Three-Dimensional Paper-Based Microfluidic Analytical Devices Integrated with a Plasma Separation Membrane for the Detection of Biomarkers in Whole Blood

Colorimetric detection of electrolyte ions in blood based on biphasic microdroplet extraction

BACKGROUND

Timely diagnosis and prevention of diseases require rapid and sensitive detection of biomarkers from blood samples without external interference. Abnormal electrolyte ion levels in the blood are closely linked to various physiological disorders, including hypertension. Therefore, accurate, interference-free, and precise measurement of electrolyte ion concentrations in the blood is particularly important.

RESULTS

In this work, a colorimetric sensor based on a biphasic microdroplet extraction is proposed for the detection of electrolyte ions in the blood. This sensor employs mini-pillar arrays to facilitate contact between adjacent blood microdroplets and organic microdroplets serving as sensing phases, with any color changes being monitored through a smartphone's colorimetric software. The sensor is highly resistant to interference and does not require pre-treatment of the blood samples. Remarkably, the sensor exhibits exceptional reliability and stability, allowing for rapid enrichment and detection of K+, Na+, and Cl- in the blood within 10 s (Cl-), 15 s (K+) and 40 s (Na+) respectively.

SIGNIFICANCE

The colorimetric sensor based on biphasic microdroplet extraction offers portability due to its compact size and ease of operation without the need for large instruments. Additionally, it is location-independent, making it a promising tool for real-time biomarker detection in body fluids such as blood.

Colorimetric sensing for translational applications: from colorants to mechanisms

Colorimetric sensing offers instant reporting via visible signals. Versus labor-intensive and instrument-dependent detection methods, colorimetric sensors present advantages including short acquisition time, high throughput screening, low cost, portability, and a user-friendly approach. These advantages have driven substantial growth in colorimetric sensors, particularly in point-of-care (POC) diagnostics. Rapid progress in nanotechnology, materials science, microfluidics technology, biomarker discovery, digital technology, and signal pattern analysis has led to a variety of colorimetric reagents and detection mechanisms, which are fundamental to advance colorimetric sensing applications. This review first summarizes the basic components (e.g., color reagents, recognition interactions, and sampling procedures) in the design of a colorimetric sensing system. It then presents the rationale design and typical examples of POC devices, e.g., lateral flow devices, microfluidic paper-based analytical devices, and wearable sensing devices. Two highlighted colorimetric formats are discussed: combinational and activatable systems based on the sensor-array and lock-and-key mechanisms, respectively. Case discussions in colorimetric assays are organized by the analyte identities. Finally, the review presents challenges and perspectives for the design and development of colorimetric detection schemes as well as applications. The goal of this review is to provide a foundational resource for developing colorimetric systems and underscoring the colorants and mechanisms that facilitate the continuing evolution of POC sensors.

Paper-based sensors: affordable, versatile, and emerging analyte detection platforms

Paper-based sensors, often referred to as paper-based analytical devices (PADs), stand as a transformative technology in the field of analytical chemistry. They offer an affordable, versatile, and accessible solution for diverse analyte detection. These sensors harness the unique properties of paper substrates to provide a cost-effective and adaptable platform for rapid analyte detection, spanning chemical species, biomolecules, and pathogens. This review highlights the key attributes that make paper-based sensors an attractive choice for analyte detection. PADs demonstrate their versatility by accommodating a wide range of analytes, from ions and gases to proteins, nucleic acids, and more, with customizable designs for specific applications. Their user-friendly operation and minimal infrastructure requirements suit point-of-care diagnostics, environmental monitoring, food safety, and more. This review also explores various fabrication methods such as inkjet printing, wax printing, screen printing, dip coating, and photolithography. Incorporating nanomaterials and biorecognition elements promises even more sophisticated and sensitive applications.

Microfluidic-based systems for the management of diabetes

Diabetes currently affects approximately 500 million people worldwide and is one of the most common causes of mortality in the United States. To diagnose and monitor diabetes, finger-prick blood glucose testing has long been used as the clinical gold standard. For diabetes treatment, insulin is typically delivered subcutaneously through cannula-based syringes, pens, or pumps in almost all type 1 diabetic (T1D) patients and some type 2 diabetic (T2D) patients. These painful, invasive approaches can cause non-adherence to glucose testing and insulin therapy. To address these problems, researchers have developed miniaturized blood glucose testing devices as well as microfluidic platforms for non-invasive glucose testing through other body fluids. In addition, glycated hemoglobin (HbA1c), insulin levels, and cellular biomechanics-related metrics have also been considered for microfluidic-based diabetes diagnosis. For the treatment of diabetes, insulin has been delivered transdermally through microdevices, mostly through microneedle array-based, minimally invasive injections. Researchers have also developed microfluidic platforms for oral, intraperitoneal, and inhalation-based delivery of insulin. For T2D patients, metformin, glucagon-like peptide 1 (GLP-1), and GLP-1 receptor agonists have also been delivered using microfluidic technologies. Thus far, clinical studies have been widely performed on microfluidic-based diabetes monitoring, especially glucose sensing, yet technologies for the delivery of insulin and other drugs to diabetic patients with microfluidics are still mostly in the preclinical stage. This article provides a concise review of the role of microfluidic devices in the diagnosis and monitoring of diabetes, as well as the delivery of pharmaceuticals to treat diabetes using microfluidic technologies in the recent literature.

Pronounced effect of lamination on plasma separation from whole blood by microfluidic paper-based analytical devices

Many diseases are detected through blood tests. Currently, most blood tests are done on plasma instead of whole blood because of the interference of blood cells on detection results. Here, we developed a laminated microfluidic paper-based analytical device (L-μPAD) for the separation of plasma from whole blood without using plasma separation membrane (PSM). A lateral flow design consisting of a circular sampling zone and rectangular detection zone was patterned on the paper substrate using laser printing technology. The μPAD was then laminated after impregnation with KCl solution. Lamination and electrolyte addition represented synergistic effects on the separation by controlling the pore size of the paper. In addition, by preventing evaporation on one hand and squeezing paper pores on the other hand, lamination caused longer movement of the separated plasma, the longest plasma path reported so far. The separation process was monitored using colorimetric reagent bromocresol green and scanning electron microscopy. The process of separation was completed in less than 90s without significant hemolysis and the separated plasma was far from the interfering effect of red blood cells. We used the device for the determination of serum albumin. However, it represents the potential for point-of-care testing in multi-assay experiments too.

A sensitive and facile electrochemical paper-based sensor for glucose detection in whole blood using the Pd/CB-Ni@rGO modified electrode

We created novel Pd/CB-Ni@rGO nanomaterials for glucose detection. The as-synthesized nanomaterials were dropped on the electrode surface using the drop casting technique. The prepared electrode was then attached to a paper-based device containing the sample zone and the reaction zone, enabling plasma isolation and an enzymatic reaction for glucose detection in whole blood. The nanomaterials and surfaces of electrodes were characterized by FTIR, TEM, and SEM. The proposed approach is a disposable glucose detection method that is unaffected by protein fouling on the electrode, and it requires only one drop of human blood. Therefore, there is no need for extensive sample preparation, and there is less sample consumption. Under optimal conditions, Pd/CB-Ni@rGO can accurately measure blood glucose levels with a linear range of 7 to 7140 μM (R2 = 0.9986) and a low detection limit of 0.82 μM. Besides, the developed sensor shows excellent anti-interference capacity, stability, and satisfactory reproducibility and repeatability. Importantly, Pd/CB-Ni@rGO was successfully applied for glucose in whole blood from 4 volunteers, with results that correlated well with those obtained using an Accucheck glucometer at a 95% confidence level. Given its low cost, high accuracy, and ease of use, the blood glucose sensor holds significant potential for clinical use and broadens the area of future noninvasive sensor development.

Modified polysulfone membrane facilitates rapid separation of plasma from whole blood for an effective anti-SARS-CoV-2-IgM diagnosis

During the outbreak of coronavirus, RT-PCR was the premier gold standard method for severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) diagnosis. However, the sophisticated procedure of RT-PCR persuades researchers to develop sustainable point-of-need immunoassay methods for tracing unwitting carriers of SARSCoV-2. Herein, by fabricating a modified polysulfone (MPSF) membrane, we developed an integrated radial flow immunoassay (IRFIA) platform as a point-of-care system, capable of multiplying the immunoassays at a short run time. The target molecule is the SARSCoV-2 IgM in separated plasma. Although the lateral flow immunoassay kits for the rapid identification of Covid-19 have already been commercially developed but, the proposed method is superior to the conventional lateral flow immunoassay. In the newly designed membrane system, we have combined the five membranes of prevalent lateral flow immunoassay (LFIA) strips in one polymeric membrane. The MPSF membrane is capable of separating plasma from whole blood sample, which will reduce the interference of red colour of hemoglobin with generated signal and enhance the immunoassay precision. The efficiency of plasma separation, reached the mean value of 97.34 v/v% in 5 s. Furthermore, the gel electrophoresis results of the separated plasma contrasted with centrifuged plasma sample, demonstrated more efficient separation by the membrane. Using the MPSF membrane, signal generation time reduced from about 20 min in conventional rapid test strip for Covid-19 to about 7 min in IRFIA platform. The sensitivity and specificity of the membrane platform were determined to be 89% and 90%, respectively and a Kappa coefficient of 0.79 showed reliable agreement between the RT-PCR and the membrane system.

Immobilization of diphenylcarbazide on paper-based analytical devices for the pre-concentration and detection of chromium VI in water samples

A novel approach using a smartphone for the detection of Cr (VI) has been developed. In this context, two different platforms were designed for the detection of Cr (VI). The first one was synthesized via a crosslinking reaction of chitosan with 1,5-Diphenylcarbazide (DPC-CS). The obtained material was integrated into a paper to develop a new paper-based analytical device (DPC-CS-PAD). The DPC-CS-PAD exhibited high specificity toward Cr (VI). The second platform (DPC-Nylon PAD) was prepared by covalent immobilization of DPC onto a Nylon paper and then its analytical performances regarding Cr (VI) extraction and detection were evaluated. DPC-CS-PAD presented a linear range of 0.1-5 ppm with detection and quantification limits of about 0.04 and 0.12 ppm, respectively. The DPC-Nylon-PAD exhibited a linear response of 0.1-2.5 ppm with detection and quantification limits of 0.06 and 0.2 ppm, respectively. Furthermore, the developed platforms were effectively applied for testing the effect of the loading solution volume for trace Cr (IV) detection. For the DPC-CS material, a volume of 20 mL allowed the detection of 4 ppb of Cr (VI). In the case of DPC-Nylon-PAD, the loading volume of 1 mL permitted the detection of the critical concentration of Cr (VI) in water.

Design and Fabrication of a High Performance Microfluidic Chip for Blood Plasma Separation: Modelling and Prediction of System Behaviour via CFD Method

This paper presents a single-step microfluidic system designed for passive separation of human fresh blood plasma using direct capillary forces. Our microfluidic system is composed of a cylindrical well between upper and lower channel pairs produced by soft photolithography. The microchip was fabricated based on hydrophobicity differences upon suitable cylindrical surfaces using gravitational and capillary forces and lateral migration of plasma and red blood cells. The plasma radiation was applied to attach the polymeric segment (polydimethylsiloxane (PDMS)) to the glass. Meanwhile, Tween 80 was used as a surfactant to increase the hydrophobicity of the lateral channel surfaces. This led to the higher movement of whole blood, including plasma. Fick's law of diffusion was validated for this diffusion transfer, the Navier-Stokes equation was used for the momentum balance, and the Laplace equation was utilized for the dynamics of the mesh. A model with high accuracy using the COMSOL Multiphysics software was created to predict the capillary forces and chip model validation. RBCs (red blood cells) were measured by the H3 cell counter instrument, by which 99% plasma purity was achieved. Practically, 58.3% of the plasma was separated from the blood within 12 min. Correlation between plasma separation results obtained from software and experimental data showed a coefficient of determination equal to 0.9732. This simple, rapid, stable, and reliable microchip can be considered as a promising candidate for providing plasma in point-of-care diagnostics.

Microfluidic paper and thread-based separations: Chromatography and electrophoresis

Paper and thread are widely used as the substrates for fabricating low-cost, disposable, and portable microfluidic analytical devices used in clinical, environmental, and food safety monitoring. Concerning separation methods including chromatography and electrophoresis, these substrates provide unique platforms for developing portable devices. This review focuses on summarizing recent research on the miniaturization of the separation techniques using paper and thread. Preconcentration, purification, desalination, and separation of various analytes are achievable using electrophoresis and chromatography methods integrated with modified or unmodified paper/thread wicking channels. A variety of 2D and 3D designs of paper/thread platforms for zone electrophoresis, capillary electrophoresis, and modified/unmodified chromatography are discussed with emphasis on their limitation and improvements. The current progress in the signal amplification strategies such as isoelectric focusing, isotachophoresis, ion concentration polarization, isoelectric focusing, and stacking methods in paper-based devices are reviewed. Different strategies for chromatographic separations based on paper/thread will be explained. The separation of target species from complex samples and their determination by integration with other analytical methods like spectroscopy and electrochemistry are well-listed. Furthermore, the innovations for plasma and cell separation from blood as an important human biofluid are presented, and the related paper/thread modification methods are explored.

Microsampling tools for collecting, processing, and storing blood at the point-of-care

In the wake of the COVID-19 global pandemic, self-administered microsampling tools have reemerged as an effective means to maintain routine healthcare assessments without inundating hospitals or clinics. Finger-stick collection of blood is easily performed at home, in the workplace, or at the point-of-care, obviating the need for a trained phlebotomist. While the initial collection of blood is facile, the diagnostic or clinical utility of the sample is dependent on how the sample is processed and stored prior to transport to an analytical laboratory. The past decade has seen incredible innovation for the development of new materials and technologies to collect low-volume samples of blood with excellent precision that operate independently of the hematocrit effect. The final application of that blood (i.e., the test to be performed) ultimately dictates the collection and storage approach as certain materials or chemical reagents can render a sample diagnostically useless. Consequently, there is not a single microsampling tool that is capable of addressing every clinical need at this time. In this review, we highlight technologies designed for patient-centric microsampling blood at the point-of-care and discuss their utility for quantitative sampling as a function of collection material and technique. In addition to surveying methods for collecting and storing whole blood, we emphasize the need for direct separation of the cellular and liquid components of blood to produce cell-free plasma to expand clinical utility. Integrating advanced functionality while maintaining simple user operation presents a viable means of revolutionizing self-administered microsampling, establishing new avenues for innovation in materials science, and expanding access to healthcare.

A paper-based point-of-care testing device for the colourimetric estimation of bilirubin in blood sample

A paper-based colourimetric assay for the Point-of-Care Testing (PoCT) of bilirubin has been developed based on the formation of a green-coloured copper-bilirubin complex from a blue-coloured tetraamminecopper(II) sulphate complex. The reaction was studied and optimized by UV-Visible absorption spectroscopy and translated onto a paper strip. Hydrophobic circular well patterns on Whatman chromatography paper were created by wax printing. The tetraamminecopper(II) sulphate complex was drop cast and dried on the reagent zones in the wax-patterned paper. The images of reagent zones captured using a scanner were analyzed using ImageJ software. Bilirubin spiked blood serum was tested in the concentration range of 1.2 to 950 µM. The PAD exhibited sensitivities of 0.4197 a.u/μM and 0.1040 a.u/μM for concentration ranges of bilirubin 1.2 to 96 μM and 105 to 950 μM respectively and a low detection limit of 0.799 µM. The method is highly selective to bilirubin, even in the presence of other biomarkers in serum. A plasma separation membrane incorporated PAD was fabricated for the final testing and quantification of bilirubin from whole blood.

Microfluidics for diagnosis and treatment of cardiovascular disease

Cardiovascular disease (CVD), a type of circulatory system disease related to the lesions of the cardiovascular system, has become one of the main diseases that endanger human health. Currently, the clinical diagnosis of most CVDs relies on a combination of imaging technology and blood biochemical test. However, the existing technologies for diagnosis of CVDs still have limitations in terms of specificity, detection range, and cost. In order to break through the current bottleneck, microfluidic with the advantages of low cost, simple instruments and easy integration, has been developed to play an important role in the early prevention, diagnosis and treatment of CVDs. Here, we have reviewed the recent various applications of microfluidic in the clinical diagnosis and treatment of CVDs, including microfluidic devices for detecting CVD markers, the cardiovascular models based on microfluidic, and the microfluidic used for CVDs drug screening and delivery. In addition, we have briefly looked forward to the prospects and challenges of microfluidics in diagnosis and treatment of CVDs.

Microfluidic Paper-Based Device for Medicinal Diagnosis

BACKGROUND

The demand for point-of-care testing (POCT) devices has rapidly grown since they offer immediate test results with ease of use, makingthem suitable for home self-testing patients and caretakers. However, the POCT development has faced the challenges of increased cost and limited resources. Therefore, the paper substrate as a low-cost material has been employed to develop a cost-effective POCT device, known as "Microfluidic paper-based analytical devices (μPADs)". This device is gaining attention as a promising tool for medicinal diagnostic applications owing to its unique features of simple fabrication, low cost, enabling manipulation flow (capillarydriven flow), the ability to store reagents, and accommodating multistep assay requirements.

OBJECTIVE

This review comprehensively examines the fabrication methods and device designs (2D/3D configuration) and their advantages and disadvantages, focusing on updated μPADs applications for motif identification.

METHODS

The evolution of paper-based devices, starting from the traditional devices of dipstick and lateral flow assay (LFA) with μPADs, has been described. Patterned structure fabrication of each technique has been compared among the equipment used, benefits, and drawbacks. Microfluidic device designs, including 2D and 3D configurations, have been introduced as well as their modifications. Various designs of μPADs have been integrated with many powerful detection methods such as colorimetry, electrochemistry, fluorescence, chemiluminescence, electrochemiluminescence, and SER-based sensors for medicinal diagnosis applications.

CONCLUSION

The μPADs potential to deal with commercialization in terms of the state-of-the-art of μPADs in medicinal diagnosis has been discussed. A great prototype, which is currently in a reallife application breakthrough, has been updated.

Recent developments in microfluidic paper-based analytical devices for pharmaceutical analysis

In the last decade, due to the global increase in diseases, drugs for biomedical applications have increased dramatically. Therefore, there is an urgent need for analytical tools to monitor, treat, investigate, and control drug compounds in diverse matrices. The new and challenging task has been looking for simple, low-cost, rapid, and portable analytical platforms. The development of microfluidic paper-based analytical devices (µPADs) has garnered immense attention in many analytical applications due to the benefit of cellulose structure. It can be functionalized and serves as an ideal channel and scaffold for the transportation and immobilization of various substances. Microfluidic technology has been considered an effective tool in pharmaceutical analysis that facilitates the quantitative measurement of several parameters on cells or other biological systems. The µPADs represent unique advantages over conventional microfluidics, such as the self-pumping capability. They have low material costs, are easy to fabricate, and do not require external power sources. This review gives an overview of the current designs in this decade for µPADs and their respective application in pharmaceutical analysis. These include device designs, choice of paper material, and fabrication techniques with their advantages and drawbacks. In addition, the strategies for improving analytical performance in terms of simplicity, high sensitivity, and selectivity are highlighted, followed by the application of µPADs design for the detection of drug compounds for various purposes. Moreover, we present recent advances involving µPAD technologies in the field of pharmaceutical applications. Finally, we discussed the challenges and potential of µPADs for the transition from laboratory to commercialization.

Micro-Volume Blood Separation Membrane for In-Situ Biosensing

In this paper, we report a point-of-care (POCT) testing strip based on a porous membrane structure for whole blood separation and colorimetric analysis without external supporting equipment. Conventional blood tests rely on large instruments for blood pretreatment and separation to improve measurement accuracy. Cellulose acetate (CA) membranes with different pore diameters and structures were prepared via a non-solvent method for the separation of whole blood. Among them, CA@PEG-2000 membranes with nano-pores on the surface and micro-pores in the interior facilitated the capture of blood cells on the surface, as well as the free diffusion of plasma through the porous interior structure. The fluid flow of blood in the asymmetric porous structure can be theoretically estimated using the Lucas-Washburn equation. Compared with the conventional paper strips and other porous membranes, the CA@PEG-2000 membrane with an immobilized sensing layer exhibited efficient blood separation, a short response time (less than 2 min), an ultralow dosage volume (5 μL), and high sensitivity. The fabricated blood separation membranes can be further used for the detection of various biomarkers in whole blood, providing additional options for rapid quantitative POCT tests.

Current Advancements and Future Road Map to Develop ASSURED Microfluidic Biosensors for Infectious and Non-Infectious Diseases

Better diagnostics are always essential for the treatment and prevention of a disease. Existing technologies for detecting infectious and non-infectious diseases are mostly tedious, expensive, and do not meet the World Health Organization’s (WHO) ASSURED (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverable to end user) criteria. Hence, more accurate, sensitive, and faster diagnostic technologies that meet the ASSURED criteria are highly required for timely and evidenced-based treatment. Presently, the diagnostics industry is finding interest in microfluidics-based biosensors, as this integration comprises all qualities, such as reduction in the size of the equipment, rapid turnaround time, possibility of parallel multiple analysis or multiplexing, etc. Microfluidics deal with the manipulation/analysis of fluid within micrometer-sized channels. Biosensors comprise biomolecules immobilized on a physicochemical transducer for the detection of a specific analyte. In this review article, we provide an outline of the history of microfluidics, current practices in the selection of materials in microfluidics, and how and where microfluidics-based biosensors have been used for the diagnosis of infectious and non-infectious diseases. Our inclination in this review article is toward the employment of microfluidics-based biosensors for the improvement of already existing/traditional methods in order to reduce efforts without compromising the accuracy of the diagnostic test. This article also suggests the possible improvements required in microfluidic chip-based biosensors in order to meet the ASSURED criteria.

Recent Advances and Applications in Paper-Based Devices for Point-of-Care Testing

Point-of-care testing (POCT), as a portable and user-friendly technology, can obtain accurate test results immediately at the sampling point. Nowadays, microfluidic paper-based analysis devices (μPads) have attracted the eye of the public and accelerated the development of POCT. A variety of detection methods are combined with μPads to realize precise, rapid and sensitive POCT. This article mainly introduced the development of electrochemistry and optical detection methods on μPads for POCT and their applications on disease analysis, environmental monitoring and food control in the past 5 years. Finally, the challenges and future development prospects of μPads for POCT were discussed.

Glucose Sensing in Human Whole Blood Based on Near-Infrared Phosphors and Outlier Treatment with the Programming Language "R"

A near-infrared paper-based analytical device (NIR-PAD) for glucose detection in whole blood was based on iridium(III) metal complexes embedded in a three-dimensional (3D) enzyme gel. These complexes emit NIR luminescence, can avoid interference from the color of blood, and increase the sensitivity of sensing glucose. The glucose reaction behaviors of another two different iridium(III) and platinum(II) complexes were also tested. When the glucose solution was added to the device, the oxidation of glucose by glucose oxidase caused oxygen consumption and increased the intensity of the phosphorescence emission. To the best of our knowledge, this is the first time that data have been treated with the programming language "R", which uses Tukey's test to identify the outliers in the data and calculate a median for establishing a calibration curve, in order to improve the accuracy of NIR-PADs for sensing glucose. Compared with other published devices, NIR-PADs exhibit a wider linear range (1-30 mM, [relative emission intensity] = 0.0250[glucose] + 0.0451, and R 2 = 0.9984), a low detection limit (0.7 mM), a short response time (<2 s), and a small sample volume (2 μL). Finally, blood specimens were obtained from 19 patients enrolled in Taipei Veterans General Hospital under an approved IRB protocol (Taiwan; 2017-12-002CC). The sensors exhibited remarkable characteristics for glucose detection in comparison with other methods, including the clinical method in hospitals as well as those without blood sample pretreatment or a dilution factor. The above results confirm that NIR-PAD sensors can be put to practical use for glucose detection.

A survey of 3D printing technology applied to paper microfluidics

Paper microfluidics is a rapidly growing subfield of microfluidics in which paper-like porous materials are used to create analytical devices that are well-suited for use in field applications. 3D printing technology has the potential to positively affect paper microfluidic device development by enabling tools and methods for the creation of devices with well-defined and tunable fluidic networks of porous matrices for high performance signal generation. This critical review focuses on the progress that has been made in using 3D printing technologies to advance the development of paper microfluidic devices. We describe printing work in three general categories: (i) solid support structures for paper microfluidic device components; (ii) channel barrier definition in existing porous materials; and (iii) porous channels for capillary flow, and discuss their value in advancing paper microfluidic device development. Finally, we discuss major areas of focus for highest impact on the next generation of paper microfluidics devices.

A sample-to-answer electrochemical biosensor system for biomarker detection

Biomarker detection is critical for the diagnosis and treatment of numerous diseases. Typically, target biomarkers in blood samples are measured through tests conducted at centralized laboratories. Testing at central laboratories increases wait times for results, in turn increasing healthcare costs and negatively impacting patient outcomes. Alternatively, point-of-care platforms enable the rapid measurement of biomarkers, expand testing location capabilities and mitigate manual processing steps through integration and automation. However, many of these systems focus on sample detection rather than the equally important sample preparation. Here we present a fully integrated and automated sample-to-answer electrochemical biosensing platform which incorporates each aspect of the biomarker testing workflow from blood collection to sample preparation to assay operation and readout. The system combines a commercial microneedle blood sampling device with membrane-based plasma filtration upstream of a bead-based electrochemical immunoassay. We characterize the high separation efficiency (>99%) and low non-specific binding of the whole blood-to-plasma filtration membrane under a range of operating conditions. We demonstrate a full sample-to-answer workflow through the analysis of interlukin-6-spiked blood samples.

Hydrogel Paper-Based Analytical Devices: Separation-Free In Situ Assay of Small-Molecule Targets in Whole Blood

While colorimetric-based assays are very convenient to determine biomarkers in point-of-care testing (POCT), they often suffer from pretreatment procedures for separation of plasma or serum from whole blood samples. Here, we report a simple colorimetric paper-based analytical device (c-PAD) that is capable of performing sample-to-answer analysis by directly dropping the whole blood sample on paper. This is accomplished by utilizing sodium alginate hydrogel, which exhibits a nanometer-scale porous structure to effectively prevent the passage of large red blood cells and hemoglobin molecules, to encapsulate enzymes and chromogenic reagents. As the small targets in the blood sample enter the sensing region to trigger a chromogenic reaction, the resulting color signal is recorded by a smartphone. The interference from the red blood to the color signal can be completely avoided without the requirement of any separation process. The analytical performance of the method is evaluated by assaying glucose in real blood samples. The results show that rapid and accurate analysis can be achieved with the limit of detection as low as 0.12 mM. In addition, simultaneous detection of different targets (glucose, cholesterol, and triglycerides) in whole blood can be achieved by fabricating c-PAD with multiple sensing regions. Owing to its several essential advantages including an extremely simple procedure for fabrication, sample-to-answer analysis without tedious pretreatment, and capability to perform high-throughput analysis, the proposed c-PAD will be of great value in POCT applications of whole blood samples.

TiO2 Nanotubes Alginate Hydrogel Scaffold for Rapid Sensing of Sweat Biomarkers: Lactate and Glucose

Versatile sensing matrixes are essential for the development of enzyme-immobilized optical biosensors. A novel three-dimensional titanium dioxide nanotubes/alginate hydrogel scaffold is proposed for the detection of sweat biomarkers, lactate, and glucose in artificial sweat. Hydrothermally synthesized titanium dioxide nanotubes were introduced to the alginate polymeric matrix, followed by cross-linking nanocomposite with dicationic calcium ions to fabricate the scaffold platform. Rapid colorimetric detection (blue color optical signal) was carried out for both lactate and glucose biomarkers in artificial sweat at 4 and 6 min, respectively. The superhydrophilicity and the capillarity of the synthesized titanium dioxide nanotubes, when incorporated into the alginate matrix, facilitate the rapid transfer of the artificial sweat components throughout the sensor scaffold, decreasing the detection times. Moreover, the scaffold was integrated on a cellulose paper to demonstrate the adaptability of the material to other matrixes, obtaining fast and homogeneous colorimetric detection of lactate and glucose in the paper substrate when image analysis was performed. The properties of this new composite provide new avenues in the development of paper-based sensor devices. The biocompatibility, the efficient immobilization of biological enzymes/colorimetric assays, and the quick optical signal readout behavior of the titanium dioxide nanotubes/alginate hydrogel scaffolds provide a prospective opportunity for integration into wearable devices.

Bi2S3@MoS2 Nanoflowers on Cellulose Fibers Combined with Octahedral CeO2 for Dual-Mode Microfluidic Paper-Based MiRNA-141 Sensors

An effective dual-mode microfluidic paper-based analysis device (μPAD) was proposed via Bi₂S₃@MoS₂ nanoflowers combined with octahedral CeO₂ for ultrasensitive miRNA-141 bioassay. To obtain the amplified electrochemical signal, Bi₂S₃@MoS₂ nanoflowers were first in situ grown onto the surface of cellulose fibers to promote the reduction of H₂O₂. The prism-anchored octahedral CeO₂ nanoparticles with a great catalytic function on the reduction of H₂O₂ were linked up to the functionalized cellulose fibers through the hybridization chain reaction to further enhance the electrochemical signal. By means of the catalysis effect of Bi₂S₃@MoS₂ nanoflowers and octahedral CeO₂ nanoparticles, the obtained signal was amplified, thereby achieving ultrasensitive electrochemical detection of the target. With the help of duplex specific nuclease, the octahedral CeO₂ could be released from the electrochemical detection area and flow to the color channel through capillary action, which could initiate the oxidation reaction of 3,3',5,5'-tetramethylbenzidine in the existence of H₂O₂ to generate a blue visual band, avoiding the error of distinguishing color depth caused by the naked eye and thus improving the accuracy of the visual method. Under the optimal conditions, satisfactory prediction and accurate detection performance were achieved in the range of 10 fM-1 nM and 0.5 fM-1 nM, respectively, by measuring the length of the blue product and the electrochemical signal intensity. The electrochemical/visual detection limits of the proposed μPAD for miRNA-141 were as low as 0.12 and 2.65 fM (S/N = 3). This work provides great potential for the construction of low-cost and high-performance dual-mode biosensors for the detection of biomarkers.

Cesium Lead Bromide (CsPbBr3) Perovskite Quantum Dot-Based Photosensor for Chemiluminescence Immunoassays

Chemiluminescence immunoassays have been widely employed for diagnosing various diseases. However, because of the extremely low intensity chemiluminescence signals, highly sensitive transducers, such as photomultiplier tubes and image sensors with cooling devices, are required to overcome this drawback. In this study, a hypersensitive photosensor was developed based on cesium lead bromide (CsPbBr₃) perovskite quantum dots (QDs) with sufficient high sensitivity for chemiluminescence immunoassays. First, CsPbBr₃ QDs with a highly uniform size, that is, 5 nm, were synthesized under thermodynamic control to achieve a high size confinement effect. For the fabrication of the photosensor, MoS₂ nanoflakes were used as an electron transfer layer and heat-treated at an optimum temperature. Additionally, a parylene-C film was used as a passivation layer to improve the physical stability and sensitivity of the photosensor. In particular, the trap states on the CsPbBr₃ QDs were reduced by the passivation layer, and the sensitivity was increased. Finally, a photosensor based on CsPbBr₃ QDs was employed in chemiluminescence immunoassays for the detection of human hepatitis B surface antigen, human immunodeficiency virus antibody, and alpha-fetoprotein (AFP, a cancer biomarker). When compared with the conventionally used equipment, the photosensor was determined to be feasible for application in chemiluminescence immunoassays.

The micro-volume liquid focusing effect in Janus membrane and its biosensing application

The micro-volume analysis and specific detection are both essential requirements in the field of chemical sensing and biological testing. Membrane prefiltration can be used to improve the selectivity and accuracy of detection. But for traditional porous membrane filtration, it is difficult to achieve the transmembrane transport of micro-volume liquid due to the influence of lateral diffusion on membrane surface. Herein, we studied the focused transmembrane transport of micro-volume liquid in the porous polyethersulfone membrane with asymmetric (Janus) surface wettability. The hydrophilic layer (polydopamine) and hydrophobic layer (fluoropolymer) were deposited with controllable thickness by dip-coating and roller-assisted liquid printing. The micro-volume liquid focusing effect was verified by experiments such as visual wetting circle and fluorescent tracer. The liquid focusing effect of as-prepared Janus membrane was integrated with glucose test strip in the application of micro-volume liquid biosensing. Compared with conventional porous membrane, detected signal amplitude and response time were improved 7.5× and 2.7×, respectively. In summary, this research studied the dynamics of liquid transport through Janus membrane and provides a new strategy for microfluidic detection applications through balancing detection volume, time and selectivity by the advantage of micro-volume liquid focusing effect.

MOF-enzyme hybrid nanosystem decorated 3D hollow fiber membranes for in-situ blood separation and biosensing array

Modified metal-organic frameworks (MOFs) doping with enzymes exhibit high enzyme stability and catalytic performance, which is a research hotspot in the field of enzyme-based sensing. Although the MOF-enzyme constitutes a 3D structure in the nanoscale, the macroscopic assembly configuration still stays in 1D or 2D structures, limiting sensing applications towards complex biological targets. Herein, the MOF-enzyme hybrid nanosystem was assembled into 3D porous conductive supports via a controllable physical embedding method, displaying high enzymatic loading, stability and cascade catalytic performance. The modified MOFs combing with enzymes served as a sensing reaction system, and the conductive hollow fiber membranes (HFMs) served as a functional platform. The multifunctional device integrates pumpless hydrodynamic transport, interconnected conductive polymer, and blood separation modules, showing fast capillary fluid flow, trace sampling (3 μL), high selectivity and accuracy. The linear sensing range was in 2-24 mM glucose, 0.05-6 mM lactic acid, and 0.1-10 mM cholesterol, respectively, with sensitivities of 24.2, 150, 73.6 nA mM^-1. Furthermore, this strategy of modular assembly of biosensing array can easily implement multiplex metabolites detection simultaneously.

Enhanced Sensing Behavior of Three-Dimensional Microfluidic Paper-Based Analytical Devices (3D-μPADs) with Evaporation-Free Enclosed Channels for Point-of-Care Testing

Despite the potential in fabrication of microfluidic paper-based analytical devices (μPADs) for point-of-care testing (POCT) kits, the development of simple, accurate, and rapid devices with higher sensitivity remains challenging. Here, we report a novel method for 3D-μPAD fabrication with enclosed channels using vat photopolymerization to avoid fluid evaporation. In detail, height of the enclosed channels was adjusted from 0.3 to 0.17 mm by varying the UV exposure time from 1 to 4 s for the top barrier, whereas the exposure time for the bottom and side barriers was fixed. As a result, sample flow in the enclosed channels of 3D-μPADs showed lesser wicking speed with very scant evaporation compared to that in the hemi channels in the 3D-μPADs. The stoppage of evaporation in the enclosed channels significantly improved the gray intensity and uniformity in the detection zone of the 3D-μPADs, resulting in as low as 0.3 mM glucose detection. Thus 3D-μPADs with enclosed channels showed enhanced sensitivity compared to the 3D-μPADs with hemi channels when dealing with a small volume sample. Our work provides a new insight into 3D-μPAD design with enclosed channels, which redefines the methodology in 3D printing.

Recent advances in lab-on-paper diagnostic devices using blood samples

Lab-on-paper, or microfluidic paper-based analytical devices (μPADs), use paper as a substrate material, and are patterned with a system of microchannels, reaction zones and sensing elements to perform analysis and detection. The sample transfer in such devices is performed by capillary action. As a result, external driving forces are not required, and hence the size and cost of the device are significantly reduced. Lab-on-paper devices have thus attracted significant attention for point-of-care medical diagnostic purposes in recent years, particularly in less-developed regions of the world lacking medical resources and infrastructures. This review discusses the major advances in lab-on-paper technology for blood analysis and diagnosis in the past five years. The review focuses particularly on the many clinical applications of lab-on-paper devices, including diabetes diagnosis, acute myocardial infarction (AMI) detection, kidney function diagnosis, liver function diagnosis, cholesterol and triglyceride (TG) analysis, sickle-cell disease (SCD) and phenylketonuria (PKU) analysis, virus analysis, C-reactive protein (CRP) analysis, blood ion analysis, cancer factor analysis, and drug analysis. The review commences by introducing the basic transmission principles, fabrication methods, structural characteristics, detection techniques, and sample pretreatment process of modern lab-on-paper devices. A comprehensive review of the most recent applications of lab-on-paper devices to the diagnosis of common human diseases using blood samples is then presented. The review concludes with a brief summary of the main challenges and opportunities facing the lab-on-paper technology field in the coming years.

Flexible/Bendable Acoustofluidics Based on Thin-Film Surface Acoustic Waves on Thin Aluminum Sheets

In this paper, we explore the acoustofluidic performance of zinc oxide (ZnO) thin-film surface acoustic wave (SAW) devices fabricated on flexible and bendable thin aluminum (Al) foils/sheets with thicknesses from 50 to 1500 μm. Directional transport of fluids along these flexible/bendable surfaces offers potential applications for the next generation of microfluidic systems, wearable biosensors and soft robotic control. Theoretical calculations indicate that bending under strain levels up to 3000 με causes a small frequency shift and amplitude change (<0.3%) without degrading the acoustofluidic performance. Through systematic investigation of the effects of the Al sheet thickness on the microfluidic actuation performance for the bent devices, we identify the optimum thickness range to both maintain efficient microfluidic actuation and enable significant deformation of the substrate, providing a guide to design such devices. Finally, we demonstrate efficient liquid transportation across a wide range of substrate geometries including inclined, curved, vertical, inverted, and lateral positioned surfaces using a 200 μm thick Al sheet SAW device.

Point-of-care diagnostics for infectious diseases: From methods to devices

The current widespread of COVID-19 all over the world, which is caused by SARS-CoV-2 virus, has again emphasized the importance of development of point-of-care (POC) diagnostics for timely prevention and control of the pandemic. Compared with labor- and time-consuming traditional diagnostic methods, POC diagnostics exhibit several advantages such as faster diagnostic speed, better sensitivity and specificity, lower cost, higher efficiency and ability of on-site detection. To achieve POC diagnostics, developing POC detection methods and correlated POC devices is the key and should be given top priority. The fast development of microfluidics, micro electro-mechanical systems (MEMS) technology, nanotechnology and materials science, have benefited the production of a series of portable, miniaturized, low cost and highly integrated POC devices for POC diagnostics of various infectious diseases. In this review, various POC detection methods for the diagnosis of infectious diseases, including electrochemical biosensors, fluorescence biosensors, surface-enhanced Raman scattering (SERS)-based biosensors, colorimetric biosensors, chemiluminiscence biosensors, surface plasmon resonance (SPR)-based biosensors, and magnetic biosensors, were first summarized. Then, recent progresses in the development of POC devices including lab-on-a-chip (LOC) devices, lab-on-a-disc (LOAD) devices, microfluidic paper-based analytical devices (μPADs), lateral flow devices, miniaturized PCR devices, and isothermal nucleic acid amplification (INAA) devices, were systematically discussed. Finally, the challenges and future perspectives for the design and development of POC detection methods and correlated devices were presented. The ultimate goal of this review is to provide new insights and directions for the future development of POC diagnostics for the management of infectious diseases and contribute to the prevention and control of infectious pandemics like COVID-19.

Paper-Based Enzymatic Colorimetric Assay for Rapid Malathion Detection

Due to their unique properties, paper-based biosensors have attracted attention as inexpensive devices for on-site analysis. To achieve fast and sensitive detection of analytes, immobilization of enzymes with high apparent activities on paper is highly desirable; however, this is challenging. Herein, we report an improved approach to attach a malathion degrading enzyme, PoOPH_M9, on paper via an interlocking network of Pluronic F127 (PF127)-poly(acrylic acid)-enzyme conjugates. The addition of PF127 improved retention of enzymatic activity as the apparent kinetic constant V_max of the immobilized enzyme increased two-fold compared with the paper prepared without PF127. The PF127-poly(acrylic acid)-PoOPH_M9 papers provided rapid colorimetric detection of malathion at 0.1-50 mM. The detection was completed within 5 min using a smartphone and image analysis software. As a proof-of-concept, malathion-contaminated water, plant, and apple samples were analyzed with the papers successfully. This material is promising for on-site rapid analysis of malathion-contaminated samples.

Three-Dimensional Paper-Based Microfluidic Analysis Device for Simultaneous Detection of Multiple Biomarkers with a Smartphone

Paper-based microfluidic analysis devices (μPADs) have attracted attention as a cost-effective platform for point-of-care testing (POCT), food safety, and environmental monitoring. Recently, three-dimensional (3D)-μPADs have been developed to improve the performance of μPADs. For accurate diagnosis of diseases, however, 3D-μPADs need to be developed to simultaneously detect multiple biomarkers. Here, we report a 3D-μPADs platform for the detection of multiple biomarkers that can be analyzed and diagnosed with a smartphone. The 3D-μPADs were fabricated using a 3D digital light processing printer and consisted of a sample reservoir (300 µL) connected to 24 detection zones (of 4 mm in diameter) through eight microchannels (of 2 mm in width). With the smartphone application, eight different biomarkers related to various diseases were detectable in concentrations ranging from normal to abnormal conditions: glucose (0–20 mmol/L), cholesterol (0–10 mmol/L), albumin (0–7 g/dL), alkaline phosphatase (0–800 U/L), creatinine (0–500 µmol/L), aspartate aminotransferase (0–800 U/L), alanine aminotransferase (0–1000 U/L), and urea nitrogen (0–7.2 mmol/L). These results suggest that 3D-µPADs can be used as a POCT platform for simultaneous detection of multiple biomarkers.