab-on-a-chip (LOC), and can concentrate biological and chemical experiments in traditional laboratories on a chip of several square centimeters with high integration. Therefore, microfluidic devices have become the primary implementation platform of POCT technology. POCT devices based on microfluidic technology combine the advantages of both POCT and microfluids, and are expected to shine in the biomedical field. This review introduces microfluidic technology and its applications in combination with other technologies.

Point-of-care diagnostic tests for tuberculosis disease

Rapid diagnosis is one key pillar to end tuberculosis (TB). Point-of-care tests (POCTs) facilitate early detection, immediate treatment, and reduced transmission of TB disease. This Review evaluates current diagnostic assays endorsed by the World Health Organization and identifies the gaps between existing conventional tests and the ideal POCT. We discuss the commercial development of new rapid tests and research studies on nonsputum-based diagnostic biomarkers from both pathogen and host. Last, we highlight advances in integrated microfluidics technology that may aid the development of new POCTs.

Microfluidics based point-of-care for disease diagnostics

Microfluidics platform is widely used for several basic biological to advanced biotechnological applications. It reduces the expenditure of reagent consumption by readily reducing the volume of the reaction system. It is being used for early diagnosis of diseases, detection of pathogens, cancer markers, high-throughput screening and many such applications. Currently, microfluidics and lab-on-chip is integrated together with sample preparation, extraction, analysis and detection of biomarkers for disease diagnosis. This technology offers low-cost, rapid, sensitive and paper-based lateral flow mode of detection which is user-friendly and scalable. In this chapter, we highlight recent developments in microfluidics platform for disease diagnosis.

Micro and nanofluidics for high throughput drug screening

In this book chapter, we elaborate on the state-of-the-art technology developments in high throughput screening, microfluidics and nanofluidics. This book chapter further elaborated on the application of microfluidics and nanofluidics for high throughput drug screening with respect to communicable diseases and non-communicable diseases such as cancer. As a future perspective, there is tremendous potential for microfluidics and nanofluidics to be applied in high throughput drug screening which could be applied for various biotechnology applications such as in cancer precision medicine, point-of-care diagnostics and imaging. With the integration of Fourth industrial revolution (4IR) technologies with micro and nanofluidics technologies, it envisioned that such integration along with digital health would enable next generation technology development in medical field.

Closed dumbbell mediated isothermal amplification of nucleic acids for DNA diagnostic assays

Nucleic acid amplification tests have been widely applied in clinical diagnostics, food safety monitoring, and molecular biology. As a well-established isothermal amplification method, Loop-mediated isothermal amplification (LAMP) has gained recognition. However, the need for specifically designed four to six primers and non-specific amplification pose challenges for further application of LAMP based detection methods. Here, a novel isothermal amplification method, termed closed dumbbell mediated isothermal amplification (CDA) of nucleic acids, was developed. The primers are easily designed by adding two different parts of middle sequence to the canonical PCR primers at 5'-ends. CDA method was demonstrated in detecting MERS-CoV orf1a gene and H1N1 gene fragments with merits of short core primer, simple primer design process and high amplification efficiency. In addition, CDA showed excellent amplification efficacy over LAMP and competitive annealing mediated isothermal amplification (CAMP) by slight modification of primers targeting at same sequence. Furthermore, real-time and HNB based colorimetric CDA detection of Shigella were developed for practical application, both exhibited 100% success. In all, the developed CDA method with high specificity, simplicity, efficiency and rapidity has shown its great potential for point of care nucleic acids diagnostic.

Multiplexed detection of respiratory pathogens with a portable analyzer in a "raw-sample-in and answer-out" manner

Coronavirus disease 2019 (COVID-19) has emerged, rapidly spread and caused significant morbidity and mortality worldwide. There is an urgent public health need for rapid, sensitive, specific, and on-site diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, a fully integrated and portable analyzer was developed to detect SARS-CoV-2 from swab samples based on solid-phase nucleic acid extraction and reverse transcription loop-mediated isothermal amplification (RT-LAMP). The swab can be directly inserted into a cassette for multiplexed detection of respiratory pathogens without pre-preparation. The overall detection process, including swab rinsing, magnetic bead-based nucleic acid extraction, and 8-plex real-time RT-LAMP, can be automatically performed in the cassette within 80 min. The functionality of the cassette was validated by detecting the presence of a SARS-CoV-2 pseudovirus and three other respiratory pathogens, i.e., Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The limit of detection (LoD) for the SARS-CoV-2 pseudovirus was 2.5 copies/μL with both primer sets (N gene and ORF1ab gene), and the three bacterial species were successfully detected with an LoD of 2.5 colony-forming units (CFU)/μL in 800 μL of swab rinse. Thus, the analyzer developed in this study has the potential to rapidly detect SARS-CoV-2 and other respiratory pathogens on site in a “raw-sample-in and answer-out” manner.

Amplification factor in DC insulator-based electrokinetic devices: a theoretical, numerical, and experimental approach to operation voltage reduction for particle trapping

Insulator-based microfluidic devices are attractive for handling biological samples due to their simple fabrication, low-cost, and efficiency in particle manipulation. However, their widespread application is limited by the high operation voltages required to achieve particle trapping. We present a theoretical, numerical, and experimental study that demonstrates these voltages can be significantly reduced (to sub-100 V) in direct-current insulator-based electrokinetic (DC-iEK) devices for micron-sized particles. To achieve this, we introduce the concept of the amplification factor-the fold-increase in electric field magnitude due to the presence of an insulator constriction-and use it to compare the performance of different microchannel designs and to direct our design optimization process. To illustrate the effect of using constrictions with smooth and sharp features on the amplification factor, geometries with circular posts and semi-triangular posts were used. These were theoretically approximated in two different systems of coordinates (bipolar and elliptic), allowing us to provide, for the first time, explicit electric field amplification scaling laws. Finite element simulations were performed to approximate the 3D insulator geometries and provide a parametric study of the effect of changing different geometrical features. These simulations were used to predict particle trapping voltages for four different single-layer microfluidic devices using two particle suspensions (2 and 6.8 μm in size). The general agreement between our models demonstrates the feasibility of using the amplification factor, in combination with nonlinear electrokinetic theory, to meet the prerequisites for the development of portable DC-iEK microfluidic systems.

Recent advances in the detection of interferon-gamma as a TB biomarker

Tuberculosis (TB) is one of the main infectious diseases worldwide and accounts for many deaths. It is caused by Mycobacterium tuberculosis usually affecting the lungs of patients. Early diagnosis and treatment are essential to control the TB epidemic. Interferon-gamma (IFN-γ) is a cytokine that plays a part in the body’s immune response when fighting infection. Current conventional antibody-based TB sensing techniques which are commonly used include enzyme-linked immunosorbent assay (ELISA) and interferon-gamma release assays (IGRAs). However, these methods have major drawbacks, such as being time-consuming, low sensitivity, and inability to distinguish between the different stages of the TB disease. Several electrochemical biosensor systems have been reported for the detection of interferon-gamma with high sensitivity and selectivity. Microfluidic techniques coupled with multiplex analysis in regular format and as lab-on-chip platforms have also been reported for the detection of IFN-γ. This article is a review of the techniques for detection of interferon-gamma as a TB disease biomarker. The objective is to provide a concise assessment of the available IFN-γ detection techniques (including conventional assays, biosensors, microfluidics, and multiplex analysis) and their ability to distinguish the different stages of the TB disease.

Saliva as a Source of Biomarkers for Periodontitis and Periimplantitis

Saliva has the potential to be used as a diagnostic and monitoring tool for various diseases if biomarkers of an adequate sensitivity and specificity could be identified. Several reviews and even meta-analyses have been performed in recent years, which have found some candidate biomarkers for periodontitis, like macrophage inflammatory protein-1 alpha, interleukin-1ß, interleukin-6, matrix metalloproteinase-8, or hemoglobin. However, none of those are currently in use to replace conventional periodontal diagnostics with a periodontal probe. For periimplantitis, to date, heterogeneity of different study protocols and implant types did not permit to discover clear biomarkers, which were able to distinguish between healthy and diseased implants. Few proinflammatory cytokines, similar to periodontitis, have been characterized as adjunct tools to clinical diagnosis. The additional determination of antimicrobial peptides, bone turnover markers, and bacteria could help to enhance sensitivity and specificity in a combined model for periodontitis and periimplantitis. Furthermore, proteomic approaches might be preferred over single biomarker determinations. A global consensus is also needed to harmonize salivary sampling methods as well as procedures of biomarker analysis to ensure future comparability.

Challenge of diagnosing acute infections in poor resource settings in Africa

Frequent disease outbreaks and acute infections occur in rural and low-income urban areas of Africa, with many health systems unprepared to diagnose and control diseases that are recurrent, endemic or have extended their geographic zone. In this review, we focus on acute infections that can be characterized by sudden onset, rapid progression, severe symptoms and poor prognosis. Consequently, these infections require early diagnosis and intervention. While effective vaccines have been developed against some of these diseases, lack of compliance and accessibility, and the need for repeated or multiple vaccinations mean large populations can remain vulnerable to infection. It follows that there is a need for enhancement of national surveillance and diagnostic capacity to avert morbidity and mortality from acute infections. We discuss the limitations of traditional diagnostic methods and explore the relative merits and applicability of protein-, carbohydrate- and nucleic acid-based rapid diagnostic tests that have been trialled for some infectious diseases. We also discuss the utility and limitations of antibody-based serological diagnostics and explore how systems biology approaches can better inform diagnosis. Lastly, given the complexity and high cost associated with after-service support of emerging technologies, we propose that, for resource-limited settings in Africa, multiplex point-of-care diagnostic tools be tailor-made to detect both recurrent acute infections and endemic infections.

Point-of-care testing detection methods for COVID-19

COVID-19 is an acute respiratory disease caused by SARS-CoV-2, which has high transmissibility. People infected with SARS-CoV-2 can develop symptoms including cough, fever, pneumonia and other complications, which in severe cases could lead to death. In addition, a proportion of people infected with SARS-CoV-2 may be asymptomatic. At present, the primary diagnostic method for COVID-19 is reverse transcription-polymerase chain reaction (RT-PCR), which tests patient samples including nasopharyngeal swabs, sputum and other lower respiratory tract secretions. Other detection methods, e.g., isothermal nucleic acid amplification, CRISPR, immunochromatography, enzyme-linked immunosorbent assay (ELISA) and electrochemical sensors are also in use. As the current testing methods are mostly performed at central hospitals and third-party testing centres, the testing systems used mostly employ large, high-throughput, automated equipment. Given the current situation of the epidemic, point-of-care testing (POCT) is advantageous in terms of its ease of use, greater approachability on the user's end, more timely detection, and comparable accuracy and sensitivity, which could reduce the testing load on central hospitals. POCT is thus conducive to daily epidemic control and achieving early detection and treatment. This paper summarises the latest research advances in POCT-based SARS-CoV-2 detection methods, compares three categories of commercially available products, i.e., nucleic acid tests, immunoassays and novel sensors, and proposes the expectations for the development of POCT-based SARS-CoV-2 detection including greater accessibility, higher sensitivity and lower costs.

Multi-frequency impedance sensing for detection and sizing of DNA fragments

Electronic biosensors for DNA detection typically utilize immobilized oligonucleotide probes on a signal transducer, which outputs an electronic signal when target molecules bind to probes. However, limitation in probe selectivity and variable levels of non-target material in complex biological samples can lead to nonspecific binding and reduced sensitivity. Here we introduce the integration of 2.8 μm paramagnetic beads with DNA fragments. We apply a custom-made microfluidic chip to detect DNA molecules bound to beads by measuring Impedance Peak Response (IPR) at multiple frequencies. Technical and analytical performance was evaluated using beads containing purified Polymerase Chain Reaction (PCR) products of different lengths (157, 300, 613 bp) with DNA concentration ranging from 0.039 amol to 7.8 fmol. Multi-frequency IPR correlated positively with DNA amounts and was used to calculate a DNA quantification score. The minimum DNA amount of a 300 bp fragment coupled on beads that could be robustly detected was 0.0039 fmol (1.54 fg or 4750 copies/bead). Additionally, our approach allowed distinguishing beads with similar molar concentration DNA fragments of different lengths. Using this impedance sensor, purified PCR products could be analyzed within ten minutes to determine DNA fragment length and quantity based on comparison to a known DNA standard.

Fabrication of PDMS microfluidic devices using nanoclay-reinforced Pluronic F-127 as a sacrificial ink

Three-dimensional (3D) printing technology is increasingly being employed in biochemical as well as clinical applications and more importantly in fabrication of microfluidic devices. However, the microfluidic community mainly relies on photolithography for fabrication of a defined mask, which is both tedious and expensive requiring clean room settings as well as limited to the generation of two-dimensional (2D) features. In this work, we 3D printed nanoclay-reinforced Pluronic ink as a sacrificial material, which exhibited shear thinning behavior and superior printability allowing the fabrication of unsupported or overhanging templates of channels with uniform diameter and circular cross-sections. To highlight the potential and effectiveness of the presented approach, we fabricated a human blood vessel-on-a-chip model with curved as well as straight channels. These channels were then lined with Human Umbilical Vein Endothelial cells (HUVECs) and subjected to a dynamic culture for 10 days to explore the effect of shear stress on HUVEC morphology based on the location of HUVECs in the devices. Overall, we presented a highly affordable, useful, and practical approach in fabrication of closed microfluidic channels in PDMS based devices, which holds great potential for numerous applications, such as but not limited to tissue/organ-on-chip, microfluidics, point-of-care devices and drug screening platforms.

Colorimetric loop-mediated isothermal amplification (LAMP) for cost-effective and quantitative detection of SARS-CoV-2: the change in color in LAMP-based assays quantitatively correlates with viral copy number

We demonstrate a loop-mediated isothermal amplification (LAMP) method to detect and amplify SARS-CoV-2 genetic sequences using a set of in-house designed initiators that target regions encoding the N protein. We were able to detect and amplify SARS-CoV-2 nucleic acids in the range of 62 to 2 × 105 DNA copies by this straightforward method. Using synthetic SARS-CoV-2 samples and RNA extracts from patients, we demonstrate that colorimetric LAMP is a quantitative method comparable in diagnostic performance to RT-qPCR (i.e., sensitivity of 92.85% and specificity of 81.25% in a set of 44 RNA extracts from patients analyzed in a hospital setting).

Microfluidic Point-of-Care Testing: Commercial Landscape and Future Directions

Point-of-care testing (POCT) allows physicians to detect and diagnose diseases at or near the patient site, faster than conventional lab-based testing. The importance of POCT is considerably amplified in the trying times of the COVID-19 pandemic. Numerous point-of-care tests and diagnostic devices are available in the market including, but not limited to, glucose monitoring, pregnancy and infertility testing, infectious disease testing, cholesterol testing and cardiac markers. Integrating microfluidics in POCT allows fluid manipulation and detection in a singular device with minimal sample requirements. This review presents an overview of two technologies - (a.) Lateral Flow Assay (LFA) and (b.) Nucleic Acid Amplification - upon which a large chunk of microfluidic POCT diagnostics is based, some of their applications, and commercially available products. Apart from this, we also delve into other microfluidic-based diagnostics that currently dominate the in-vitro diagnostic (IVD) market, current testing landscape for COVID-19 and prospects of microfluidics in next generation diagnostics.

COVID-19: advance in laboratory diagnostic strategy and technology

SARS-CoV-2 is one of the beta-coronaviruses with the spike protein. It invades host cells by binding to angiotensin converting enzyme 2 (ACE2). This newly discovered virus can result in excessive inflammation and immune pathological damage, as shown by a decreased number of peripheral lymphocytes, increased levels of cytokines, and damages of lung, heart, liver, kidney, and other organs. Effective therapeutic modalities such as new antiviral drugs and vaccines against this emerging virus need to be thoroughly studied and developed. However, so far the only recognized but mild progress in this area is the screening of old drugs for new uses. Therefore, rapid and accurate laboratory SARS-CoV-2 testing approaches are the important basis of identification and blockage of COVID-19 transmission. For COVID-19 patients with different clinical classifications (mild, common, severe, and critically severe), dynamic monitoring of functional indicators of susceptible and vital organs is an important strategy for evaluating therapeutic efficacy and prognosis. In this review, we summarized SARS-CoV-2 laboratory diagnostic schemes, pathophysiological indices of tissues and organs of COVID-19 patients, and laboratory diagnostic strategies for distinct disease stages. Further, we discussed the importance of hierarchical management and dynamic observation in SARS-CoV-2 laboratory diagnostics. We then summed up the advance in SARS-CoV-2 testing technology and described the prospect of intelligent medicine in the prevention of infectious disease outbreaks.

Cyclic on-chip bacteria separation and preconcentration

Nanoparticles and biological molecules high throughput robust separation is of significant interest in many healthcare and nanoscience industrial applications. In this work, we report an on-chip automatic efficient separation and preconcentration method of dissimilar sized particles within a microfluidic platform using integrated membrane valves controlled microfiltration. Micro-sized E. coli bacteria are sorted from nanoparticles and preconcentrated on a microfluidic chip with six integrated pneumatic valves (sub-100 nL dead volume) using hydrophilic PVDF filter with 0.45 μm pore diameter. The proposed on-chip automatic sorting sequence includes a sample filtration, dead volume washout and retentate backflush in reverse flow. We showed that pulse backflush mode and volume control can dramatically increase microparticles sorting and preconcentration efficiency. We demonstrate that at the optimal pulse backflush regime a separation efficiency of E. coli cells up to 81.33% at a separation throughput of 120.45 μL/min can be achieved. A trimmed mode when the backflush volume is twice smaller than the initial sample results in a preconcentration efficiency of E. coli cells up to 121.96% at a throughput of 80.93 μL/min. Finally, we propose a cyclic on-chip preconcentration method which demonstrates E. coli cells preconcentration efficiency of 536% at a throughput of 1.98 μL/min and 294% preconcentration efficiency at a 10.9 μL/min throughput.

Toward low-voltage dielectrophoresis-based microfluidic systems: A review

Dielectrophoretically driven microfluidic devices have demonstrated great applicability in biomedical engineering, diagnostic medicine, and biological research. One of the potential fields of application for this technology is in point-of-care (POC) devices, ideally allowing for portable, fully integrated, easy to use, low-cost diagnostic platforms. Two main approaches exist to induce dielectrophoresis (DEP) on suspended particles, that is, electrode-based DEP and insulator-based DEP, each featuring different advantages and disadvantages. However, a shared concern lies in the input voltage used to generate the electric field necessary for DEP to take place. Therefore, input voltage can determine portability of a microfluidic device. This review outlines the recent advances in reducing stimulation voltage requirements in DEP-driven microfluidics.

One-Step Hot Microembossing for Fabrication of Paper-Based Microfluidic Chips in 10 Seconds

In recent years, microfluidic paper-based analytical devices (µPADs) have been developed because they are simple, inexpensive and power-free for low-cost chemical, biological and environmental detection. Moreover, paper is lightweight; easy to stack, store and transport; biodegradable; biocompatible; good for colorimetric tests; flammable for easy disposal of used paper-based diagnostic devices by incineration; and can be chemically modified. Different methods have been demonstrated to fabricate µPADs such as solid wax printing, craft cutting, photolithography, etc. In this study, one-step hot microembossing was proposed and demonstrated to fabricate µPADs. The processing parameters like embossing temperature, pressure and time were systematically investigated. It was found that, at 55 °C embossing temperature, the embossing pressure ranging from 10 to 14 MPa could be applied and the embossing time was only 5 s. This led to the overall processing time for fabrication of µPADs within 10 s. Glucose detection was conducted using the µPADs as fabricated, and a linear relationship was obtained between 5 and 50 mM.

Portable and accurate diagnostics for COVID-19: Combined use of the miniPCR thermocycler and a well-plate reader for SARS-CoV-2 virus detection

The coronavirus disease 2019 (COVID-19) pandemic has crudely demonstrated the need for massive and rapid diagnostics. By the first week of July, more than 10,000,000 positive cases of COVID-19 have been reported worldwide, although this number could be greatly underestimated. In the case of an epidemic emergency, the first line of response should be based on commercially available and validated resources. Here, we demonstrate the use of the miniPCR, a commercial compact and portable PCR device recently available on the market, in combination with a commercial well-plate reader as a diagnostic system for detecting genetic material of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of COVID-19. We used the miniPCR to detect and amplify SARS-CoV-2 DNA sequences using the sets of initiators recommended by the World Health Organization (WHO) for targeting three different regions that encode for the N protein. Prior to amplification, samples were combined with a DNA intercalating reagent (i.e., EvaGreen Dye). Sample fluorescence after amplification was then read using a commercial 96-well plate reader. This straightforward method allows the detection and amplification of SARS-CoV-2 nucleic acids in the range of ~625 to 2×105 DNA copies. The accuracy and simplicity of this diagnostics strategy may provide a cost-efficient and reliable alternative for COVID-19 pandemic testing, particularly in underdeveloped regions where RT-QPCR instrument availability may be limited. The portability, ease of use, and reproducibility of the miniPCR makes it a reliable alternative for deployment in point-of-care SARS-CoV-2 detection efforts during pandemics.

A one-step molded microfluidic chip featuring a two-layer silver-PDMS microelectrode for dielectrophoretic cell separation

Dielectrophoresis (DEP) is a powerful technique for label-free cell separation in microfluidics. Easily-fabricated DEP separators with low cost and short turnaround time are in extremely high demand in practical applications, especially clinical usage where disposable devices are needed. DEP separators exploiting microelectrodes made of conducting polydimethylsiloxane (PDMS) composites enable the construction of advantageous 3D volumetric electrodes with a simple soft-lithography process. Yet, existing devices incorporating microelectrodes in conducting PDMS generally have their fluidic sidewalls constructed using a different material, and consequently require extra lithography of a sacrificial layer on the semi-finished master for molding the electrode and fluidic sidewalls in separate steps. Here we demonstrate a novel microfluidic DEP separator with a 3D electrode and fluidic structure entirely integrated within silver-PDMS composites. We develop a further simplified one-step molding process with lower cost using a readily-available and reusable SU8 master, eliminating the need for the additional lithography step in existing techniques. The uniquely designed two-layer electrode exhibits a spatially non-uniform electric field that enables cell migration in the vertical direction. The electrode upper layer then offers a harbor-like region for the trapping of the target cells that have drifted upwards, which shelters them from being dragged away by the main flow streams in the lower layer, and thus allows higher operation flow rate. We also optimize the upper layer thickness as a critical dimension for protecting the trapped cells from high drag and show easy widening of our device by elongation of the digits. We demonstrate that the elongated digits involving more parallel flow paths maintain a high capture efficiency of 95.4% for live cells with 85.6% purity in the separation of live/dead HeLa cells. We also investigate the device feasibility in a viability assay for cells post anti-cancer drug treatment.

Fabrication of Hard-Soft Microfluidic Devices Using Hybrid 3D Printing

Widely accessible, inexpensive, easy-to-use consumer 3D printers, such as desktop stereolithography (SLA) and fused-deposition modeling (FDM) systems are increasingly employed in prototyping and customizing miniaturized fluidic systems for diagnostics and research. However, these 3D printers are generally limited to printing parts made of only one material type, which limits the functionality of the microfluidic devices without additional assembly and bonding steps. Moreover, mating of different materials requires good sealing in such microfluidic devices. Here, we report methods to print hybrid structures comprising a hard, rigid component (clear polymethacrylate polymer) printed by a low-cost SLA printer, and where the first printed part is accurately mated and adhered to a second, soft, flexible component (thermoplastic polyurethane elastomer) printed by an FDM printer. The prescribed mounting and alignment of the first-printed SLA-printed hard component, and its pre-treatment and heating during the second FDM step, can produce leak-free bonds at material interfaces. To demonstrate the utility of such hybrid 3D-printing, we prototype and test three components: i) finger-actuated pump, ii) quick-connect fluid coupler, and iii) nucleic acid amplification test device with screw-type twist sealing for sample introduction.

Sealing 3D-printed parts to poly(dimethylsiloxane) for simple fabrication of Microfluidic devices

Microfluidics has revolutionized the fields of bioanalytical chemistry, cellular biology, and molecular biology. Advancements in microfluidic technologies, however, are often limited by labor, time, and resource-intensive fabrication methods, most commonly a form of photolithography. The advent of 3D printing has helped researchers fabricate proof-of-concept microfluidics more rapidly and at lower costs but suffers from poor resolution and tedious post-processing to remove uncured resin from enclosed channels. Additionally, custom resins and printers are often needed to create entirely enclosed channels, which increases cost and complexity of fabrication. In this work we demonstrate the ability to create microfluidic devices by covalently sealing 3D-printed parts with open-faced channels to polydimethylsiloxane (PDMS). Open-faced channels are easier to print than fully enclosed channels and can be printed using an inexpensive and commercially available stereolithography 3D printer and resin. The 3D-printed parts are sealed to PDMS, a common substrate used in traditional microfluidic fabrication, using two different techniques. The first involves coating the part with a commercially available silicone spray before sealing to PDMS via plasma treatment. In the second technique, the cured methacrylate resin is silanized with (3-Aminopropyl)triethoxysilane (APTES) before binding to PDMS with plasma treatment. Both methods create a strong seal between the two substrates, which is demonstrated with several types of microfluidic devices including droplet and gradient generators.

Lab-on-a-Chip Technologies for the Single Cell Level: Separation, Analysis, and Diagnostics

In the last three decades, microfluidics and its applications have been on an exponential rise, including approaches to isolate rare cells and diagnose diseases on the single-cell level. The techniques mentioned herein have already had significant impacts in our lives, from in-the-field diagnosis of disease and parasitic infections, through home fertility tests, to uncovering the interactions between SARS-CoV-2 and their host cells. This review gives an overview of the field in general and the most notable developments of the last five years, in three parts: 1. What can we detect? 2. Which detection technologies are used in which setting? 3. How do these techniques work? Finally, this review discusses potentials, shortfalls, and an outlook on future developments, especially in respect to the funding landscape and the field-application of these chips.

Differential Sorting of Microparticles Using Spiral Microchannels with Elliptic Configurations

Label-free, size-dependent cell-sorting applications based on inertial focusing phenomena have attracted much interest during the last decade. The separation capability heavily depends on the precision of microparticle focusing. In this study, five-loop spiral microchannels with a height of 90 µm and a width of 500 µm are introduced. Unlike their original spiral counterparts, these channels have elliptic configurations of varying initial aspect ratios, namely major axis to minor axis ratios of 3:2, 11:9, 9:11, and 2:3. Accordingly, the curvature of these configurations increases in a curvilinear manner through the channel. The effects of the alternating curvature and channel Reynolds number on the focusing of fluorescent microparticles with sizes of 10 and 20 µm in the prepared suspensions were investigated. At volumetric flow rates between 0.5 and 3.5 mL/min (allowing separation), each channel was tested to collect samples at the designated outlets. Then, these samples were analyzed by counting the particles. These curved channels were capable of separating 20 and 10 µm particles with total yields up to approximately 95% and 90%, respectively. The results exhibited that the level of enrichment and the focusing behavior of the proposed configurations are promising compared to the existing microfluidic channel configurations.

Microfluidic tools for probing micro-culprits: Opportunities and challenges in microfluidic diagnostics

Microfluidics is a highly promising technology platform for cancer diagnosis. It will need a change of mindset among engineers, clinicians and regulators to fully embrace its potential.