Cardiac biomarkers and the case for point-of-care testing

Quantitative measurement of acute myocardial infarction cardiac biomarkers by "All-in-One" immune microfluidic chip for early diagnosis of myocardial infarction

Acute myocardial infarction (AMI) is a life-threatening condition with a narrow treatment window, necessitating rapid and accurate diagnostic methods. We present an "all-in-one" convenient and rapid immunoassay system that combines microfluidic technology with a colloidal gold immunoassay. A degassing-driven chip replaces a bulky external pump, resulting in a user-friendly and easy-to-operate immunoassay system. The chip comprises four units: an inlet reservoir, an immunoreaction channel, a waste pool, and an immunocomplex collection chamber, allowing single-channel flow for rapid and accurate AMI biomarker detection. In this study, we focused on cardiac troponin I (cTnI). With a minimal sample of just 4 μL and a total detection time of under 3 min, the chip enabled a quantitative visual analysis of cTnI concentration within a range of 0.5 ∼ 60.0 ng mL-1. This all-in-one integrated microfluidic chip with colloidal gold immunoassay offers a promising solution for rapid AMI diagnosis. The system's portability, small sample requirement, and quantitative visual detection capabilities make it a valuable tool for AMI diagnostics.

Advancements in electrochemical biosensing of cardiovascular disease biomarkers

Cardiovascular diseases (CVDs) stand as a predominant global health concern, introducing vast socioeconomic challenges. In addressing this pressing dilemma, enhanced diagnostic modalities have become paramount, positioning electrochemical biosensing as an instrumental innovation. This comprehensive review navigates the multifaceted terrain of CVDs, elucidating their defining characteristics, clinical manifestations, therapeutic avenues, and intrinsic risk factors. Notable emphasis is placed on pivotal diagnostic tools, spotlighting cardiac biomarkers distinguished by their unmatched clinical precision in terms of relevance, sensitivity, and specificity. Highlighting the broader repercussions of CVDs, there emerges an accentuated need for refined diagnostic strategies. Such an exploration segues into a profound analysis of electrochemical biosensing, encapsulating its foundational principles, diverse classifications, and integral components, notably recognition molecules and transducers. Contemporary advancements in biosensing technologies are brought to the fore, emphasizing pioneering electrode architectures, cutting-edge signal amplification processes, and the synergistic integration of biosensors with microfluidic platforms. At the core of this discourse is the demonstrated proficiency of biosensors in detecting cardiovascular anomalies, underpinned by empirical case studies, systematic evaluations, and clinical insights. As the narrative unfolds, it addresses an array of inherent challenges, spanning intricate technicalities, real-world applicability constraints, and regulatory considerations, finally, by casting an anticipatory gaze upon the future of electrochemical biosensing, heralding a new era of diagnostic tools primed to revolutionize cardiovascular healthcare.

SILAR Growth of ZnO NSs/CdS QDs on the Optical Fiber-Based Opto-Electrode with Guided In Situ Light and Its Application for the "Signal-On" Detection of Inflammatory Cytokine

In this study, a novel integrated photoelectrochemical (PEC) sensor platform was proposed, utilizing an optical fiber (OF) as the working electrode for guided in situ light. A CdS quantum dots (QDs)/ZnO nanosheets (NSs) n-n heterojunction was quickly and easily constructed on the OF surface by successive ionic layer adsorption and reaction (SILAR). Au nanoparticles (NPs)@dsDNA as a capturing probe were modified on the CdS QDs/ZnO NSs@OF (CZ@OF). Due to the energy transfer between Au NPs@dsDNA and CdS QDs, the resultant opto-electrode has a lower background near zero, enabling the "signal-on" detection of biomarkers (interleukin-6 (IL-6) as a model). The OF-PEC biosensor demonstrated a wide linear range from 1 to 100 pg mL-1 with a regression coefficient (R2) of 0.9958 and an impressive detection limit (LOD) of 0.19 pg mL-1. More significantly, the proposed OF-PEC can be successfully used for the detection of IL-6 in serum samples from patients with pulmonary arterial hypertension, and it showed consistency and is more sensitive to trace concentrations compared to BD FACSCanto II flow cytometry used at the hospital. This holds significance for an early disease diagnosis. Therefore, the proposed OF-PEC not only achieves integration of the light source and sensing interface but also enables sensitive and accurate "signal-on" detection of IL-6. Furthermore, due to the flexibility and remote detection capabilities of OF, the application of OF-PEC is expected to be expanded more widely. This approach opens up possibilities for advances in PEC sensing.

A self-driven, microfluidic, integrated-circuit biosensing chip for detecting four cardiovascular disease biomarkers

Cardiovascular diseases (CVDs) claimed the lives of nearly 21 million people worldwide in 2021, accounting for 30% of global deaths. However, one in five CVD patients is unaware that they have the disease, emphasizing the need for accurate biomarker monitoring. Herein we developed an integrated microfluidic system (IMS) for rapid quantification of four CVD biomarkers, including N-terminal pro B-type natriuretic peptide (NT-proBNP), fibrinogen, cardiac troponin I (cTnI), and C-reactive protein (CRP)- via aptamer-coated interdigitated electrodes (IDE) with integrated circuits (IC) and a self-driven IMS for sample treatment. The device was composed of plasma filtration, metering, and fluidic delay modules, and the former could extract 45% of plasma from a 20-μL blood sample; the metering module could quantify 5 μL of plasma within 90 s. Subsequently, the plasma was transported to a detection chamber, where IC-based IDE sensors made measurements within 5 min. The entire 15-min process allowed us to evaluate biomarkers across a wide dynamic range: NT-proBNP (0.1-10,000 pg/mL), fibrinogen (50-1,000 mg/dL), cTnI (0.1-10,000 pg/mL), and CRP (0.5-9 mg/L). Given that spiked blood samples were measured with reasonable accuracy (>80%), the IMS could see utility in CVD risk assessment and personalized medicine.

A multiplexed immunochemical microarray for the determination of cardiovascular disease biomarkers

A fluorescence antibody microarray has been developed for the determination of relevant cardiovascular disease biomarkers for the analysis of human plasma samples. Recording characteristic protein molecular fingerprints to assess individual's states of health could allow diagnosis to go beyond the simple identification of the disease, providing information on its stage or prognosis. Precisely, cardiovascular diseases (CVDs) are complex disorders which involve different degenerative processes encompassing a collection of biomarkers related to disease progression or stage. The novel approach that we propose is a fluorescent microarray chip has been developed accomplishing simultaneous determination of the most significant cardiac biomarkers in plasma aiming to determine the CVD status stage of the patient. As proof of concept, we have chosen five relevant biomarkers, C-reactive protein (CRP) as biomarker of inflammation, cystatin C (CysC) as biomarker of renal failure that is directly related with heart failure, cardiac troponin I (cTnI) as already established biomarker for cardiac damage, heart fatty acid binding protein as biomarker of ischemia (H-FABP), and finally, NT-proBNP (N-terminal pro-brain natriuretic peptide), a well-established heart failure biomarker. After the optimization of the multiplexed microarray, the assay allowed the simultaneous determination of 5 biomarkers in a buffer solution reaching LODs of 15 ± 5, 3 ± 1, 24 ± 3, 25 ± 3, and 3 ± 1 ng mL-1, for CRP, CysC, H-FABP, cTnI, and NT-proBNP, respectively. After solving the matrix effect, and demonstrating the accuracy for each biomarker, the chip was able to determine 24 samples per microarray chip. Then, the microarray has been used on a small pilot clinical study with 29 plasma samples from clinical patients which suffered different CVD and other related disorders. Results show the superior capability of the chip to provide clinical information related to the disease in terms of turnaround time (1 h 30 min total assay and measurement) and amount of information delivered in respect to reference technologies used in hospital laboratories (clinical analyzers). Despite the failure to detect c-TnI at the reported threshold, the microarray technology could be a powerful approach to diagnose the cardiovascular disease at early stage, monitor its progress, and eventually providing information about an eminent potential risk of suffering a myocardial infarction. The microarray chip here reported could be the starting point for achieving powerful multiplexed diagnostic technologies for the diagnosis of CVDs or any other pathology for which biomarkers have been identified at different stages of the disease.

Exploring the Clinical Utility of Raman Spectroscopy for Point-of-Care Cardiovascular Disease Biomarker Detection

A variety of innovative point-of-care (POC) solutions using Raman systems have been explored. However, the vast effort is in assay development, while studies of the characteristics required for Raman spectrometers to function in POC applications are lacking. In this study, we tested and compared the performance of eight commercial Raman spectrometers ranging in size from benchtop Raman microscopes to portable and handheld Raman spectrometers using paper fluidic cartridges, including their ability to detect cardiac troponin I and heart fatty acid binding protein, both of which are well-established biomarkers for evaluating cardiovascular health. Each spectrometer was evaluated in terms of excitation wavelength, laser characteristics, and ease of use to investigate POC utility. We found that the Raman spectrometers equipped with 780 and 785 nm laser sources exhibited a reduced background signal and provided higher sensitivity compared to those with 633 and 638 nm laser sources. Furthermore, the spectrometer equipped with the single acquisition line readout functionality showed improved performance when compared to the point scan spectrometers and allowed measurements to be made faster and easier. The portable and handheld spectrometers also showed similar detection sensitivity to the gold standard instrument. Lastly, we reduced the laser power for the spectrometer with single acquisition line readout capability to explore the system performance at a laser power that change the classification from a Class 3B laser device to a Class 3R device and found that it showed comparable performance. Overall, these findings show that portable Raman spectrometers have the potential to be used in POC settings with accuracy comparable to laboratory-grade instruments, are relatively low-cost, provide fast signal readout, are easy to use, and can facilitate access for underserved communities.

Paper-Based All-in-One Origami Nanobiosensor for Point-of-Care Detection of Cardiac Protein Markers in Whole Blood

Rapid and accurate diagnosis of cardiovascular diseases (CVDs) at the earliest stage is of paramount importance to improve the treatment outcomes and avoid irreversible damage to a patient's cardiovascular system. Microfluidic paper-based devices (μPADs) represent a promising platform for rapid CVD diagnosis at the point of care (POC). This paper presents an electrochemical μPAD (E-μPAD) with an all-in-one origami design for rapid and POC testing of cardiac protein markers in whole blood. Based on the label-free, electrochemical impedance spectroscopy (EIS) immunoassay, the E-μPAD integrates all essential components on a single chip, including three electrochemical cells, a plasma separation membrane, and a buffer absorption pad, enabling easy and streamlined operations for multiplexed detection of three cardiac protein markers [cardiac troponin I (cTnI), brain natriuretic peptide (BNP)-32, and D-Dimer] on a finger-prick whole blood sample within 46 min. Superior analytical performance is achieved through sensitive EIS measurement on carbon electrodes decorated with semiconductor zinc oxide nanowires (ZnO NWs). Using spiked human plasma samples, ultralow limits of detection (LODs) of E-μPAD are achieved at 4.6 pg/mL (190 fM) for cTnI, 1.2 pg/mL (40 fM) for BNP-32, and 146 pg/mL (730 fM) for D-Dimer. Real human blood samples spiked with purified proteins are also tested, and the device's analytical performance was proven to be comparable to commercial ELISA kits. The all-in-one E-μPAD will allow rapid and sensitive testing of cardiac protein markers through easy operations, which holds great potential for on-site screening of acute CVDs in nonlaboratory settings such as emergency rooms, doctor's offices, or patient homes.

A capillary-based microfluidic chip with the merits of low cost and easy fabrication for the rapid detection of acute myocardial infarction

Point-of-care testing methods currently utilize rapid, portable, inexpensive, and multiplexed on-site detection. Microfluidic chips have become a very promising platform with broad development prospects due to their breakthrough improvement in miniaturization and integration. However, the conventional microfluidic chips still have disadvantages, such as difficulty in fabrication processing, long production time and high cost, which hinder its applications in the fields of POCT and in vitro diagnostics. In this study, a capillary-based microfluidic chip with the characteristics of low cost and easy fabrication was developed for the rapid detection of acute myocardial infarction (AMI). Several short capillaries, which were already conjugated with the capture antibodies respectively, were connected by peristaltic pump tubes and then formed the working capillary. Two working capillaries were encapsulated in the plastic shell and ready for the immunoassay. Multiplex detection of Myoglobin (Myo), cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) were chosen to demonstrate the feasibility and analytical performance of the microfluidic chip, which requires rapid and accurate detection during diagnosis and therapy for AMI. The capillary-based microfluidic chip required tens of minutes to prepared, and its cost was less than $1. The limit of detection (LOD) was 0.5 ng/mL for Myo, 0.1 ng/mL for cTnI and 0.5 ng/mL for CK-MB respectively. The capillary-based microfluidic chips with easy fabrication and low cost hold promise for the portable and low-cost detection of target biomarkers.

Label-Free Myoglobin Biosensor Based on Pure and Copper-Doped Titanium Dioxide Nanomaterials

In this study, using pure and copper-doped titanium dioxide (Cu-TiO₂) nanostructures as the base matrix, enzyme-less label free myoglobin detection to identify acute myocardial infarction was performed and presented. The Cu-TiO₂ nanomaterials were prepared using facile sol-gel method. In order to comprehend the morphologies, compositions, structural, optical, and electrochemical characteristics, the pure and Cu-TiO₂ nanomaterials were investigated by several techniques which clearly revealed good crystallinity and high purity. To fabricate the enzyme-less label free biosensor, thick films of synthesized nanomaterials were applied to the surface of a pre-fabricated gold screen-printed electrode (Au-SPE), which serves as a working electrode to construct the myoglobin (Mb) biosensors. The interference study of the fabricated biosensor was also carried out with human serum albumin (HSA) and cytochrome c (cyt-c). Interestingly, the Cu-doped TiO₂ nanomaterial-based Mb biosensor displayed a higher sensitivity of 61.51 µAcm^-2/nM and a lower detection limit of 14 pM with a response time of less than 10 ms.

The Future of Biomarkers in Veterinary Medicine: Emerging Approaches and Associated Challenges

Simple Summary

In this review we seek to outline the role of new technologies in biomarker discovery, particularly within the veterinary field and with an emphasis on ‘omics’, as well as to examine why many biomarkers-despite much excitement-have not yet made it to clinical practice. Further we emphasise the critical need for close collaboration between clinicians, researchers and funding bodies and the need to set clear goals for biomarker requirements and realistic application in the clinical setting, ensuring that biomarker type, method of detection and clinical utility are compatible, and adequate funding, time and sample size are available for all phases of development.

Abstract

New biomarkers promise to transform veterinary practice through rapid diagnosis of diseases, effective monitoring of animal health and improved welfare and production efficiency. However, the road from biomarker discovery to translation is not always straightforward. This review focuses on molecular biomarkers under development in the veterinary field, introduces the emerging technological approaches transforming this space and the role of ‘omics platforms in novel biomarker discovery. The vast majority of veterinary biomarkers are at preliminary stages of development and not yet ready to be deployed into clinical translation. Hence, we examine the major challenges encountered in the process of biomarker development from discovery, through validation and translation to clinical practice, including the hurdles specific to veterinary practice and to each of the ‘omics platforms–transcriptomics, proteomics, lipidomics and metabolomics. Finally, recommendations are made for the planning and execution of biomarker studies with a view to assisting the success of novel biomarkers in reaching their full potential.

N, Adigal S, Lukose J, Kartha VB, Chidangil S. Cardiovascular biomarkers in body fluids: progress and prospects in optical sensors

Cardiovascular diseases (CVD) are the major causative factors for high mortality and morbidity in developing and developed nations. The biomarker detection plays a crucial role in the early diagnosis of several non-infectious and life-threatening diseases like CVD and many cancers, which in turn will help in more successful therapy, reducing the mortality rate. Biomarkers have diagnostic, prognostic and therapeutic significances. The search for novel biomarkers using proteomics, bio-sensing, micro-fluidics, and spectroscopic techniques with good sensitivity and specificity for CVD is progressing rapidly at present, in addition to the use of gold standard biomarkers like troponin. This review is dealing with the current progress and prospects in biomarker research for the diagnosis of cardiovascular diseases.

Expert opinion.

Fast diagnosis of cardiovascular diseases (CVDs) can help to provide rapid medical intervention, which can affect the patient’s short and long-term health. Identification and detection of proper biomarkers for early diagnosis are crucial for successful therapy and prognosis of CVDs. The present review discusses the analysis of clinical samples such as whole blood, blood serum, and other body fluids using techniques like high-performance liquid chromatography-LASER/LED-induced fluorescence, Raman spectroscopy, mainly, optical methods, combined with nanotechnology and micro-fluidic technologies, to probe patterns of multiple markers (marker signatures) as compared to conventional techniques.

Antibody coated conductive polymer for the electrochemical immunosensing of Human Cardiac Troponin I in blood plasma

Cardiac troponin I (cTnI) is a sensitive biomarker for cardiovascular disease (CVD). Rapid determination of cTnI concentration in blood can greatly reduce the potential of significant heart damage and heart failure. Herein, we demonstrate a new electrochemical immunosensor for selective affinity binding and rapid detection of cTnI in blood plasma by an electrochemical method. A conductive film of "poly 2,5-bis(2-thienyl)3,4-diamine-terthiophene (PDATT)" was deposited onto an Indium Tin Oxide (ITO) electrode using chronoamperometry. Anti-cardiac troponin I antibody was then attached to the two amine (NH₂) groups substituted on the central thiophene of terthiophene repeating unit of the polymer chain via amide bond formation. The gaps on the surface of the antibody coated immunosensor were backfilled with bovine serum albumin (BSA) to prevent nonspecific binding of interfering molecules. Differential pulse voltammetry (DPV) was used to determine cTnI upon the formation of cTnI immunocomplex on the sensing surface, appearing a peak at 0.27 V. The response range was 0.01-100 ng mL^-1 with limit of quantification down to 0.01 ng mL^-1. The developed immunosensor was used to determine cTnI in spiked blood plasma without interference from cardiac troponin T (cTnT). Therefore, this new sensor can be utilised for the detection of cTnI biomarker in pathological laboratories and points of care in less than 15 min.

Challenges in Detection of Serum Oncoprotein: Relevance to Breast Cancer Diagnostics

Breast cancer is a highly prevalent malignancy that shows improved outcomes with earlier diagnosis. Current screening and monitoring methods have improved survival rates, but the limitations of these approaches have led to the investigation of biomarker evaluation to improve early diagnosis and treatment monitoring. The enzyme-linked immunosorbent assay (ELISA) is a specific and robust technique ideally suited for the quantification of protein biomarkers from blood or its constituents. The continued clinical relevancy of this assay format will require overcoming specific technical challenges, including the ultra-sensitive detection of trace biomarkers and the circumventing of potential assay interference due to the expanding use of monoclonal antibody (mAb) therapeutics. Approaches to increasing the sensitivity of ELISA have been numerous and include employing more sensitive substrates, combining ELISA with the polymerase chain reaction (PCR), and incorporating nanoparticles as shuttles for detection antibodies and enzymes. These modifications have resulted in substantial boosts in the ability to detect extremely low levels of protein biomarkers, with some systems reliably detecting antigen at sub-femtomolar concentrations. Extensive utilization of mAb therapies in oncology has presented an additional contemporary challenge for ELISA, particularly when both therapeutic and assay antibodies target the same protein antigen. Resolution of issues such as epitope overlap and steric hindrance requires a rational approach to the design of diagnostic antibodies that takes advantage of modern antibody generation pipelines, epitope binning techniques and computational methods to strategically target biomarker epitopes. This review discusses technical strategies in ELISA implemented to date and their feasibility to address current constraints on sensitivity and problems with interference in the clinical setting. The impact of these recent advancements will depend upon their transformation from research laboratory protocols into facile, reliable detection systems that can ideally be replicated in point-of-care devices to maximize utilization and transform both the diagnostic and therapeutic monitoring landscape.

Enhancing the Sensitivity of the Virus BioResistor by Overoxidation: Detecting IgG Antibodies

The Virus BioResistor (VBR) is a biosensor capable of rapid and sensitive detection of small protein disease markers using a simple dip-and-read modality. For example, the bladder cancer-associated protein DJ-1 (22 kDa) can be detected in human urine within 1.0 min with a limit of detection (LOD) of 10 pM. The VBR uses engineered virus particles as receptors to recognize and selectively bind the protein of interest. These virus particles are entrained in a conductive poly(3,4-ethylenedioxythiophene) or PEDOT channel. The electrical impedance of the channel increases when the target protein is bound by the virus particles. But VBRs exhibit a sensitivity that is inversely related to the molecular weight of the protein target. Thus, large proteins, such as IgG antibodies (150 kDa), can be undetectable even at high concentrations. We demonstrate that the electrochemical overoxidation of the VBR's PEDOT channel increases its electrical impedance, conferring enhanced sensitivity for both small and large proteins. Overoxidation makes possible the detection of two antibodies, undetectable at a normal VBR, with a limit of detection of 40 ng/mL (250 pM), and a dynamic range for quantitation extending to 600 ng/mL.

A review of biosensors for the detection of B-type natriuretic peptide as an important cardiovascular biomarker

Heart disease, as the most serious threat to human health globally, is responsible for rising mortality rates, largely due to lifestyle and diet. Unfortunately, the main problem for patients at high risk of heart disease is the validation of prognostic tests. To this end, the detection of cardiovascular biomarkers has been employed to obtain pathological and physiological information in order to improve prognosis and early-stage diagnosis of chronic heart failure. Short-term changes in B-type natriuretic peptide are known as a standard and important biomarker for diagnosis of heart failure. The most important problem for detection is low concentration and short half-life in the blood. The normal concentration of BNP in blood is less than 7 nM (25 pg/mL), which increases significantly to more than 80 pg/mL. Therefore, the development of new biosensors with better sensitivity, detection limit, and dynamic range than current commercial kits is urgently needed. This review classifies the biosensors designed for detection of BNP into electrochemical, optical, microfluidic, and lateral-flow immunoassay techniques. The review clearly demonstrates that a variety of immunoassay, aptasensor, enzymatic and catalytic nanomaterials, and fluorophores have been successfully employed for detection of BNP at low attomolar ranges. Dtection of B-type natriuretic peptide with biosensors.

Electroanalysis of Biomolecules: Rational Selection of Sensor Construction

Methods of electrochemical analysis of biological objects based on the reaction of electro-oxidation/electro-reduction of molecules are presented. Polymer nanocomposite materials that modify electrodes to increase sensitivity of electrochemical events on the surface of electrodes are described. Examples of applications electrochemical biosensors constructed with nanocomposite material for detection of biological molecules are presented, advantages and drawbacks of different applications are discussed.

Performance of ivisen IA-1400, a new point-of-care device with an internal centrifuge system, for the measurement of cardiac troponin I levels

BACKGROUND

We present the analytical performance of the ivisen IA-1400, a new point-of-care device that features a characteristic built-in centrifuge system, to measure blood cardiac troponin I (cTnI) levels.

METHODS

Whole blood and plasma samples obtained from patients who visited Korea University Guro Hospital were used to analyze measurement range, cross-reactivity, interference, and sensitivity and specificity. We performed a correlation analysis of the ivisen IA-1400 versus the Access AccuTnI+3 immunoassay using the UniCel™ DxI 800 platform and the PATHFAST™ hs-cTnI assay.

RESULTS

Within-run precisions were classified as low, 9.8%; middle, 10.2%; and high, 8.5%. The limit of blank was 3.1 ng/L for plasma samples and 4.3 ng/L for whole blood samples. The limit of detection was 8.4 ng/L for plasma samples and 10.0 ng/L for whole blood samples, respectively. The limit of quantitation at a coefficient of variation of 20% and 10% was 19.5 ng/L and 45.5 ng/L for plasma samples, respectively. The comparative evaluation between the two other assays and ivisen IA-1400 showed excellent correlation, with Spearman's correlation coefficients (R) of 0.992 and 0.985. The sensitivity and specificity of ivisen IA-1400 using the optimum cut-off value of 235 ug/L were 94.6% and 98.2%, respectively.

CONCLUSION

The ivisen IA-1400 showed acceptable and promising performance in cTnI measurements using whole blood and plasma samples, with limited information in the clinical performance. The flexibility for sample selection using the internal centrifugation system is the main advantage of this point-of-care device.

Biosensing platforms based on silicon nanostructures: A critical review

Biosensors are revolutionizing the health-care systems worldwide, permitting to survey several diseases, even at their early stage, by using different biomolecules such as proteins, DNA, and other biomarkers. However, these sensing approaches are still scarcely diffused outside the specialized medical and research facilities. Silicon is the undiscussed leader of the whole microelectronics industry, and novel sensors based on this material may completely change the health-care scenario. In this review, we will show how novel sensing platforms based on Si nanostructures may have a disruptive impact on applications with a real commercial transfer. A critical study for the main Si-based biosensors is herein presented with a comparison of their advantages and drawbacks. The most appealing sensing devices are discussed, starting from electronic transducers, with Si nanowires field-effect transistor (FET) and porous Si, to their optical alternatives, such as effective optical thickness porous silicon, photonic crystals, luminescent Si quantum dots, and finally luminescent Si NWs. All these sensors are investigated in terms of working principle, sensitivity, and selectivity with a specific focus on the possibility of their industrial transfer, and which ones may be preferred for a medical device.

Siphon-Controlled Automation on a Lab-on-a-Disc Using Event-Triggered Dissolvable Film Valves

Within microfluidic technologies, the centrifugal microfluidic “Lab-on-a-Disc” (LoaD) platform offers great potential for use at the PoC and in low-resource settings due to its robustness and the ability to port and miniaturize ‘wet bench’ laboratory protocols. We present the combination of ‘event-triggered dissolvable film valves’ with a centrifugo-pneumatic siphon structure to enable control and timing, through changes in disc spin-speed, of the release and incubations of eight samples/reagents/wash buffers. Based on these microfluidic techniques, we integrated and automated a chemiluminescent immunoassay for detection of the CVD risk factor marker C-reactive protein displaying a limit of detection (LOD) of 44.87 ng mL⁻¹ and limit of quantitation (LoQ) of 135.87 ng mL⁻¹.

Microfluidics in cardiovascular disease research: state of the art and future outlook

Due to extremely severe morbidity and mortality worldwide, it is worth achieving a more in-depth and comprehensive understanding of cardiovascular diseases. Tremendous effort has been made to replicate the cardiovascular system and investigate the pathogenesis, diagnosis and treatment of cardiovascular diseases. Microfluidics can be used as a versatile primary strategy to achieve a holistic picture of cardiovascular disease. Here, a brief review of the application of microfluidics in comprehensive cardiovascular disease research is presented, with specific discussions of the characteristics of microfluidics for investigating cardiovascular diseases integrally, including the study of pathogenetic mechanisms, the development of accurate diagnostic methods and the establishment of therapeutic treatments. Investigations of critical pathogenetic mechanisms for typical cardiovascular diseases by microfluidic-based organ-on-a-chip are categorized and reviewed, followed by a detailed summary of microfluidic-based accurate diagnostic methods. Microfluidic-assisted cardiovascular drug evaluation and screening as well as the fabrication of novel delivery vehicles are also reviewed. Finally, the challenges with and outlook on further advancing the use of microfluidics technology in cardiovascular disease research are highlighted and discussed.

Gold Nanoparticle-Based Platforms for Diagnosis and Treatment of Myocardial Infarction

In recent years, an increasing rate of mortality due to myocardial infarction (MI) has led to the development of nanobased platforms, especially gold nanoparticles (AuNPs), as promising nanomaterials for diagnosis and treatment of MI. These promising NPs have been used to develop different nanobiosensors, mainly optical sensors for early detection of biomarkers as well as biomimetic/bioinspired platforms for cardiac tissue engineering (CTE). Therefore, in this Review, we presented an overview on the potential application of AuNPs as optical (surface plasmon resonance, colorimetric, fluorescence, and chemiluminescence) nanobiosensors for early diagnosis and prognosis of MI. On the other hand, we discussed the potential application of AuNPs either alone or with other NPs/polymers as promising three-dimensional (3D) scaffolds to regulate the microenvironment and mimic the morphological and electrical features of cardiac cells for potential application in CTE. Furthermore, we presented the challenges and ongoing efforts associated with the application of AuNPs in the diagnosis and treatment of MI. In conclusion, this Review may provide outstanding information regarding the development of AuNP-based technology as a promising platform for current MI treatment approaches.

An ultrasensitive electrochemical sensing platform for the detection of cTnI based on aptamer recognition and signal amplification assisted by TdT

We have developed an ultrasensitive and highly specific electrochemical sensing platform for the detection of cardiac troponin I (cTnI), a recognized biomarker for the diagnosis of acute myocardial infarction (AMI) and related cardiovascular diseases (CVDs). This strategy is based on the assists of terminal deoxynucleotidyl transferase (TdT)-mediated signal amplification and the specific recognition between cTnI and the aptamer of cTnI. In this experiment, we prepared a gold electrode that modified with probe 2 (P2), in the presence of cTnI, the aptamer of cTnI that in probe 1 (P1)/aptamer complexes bond with cTnI specifically and release the free P1. P1 would bind with P2, resulting in the formation of 3'-OH of DNA. In the presence of terminal deoxynucleotidyl transferase (TdT) and dTTP, TdT mediated P1 to extend and formed the structure of poly T. Methylene blue (MB)-poly A hybridized with the extended poly T and generated an electrochemical signal. The detection limit can be as low as 40 pg mL-1. This sensor was also successfully applied to the detection of cTnI in numerous spiked biological samples, and it can be a great reference for the clinical diagnosis, prognosis, and treatment of CVDs and AMI.

Plasmon-enhanced quantum dots electrochemiluminescence aptasensor for selective and sensitive detection of cardiac troponin I

The development of highly sensitive electrochemiluminescence (ECL) immunosensors by using functional nanoparticles as signal amplifiers is a solution towards sensitive determination of many low concentration disease biomarkers. Herein, a sensitive aptamer-based, sandwich-type surface plasmon enhanced electrochemiluminescence (SPEECL) immunosensor was demonstrated for the detection of cardiac troponin I (cTnI), by means of aptamer conjugated CdS QDs and AuNPs as ECL luminophores and plasmon sources, respectively, in which Tro4 aptamer was used as a capture probe for cTnI and Tro6 aptamer as a detecting probe. The signal of the developed SPEECL system showed ~ 5-fold increment as compared to that of without AuNPs. Using this ECL platform for the detection of cTnI, a linear range and the limit of detection (LOD) were found to be 1 fg/mL - 10 ng/mL and 0.75 fg/mL, respectively.

Aptamer-based surface-enhanced resonance Raman scattering assay on a paper fluidic platform for detection of cardiac troponin I

SIGNIFICANCE

Cardiac troponin I (cTnI) is a primary biomarker for diagnosis of myocardial infarction (MI). In contrast to central laboratory tests for cTnI, point-of-care (POC) testing has the advantage of providing results when the patient is first encountered, which helps high-risk patients to be treated more rapidly and low-risk patients to be released in a timely fashion. A paper fluidic platform is good for POC testing because the paper is abundant, low cost, and disposable. However, current cTnI assays on paper platforms use antibodies as the recognition element, which has limitations due to the high cost of production and antibody stability issues at the POC.

AIM

To develop an aptamer-based assay on a paper strip using surface-enhanced resonance Raman spectroscopy (SERRS) for detection of cTnI in the clinically relevant range at the POC.

APPROACH

Gold nanoparticles (AuNPs) were functionalized with a Raman reporter molecule, malachite green isothiocyanate. The functionalized AuNPs were encapsulated in a silica shell and provided a SERRS signal using a handheld Raman system with a 638-nm excitation wavelength. A primary aptamer and a secondary aptamer of cTnI were used in a sandwich assay format to bind the cTnI on a test line of a paper fluidic platform. By measuring the SERRS signal from the test line, the concentration of cTnI was quantitatively determined.

RESULTS

The aptamer-based SERRS assay on a paper strip had a detection range of 0.016 to 0.1  ng  /  ml for cTnI, had good selectivity for cTnI compared to three other markers, had good stability over 10 days, and had good performance in the more complex serum sample matrix.

CONCLUSIONS

The aptamer-based SERRS assay on a paper strip has the potential to provide a sensitive, selective, stable, repeatable, and cost-effective platform for the detection of cTnI toward eventual use in diagnosis of MI at the POC.

Recent Trends in Electrochemical Sensors for Vital Biomedical Markers Using Hybrid Nanostructured Materials

This work provides a succinct insight into the recent developments in electrochemical quantification of vital biomedical markers using hybrid metallic composite nanostructures. After a brief introduction to the biomarkers, five types of crucial biomarkers, which require timely and periodical monitoring, are shortlisted, namely, cancer, cardiac, inflammatory, diabetic and renal biomarkers. This review emphasizes the usage and advantages of hybrid nanostructured materials as the recognition matrices toward the detection of vital biomarkers. Different transduction methods (fluorescence, electrophoresis, chemiluminescence, electrochemiluminescence, surface plasmon resonance, surface-enhanced Raman spectroscopy) reported for the biomarkers are discussed comprehensively to present an overview of the current research works. Recent advancements in the electrochemical (amperometric, voltammetric, and impedimetric) sensor systems constructed with metal nanoparticle-derived hybrid composite nanostructures toward the selective detection of chosen vital biomarkers are specifically analyzed. It describes the challenges involved and the strategies reported for the development of selective, sensitive, and disposable electrochemical biosensors with the details of fabrication, functionalization, and applications of hybrid metallic composite nanostructures.

One-Step Digital Immunoassay for Rapid and Sensitive Detection of Cardiac Troponin I

A rapid and sensitive method to detect cardiac troponin I (cTnI) in human blood is critical to the diagnosis and treatment of acute myocardial infarction (AMI). Here, we describe a simple one-step digital immunoassay for single-molecule detection without washing steps. A sample containing cTnI mixed with detection antibody-conjugated gold nanoparticles (AuNPs) is added to a capture antibody-coated sensor surface and the formation of the antibody-cTnI-antibody sandwich is detected by digitally counting the binding of the individual gold nanoparticles to the sensor surface in real time using a bright-field optical imaging setup together with a differential imaging algorithm. The digital immunoassay detects cTnI in undiluted human plasma, which achieves a detection limit of 5.7 ng/L within a detection time of only 10 min, which meets the requirement of current clinical high-sensitivity troponin assay (∼70 ng/L cutoff). We anticipate that the one-step and real-time digital immunoassay can be applied to the detection of other disease biomarkers in blood.

How to choose a point-of-care testing for troponin

BACKGROUND

Point-of-care (POC) cTn assays are needed when the central laboratory is unable to provide timely results to the emergency department. Many POC devices are available. The prospect of choosing them is daunting. In order to provide a quick decision-making reference for POC cTn device selection comparing them to the central laboratory, seven POC devices commonly employed by emergency department were evaluated.

METHODS

Firstly, we reviewed all devices package inserts. Secondly, we evaluated several POC cTn assays for imprecision, linearity, and correlation with central laboratory assays according to CLSI EP protocols. The linear regression analyses were performed only for the detectable concentrations. Five cTnI devices (Alere Triage, BioMerieux Vidas, Mitsubishi Pathfast, ReLIA TZ-301, and Radiometer AQT90) were evaluated against a contemporary cTnI assay (Beckman Access II Accu TnI). Two cTnT assays (Radiometer AQT90 and Roche Cobas h232) were compared to a high-sensitivity (hs) cTnT method (Roche Cobas e601).

RESULTS

For cTn levels around the 99th percentile upper reference limits (URLs) of the comparator assays, imprecision could not be assessed for the Alere, BioMerieux, and Cobas h232 as they gave undetectable readings due to a lack of assay sensitivity. Imprecision (CV) was unacceptably high for the ReLIA (33.3%). On account of this precision metric, these four assays were deemed unsuitable. Regression analyses showed acceptable linearity for all the POC devices. The correlation coefficients for ReLIA, BioMerieux, Cobas h232, and Radiometer cTnT were >0.95. Unlike the cTnT devices, the cTnI assays employ different capture and detection antibodies leading to non-commutable results. The POC cTn results were concordant with their comparator-Radiometer cTnT 90%, Pathfast cTnI 85%, and Radiometer cTnI 75%.

CONCLUSION

Our study provides the procedure and essential data to guide selection of a POC cTn device. Of the point-of-care devices, methods evaluated Radiometer AQT90 (cTnI and cTnT) and Pathfast might be considered.

Eight biomarkers on a novel strip for early diagnosis of acute myocardial infarction

Accurate detection of markers in human serum is important in the early diagnosis of acute myocardial infarction (AMI). This work presents a novel eight biomarker strip, which combines dry chemistry with a fluorescence lateral flow assay. Eight AMI markers were employed simultaneously for sensitive detection, including cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), uric acid (UA), myoglobin (Myo), creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI). The strip offers the advantages of simple fabrication, convenience, time-saving detection and accurate assessment for AMI. Moreover, the strip possesses acceptable applicability for human serum. This proposed strategy establishes a remarkable platform for the construction of a multi-target detection strip that is feasible for accurate detection for real human serum samples.

Label-Free, Highly Sensitive Electrochemical Aptasensors Using Polymer-Modified Reduced Graphene Oxide for Cardiac Biomarker Detection

Acute myocardial infarction (AMI), also recognized as a "heart attack," is one leading cause of death globally, and cardiac myoglobin (cMb), an important cardiac biomarker, is used for the early assessment of AMI. This paper presents an ultrasensitive, label-free electrochemical aptamer-based sensor (aptasensor) for cMb detection using polyethylenimine (PEI)-functionalized reduced graphene oxide (PEI-rGO) thin films. PEI, a cationic polymer, was used as a reducing agent for graphene oxide (GO), providing highly positive charges on the rGO surface and allowing direct immobilization of negatively charged single-strand DNA aptamers against cMb via electrostatic interaction without any linker or coupling chemistry. The presence of cMb was detected on Mb aptamer-modified electrodes using differential pulse voltammetry via measuring the current change due to the direct electron transfer between the electrodes and cMb proteins (Fe3+/Fe2+). The limits of detection were 0.97 pg mL-1 (phosphate-buffered saline) and 2.1 pg mL-1 (10-fold-diluted human serum), with a linear behavior with logarithmic cMb concentration. The specificity and reproducibility of the aptasensors were also examined. This electrochemical aptasensor using polymer-modified rGO shows potential for the early assessment of cMb in point-of-care testing applications.

Simultaneous detection and quantification of DNA and protein biomarkers in spectrum of cardiovascular diseases in a microfluidic microbead chip

The rapid and simultaneous detection of DNA and protein biomarkers is necessary to detect the outbreak of a disease or to monitor a disease. For example, cardiovascular diseases are a major cause of adult mortality worldwide. We have developed a rapidly adaptable platform to assess biomarkers using a microfluidic technology. Our model mimics autoantibodies against three proteins, C-reactive protein (CRP), brain natriuretic peptide (BNP), and low-density lipoprotein (LDL). Cell-free mitochondrial DNA (cfmDNA) and DNA controls are detected via fluorescence probes. The biomarkers are covalently bound on the surface of size- (11–15 μm) and dual-color encoded microbeads and immobilized as planar layer in a microfluidic chip flow cell. Binding events of target molecules were analyzed by fluorescence measurements with a fully automatized fluorescence microscope (end-point and real-time) developed in house. The model system was optimized for buffers and immobilization strategies of the microbeads to enable the simultaneous detection of protein and DNA biomarkers. All prime target molecules (anti-CRP, anti-BNP, anti-LDL, cfmDNA) and the controls were successfully detected both in independent reactions and simultaneously. In addition, the biomarkers could also be detected in spiked human serum in a similar way as in the optimized buffer system. The detection limit specified by the manufacturer is reduced by at least a factor of five for each biomarker as a result of the antibody detection and kinetic experiments indicate that nearly 50 % of the fluorescence intensity is achieved within 7 min. For rapid data inspection, we have developed the open source software digilogger, which can be applied for data evaluation and visualization.

An ultra-sensitive label-free electrochemiluminescence CKMB immunosensor using a novel nanocomposite-modified printed electrode

This study presents a novel and ultrasensitive electrochemiluminescence approach for the quantitative assessment of creatine kinase MB (CK-MB). Both carbon, carbon nano-onions (CNOs) and metal-based nanoparticles, such as gold nanoparticles (AuNPs) and iron oxide (Fe3O4), were combined to generate a unique nanocomposite for the detection of CKMB. The immunosensor construction involved the deposition of the nanocomposite on the working electrode, followed by the incubation of an antibody and a blocking agent. Tris(2,2'-bipyridyl)-ruthenium(ii) chloride ([Ru(bpy)3]2+Cl) was used as a luminophore, where tri-n-propylamine (TPrA) was selected as the co-reactant due to its aqueous immobility and luminescence properties. The analytical performance was demonstrated by cyclic voltammetry on ECL. The characterization of each absorbed layer was performed by cyclic voltammetry (CV) and chronocoulometry (CC) techniques in both EC and ECL. For further characterization of iron oxide, gold nanoparticles and carbon nano-onions, scanning electron microscopy (SEM), transmission electron microscopy (TEM) and X-ray diffraction (XRD) were performed. The proposed immunosensor showcases a wide linear range (10 ng mL-1 to 50 fg mL-1), with an extremely low limit of detection (5 fg mL-1). This CKMB immunosensor also exhibits remarkable selectivity, reproducibility, stability and resistance capability towards common interferences available in human serum. In addition, the immunosensor holds great potential to work with real serum samples for clinical diagnosis.

Evaluation of Molecularly Imprinted Polymers for Point-of-Care Testing for Cardiovascular Disease

Molecular imprinting is a rapidly growing area of interest involving the synthesis of artificial recognition elements that enable the separation of analyte from a sample matrix and its determination. Traditionally, this approach can be successfully applied to small analyte (<1.5 kDa) separation/ extraction, but, more recently it is finding utility in biomimetic sensors. These sensors consist of a recognition element and a transducer similar to their biosensor counterparts, however, the fundamental distinction is that biomimetic sensors employ an artificial recognition element. Molecularly imprinted polymers (MIPs) employed as the recognition elements in biomimetic sensors contain binding sites complementary in shape and functionality to their target analyte. Despite the growing interest in molecularly imprinting techniques, the commercial adoption of this technology is yet to be widely realised for blood sample analysis. This review aims to assess the applicability of this technology for the point-of-care testing (POCT) of cardiovascular disease-related biomarkers. More specifically, molecular imprinting is critically evaluated with respect to the detection of cardiac biomarkers indicative of acute coronary syndrome (ACS), such as the cardiac troponins (cTns). The challenges associated with the synthesis of MIPs for protein detection are outlined, in addition to enhancement techniques that ultimately improve the analytical performance of biomimetic sensors. The mechanism of detection employed to convert the analyte concentration into a measurable signal in biomimetic sensors will be discussed. Furthermore, the analytical performance of these sensors will be compared with biosensors and their potential implementation within clinical settings will be considered. In addition, the most suitable application of these sensors for cardiovascular assessment will be presented.

Smartphone-app based point-of-care testing for myocardial infarction biomarker cTnI using an autonomous capillary microfluidic chip with self-aligned on-chip focusing (SOF) lenses

Cardiovascular disease is one of the most common causes of mortality in the world. Most of the diagnostic processes usually require bulky instruments and trained professionals, which cannot meet the demand for fast, early and regular bedside diagnosis. In this paper, a bespoke app on a smartphone and an autonomous capillary microfluidic chip (ACMC) are combined to realize the point-of-care testing of cardiac troponin I (cTnI). The smartphone-app-ACMC platform was based on the sandwich immunofluorescence principle and featured self-aligned on-chip focusing (SOF) lenses which can avoid the complex optical coupling process. The operator only needs to introduce 100 μl sample into the ACMC, where the priming, time-delaying, mixing and washing steps for the assay can be accomplished automatically. With the help of the bespoke app and a palm-sized optical attachment, the smartphone can capture fluorescence images, process fluorescence intensity information, output detection results and save the results for long-term monitoring. Our results showed that within 12 min, the detection limit of 78 pg ml-1 and 94 pg ml-1 for cTnI was attained in buffer and spiked human serum, respectively. Our proposed platform has the potential to be applied in the POCT field especially for some resource-limited settings.

Development of the Troponin Detection System Based on the Nanostructure

During the last 30 years, the World Health Organization (WHO) reported a gradual increase in the number of patients with cardiovascular disease (CVD), not only in developed but also in developing countries. In particular, acute myocardial infarction (AMI) is one of the severe CVDs because of the high death rate, damage to the body, and various complications. During these harmful effects, rapid diagnosis of AMI is key for saving patients with CVD in an emergency. The prompt diagnosis and proper treatment of patients with AMI are important to increase the survival rate of these patients. To treat patients with AMI quickly, detection of a CVD biomarker at an ultra-low concentration is essential. Cardiac troponins (cTNs), cardiac myoglobin (cMB), and creatine kinase MB are typical biomarkers for AMI detection. An increase in the levels of those biomarkers in blood implies damage to cardiomyocytes and thus is related to AMI progression. In particular, cTNs are regarded as a gold standard biomarker for AMI diagnosis. The conventional TN detection system for detection of AMI requires long measurement time and is labor-intensive and tedious. Therefore, the demand for sensitive and selective TN detection techniques is increasing at present. To meet this demand, several approaches and methods have been applied to develop a TN detection system based on a nanostructure. In the present review, the authors reviewed recent advances in TN biosensors with a focus on four detection systems: (1) An electrochemical (EC) TN nanobiosensor, (2) field effect transistor (FET)-based TN nanobiosensor, (3) surface plasmon resonance (SPR)-based TN nanobiosensor and (4) surface enhanced Raman spectroscopy (SERS)-based TN nanobiosensor.

Manganese doped CdS sensitized graphene/Cu2MoS4 composite for the photoelectrochemical immunoassay of cardiac troponin I

As a newly emerged photoactive material, Cu₂MoS₄ has motivated wide research interests in the field of photoelectrochemistry. Based on manganese doped CdS (CdS:Mn) sensitized graphene (G)/Cu₂MoS₄ composite, we developed a label-free photoelectrochemical (PEC) immunosensor for the detection of cardiac troponin I (cTnI). G as an excellent 2D conductive material, combined with Cu₂MoS₄ could improve its charge transfer efficiency. CdS:Mn nanoparticles (NPs) loaded on G/Cu₂MoS₄ further enlarged the light absorption range of Cu₂MoS₄ and restrained the electron-hole pairs recombination. Under optimal conditions, the proposed PEC immunosensor responded sensitively to cTnI with a low detection limit of 0.18 pg/mL and a wide linear range (0.005-1000 ng/mL). Moreover, as-fabricated immunosensor also exhibited high sensitivity, excellent selectivity and good stability. This work also was extended to real samples analysis and obtained satisfied results.

Two desired epitopes of cTnI benefit for preparation of standardized monoclonal antibodies

Acute myocardial infarction (AMI) is one of the most severe cardiovascular diseases in humans, often resulting in unexpected death. Early detection is critical for patient survival. Sandwich ELISA is a common method for the detection of AMI. However, ELISA kits from different manufacturers can give different results, in part because of the lack of standardized epitopes. Therefore, the purpose of this study was to find two standardized epitopes. We predicted two antigen epitopes and respectively immunize mice to manufacture standardized monoclonal antibodies. Eight monoclonal antibodies were prepared. Monoclonal antibodies 7D2 and 2C3 were selected with high affinity, and their characteristics were explored. The results show that monoclonal antibodies 7D2 and 2C3 can both bind to various modified forms and complexes of cardiac troponin I (cTnI), were not cross-reaction with related antigens of normal human serum and can be paired. Therefore, we deem epitopes 30 to 42 and 77 to 89 standardized epitopes.

A hollow-nanosphere-based microfluidic biosensor for biomonitoring of cardiac troponin I

Cardiovascular diseases (CVDs) are the leading causes of death worldwide.

Point-of-Care Compatibility of Ultra-Sensitive Detection Techniques for the Cardiac Biomarker Troponin I-Challenges and Potential Value

Cardiac biomarkers are frequently measured to provide guidance on the well-being of a patient in relation to cardiac health with many assays having been developed and widely utilised in clinical assessment. Effectively treating and managing cardiovascular disease (CVD) relies on swiftly responding to signs of cardiac symptoms, thus providing a basis for enhanced patient management and an overall better health outcome. Ultra-sensitive cardiac biomarker detection techniques play a pivotal role in improving the diagnostic capacity of an assay and thus enabling a better-informed decision. However, currently, the typical approach taken within healthcare depends on centralised laboratories performing analysis of cardiac biomarkers, thus restricting the roll-out of rapid diagnostics. Point-of-care testing (POCT) involves conducting the diagnostic test in the presence of the patient, with a short turnaround time, requiring small sample volumes without compromising the sensitivity of the assay. This technology is ideal for combatting CVD, thus the formulation of ultra-sensitive assays and the design of biosensors will be critically evaluated, focusing on the feasibility of these techniques for point-of-care (POC) integration. Moreover, there are several key factors, which in combination, contribute to the development of ultra-sensitive techniques, namely the incorporation of nanomaterials for sensitivity enhancement and manipulation of labelling methods. This review will explore the latest developments in cardiac biomarker detection, primarily focusing on the detection of cardiac troponin I (cTnI). Highly sensitive detection of cTnI is of paramount importance regarding the rapid rule-in/rule-out of acute myocardial infarction (AMI). Thus the challenges encountered during cTnI measurements are outlined in detail to assist in demonstrating the drawbacks of current commercial assays and the obstructions to standardisation. Furthermore, the added benefits of introducing multi-biomarker panels are reviewed, several key biomarkers are evaluated and the analytical benefits provided by multimarkers-based methods are highlighted.

Usefulness of the Adipokines as Biomarkers of Ischemic Cardiac Dysfunction

Cardiovascular disease is the leading cause of death among both women and men, but there is still a great percentage of misdiagnosis and lack of clearly defined criteria. Advances in biomolecular science have proven the crucial role of inflammation and, more importantly, the role of adipokines in mediating all stages of coronary artery disease. It has also been suggested that regional fat deposits, more precisely from thoracic region, have a major influence on the development of coronary artery disease by creating a local proatherogenic environment. The immune system closely interacts with metabolic risk factors to initiate, promote, and further aggravate the atherosclerotic lesions on the arterial wall all with the "help" of adipokines. So nowadays, research extensively focuses on uncovering biomarkers that would provide an increased chance of detecting subclinical cardiac distress and also add a consistent value to current guideline-imposed risk criteria.

Electrochemical Aptamer-Based Biosensors for the Detection of Cardiac Biomarkers

Rapid and accurate diagnostic technologies for early-state identification of cardiovascular abnormalities have become of high importance to prevent and attenuate their progression. The capability of biosensors to determine an increase in the concentration of cardiovascular protein biomarkers in circulating blood immediately after a myocardial infarction makes them ideal point-of-care platforms and alternative approaches to electrocardiograms, chest X-rays, and different laboratory-based immunoassays. We report here a generic approach toward multianalyte sensing platforms for cardiac biomarkers by developing aptamer-based electrochemical sensors for brain natriuretic peptide (BNP-32) and cardiac troponin I (cTnI). For this, commercial gold-based screen-printed electrodes were modified electrophoretically with polyethyleneimine/reduced graphene oxide films. Covalent grafting of propargylacetic acid integrates propargyl groups onto the electrode to which azide-terminated aptamers can be immobilized using Cu(I)-based "click" chemistry. To ensure low biofouling and high specificity, cardiac sensors were modified with pyrene anchors carrying poly(ethylene glycol) units. In the case of BNP-32, the sensor developed has a linear response from 1 pg mL^-1 to 1 μg mL^-1 in serum; for cTnI, linearity is observed from 1 pg mL^-1 to 10 ng mL^-1 as demanded for early-stage diagnosis of heart failure. These electrochemical aptasensors represent a step further toward multianalyte sensing of cardiac biomarkers.