Mobile Phone Ratiometric Imaging Enables Highly Sensitive Fluorescence Lateral Flow Immunoassays without External Optical Filters

Accelerated Development of a COVID-19 Lateral Flow Test in an Academic Setting: Lessons Learned

The COVID-19 pandemic further demonstrated the need for usable, reliable, and cost-effective point-of-care diagnostics that can be broadly deployed, ideally for self-testing at home. Antigen tests using more-detectable reporter labels (usually at the cost of reader complexity) achieve better diagnostic sensitivity, supporting the value of higher-analytical-sensitivity reporter technologies in lateral flow.We developed a new approach to simple, inexpensive lateral flow assays (LFAs) of great sensitivity, based on the glow stick peroxyoxalate chemistry widely used in emergency settings and in children's toys. At the peak of the COVID-19 pandemic, we had the opportunity to participate in the pandemic-driven NIH Rapid Acceleration of Diagnostics (RADx) initiative aiming to develop a deployable lateral flow diagnostic for SARS-CoV-2 nucleoprotein based on our novel glow stick-inspired light-emitting reporter technology. During this project, we screened more than 250 antibody pairs for analytical sensitivity and specificity directly in LFA format, using recombinant nucleoprotein and then gamma-irradiated virions spiked into negative nasal swab extracts. Membranes and other LFA materials and swabs and extraction reagent components also were screened and selected. Optimization of conjugate preparation and spraying as well as pretreatment/conditioning of the sample pad led to the final optimized LFA strip. Technology development also included optimization of excitation liquid enclosed in disposable droppers, design of a custom cartridge and smartphone-based reader, and app development, even a prototype reader usable with any mobile phone. Excellent preclinical performance was first demonstrated with contrived samples and then with leftover clinical samples. Moving beyond traditional academic focus areas, we were able to establish a quality management system (QMS), produce large numbers of customized LFA cassettes by contract injection molding, build in-house facilities to assemble and store thousands of complete tests for verification and validation and usability studies, and source kitting/packaging services and quality standard reagents and build partnerships for clinical translation, regulatory guidance, scale up, and market deployment. We were not able to bring this early stage technology to the point of commercialization within the limited time and resources available, but we did achieve strong proof-of-concept and advance translational aspects of the platform including initial high-performance LFAs, reading by the iPhone app using only a $2 plastic dark box with no lens, and convenient, usable excitation liquid packaging in droppers manufacturable in very large numbers.In this Account, we aim to provide a concise overview of our 18-month sprint toward the practical development of a deployable antigen lateral flow assay under pandemic conditions and the challenges and successes experienced by our team. We highlight what it takes to coach a technically savvy but commercially inexperienced academic team through the accelerated translation of an early stage technology into a useful product. Finally, we provide a guided tutorial and workflow to empower others interested in the rapid development of translatable LFAs.

UbiNAAT: a multiplexed point-of-care nucleic acid diagnostic platform for rapid at-home pathogen detection

The COVID-19 pandemic increased demands for respiratory disease testing to facilitate treatment and limit transmission, demonstrating in the process that most existing test options were too complex and expensive to perform in point-of-care or home scenarios. Lab-based molecular techniques can detect viral RNA in respiratory illnesses but are expensive and require trained personnel, while affordable antigen-based home tests lack sensitivity for early detection in newly infected or asymptomatic individuals. The few home RNA detection tests deployed were prohibitively expensive. Here, we demonstrate a point-of-care, paper-based rapid analysis device that simultaneously detects multiple viral RNAs; it is demonstrated on two common respiratory viruses (COVID-19 and influenza A) spiked onto a commercial nasal swab. The automated device requires no sample preparation by the user after insertion of the swab, minimizing user operation steps. We incorporated lyophilized amplification reagents immobilized in a porous matrix, a novel thermally actuated valve for multiplexed fluidic control, a printed circuit board that performs on-device lysis and amplification within a cell-phone-sized disposable device. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) products are visualized via fluorescent dyes using a modified cell phone, resulting in detection of as few as 104 viral copies per swab across both pathogens within 30 minutes. This integrated platform could be commercialized in a form that would be inexpensive, portable, and sensitive; it can readily be multiplexed to detect as many as 8 different RNA or DNA sequences, and adapted to any desired RNA or DNA detection assays.

Supra-Quantum Dot Assemblies to Maximize Color-Based Multiplexed Fluorescence Detection with a Smartphone Camera

Photoluminescence (PL) imaging and bioanalysis with smartphone-based devices are of growing interest for point-of-care/point-of-need diagnostics. Strategies for maximizing sensitivity have been explored in this context, but color multiplexing has been very limited, with its maximum level unexplored. Here, we evaluated color multiplexing with smartphone-based PL imaging by using supra-nanoparticle assemblies of quantum dots (supra-QDs). These materials were prepared as composite colors that were tailored to the red-green-blue (RGB) color space of smartphone cameras by coassembling different ratios of R-, G-, and B-emitting QDs on a silica nanoparticle scaffold. The supra-QDs were characterized and used to label cell-sized objects that were measured under flow with a smartphone-based device. Each color followed an approximately linear trajectory in the RGB space, and training of support vector machine models enabled color classification with overall accuracies ≥87% for 10-color multiplexing and better accuracies for fewer colors. Most misclassification occurred at low signal levels, such that establishing a nonclassifiable zone near the origin of RGB color space improved the overall 10-color classification accuracy to ≥94%. Similar improvements in accuracy with greater retention of data were possible with a probabilistic rather than a radial threshold. Simulations that were parameterized by experimental data suggested that ≥14-color multiplexing with accuracies ≥90% should be possible with an optimized supra-QD color set. This study is an important foundation for advancing RGB color-based multiplexing for imaging and analyses with smartphone cameras and related charge-coupled device and CMOS color image sensor technologies.

Highly Sensitive Photothermal Microfluidic Thread-Based Duplex Immunosensor for Point-of-Care Monitoring

Herein, we successfully developed a thread-based analytical device (μTAD) for simultaneous immunosensing of two biomolecules with attomolar sensitivity by using a photothermal effect. A photothermal effect exploits a strong light-to-heat energy conversion of plasmonic metallic nanoparticles at localized surface plasmon resonance. The key innovation is to utilize the cotton thread to realize this sensor and the use of chitosan modification for enhancing the microfluidic properties, for improving the efficiency of photothermal conversion, and for sensor stability. The developed μTAD sensor consists of (i) a sample zone, (ii) a conjugation zone coated with gold nanoparticles bound with an antibody (AuNPs-Ab2), and (iii) a test zone immobilized with a capture antibody (anti-Ab1). The prepared μTAD is assembled in a custom three-dimensional (3D) printed device which holds the laser for illumination and the thermometer for readout. The 3D-printed supportive device enhances signal response by focusing light and localizing the heat generated. For proof of concept, simultaneous sensing of two key stress and inflammation biomarkers, namely, cortisol and interleukin-6 (IL-6), are monitored using this technique. Under optimization, this device exhibited a detection linear range of 2.0-14.0 ag/mL (R2 = 0.9988) and 30.0-360.0 fg/mL (R2 = 0.9942) with a detection limit (LOD) of 1.40 ag/mL (∼3.86 amol/L) and 20.0 fg/mL (∼950.0 amol/L) for cortisol and IL-6, respectively. Furthermore, the analysis of both biomolecules in human samples indicated recoveries in the range of 98.8%-102.88% with the highest relative standard deviation being 3.49%, offering great accuracy and precision. These results are the highest reported sensitivity for these analytes using an immunoassay method. Our PT-μTAD strategy is therefore a promising approach for detecting biomolecules in resource-limited point-of-care settings.

A novel point-of-care diagnostic prototype system for the simultaneous electrochemiluminescent sensing of multiple traumatic brain injury biomarkers

Traumatic brain injuries (TBI) are typically acquired when a sudden violent event causes damage to the brain tissue. A high percentage (70-85%) of all TBI patients are suffering from mild TBI (mTBI), which is often difficult to detect and diagnose with standard imaging tools (MRI, CT scan) due to the absence of significant lesions and specific symptoms. Recent studies suggest that a screening test based on the measurement of a protein biomarker panel directly from a patient's blood can facilitate mTBI diagnosis. Herein, we report a novel prototype system designed as a precursor of a future hand-held point-of-care (POC) diagnostic device for the simultaneous multi-biomarker sensing, employing a microarray-type spatially resolved electrochemiluminescence immunoassay (SR-ECLIA). The small tabletop prototype consists of a screen-printed electrode compartment to conduct multi-analyte ECL sandwich assays, a potentiostat module and a light collection module, all integrated into a compact 3D-printed housing (18.2 × 16.5 × 5.0 cm), as well as an sCMOS detector. Based on this design concept, further miniaturization, system integration, performance optimization and clinical evaluation shall pave the way towards the development of a portable instrument for use at the site of accident and healthcare. To demonstrate the system's feasibility, current performance and efficiency, the simultaneous detection of three mTBI biomarkers (GFAP, h-FABP, S100β) in 50% serum was achieved in the upper pg mL-1 range. The proposed device is amenable to the detection of other biomarker panels and thus could open new medical diagnostic avenues for sensitive multi-analyte measurements with low-volume biological sample requirements.

Rapidly adaptable automated interpretation of point-of-care COVID-19 diagnostics

BACKGROUND

Point-of-care diagnostic devices, such as lateral-flow assays, are becoming widely used by the public. However, efforts to ensure correct assay operation and result interpretation rely on hardware that cannot be easily scaled or image processing approaches requiring large training datasets, necessitating large numbers of tests and expert labeling with validated specimens for every new test kit format.

METHODS

We developed a software architecture called AutoAdapt POC that integrates automated membrane extraction, self-supervised learning, and few-shot learning to automate the interpretation of POC diagnostic tests using smartphone cameras in a scalable manner. A base model pre-trained on a single LFA kit is adapted to five different COVID-19 tests (three antigen, two antibody) using just 20 labeled images.

RESULTS

Here we show AutoAdapt POC to yield 99% to 100% accuracy over 726 tests (350 positive, 376 negative). In a COVID-19 drive-through study with 74 untrained users self-testing, 98% found image collection easy, and the rapidly adapted models achieved classification accuracies of 100% on both COVID-19 antigen and antibody test kits. Compared with traditional visual interpretation on 105 test kit results, the algorithm correctly identified 100% of images; without a false negative as interpreted by experts. Finally, compared to a traditional convolutional neural network trained on an HIV test kit, the algorithm showed high accuracy while requiring only 1/50th of the training images.

CONCLUSIONS

The study demonstrates how rapid domain adaptation in machine learning can provide quality assurance, linkage to care, and public health tracking for untrained users across diverse POC diagnostic tests.

Lateral flow immunoassay for rapid and sensitive detection of dsRNA contaminants in in vitro-transcribed mRNA products

High purity is essential in mRNA-based therapeutic applications. A major contaminant of in vitro-transcribed (IVT) mRNA manufacturing is double-stranded RNA (dsRNA), which can induce severe anti-viral immune responses. Detection methods, such as agarose gel electrophoresis, ELISA, and dot-blot assay, are used to detect the existence of dsRNA in IVT mRNA products. However, these methods are either not sensitive enough or time-consuming. To overcome these challenges, we develop a rapid, sensitive, and easy-to-implement colloidal gold nanoparticle-based lateral flow strip assay (LFSA) with sandwich format for the detection of dsRNA from IVT process. dsRNA contaminant can be determined visually on the test strip or quantitatively with a portable optical detector. This method allows for a 15 min detection of N1-methyl-pseudouridine (m1Ψ)-containing dsRNA with a detection limit of 69.32 ng/mL. Furthermore, we establish the correlation between the LFSA test results and the immune response caused by dsRNA in mice. The LFSA platform allows the rapid, sensitive, and quantitative monitoring of purity in massive IVT mRNA products and aids for the prevention of immunogenicity by dsRNA impurities.

Advances in quantum dots as diagnostic tools

Quantum dots (QDs) are crystalline inorganic semiconductor nanoparticles a few nanometers in size that possess unique optical electronic properties vs those of larger materials. For example, QDs usually exhibit a strong and long-lived photoluminescence emission, a feature dependent on size, shape and composition. These special optoelectronic properties make them a promising alternative to conventional luminescent dyes as optical labels in biomedical applications including biomarker quantification, biomolecule targeting and molecular imaging. A key parameter for use of QDs is to functionalize their surface with suitable (bio)molecules to provide stability in aqueous solutions and efficient and selective tagging biomolecules of interest. Researchers have successfully developed biocompatible QDs and have linked them to various biomolecule recognition elements, i.e., antibodies, proteins, DNA, etc. In this chapter, QD synthesis and characterization strategies are reviewed as well as the development of nanoplatforms for luminescent biosensing and imaging-guided targeting. Relevant biomedical applications are highlighted with a particular focus on recent progress in ultrasensitive detection of clinical biomarkers. Finally, key future research goals to functionalize QDs as diagnostic tools are explored.

Tunable Duplex Semiquantitative Detection of Nucleic Acids with a Visual Lateral Flow Immunoassay Readout

Quantitative nucleic acid amplification testing (NAAT) is a key enabling technology for infectious disease management, especially in instances where viral load informs therapeutic decisions. Inadequate access to quantitative NAATs remains a challenge to the successful deployment of antiretroviral therapy (ART) regimens for patients with chronic hepatitis B virus (CHB) in low resourced settings (LRS). Current field-deployable NAATs are generally qualitative (yes/no) rather than quantitative in nature, making them ill-suited for viral load monitoring programs for CHB patients. Here, we report the development of a proof-of-concept molecular diagnostic test, the semiquantitative ligation and amplification (SQLA) assay, which achieves semiquantitative detection of input target DNA at two independently tunable detection thresholds with a simple visual readout. The SQLA assay utilizes a duplex competitive thermophilic helicase-dependent amplification (tHDA) chemistry and can be performed in under 1 h.

COVID-19: A systematic review and update on prevention, diagnosis, and treatment

Since the rapid onset of the COVID-19 or SARS-CoV-2 pandemic in the world in 2019, extensive studies have been conducted to unveil the behavior and emission pattern of the virus in order to determine the best ways to diagnosis of virus and thereof formulate effective drugs or vaccines to combat the disease. The emergence of novel diagnostic and therapeutic techniques considering the multiplicity of reports from one side and contradictions in assessments from the other side necessitates instantaneous updates on the progress of clinical investigations. There is also growing public anxiety from time to time mutation of COVID-19, as reflected in considerable mortality and transmission, respectively, from delta and Omicron variants. We comprehensively review and summarize different aspects of prevention, diagnosis, and treatment of COVID-19. First, biological characteristics of COVID-19 were explained from diagnosis standpoint. Thereafter, the preclinical animal models of COVID-19 were discussed to frame the symptoms and clinical effects of COVID-19 from patient to patient with treatment strategies and in-silico/computational biology. Finally, the opportunities and challenges of nanoscience/nanotechnology in identification, diagnosis, and treatment of COVID-19 were discussed. This review covers almost all SARS-CoV-2-related topics extensively to deepen the understanding of the latest achievements (last updated on January 11, 2022).

Prototype Smartphone-Based Device for Flow Cytometry with Immunolabeling via Supra-nanoparticle Assemblies of Quantum Dots

Methods for the detection, enumeration, and typing of cells are important in many areas of research and healthcare. In this context, flow cytometers are a widely used research and clinical tool but are also an example of a large and expensive instrument that is limited to specialized laboratories. Smartphones have been shown to have excellent potential to serve as portable and lower-cost platforms for analyses that would normally be done in a laboratory. Here, we developed a prototype smartphone-based flow cytometer (FC). This compact 3D-printed device incorporated a laser diode and a microfluidic flow cell and used the built-in camera of a smartphone to track immunofluorescently labeled cells in suspension and measure their color. This capability was enabled by high-brightness supra-nanoparticle assemblies of colloidal semiconductor quantum dots (SiO₂@QDs) as well as a support vector machine (SVM) classification algorithm. The smartphone-based FC device detected and enumerated target cells against a background of other cells, simultaneously and selectively counted two different cell types in a mixture, and used multiple colors of SiO₂@QD-antibody conjugates to screen for and identify a particular cell type. The potential limits of multicolor detection are discussed alongside ideas for further development. Our results suggest that innovations in materials and engineering should enable eventual smartphone-based FC assays for clinical applications.

Paper-microfluidic signal-enhanced immunoassays

Over the past decade, paper-based microfluidic devices have become popular for their simplicity and ability to conduct diagnostic tests at a low cost. An important class of diagnostic assays that paper-based analytical devices have been used for is immunoassays. The lateral flow immunoassay (LFIA), of which the home pregnancy test is the most prominent example, has been one of the most commercially successful membrane-based diagnostic tests. Yet, the analytical sensitivity of LFIAs is lower than the corresponding laboratory technique called ELISA (enzyme-linked immunoassay). As a consequence, traditional LFIAs fail to deliver on the promise of bedside diagnostic testing for many applications. Recognizing this shortcoming, several new developments have been made by researchers to enhance the sensitivity of membrane-based immunoassays. In this chapter, we present the various strategies that have been employed to this end. In the end, we present a brief SWOT analysis to guide future work in this area.

Enhancement of the Detection Performance of Paper-Based Analytical Devices by Nanomaterials

Paper-based analytical devices (PADs), including lateral flow assays (LFAs), dipstick assays and microfluidic PADs (μPADs), have a great impact on the healthcare realm and environmental monitoring. This is especially evident in developing countries because PADs-based point-of-care testing (POCT) enables to rapidly determine various (bio)chemical analytes in a miniaturized, cost-effective and user-friendly manner. Low sensitivity and poor specificity are the main bottlenecks associated with PADs, which limit the entry of PADs into the real-life applications. The application of nanomaterials in PADs is showing great improvement in their detection performance in terms of sensitivity, selectivity and accuracy since the nanomaterials have unique physicochemical properties. In this review, the research progress on the nanomaterial-based PADs is summarized by highlighting representative recent publications. We mainly focus on the detection principles, the sensing mechanisms of how they work and applications in disease diagnosis, environmental monitoring and food safety management. In addition, the limitations and challenges associated with the development of nanomaterial-based PADs are discussed, and further directions in this research field are proposed.

An Overview for the Nanoparticles-Based Quantitative Lateral Flow Assay

The development of the lateral flow assay (LFA) has received much attention in both academia and industry because of their broad applications to food safety, environmental monitoring, clinical diagnosis, and so forth. The user friendliness, low cost, and easy operation are the most attractive advantages of the LFA. In recent years, quantitative detection has become another focus of LFA development. Here, the most recent studies of quantitative LFAs are reviewed. First, the principles and corresponding formats of quantitative LFAs are introduced. In the biomaterial and nanomaterial sections, the detection, capture, and signal amplification biomolecules and the optical, fluorescent, luminescent, and magnetic labels used in LFAs are described. The invention of dedicated strip readers has drawn further interest in exploiting the better performance of LFAs. Therefore, next, the development of dedicated reader devices is described and the usefulness and specifications of these devices for LFAs are discussed. Finally, the applications of LFAs in the detection of metal ions, biotoxins, pathogenic microorganisms, veterinary drugs, and pesticides in the fields of food safety and environmental health and the detection of nucleic acids, biomarkers, and viruses in clinical analyses are summarized.

Photoluminescent Nanoparticles for Chemical and Biological Analysis and Imaging

Research related to the development and application of luminescent nanoparticles (LNPs) for chemical and biological analysis and imaging is flourishing. Novel materials and new applications continue to be reported after two decades of research. This review provides a comprehensive and heuristic overview of this field. It is targeted to both newcomers and experts who are interested in a critical assessment of LNP materials, their properties, strengths and weaknesses, and prospective applications. Numerous LNP materials are cataloged by fundamental descriptions of their chemical identities and physical morphology, quantitative photoluminescence (PL) properties, PL mechanisms, and surface chemistry. These materials include various semiconductor quantum dots, carbon nanotubes, graphene derivatives, carbon dots, nanodiamonds, luminescent metal nanoclusters, lanthanide-doped upconversion nanoparticles and downshifting nanoparticles, triplet-triplet annihilation nanoparticles, persistent-luminescence nanoparticles, conjugated polymer nanoparticles and semiconducting polymer dots, multi-nanoparticle assemblies, and doped and labeled nanoparticles, including but not limited to those based on polymers and silica. As an exercise in the critical assessment of LNP properties, these materials are ranked by several application-related functional criteria. Additional sections highlight recent examples of advances in chemical and biological analysis, point-of-care diagnostics, and cellular, tissue, and in vivo imaging and theranostics. These examples are drawn from the recent literature and organized by both LNP material and the particular properties that are leveraged to an advantage. Finally, a perspective on what comes next for the field is offered.

Ratiometric Fluorescent Lateral Flow Immunoassay for Point-of-Care Testing of Acute Myocardial Infarction

We report the development of a highly sensitive ratiometric fluorescent lateral flow immunoassay (RFLFIA) strip for rapid and accurate detection of acute myocardial infarction biomarker, namely heart-type fatty acid binding protein (H-FABP). The RFLFIA strip works in terms of ratiometric change of fluorescence signal, arising from blending of fluorescence emitted by two composite nanostructures conjugated to capture and probe antibodies and inner filter effect of gold nanoparticles. In conjunction with using custom smartphone-based analytical device and tonality analysis, quantitative detection of H-FABP was achieved with a low limit of detection at 0.21 ng mL^-1 . The RFLFIA strip can generate a visually distinguishable green-to-red color change around the threshold concentration of H-FABP (6.2 ng mL^-1 ), thus allowing the semi-quantitative diagnosis by the naked eye.

Smartphone-based imaging systems for medical applications: a critical review

SIGNIFICANCE

Smartphones come with an enormous array of functionality and are being more widely utilized with specialized attachments in a range of healthcare applications. A review of key developments and uses, with an assessment of strengths/limitations in various clinical workflows, was completed.

AIM

Our review studies how smartphone-based imaging (SBI) systems are designed and tested for specialized applications in medicine and healthcare. An evaluation of current research studies is used to provide guidelines for improving the impact of these research advances.

APPROACH

First, the established and emerging smartphone capabilities that can be leveraged for biomedical imaging are detailed. Then, methods and materials for fabrication of optical, mechanical, and electrical interface components are summarized. Recent systems were categorized into four groups based on their intended application and clinical workflow: ex vivo diagnostic, in vivo diagnostic, monitoring, and treatment guidance. Lastly, strengths and limitations of current SBI systems within these various applications are discussed.

RESULTS

The native smartphone capabilities for biomedical imaging applications include cameras, touchscreens, networking, computation, 3D sensing, audio, and motion, in addition to commercial wearable peripheral devices. Through user-centered design of custom hardware and software interfaces, these capabilities have the potential to enable portable, easy-to-use, point-of-care biomedical imaging systems. However, due to barriers in programming of custom software and on-board image analysis pipelines, many research prototypes fail to achieve a prospective clinical evaluation as intended. Effective clinical use cases appear to be those in which handheld, noninvasive image guidance is needed and accommodated by the clinical workflow. Handheld systems for in vivo, multispectral, and quantitative fluorescence imaging are a promising development for diagnostic and treatment guidance applications.

CONCLUSIONS

A holistic assessment of SBI systems must include interpretation of their value for intended clinical settings and how their implementations enable better workflow. A set of six guidelines are proposed to evaluate appropriateness of smartphone utilization in terms of clinical context, completeness, compactness, connectivity, cost, and claims. Ongoing work should prioritize realistic clinical assessments with quantitative and qualitative comparison to non-smartphone systems to clearly demonstrate the value of smartphone-based systems. Improved hardware design to accommodate the rapidly changing smartphone ecosystem, creation of open-source image acquisition and analysis pipelines, and adoption of robust calibration techniques to address phone-to-phone variability are three high priority areas to move SBI research forward.

Tutorial: design and fabrication of nanoparticle-based lateral-flow immunoassays

Lateral-flow assays (LFAs) are quick, simple and cheap assays to analyze various samples at the point of care or in the field, making them one of the most widespread biosensors currently available. They have been successfully employed for the detection of a myriad of different targets (ranging from atoms up to whole cells) in all type of samples (including water, blood, foodstuff and environmental samples). Their operation relies on the capillary flow of the sample throughout a series of sequential pads, each with different functionalities aiming to generate a signal to indicate the absence/presence (and, in some cases, the concentration) of the analyte of interest. To have a user-friendly operation, their development requires the optimization of multiple, interconnected parameters that may overwhelm new developers. In this tutorial, we provide the readers with: (i) the basic knowledge to understand the principles governing an LFA and to take informed decisions during lateral flow strip design and fabrication, (ii) a roadmap for optimal LFA development independent of the specific application, (iii) a step-by-step example procedure for the assembly and operation of an LF strip for the detection of human IgG and (iv) an extensive troubleshooting section addressing the most frequent issues in designing, assembling and using LFAs. By changing only the receptors, the provided example procedure can easily be adapted for cost-efficient detection of a broad variety of targets.

Smartphone and Paper-Based Fluorescence Reader: A Do It Yourself Approach

Given their photoluminescent character, portable quantum dot readers are often sophisticated and relatively expensive. In response, we engineered a "do it yourself" fluorescence reader employing paper materials and a mid-range smartphone camera. Black paperboard facilitated a versatile, lightweight and foldable case; whereas cellophane paper was observed to behave as a simple, yet effective, optical bandpass filter leading to an advantageous device for the quantitative interrogation of quantum dot nanocrystals concentrations (from 2.5 to 20 nM), which are suitable for optical point-of-care biosensing. The streptavidin-coated nanocrystals employed are commercially available and the developed reader was benchmarked with a standard portable quantum dot reader, thereby demonstrating advantages in terms of cost and linear analytical range.

An RGB-emitting molecular cocktail for the detection of bacterial fingerprints

Accumulating evidence indicates that colonized microbes play a crucial role in regulating health and disease in the human body. Detecting microbes should be essential for understanding the relationship between microbes and diseases, as well as increasing our ability to detect diseases. Here, a combined metabolic labeling strategy was developed to identify different bacterial species and microbiota by the use of three different fluorescent metabolite derivatives emitting red, green, and blue (RGB) fluorescence. Upon co-incubation with microbes, these fluorescent metabolite derivatives are incorporated into bacteria, generating unique true-color fingerprints for different bacterial species and different microbiota. A portable spectrometer was also fabricated to automate the colorimetric analysis in combination with a smartphone to conveniently identify different bacterial species and microbiota. Herein, the effectiveness of this system was demonstrated by the identification of certain bacterial species and microbiota in mice with different diseases, such as skin infections and bacteremia. By analyzing the microbiota fingerprints of saliva samples from clinical patients and healthy people, this system was proved to precisely distinguish oral squamous cell carcinoma (OSCC, n = 29) samples from precancerous (n = 10) and healthy (n = 5) samples.

Quantum Dot Bioconjugates for Diagnostic Applications

Quantum dots (QDs) are a special type of engineered nanomaterials with outstanding optoelectronic properties that make them as a very promising alternative to conventional luminescent dyes in biomedical applications, including biomolecule (BM) targeting, luminescence imaging and drug delivery. A key parameter to ensure successful biomedical applications of QDs is the appropriate surface modification, i.e. the surface of the nanomaterials should be modified with the appropriate functional groups to ensure stability in aqueous solutions and it should be conjugated with recognition elements capable of ensuring an efficient tagging of the BMs of interest. In this review we summarize the most relevant strategies used for surface modification of QDs and for their conjugation to BMs in preparation of their application in nanoplatforms for luminescent BM sensing and imaging-guided targeting. The applications of conjugations of photoluminescent QDs with different BMs in both in vitro and in vivo chemical sensing, immunoassays or luminescence imaging are reviewed. Recent progress in the application of functionalized QDs in ultrasensitive detection in bioanalysis, diagnostics and imaging strategies are reported. Finally, some key future research goals in the progress of bioconjugation of QDs for diagnosis are identified, including novel synthetic approaches, the need for exhaustive characterization of bioconjugates and the design of signal amplification schemes.

A Portable Smartphone Platform Using a Ratiometric Fluorescent Paper Strip for Visual Quantitative Sensing

Instrument-free, portable, and direct read-out mini-devices have wider application prospects in various fields, especially for real-time/on-site sensing. Herein, combined with a paper strip, a smartphone sensing platform integrated with a UV lamp and dark cavity by 3D-printing technology has been developed for the rapid, sensitive, instrument-free, and visual quantitative analysis in real-time/on-site conditions. The platform proved the feasibility for visual quantitative detection of pesticide via a fluorescence "on-off-on" response with a single dual-emissive ratiometric paper strip. Red-emitting CdTe quantum dots (rQDs) were embedded into the silica nanoparticles (SiO₂ NPs) as an internal reference, while blue-emitting carbon dots (bCDs) as a signal report unit were covalently linked to the outer surface of SiO₂ NPs. The blue fluorescence could be quenched by gold nanoparticles (Au NPs) and then recovered with pesticide. The red (R), green (G), and blue (B) channel values of the generated images were determined by a color recognizer application (APP) installed in the smartphone, and the R/B values could be used for pesticide quantification with a sensitive detection limit (LOD) of 59 nM. The smartphone sensing platform based on 3D printing might provide a general strategy for visual quantitative detection in a variety of fields including environments, diagnosis, and safety monitoring.

Smartphones as mobile microbiological laboratories

BACKGROUND

Point-of-care (POC) tests provide an alternative to traditional laboratory-based diagnostics due to reduced turnaround times, portability and no need for highly trained laboratory staff. Smartphones can be integrated into POC platforms because of their multifunctionality, enabled by high-quality digital cameras, computer processors, touchscreen interface and wireless data transfer. It is predicted that by 2020 about 80% of the world population will use smartphones.

OBJECTIVES

This review summarizes the current state of the art regarding smartphones as part of a mobile microbiological laboratory.

SOURCES

Selected peer-reviewed publications on smartphone-based microbiological testing published between January 2015 and August 2019.

CONTENT

Smartphones can be used as instrumental interfaces, dongles, microscopes or test result readers (brightfield, colorimetric and fluorescent measurements), or combined with amplification methods such as loop-mediated isothermal amplification (LAMP) tests in portable POC test platforms. Smartphone-based tests offer opportunities for microbiological diagnostics in remote areas and both resource-limited and resource-rich settings. Wireless connectivity may facilitate epidemiological studies and creation of spatiotemporal disease prevalence maps. However, the current analytical performance of many smartphone-based POC tests must be improved and carefully validated in clinical settings by comparison with current diagnostic standards.

IMPLICATIONS

Recent developments in smartphone-based POC tests for infectious diseases are promising, as evidenced by results from many proof-of-concept studies. Further progress will foster large-scale implementation of smartphone-based POC as mobile microbiological laboratories in the near future.

Towards Lateral Flow Quantitative Assays: Detection Approaches

Point-of-care (POC) or bedside analysis is a global trend in modern diagnostics. Progress in POC testing has largely been provided by advanced manufacturing technology for lateral flow (immunochromatographic) test strips. They are widely used to rapidly and easily control a variety of biomarkers of infectious diseases and metabolic and functional disorders, as well as in consumer protection and environmental monitoring. However, traditional lateral flow tests rely on visual assessment and qualitative conclusion, which limit the objectivity and information output of the assays. Therefore, there is a need for approaches that retain the advantages of lateral flow assays and provide reliable quantitative information about the content of a target compound in a sample mixture. This review describes the main options for detecting, processing, and interpreting immunochromatographic analysis results. The possibilities of modern portable detectors that register colored, fluorescent, magnetic, and conductive labels are discussed. Prospects for further development in this direction are also examined.

Signal-Enhanced Detection of Multiplexed Cardiac Biomarkers by a Paper-Based Fluorogenic Immunodevice Integrated with Zinc Oxide Nanowires

Using a single test to comprehensively evaluate multiple cardiac biomarkers for early diagnosis and prevention of acute myocardial infarction (AMI) has faced enormous challenges. Here, we have developed paper-based fluorogenic immunodevices for multiplexed detection of three cardiac biomarkers, namely, human heart-type fatty acid binding protein (FABP), cardiac troponin I (cTnI), and myoglobin, simultaneously. The detection is based on a strategy using zinc oxide nanowires (ZnO NWs) to enhance fluorescence signals (∼5-fold compared to that on pure paper). The immunodevices showed high sensitivity and selectivity for FABP, cTnI, and myoglobin with detection limits of 1.36 ng/mL, 1.00 ng/mL, and 2.38 ng/mL, respectively. Additionally, the paper-based immunoassay was rapid (∼5 min to complete the test) and portable (using a homemade chamber with a smartphone and an ultraviolet lamp). The developed devices integrated with ZnO NWs enable quantitative, sensitive, and simultaneous detection of multiple cardiac biomarkers in point-of-care settings, which provides a useful approach for monitoring AMI diseases and may be extended to other medical diagnostics and environmental assessments.

Accessory-free quantitative smartphone imaging of colorimetric paper-based assays

The combination of smartphone technology and colorimetric paper-based microfluidics can enable simple, inexpensive diagnostics. However, imaging colorimetric diagnostic results via smartphones currently requires accessories to mitigate the influence of variability in surrounding lighting conditions. Here, we present an accessory-free smartphone-based colorimetric imaging method that enlists the built-in LED light source to dominate ambient lighting in combination with background and colour rescaling. This simple approach enables quantitative measurements from paper-based tests by compensating for different environmental lighting conditions and is universally applicable with respect to phone models and manufacturers. We demonstrate the method with three dominant phone makes and models in a cell counting application with a paper-based yeast detection device. The detection results are in good agreement with cell counting using automated cell counters. Eliminating the need for make/model specific accessories, this approach helps realize the potential for low-cost, broadly applicable paper-based diagnostics.

Overreliance on Cost Reduction as a Featured Element of Sensor Design

In this Perspective, we examine the role of cost in sensor design, its meaning within the context of converting academic prototypes into commercial products, and the importance of these issues to clear scientific communication. The possible motivations to consider the cost of a technology, sensor, or assay are both numerous and apparent. However, the idea that the cost of reagents and materials at the laboratory scale will directly translate to the purchase price for a user is inaccurate. While calculating the bill of materials is easy, there are many business considerations that make commercial products entirely different from academic prototypes. With these critical aspects of commercialization considered, academics are often not equipped to predict what the final price of an assay, sensor, or instrument will be to the end user. When used without proper context and accuracy, an overreliance on the phrase "low cost" in the absence of a sufficient discussion of cost weakens the meaning of this popular term and precludes practical scientific advancements. To demonstrate how the relationship between a bill of materials and "expected purchase price" breaks down when considering academic innovations, we discuss pregnancy tests as a case study where an academic bill of materials can lead to both overestimations and underestimations of pricing.

An amphiphilic-ligand-modified gold nanoflower probe for enhancing the stability of lateral flow immunoassays in dried distillers grains

An amphiphilic ligand-capped gold nanoflower (AuNF) was proposed as a novel lateral flow immunoassay (LFA) reporter for zearalenone (ZEN) detection in distillers dried grains solubles (DDGS).

Development of a smartphone-based rapid dual fluorescent diagnostic system for the simultaneous detection of influenza A and H5 subtype in avian influenza A-infected patients

Accurate and rapid diagnosis of highly pathogenic avian influenza A H5N1 is of critical importance for the effective clinical management of patients. Here, we developed a rapid and simultaneous detection toolkit for influenza A H5 subtype viruses in human samples based on a bioconjugate of quantum dots (QDs) assembly and a smartphone-based rapid dual fluorescent diagnostic system (SRDFDS). Methods: Two types of QDs were assembled on a latex bead to enhance the detection sensitivity and specificity of influenza A infection (QD580) and H5 subtype (QD650). The dual signals of influenza A and H5 subtype of H5N1-infected patients were detected simultaneously and quantified separately by SRDFDS equipped with two emission filters. Results: Our results showed a high sensitivity of 92.86% (13/14) and 78.57% (11/14), and a specificity of 100% (38/38, P < 0.0001) and 97.37% (37/38) for influenza A and H5 subtype detection, respectively. Conclusion: Therefore, our multiplex QD bioconjugates and SRDFDS-based influenza virus detection toolkit potentially provide accurate and meaningful diagnosis information with improved detection accuracies and sensitivities for H5N1 patients.

Paper-Based Analytical Methods for Smartphone Sensing with Functional Nanoparticles: Bridges from Smart Surfaces to Global Health

In this Feature, the most recent developments as well as "pros and cons" in smartphone sensing, which have been developed using various functional nanoparticles in paper-based sensing systems, will be discussed. Additionally, smart phone sensing and POC combination as a potential tool that opens a gate for knowledge flow "from lab scale data to public use" will be evaluated.