Pen-on-paper strategies for point-of-care testing of human health

Multiplexed colorimetric assay of antioxidants in wines with paper-based sensors fabricated by pen plotting

This work reports the development of low-cost and rapid multiplexed colorimetric assay of antioxidants (total phenolics, antioxidant capacity, flavonoids and anthocyanins) in wines at daisy-shaped fluidic paper-based analytical devices (PADs). The desired fluidic patterns were formed on paper by pen drawing and colorimetric reagents were immobilized at the 6 peripheral test zones. The sample was added at the central sample zone, migrated to the test zones and reacted with the immobilized reagents producing characteristic colors that were captured and analyzed. The paper-based approach was applied to the analysis of several wine samples and the results were statistically correlated to standard solution-based colorimetric assays, indicating that it could be reliably used for ranking wines according to their antioxidants content. In addition, the paper-based analytical methodology is simple, instrument-free, portable, cost-effective, rapid and environment friendly.

Pen direct writing of SERRS-based lateral flow assays for detection of penicillin G in milk

Direct pen writing offers versatile opportunities for development of low-cost tests for point-of-care applications. In this work a lateral flow immunoassay (LFIA) test was fabricated by hand "writing" immunoprobes onto hand-cut nitrocellulose strips with a commercial fountain pen. The qualitative capabilities of the test were extended by addition of a Raman reporter and consequent design and fabrication of a Surface Enhanced Resonant Raman Scattering (SERRS)-LFIA test. As proof-of-concept, dual detection of penicillin G was achieved in milk with a visual LOD of 20 ppm and a dynamic range of 0.03-97.5 ppm. Evaluation against equivalent tests performed with conventionally prepared LFIA strips showed comparable results, thus demonstrating the validity of the test. These results demonstrate the potential for further decrease in cost and consequent broader use of LFIA tests in remote regions and resource-limited environments.

Paper-based colorimetric sensors for point-of-care testing

By eliminating the need for sample transportation and centralized laboratory analysis, point-of-care testing (POCT) enables on-the-spot testing, with results available within minutes, leading to improved patient management and overall healthcare efficiency. Motivated by the rapid development of POCT, paper-based colorimetric sensing, a powerful analytical technique that exploits the changes in color or absorbance of a chemical species to detect and quantify analytes of interest, has garnered increasing attention. In this review, we strive to provide a bird's eye view of the development landscape of paper-based colorimetric sensors that harness the unique properties of paper to create low-cost, easy-to-use, and disposable analytical devices, thematically covering both fundamental aspects and categorized applications. In the end, we authors summarized the review with the remaining challenges and emerging opportunities. Hopefully, this review will ignite new research endeavors in the realm of paper-based colorimetric sensors.

Photoelectrochemical sensors based on paper and their emerging applications in point-of-care testing

Point-of-care testing (POCT) technology is urgently required owing to the prevalence of the Internet of Things and portable electronics. In light of the attractive properties of low background and high sensitivity caused by the complete separation of excitation source and detection signal, the paper-based photoelectrochemical (PEC) sensors, featured with fast in analysis, disposable and environmental-friendly have become one of the most promising strategies in POCT. Therefore, in this review, the latest advances and principal issues in the design and fabrication of portable paper-based PEC sensors for POCT are systematically discussed. Primarily, the flexible electronic devices that can be constructed by paper and the reasons why they can be used in PEC sensors are expounded. Afterwards, the photosensitive materials involved in paper-based PEC sensor and the signal amplification strategies are emphatically introduced. Subsequently, the application of paper-based PEC sensors in medical diagnosis, environmental monitoring and food safety are further discussed. Finally, the main opportunities and challenges of paper-based PEC sensing platforms for POCT are briefly summarized. It provides a distinct perspective for researchers to construct paper-based PEC sensors with portable and cost-effective, hoping to enlighten the fast development of POCT soon after, as well as benefit human society.

COVID-19 detection using AIE-active iridium complexes

The highly contagious COVID-19, caused by the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is commonly diagnosed using reverse transcription polymerase chain reaction (RT-PCR). However, despite being highly sensitive, RT-PCR is also time consuming and quite complex, which limits its use for point-of-care (POC) testing. We have developed a simple single-step fluorescence assay for SARS-CoV-2 RNA detection based on the principle of aggregation-induced emission (AIE) using iridium complexes. Our smartly designed iridium probes fluorescently "turn-on" in the presence of SARS-CoV-2 RNA and give specific results at room temperature within 10 min. The lower limit of detection (LOD) is 1.84 genome copies per reaction, and the sensitivity and specificity of the assay in 20 clinical samples are found to be 90% and 80%, respectively.

Microfluidic platforms integrated with nano-sensors for point-of-care bioanalysis

Microfluidic technology provides a portable, cost-effective, and versatile tool for point-of-care (POC) bioanalysis because of its associated advantages such as fast analysis, low volumes of reagent consumption, and high portability. Along with microfluidics, the application of nanomaterials in biosensing has attracted lots of attention due to their unique physical and chemical properties for enhanced signal modulation such as signal amplification and signal transduction for POC bioanalysis. Hence, an enormous number of microfluidic devices integrated with nano-sensors have been developed for POC bioanalysis targeting low-resource settings. Herein, we review recent advances in POC bioanalysis on nano-sensor-based microfluidic platforms. We first briefly summarized the different types of cost-effective microfluidic platforms, followed by a concise introduction to nanomaterial-based biosensors. Then, we highlighted the application of microfluidic platforms integrated with nano-sensors for POC bioanalysis. Finally, we discussed the current limitations and perspective trends of the nano-sensor-based microfluidic platforms for POC bioanalysis.

Plot-on-demand integrated paper-based sensors for drop-volume voltammetric monitoring of Pb(II) and Cd(II) using a bismuth nanoparticle-modified electrode

The fabrication of fully ink-drawn fluidic electrochemical paper-based analytical devices (ePADs) is reported for the determination of trace Pb(II) and Cd(II) by differential pulse anodic stripping voltammetry (DPASV). The fluidic pattern was formed on the paper substrate using an inexpensive computer-controlled x-y plotter and a commercial hydrophobic marker pen. Then, electrodes were deposited on the devices using a second x-y plotting step with a commercial technical pen filled with a graphite-based conductive ink prepared in house. The fabrication parameters of the ePADs were studied by cyclic voltammetry using the ferro/ferri couple as a probe and by scanning electron microscopy. The ePADs, featuring a bismuth nanoparticle-modified working electrode, were applied to the determination of Pb(II) and Cd(II) by DPASV. The chemical and instrumental conditions were studied. The limits of detection were 3.1 μg L^-1 for Cd(II) and 4.5 μg L^-1 for Pb(II) whereas the between-device reproducibility (expressed as the % relative standard deviation of the response at 6 different ePADs) was < 14%. Each ePAD requires 120 s to fabricate and costs less than 0.15 € in terms of consumables. The ePADs are suitable for the on-site determination of Pb(II) and Cd(II) in environmental and food samples.

Fully handwritten electrodes on paper substrate using rollerball pen with silver nanoparticle ink, marker pen with carbon nanotube ink and graphite pencil

Herein, a so-called carbon nanotube (CNT) electrode was printed in on a paper substrate using the handwriting technique and carbon nanotube ink in a marker pen to print the working electrode, graphite pencil to print the counter electrode and graphite/silver nanoparticle (AgNP) ink in a rollerball pen to print the quasi-reference electrode. The carbon nanotube electrode was characterized via scanning electron microscopy. The electrode was optimized based on the type of paper, hydrophobic barrier and number of layers. In summary, the optimized parameters included the use of matte paper with a mineral spirit layer. The number of carbon nanotube layers to achieve the best electrochemical performance was 25. The final graphite electrode was a miniaturized and flexible paper-based electrochemical electrode. To evaluate the electrical properties of the electrodes, the ohmic resistance of each ink was tested using a multimeter and the obtained values were 18.62 kΩ for the CNT ink, 1.53 Ω for the AgNP ink and 3.53 kΩ for the graphite trace. These results indicate the good conductivity of each synthesized ink used in the fabrication of the CNT electrode. Finally, the electrode was used to measure the electrochemical response of different concentrations of K₄[Fe(CN)₆]. Then, a calibration curve was obtained from the voltammograms and linearity was observed in the range of 0.5-3.5 mM. This suggests that the CNT electrode has the potential to be used as an amperometric electrode.

Paper and thread as media for the frugal detection of urinary tract infections (UTIs)

Urinary tract infections (UTIs) make up a significant proportion of the global burden of disease in vulnerable groups and tend to substantially impair the quality of life of those affected, making timely detection of UTIs a priority for public health. However, economic and societal barriers drastically reduce accessibility of traditional lab-based testing methods for critical patient groups in low-resource areas, negatively affecting their overall healthcare outcomes. As a result, cellulose-based materials such as paper and thread have garnered significant interest among researchers as substrates for so-called frugal analytical devices which leverage the material's portability and adaptability for facile and reproducible diagnoses of UTIs. Although the field may be only in its infancy, strategies aimed at commercial penetration can appreciably increase access to more healthcare options for at-risk people. In this review, we catalogue recent advances in devices that use cellulose-based materials as the primary housing or medium for UTI detection and chart out trends in the field. We also explore different modalities employed for detection, with particular emphasis on their ability to be ported onto discreet casings such as sanitary products.

A Pencil-Lead Immunosensor for the Rapid Electrochemical Measurement of Anti-Diphtheria Toxin Antibodies

Diphtheria is a vaccine-preventable disease, yet immunization can wane over time to non-protective levels. We have developed a low-cost, miniaturized electroanalytical biosensor to quantify anti-diphtheria toxin (DTx) immunoglobulin G (anti-DTx IgG) antibody to minimize the risk for localized outbreaks. Two epitopes specific to DTx and recognized by antibodies generated post-vaccination were selected to create a bi-epitope peptide, biEP, by synthesizing the epitopes in tandem. The biEP peptide was conjugated to the surface of a pencil-lead electrode (PLE) integrated into a portable electrode holder. Captured anti-DTx IgG was measured by square wave voltammetry from the generation of hydroquinone (HQ) from the resulting immunocomplex. The performance of the biEP reagent presented high selectivity and specificity for DTx. Under the optimized working conditions, a logarithmic calibration curve showed good linearity over the concentration range of 10-5-10-1 IU mL-1 and achieved a limit of detection of 5 × 10-6 IU mL-1. The final device proved suitable for interrogating the immunity level against DTx in actual serum samples. Results showed good agreement with those obtained from a commercial enzyme-linked immunosorbent assay. In addition, the flexibility for conjugating other capture molecules to PLEs suggests that this technology could be easily adapted to the diagnoses of other pathogens.

Efficient fabrication of highly sensitive AgNPs-drawing paper SERS substrates by robotic writing approach

Inspired by hand writing approach for preparing surface-enhanced Raman scattering (SERS) substrates, silver nanoparticles (AgNPs) decorated drawing paper substrates were prepared by robotic writing technique. The wettabilities and surface morphologies of the drawing paper before and after the deposition of AgNPs were characterized by contact angle analyzer and scanning electron microscope, respectively. Malachite green was employed as a probe molecule to evaluate the SERS activities of the AgNPs-drawing paper substrates. The AgNPs-drawing paper substrates exhibited extremely high sensitivity that the detection limit for malachite green was down to 10^-18 mol/L and the Raman enhancement factor was calculated to be 10¹⁵. The relative standard deviation (RSD) values of the Raman peaks intensities collected from twelve points on a single substrate and fifteen substrates were used to evaluate the uniformity and reproducibility of the AgNPs-drawing paper substrates. It was found that the substrates had good reproducibility and uniformity with RSD values of 7.29% and 9.70%, respectively. Furthermore, the prepared AgNPs-drawing paper substrates exhibited long-term stability among six months.

A Colorimetric Membrane-Based Sensor with Improved Selectivity towards Amphetamine

Due to their simplicity, speed and low cost, chemical spot tests are increasingly demanded for the presumptive identification of illicit drugs in a variety of contexts such as point-of-care assistance or prosecution of drug trafficking. However, most of the colorimetric reactions used in these tests are, at best, drug class selective. Therefore, the development of tests based on chemical reactions with improved discrimination power is of great interest. In this work, we propose a new colorimetric assay for amphetamine (AMP) based on its reaction with solutions of alkaline gold bromide to form an insoluble yellow–orange derivative. The resulting suspensions are then filtered onto nylon membranes and the precipitate collected is used for the visual identification of AMP. The measurement of the absorbance of the membranes by diffuse reflectance spectroscopy also allows the quantification of AMP in a simple and rapid way, as demonstrated for different synthetic and drug street samples. On the basis of the results obtained, it was concluded that the proposed procedure is highly selective towards AMP, as this compound could be easily differentiated from other common drugs such as methamphetamine (MET), ephedrine (EPH), scopolamine (SCP) and cocaine (COC).

Development of a High-Throughput Low-Cost Approach for Fabricating Fully Drawn Paper-Based Analytical Devices Using Commercial Writing Tools

This work reports the development and optimization of a rapid and low-cost pen-on-paper plotting approach for the fabrication of paper-based analytical devices (PADs) using commercial writing stationery. The desired fluidic patterns were drawn on the paper substrate with commercial marker pens using an inexpensive computer-controlled x–y plotter. For the fabrication of electrochemical PADs, electrodes were further deposited on the devices using a second x–y plotting step with commercial writing pencils. The effect of the fabrication parameters (type of paper, type of marker pen, type of pencil, plotting speed, number of passes, single- vs. double-sided plotting), the chemical resistance of the plotted devices to different solvents and the structural rigidity to multiple loading cycles were assessed. The analytical utility of these devices is demonstrated through application in optical sensing of total phenols using reflectance calorimetry and in electrochemical sensing of paracetamol and ascorbic acid. The proposed manufacturing approach is simple, low cost, flexible, rapid and fit-for-purpose and enables the fabrication of sub-“one-dollar” PADs with satisfactory mechanical and chemical resistance and good analytical performance.

Paper-Based Electrochemical Sensors Using Paper as a Scaffold to Create Porous Carbon Nanotube Electrodes

Paper-based sensors and assays have evolved rapidly due to the conversion of paper-based microfluidics, functional paper coatings, and new electrical and optical readout techniques. Nanomaterials have gained substantial attraction as key components in paper-based sensors, as they can be coated or printed relatively easily on paper to locally control the device functionality. Here, we report a new combination of methods to fabricate carbon nanotube-based (CNT) electrodes for paper-based electrochemical sensors using a combination of laser cutting, drop-casting, and origami. We applied this process to a range of filter papers with different porosities and used their differences in three-dimensional cellulose networks to study the influence of the cellulose scaffold on the final CNT network and the resulting electrochemical detection of glucose. We found that an optimal porosity exists, which balances the benefits of surface enhancement and electrical connectivity within the cellulose scaffold of the paper-based device and demonstrates a cost-effective process for the fabrication of device arrays.

Recent Advances in Microfluidic Paper-Based Analytical Devices toward High-Throughput Screening

Microfluidic paper-based analytical devices (µPADs) have become promising tools offering various analytical applications for chemical and biological assays at the point-of-care (POC). Compared to traditional microfluidic devices, µPADs offer notable advantages; they are cost-effective, easily fabricated, disposable, and portable. Because of our better understanding and advanced engineering of µPADs, multistep assays, high detection sensitivity, and rapid result readout have become possible, and recently developed µPADs have gained extensive interest in parallel analyses to detect biomarkers of interest. In this review, we focus on recent developments in order to achieve µPADs with high-throughput capability. We discuss existing fabrication techniques and designs, and we introduce and discuss current detection methods and their applications to multiplexed detection assays in relation to clinical diagnosis, drug analysis and screening, environmental monitoring, and food and beverage quality control. A summary with future perspectives for µPADs is also presented.

A Eu3+-inspired fluorescent carbon nanodot probe for the sensitive visualization of anthrax biomarker by integrating EDTA chelation

The rapid and sensitive visualization of 2,6-dipicolinic acid (DPA, a unique anthrax biomarker) is essential to prevent anthrax disease or biological terrorist attack. In this study, a Eu³⁺-labeled ethylenediaminetetraacetic acid loaded hyperbranched polyethyleneimine carbon nanodot (hPEI-CD-EDTA-Eu³⁺) nanoprobe has been proposed for the ratiometric DPA detection. The sensing mechanism is based on the rapid DPA-Eu³⁺ chelation within 30 s and subsequent enhanced fluorescence emission through the antenna effect. With the introduction of EDTA chelating unit, the resulted fluorescence of Eu³⁺-complex is greatly enhanced, which endows sensitive DPA perception. By employing hPEI-CD as the internal reference, ratiometric DPA sensing is realized with a good linearity in the concentration range from 1.0 to 100 nM, with a limit of detection of 190 pM (S/N = 3). The specific chelation affinity between Eu³⁺ and DPA provides satisfying selectivity over other amino acids and ions. Using nanoprobe-loaded polyvinylidene fluoride paper as the analytical device, point-of-care DPA visualization is achieved. Furthermore, the practical application of designed paper device is validated by the visual detection of metabolic DPA-release from Bacillus subtilis spores.

Acoustofluidic Micromixing Enabled Hybrid Integrated Colorimetric Sensing, for Rapid Point-of-Care Measurement of Salivary Potassium

The integration of microfluidics with advanced biosensor technologies offers tremendous advantages such as smaller sample volume requirement and precise handling of samples and reagents, for developing affordable point-of-care testing methodologies that could be used in hospitals for monitoring patients. However, the success and popularity of point-of-care diagnosis lies with the generation of instantaneous and reliable results through in situ tests conducted in a painless, non-invasive manner. This work presents the development of a simple, hybrid integrated optical microfluidic biosensor for rapid detection of analytes in test samples. The proposed biosensor works on the principle of colorimetric optical absorption, wherein samples mixed with suitable chromogenic substrates induce a color change dependent upon the analyte concentration that could then be detected by the absorbance of light in its path length. This optical detection scheme has been hybrid integrated with an acoustofluidic micromixing unit to enable uniform mixing of fluids within the device. As a proof-of-concept, we have demonstrated the real-time application of our biosensor format for the detection of potassium in whole saliva samples. The results show that our lab-on-a-chip technology could provide a useful strategy in biomedical diagnoses for rapid analyte detection towards clinical point-of-care testing applications.

Innovative Hydrophobic Valve Allows Complex Liquid Manipulations in a Self-Powered Channel-Based Microfluidic Device

We present an innovative, simple, and versatile hydrophobic valve enabling all-important complex liquid manipulations on self-powered, channel-based microfluidic devices and as such being extremely valuable for the design of highly demanding point-of-care (POC) platforms. The presented hydrophobic valve is made of filter paper treated with a fluorinated compound (i.e., Aquapel) and shows both superhydrophobic properties (contact angle up to 155°) and high resistance to liquid pressure (up to 9 kPa), while retaining gas permeability and utter fabrication simplicity. Whereas this valve can be integrated in any channel-based system and can be used both as a vent, to delay liquid displacement on chip, or as a barrier, to stop the liquid flow in a certain direction, in this work we demonstrate some of its capacities by combining it with our in house developed self-powered SIMPLE and iSIMPLE platforms. First, we integrated it with the infusion iSIMPLE pump, thus generating completely fail-proof activation regardless of how the operator is actuating the system. Second, we used hydrophobic valves as both barrier and vent in the same microfluidic chip, which allowed the combination of two SIMPLE pumps for splitting one sample in two parallel channels. This attribute is fundamental for achieving multiplex analysis on completely autonomous microfluidic platforms. Finally, we achieved an unprecedented liquid manipulation for a self-powered microfluidic platform, namely, shuttling of liquid, after a single user activation by combining for the first time SIMPLE and iSIMPLE with the developed hydrophobic vent and barrier, all in a single chip. These results convincingly demonstrated that the developed hydrophobic valve combined with SIMPLE/iSIMPLE presents an essential building block for an ideal POC system, which is self-powered, inexpensive, and robust and can perform complex bioassays upon a single user activation.

Recent advances in and potential utilities of paper-based electrochemical sensors: beyond qualitative analysis

Paper based electrochemical sensors (PESs) are simple, low-cost, portable and disposable analytical sensing platforms that can be applied in clinical diagnostics, food quality control and environmental monitoring.