Advances of Paper-Based Microfluidics for Diagnostics—The Original Motivation and Current Status

Emerging innovations in portable chemical sensing devices: Advancements from microneedles to hydrogel, microfluidic, and paper-based platforms

With the public heightened emphasis on mitigating the occurrence risks of health-related ailment and optimizing personal physical performance, portable chemical sensing devices emerged as an indispensable component of pervasive health monitoring. Chemical sensing enabled the immediate and on-site identification of biomarkers in biological fluids by integrating colorimetry, fluorescence, electrochemical, and other methods into portable sensor devices. These sensor devices incorporated microneedles, hydrogels, microfluidic modules, and papers, facilitating conformal human-device contact and providing several visual sensing options for disease prevention and healthcare management. This review systematically overviewed recent advancements in chemical sensors for marker detection, categorizing them based on monitoring device types. Furthermore, we also offered recommendations and opportunities for developing portable chemical sensing devices by summarizing sensor integration methods and tracking sites on the human body.

Cellulose acetate microwell plates for high-throughput colorimetric assays

Single use plasticware (SUP) in scientific, diagnostic, and academic laboratories makes a significant contribution to plastic waste generation worldwide. Polystyrene (PS) microwell plates form a part of this waste. These plates are the backbone of high throughput colorimetric measurements in academic, research, and healthcare settings for detection/quantification of wide-ranging analytes including proteins, carbohydrates, nucleic acids, and enzyme activity. Polystyrene (PS) microwell plates serve as a platform for holding samples and reagents, where mixing initiates chemical reaction(s), and the ensuing color changes are quantified using a microplate reader. However, these plates are rarely reused or recycled, contributing to the staggering amounts of plastic waste generated in scientific laboratories. Here, we are reporting the fabrication of cellulose acetate (CA) microwell plates as a greener alternative to non-biodegradable PS plates and we demonstrate their application in colorimetric assays. These easy to fabricate, lighter weight, customizable, and environmentally friendly plates were fabricated in 96- and 384-well formats and made water impermeable through chemical treatment. The plates were tested in three different colorimetric analyses: (i) bicinchoninic acid assay (BCA) for protein quantification; (ii) chymotrypsin (CT) activity assay; and (iii) alkaline phosphatase (AP) activity assay. Color intensities were quantified using a freely available smartphone application, Spotxel® Reader (Sicasys Software GmbH). To benchmark the performance of this platform, the same assays were performed in commercial PS plates too and quantified using a UV/Vis microplate reader. The two systems yielded comparable linear correlation coefficients, LOD and LOQ values, thereby validating the CA plate-cell phone based analytical method. The CA microwell plates, coupled with smart phone optical data capture, provide greener, accessible, and scalable tools for all laboratory settings and are particularly well-suited for resource- and infrastructure-limited environments.

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

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

Paper-Based Humidity Sensors as Promising Flexible Devices: State of the Art: Part 1. General Consideration

In the first part of the review article "General considerations" we give information about conventional flexible platforms and consider the advantages and disadvantages of paper when used in humidity sensors, both as a substrate and as a humidity-sensitive material. This consideration shows that paper, especially nanopaper, is a very promising material for the development of low-cost flexible humidity sensors suitable for a wide range of applications. Various humidity-sensitive materials suitable for use in paper-based sensors are analyzed and the humidity-sensitive characteristics of paper and other humidity-sensitive materials are compared. Various configurations of humidity sensors that can be developed on the basis of paper are considered, and a description of the mechanisms of their operation is given. Next, we discuss the manufacturing features of paper-based humidity sensors. The main attention is paid to the consideration of such problems as patterning and electrode formation. It is shown that printing technologies are the most suitable for mass production of paper-based flexible humidity sensors. At the same time, these technologies are effective both in the formation of a humidity-sensitive layer and in the manufacture of electrodes.

Biomarker Detection in Early Diagnosis of Cancer: Recent Achievements in Point-of-Care Devices Based on Paper Microfluidics

Microfluidics is very crucial in lab-on-a-chip systems for carrying out operations in a large-scale laboratory environment on a single chip. Microfluidic systems are miniaturized devices in which the fluid behavior and control can be manipulated on a small platform, with surface forces on the platform being greater than volumetric forces depending on the test method used. In recent years, paper-based microfluidic analytical devices (μPADs) have been developed to be used in point-of-care (POC) technologies. μPADs have numerous advantages, including ease of use, low cost, capillary action liquid transfer without the need for power, the ability to store reagents in active form in the fiber network, and the capability to perform multiple tests using various measurement techniques. These benefits are critical in the advancement of paper-based microfluidics in the fields of disease diagnosis, drug application, and environment and food safety. Cancer is one of the most critical diseases for early detection all around the world. Detecting cancer-specific biomarkers provides significant data for both early diagnosis and controlling the disease progression. μPADs for cancer biomarker detection hold great promise for improving cure rates, quality of life, and minimizing treatment costs. Although various types of bioanalytical platforms are available for the detection of cancer biomarkers, there are limited studies and critical reviews on paper-based microfluidic platforms in the literature. Hence, this article aims to draw attention to these gaps in the literature as well as the features that future platforms should have.

Tetrahedral DNA framework assisted rotational paper-based analytical device for differential detection of SARS-CoV-2 and influenza A H1N1 virus

Coronavirus disease 2019 (COVID-19) and influenza A are two respiratory infectious diseases with similar clinical manifestations. Because of the complex global epidemic situation of COVID-19, the distinction and diagnosis of COVID-19 and influenza A infected persons is crucial for epidemic prevention and control. In this study, tetrahedral DNA framework (TDF) was combined with a rotational paper-based analytical device, and the color change generated by the reaction between horseradish peroxidase (HRP) and 3,3'5,5'-tetramethylbenzidine (TMB)-H₂O₂ was used for grayscale signal analysis by ImageJ software. The quantitative detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A H1N1 virus were realized simultaneously. Under the optimal conditions, the paper-based analytical device showed a good linear relationship between the two viruses in the range of 10^-14-10^-8g/mL, and the two viruses were not affected by cross reaction. This sensor provides a convenient and reliable method for clinical rapid differentiation and diagnosis of COVID-19 and influenza A.

Progression of Paper-Based Point-of-Care Testing toward Being an Indispensable Diagnostic Tool in Future Healthcare

Point-of-care (POC) diagnostics in particular focuses on the timely identification of harmful conditions close to the patients' needs. For future healthcare these diagnostics could be an invaluable tool especially in a digitalized or telemedicine-based system. However, while paper-based POC tests, with the most prominent example being the lateral flow assay (LFA), have been especially successful due to their simplicity and timely response, the COVID-19 pandemic highlighted their limitations, such as low sensitivity and ambiguous responses. This perspective discusses strategies that are currently being pursued to evolve such paper-based POC tests toward a superior diagnostic tool that provides high sensitivities, objective result interpretation, and multiplexing options. Here, we pinpoint the challenges with respect to (i) measurability and (ii) public applicability, exemplified with select cases. Furthermore, we highlight promising endeavors focused on (iii) increasing the sensitivity, (iv) multiplexing capability, and (v) objective evaluation to also ready the technology for integration with machine learning into digital diagnostics and telemedicine. The status quo in academic research and industry is outlined, and the likely highly relevant role of paper-based POC tests in future healthcare is suggested.

Direct 3D printed biocompatible microfluidics: assessment of human mesenchymal stem cell differentiation and cytotoxic drug screening in a dynamic culture system

BACKGROUND

In vivo-mimicking conditions are critical in in vitro cell analysis to obtain clinically relevant results. The required conditions, comparable to those prevalent in nature, can be provided by microfluidic dynamic cell cultures. Microfluidics can be used to fabricate and test the functionality and biocompatibility of newly developed nanosystems or to apply micro- and nanoelectromechanical systems embedded in a microfluidic system. However, the use of microfluidic systems is often hampered by their accessibility, acquisition cost, or customization, especially for scientists whose primary research focus is not microfluidics.

RESULTS

Here we present a method for 3D printing that can be applied without special prior knowledge and sophisticated equipment to produce various ready-to-use microfluidic components with a size of 100 µm. Compared to other available methods, 3D printing using fused deposition modeling (FDM) offers several advantages, such as time-reduction and avoidance of sophisticated equipment (e.g., photolithography), as well as excellent biocompatibility and avoidance of toxic, leaching chemicals or post-processing (e.g., stereolithography). We further demonstrate the ease of use of the method for two relevant applications: a cytotoxicity screening system and an osteoblastic differentiation assay. To our knowledge, this is the first time an application including treatment, long-term cell culture and analysis on one chip has been demonstrated in a directly 3D-printed microfluidic chip.

CONCLUSION

The direct 3D printing method is tested and validated for various microfluidic components that can be combined on a chip depending on the specific requirements of the experiment. The ease of use and production opens up the potential of microfluidics to a wide range of users, especially in biomedical research. Our demonstration of its use as a cytotoxicity screening system and as an assay for osteoblastic differentiation shows the methods potential in the development of novel biomedical applications. With the presented method, we aim to disseminate microfluidics as a standard method in biomedical research, thus improving the reproducibility and transferability of results to clinical applications.

A passive and programmable 3D paper-based microfluidic pump for variable flow microfluidic applications

Paper has attracted significant attention recently as a microfluidic component and platform, especially in passive pumping devices due to its porous and uniform absorbing nature. Many investigations on 1D and 2D fluid flows were carried out. However, no experimental work has been reported on the three-dimensional effect in porous geometry to improve pumping characteristics in microchannels. Therefore, in this study, the fluid flow in 3D paper-based passive pumps was investigated in microchannels using cylindrical pumps. The effect of pump diameter, porosity, and programmability was investigated to achieve desired flow variations. The results indicated that the flow rate of water increased with an increase in the diameter and porosity of paper pumps. Maximum flow rates achieved for 14 mm diameter pumps of 0.5 and 0.7 porosities were 5.29 mm3/s (317.4 μl/min) and 6.97 mm3/s (418.2 μl/min), respectively. The total volume of fluid imbibition ranged between 266 and 567 μl for 8 and 14 mm diameter pumps, respectively. Moreover, 3D passive pumps can transport larger volumes of liquid with an improved flow rate, programmability, and control, in addition to being inexpensive and simple to design and fabricate. Most importantly, a single 3D paper pump showed an increasing, decreasing, and constant flow rate all in a single microchannel. With these benefits, the passive pumps can further improve the pumping characteristics of microfluidic platforms enabling a cost effective and programmable point-of-care diagnostic device.

Simple and Sensitive Detection of Bacterial Hydrogen Sulfide Production Using a Paper-Based Colorimetric Assay

Hydrogen sulfide (H₂S) is known to participate in bacteria-induced inflammatory response in periodontal diseases. Therefore, it is necessary to quantify H₂S produced by oral bacteria for diagnosis and treatment of oral diseases including halitosis and periodontal disease. In this study, we introduce a paper-based colorimetric assay for detecting bacterial H₂S utilizing silver/Nafion/polyvinylpyrrolidone membrane and a 96-well microplate. This H₂S-sensing paper showed a good sensitivity (8.27 blue channel intensity/μM H₂S, R² = 0.9996), which was higher than that of lead acetate paper (6.05 blue channel intensity/μM H₂S, R² = 0.9959). We analyzed the difference in H₂S concentration released from four kinds of oral bacteria (Eikenella corrodens, Streptococcus sobrinus, Streptococcus mutans, and Lactobacillus casei). Finally, the H₂S level in Eikenella corrodens while varying the concentration of cysteine and treatment time was quantified. This paper-based colorimetric assay can be utilized as a simple and effective tool for in vitro screening of H₂S-producing ability of many bacteria as well as salivary H₂S analysis.

Microfluidic Paper-Based Analytical Devices for the Determination of Food Contaminants: Developments and Applications

Food safety is an issue that cannot be ignored at any time because of the great impact of food contaminants on people's daily life, social production, and the economy. Because of the extensive demand for high-quality food, it is necessary to develop rapid, reliable, and efficient devices for food contaminant detection. Microfluidic paper-based analytical devices (μPADs) have been applied in a variety of detection fields owing to the advantages of low-cost, ease of handling, and portability. This review systematically discusses the latest progress of μPADs, including the fundamentals of fabrication as well as applications in the detection of chemical and biological hazards in foods, hoping to provide suitable screening strategies for contaminants in foods and accelerating the technology transformation of μPADs from the lab into the field.

Microtoxicology by microfluidic instrumentation: a review

Microtoxicology is concerned with the toxic effects of small amounts of substances. This review paper discusses the application of small amounts of noxious substances for toxicological investigation in small volumes. The vigorous development of miniaturized methods in microfluidics over the last two decades involves chip-based devices, micro droplet-based procedures, and the use of micro-segmented flow for microtoxicological studies. The studies have shown that the microfluidic approach is particularly valuable for highly parallelized and combinatorial dose-response screenings. Accurate dosing and mixing of effector substances in large numbers of microcompartments supplies detailed data of dose-response functions by highly concentration-resolved assays and allows evaluation of stochastic responses in case of small separated cell ensembles and single cell experiments. The investigations demonstrate that very different biological targets can be studied using miniaturized approaches, among them bacteria, eukaryotic microorganisms, cell cultures from tissues of multicellular organisms, stem cells, and early embryonic states. Cultivation and effector exposure tests can be performed in small volumes over weeks and months, confirming that the microfluicial strategy is also applicable for slow-growing organisms. Here, the state of the art of miniaturized toxicology, particularly for studying antibiotic susceptibility, drug toxicity testing in the miniaturized system like organ-on-chip, environmental toxicology, and the characterization of combinatorial effects by two and multi-dimensional screenings, is discussed. Additionally, this review points out the practical limitations of the microtoxicology platform and discusses perspectives on future opportunities and challenges.

Current and Future Perspectives on Microfluidic Tear Analytic Devices

Most current invasive analytic devices for disease diagnosis and monitoring require the collection of blood, which causes great discomfort for patients and may potentially cause infection. This explains the great need for noninvasive devices that utilize other bodily fluids like sweat, saliva, tears, or urine. Among them, eye tears are easily accessible, less complex in composition, and less susceptible to dilution. Tears also contain valuable clinical information for the diagnosis of ocular and systemic diseases as the tear analyte level shows great correlation with the blood analyte level. These unique advantages make tears a promising platform for use in clinical settings. As the volume of tear film and the rate of tear flow are only microliters in size, the use of microfluidic technology in analytic devices allows minimal sample consumption. Hence, more and more microfluidic tear analytic devices have been proposed, and their working mechanisms can be broadly categorized into four main types: (a) electrochemical, (b) photonic crystals, (c) fluorescence, and (d) colorimetry. These devices are being developed toward the application of point-of-care tests with rapid yet accurate results. This review aims to provide a general overview of the recent developmental trend of microfluidic devices for tear analysis. Moreover, the fundamental principle behind each type of device along with their strengths and weaknesses will be discussed, especially in terms of their abilities and potential in being used in point-of-care settings.

Microfluidic Paper-Based Blood Plasma Separation Device as a Potential Tool for Timely Detection of Protein Biomarkers

A current challenge regarding microfluidic paper-based analytical devices (µPAD) for blood plasma separation (BPS) and electrochemical immunodetection of protein biomarkers is how to achieve a µPAD that yields enough plasma to retain the biomarker for affinity biosensing in a functionalized electrode system. This paper describes the development of a BPS µPAD to detect and quantify the S100B biomarker from peripheral whole blood. The device uses NaCl functionalized VF2 filter paper as a sample collection pad, an MF1 filter paper for plasma retention, and an optimized microfluidic channel geometry. An inverted light microscope, scanning electron microscope (SEM), and image processing software were used for visualizing BPS efficiency. A design of experiments (DOE) assessed the device’s efficacy using an S100B ELISA Kit to measure clinically relevant S100B concentrations in plasma. The BPS device obtained 50 μL of plasma from 300 μL of whole blood after 3.5 min. The statistical correlation of S100B concentrations obtained using plasma from standard centrifugation and the BPS device was 0.98. The BPS device provides a simple manufacturing protocol, short fabrication time, and is capable of S100B detection using ELISA, making one step towards the integration of technologies aimed at low-cost POC testing of clinically relevant biomarkers.

Traffic light type paper-based analytical device for intuitive and semi-quantitative naked-eye signal readout

Microfluidic paper-based analytical devices (μPADs) have attracted great attention as potential candidates for point-of-care testing (POCT). Nevertheless, only a limited number of μPADs expected to satisfy the standard of Clinical Laboratory Improvement Amendments (CLIA) waived tests as issued by the US Food and Drug Administration (FDA) have been reported. This work introduces a "traffic light type μPAD", enabling highly intuitive semi-quantitative equipment-free naked-eye readout with no need for calibration, subjective interpretation or calculation. Assay results are displayed as traffic light colours reporting 5 analyte concentration levels (green/green & yellow/yellow/yellow & red/red). The device has been designed to never display all three colours simultaneously, eliminating any risk for misinterpretation. The mechanism relies on the modulation of sample flow through a network of paperfluidic channels modified with a hydrophobic to hydrophilic phase-switching substance responsive to H₂O₂. User operation is limited to sample application, followed by observing a clear and time-independent traffic light signal after approximately 10-30 min. Multiple factors influencing the H₂O₂ concentration-dependent appearance of a specific traffic light signal were studied. Making use of the possibilities for customising the concentration threshold levels for traffic light colour appearance, quantification of glucose at 5 levels in a clinically relevant concentration range was demonstrated in artificial urine as a model proof-of-concept. This platform is expected to offer the possibility for the future detection of other important metabolites.

Recent advancements in microfluidic chip biosensor detection of foodborne pathogenic bacteria: a review

Foodborne diseases caused by pathogenic bacteria pose a serious threat to human health. Early and rapid detection of foodborne pathogens is an urgent task for preventing disease outbreaks. Microfluidic devices are simple, automatic, and portable miniaturized systems. Compared with traditional techniques, microfluidic devices have attracted much attention because of their high efficiency and convenience in the concentration and detection of foodborne pathogens. This article firstly reviews the bio-recognition elements integrated on microfluidic chips in recent years and the progress of microfluidic chip development for pathogen pretreatment. Furthermore, the research progress of microfluidic technology based on optical and electrochemical sensors for the detection of foodborne pathogenic bacteria is summarized and discussed. Finally, the future prospects for the application and challenges of microfluidic chips based on biosensors are presented.

Multipurpose made colorimetric materials for amines, pH change and metal ion detection

Sensors are routinely developed for specific applications, but multipurpose sensors are challenging, due to stability and poor functional design. We report organic materials that operate in solution and gas phase. They show a strong response behaviour to at least three types of environmental changes: pH, amine and metal ion binding/detection. We have confirmed and validated our findings using various analytical and computational methods. We found that the changes in polarity of the solvent and pH not only red shift the tail of the absorption spectra, but also extend the peak optical absorption of these structures by up to 100 nm, with consequential effects on the optical gap and colour changes of the materials. Acid–base response has been studied by spectrophotometric titrations with trifluoroacetic acid (TFA) and triethyl amine (TEA). The experiments show excellent reversibility with greater sensitivity to base than acid for all compounds. Analysis into metal sensing using Zn(ii) and Cu(ii) ions as analytes show that the materials can successfully bind the cations forming stable complexes. Moreover, a strong suppression of signal with copper gives an operative modality to detect the copper ion as low as 2.5 × 10⁻⁶ M. The formation of the metal complexes was also confirmed by growing crystals using a slow diffusion method; subsequent single crystal X-ray analysis reveals the ratio of ligand to metal to be 2 to 1. To test sensitivity towards various amine vapours, paper-based sensors have been fabricated. The sensors show a detection capability at 1 ppm of amine concentration. We have employed CIE L*a*b* colour space as the evaluation method, this provides numeric comparison of the samples from different series and allows comparison of small colour differences, which are generally undetectable by the human-eye. It shows that the CIE L*a*b* method can assess both sensitivity to a particular class of analytes and a specificity response to individual amines in this subclass offering an inexpensive and versatile methodology.

Multi-responsive colorimetric sensors based on the hydrazone motif, which are perfectly suited for chemo sensing applications have been developed.

Paper based micro/nanofluidics devices for biomedical applications

This chapter details the significance, fabrication and biomedical applications of paper-based microfluidic devices. The first part of the chapter describes the importance of paper diagnostic devices, highlighting pretreatment, dipsticks, lateral flow assays, and microPADs. Various methods followed for the fabrication of the paper analytical devices are discussed in the second part. The last part is about some of the important biomedical applications of paper analytical devices. Finally, the challenges and research gaps in the paper microfluidics for biomedical applications are presented.

Micro/nanofluidic devices for DNA/RNA detection and separation

The development and research have ramped up at a greater speed than ever in the field of diseases diagnosis. Still there is struggle in developing early detection techniques which uses complex biomolecules like RNA, DNA and proteins in order to detect diseases caused by bacteria, viruses or fungi. Until now separation techniques used before detection rely on traditional techniques like electrophoresis etc. which often require centralized services. Although efforts are made in developing devices that is capable enough on carrying out separation and detection based on microfluidic (MF) and nanofluidic (NF) or lab on chip. Hence, in this chapter, we have discussed about the advancement, limitations and future steps that needs to be taken to flourish the field of NF and MF for the detection and separation of nucleic acid.

An automated fast-flow/delayed paper-based platform for the simultaneous electrochemical detection of hepatitis B virus and hepatitis C virus core antigen

Electrochemical paper-based analytical devices (ePADs) are useful analytical devices that serve as point-of-care testing (POCT) devices for various clinical biomarkers in view of their simplicity, portability, and low-cost format. However, multistep reagent manipulation usually restricts the performance of the device for end users. Herein, we developed a sequential ePAD for sequential immunosensing fluid delivery by integrating dual flow behaviors (fast-flow/delayed) within a single paper platform for the simultaneous detection of hepatitis B surface antigen (HBsAg) and hepatitis C core antigen (HCVcAg). In the present work, a fast-flow channel was used for the automated washing of unbound antigens, while a delayed channel was created to store a redox reagent for further electrochemical analysis with a single buffer loading (the analysis time can be completed within 500 s). Hence, the undesirable complex procedure of multi-step reagent manipulation is scarcely needed by the user. The detection limit of the proposed ePAD was as low as 18.2 pg mL^-1 for HBsAg and 1.19 pg mL^-1 for HCVcAg. In addition, this proposed ePAD was also proven to be effective in real clinical sera from patients to verify its biological applicability. The ePAD sensor shows high promise as an easy-to-use, portable, and extendable sensor for other multiplex biological assays.

Nano-functionalized paper-based IoT enabled devices for point-of-care testing: a review

Over the last few years, the microfluidics phenomenon coupled with the Internet of Things (IoT) using innovative nano-functional materials has been recognized as a sustainable and economical tool for point-of-care testing (POCT) of various pathogens influencing human health. The sensors based on these phenomena aim to be designed for cost-effectiveness, make it handy, environment-friendly, and get an accurate, easy, and rapid response. Considering the burgeoning importance of analytical devices in the healthcare domain, this review paper is based on the gist of sensing aspects of the microfabricated paper-based analytical devices (μPADs). The article discusses the various used design methodologies and fabrication approaches and elucidates the recently reported surface modification strategies, detection mechanisms viz., colorimetric, electrochemical, fluorescence, electrochemiluminescence, etc. In a nutshell, this article summarizes the state-of-the-art research work carried out over the nano functionalized paper-based analytical devices and associated challenges/solutions in the point of care testing domain.

Chemiluminescence-Derived Self-Powered Photoelectrochemical Immunoassay for Detecting a Low-Abundance Disease-Related Protein

Early diagnosis of cancers relies on the sensitive detection of specific biomarkers, but most of the current testing methods are inaccessible to home healthcare due to cumbersome steps, prolonged testing time, and utilization of toxic and hazardous substances. Herein, we developed a portable self-powered photoelectrochemical (PEC) sensing platform for rapid detection of prostate-specific antigen (PSA, as a model disease-related protein) by integrating a self-powered photoelectric signal output system catalyzed with chemiluminescence-functionalized Au nanoparticles (AuNPs) and a phosphomolybdic acid (PMA)-based photochromic visualization platform. TiO₂-g-C₃N₄-PMA photosensitive materials were first synthesized and functionalized on a sensor chip. The sensor consisted of filter paper modified with a photocatalytic material and a regional laser-etched FTO electrode as an alternative to a conventional PEC sensor with a glass-based electrode. The targeting system involved a monoclonal anti-PSA capture antibody-functionalized Fe₃O₄ magnetic bead (mAb₁-MB) and a polyclonal anti-PSA antibody (pAb₂)-N-(4-aminobutyl)-N-ethylisoluminol-AuNP (ABEI-AuNP). Based on the signal intensity of the chemiluminescent system, the photochromic device color changed from light yellow to heteropoly blue through the PMA photoelectric materials integrated into the electrode for visualization of the signal output. In addition, the electrical signal in the PEC system was amplified by a sandwich-type capacitor and readout on a handheld digital multimeter. Under optimum conditions, the sensor exhibited high sensitivity relative to PSA in the range of 0.01-50 ng mL^-1 with a low detection limit of 6.25 pg mL^-1. The flow-through chemiluminescence reactor with a semiautomatic injection device and magnetic separation was avoid of unstable light source intensity inherent in the chemiluminescence process. Therefore, our strategy provides a new horizon for point-of-care analysis and rapid cost-effective clinical diagnosis.

Sample Preparation and Diagnostic Methods for a Variety of Settings: A Comprehensive Review

Sample preparation is an essential step for nearly every type of biochemical analysis in use today. Among the most important of these analyses is the diagnosis of diseases, since their treatment may rely greatly on time and, in the case of infectious diseases, containing their spread within a population to prevent outbreaks. To address this, many different methods have been developed for use in the wide variety of settings for which they are needed. In this work, we have reviewed the literature and report on a broad range of methods that have been developed in recent years and their applications to point-of-care (POC), high-throughput screening, and low-resource and traditional clinical settings for diagnosis, including some of those that were developed in response to the coronavirus disease 2019 (COVID-19) pandemic. In addition to covering alternative approaches and improvements to traditional sample preparation techniques such as extractions and separations, techniques that have been developed with focuses on integration with smart devices, laboratory automation, and biosensors are also discussed.

A new paper-based biosensor for therapeutic drug monitoring

Tacrolimus is one of the most effective and prevalent drugs used to combat vascularized composite allotransplantation rejection. We have fabricated a rapid and easy-to-use six-layer paper based microfluidic device using the principles of competitive immunoassays and vertical flow microfluidics for colorimetric detection of tacrolimus in a small volume of blood.

Paper-Based Electrochemical Biosensors for Voltammetric Detection of miRNA Biomarkers Using Reduced Graphene Oxide or MoS2 Nanosheets Decorated with Gold Nanoparticle Electrodes

Paper-based biosensors are considered simple and cost-efficient sensing platforms for analytical tests and diagnostics. Here, a paper-based electrochemical biosensor was developed for the rapid and sensitive detection of microRNAs (miRNA-155 and miRNA-21) related to early diagnosis of lung cancer. Hydrophobic barriers to creating electrode areas were manufactured by wax printing, whereas a three-electrode system was fabricated by a simple stencil approach. A carbon-based working electrode was modified using either reduced graphene oxide or molybdenum disulfide nanosheets modified with gold nanoparticle (AuNPs/RGO, AuNPs/MoS2) hybrid structures. The resulting paper-based biosensors offered sensitive detection of miRNA-155 and miRNA-21 by differential pulse voltammetry (DPV) in only 5.0 µL sample. The duration in our assay from the point of electrode modification to the final detection of miRNA was completed within only 35 min. The detection limits for miRNA-21 and miRNA-155 were found to be 12.0 and 25.7 nM for AuNPs/RGO and 51.6 and 59.6 nM for AuNPs/MoS2 sensors in the case of perfectly matched probe-target hybrids. These biosensors were found to be selective enough to distinguish the target miRNA in the presence of single-base mismatch miRNA or noncomplementary miRNA sequences.

Nanotechnology-assisted microfluidic systems: from bench to bedside

With significant advancements in research technologies, and an increasing global population, microfluidic and nanofluidic systems (such as point-of-care, lab-on-a-chip, organ-on-a-chip, etc) have started to revolutionize medicine. Devices that combine micron and nanotechnologies have increased sensitivity, precision and versatility for numerous medical applications. However, while there has been extensive research on microfluidic and nanofluidic systems, very few have experienced wide-spread commercialization which is puzzling and deserves our collective attention. For the above reasons, in this article, we review research advances that combine micro and nanotechnologies to create the next generation of nanomaterial-based microfluidic systems, the latest in their commercialization success and failure and highlight the value of these devices both in industry and in the laboratory.

Affinity biosensors developed with quantum dots in microfluidic systems

Quantum dots (QDs) are synthetic semiconductor nanocrystals with unique optical and electronic properties due to their size (2-10 nm) such as high molar absorption coefficient (10-100 times higher than organic dyes), resistance to chemical degradation, and unique optoelectronic properties due to quantum confinement (high quantum yield, emission color change with size). Compared to organic fluorophores, the narrower emission band and wider absorption bands of QDs offer great advantages in cell imaging and biosensor applications. The optoelectronic features of QDs have prompted their intensive use in bioanalytical, biophysical, and biomedical research. As the nanomaterials have been integrated into microfluidic systems, microfluidic technology has accelerated the adaptation of nanomaterials to clinical evaluation together with the advantages such as being more economical, more reproducible, and more susceptible to modification and integration with other technologies. Microfluidic systems serve an important role by being a platform in which QDs are integrated for biosensing applications. As we combine the advantages of QDs and microfluidic technology for biosensing technology, QD-based biosensor integrated with microfluidic systems can be used as an advanced and versatile diagnostic technology in case of pandemic. Specifically, there is an urgent necessity to have reliable and fast detection systems for COVID-19 virus. In this review, affinity-based biosensing mechanisms which are developed with QDs are examined in the domain of microfluidic approach. The combination of microfluidic technology and QD-based affinity biosensors are presented with examples in order to develop a better technological framework of diagnostic for COVID-19 virus.

A Multifunctional Microfluidic Device for Blood Typing and Primary Screening of Blood Diseases

In this work, we demonstrate a multifunctional, portable, and disposable microfluidic device for blood typing and primary screening of blood diseases. Preloaded antibodies (anti-A, anti-B, and anti-D) interact with injected whole blood cells to cause an agglutination reaction that blocks a microslit in the microfluidic channel to accumulate red blood cells and form a visible red line that can be easily read to determine the blood type. Moreover, the different blood density and agglutination properties of normal and subtype blood groups, as well as different blood diseases, including anemia and polycythemia vera, generate different lengths of blood agglutination within the channels, which allows us to successfully screen these various conditions in as little as 2 min. The required blood volume for each test is just 1 μL, which can be obtained by minimally invasive finger pricking. This novel method of observing agglutinated red blood cells to distinguish blood types and diseases is both feasible and affordable, suggesting its promise for use in areas with limited resources.

Pump-Free Microfluidic Rapid Mixer Combined with a Paper-Based Channel

Capillary forces are commonly employed to transport fluids in pump-free microfluidic platforms such as paper-based microfluidics. However, since paper is a porous material consisting of nonuniform cellulose fibers, it has some limitations in performing stable flow functions like mixing. Here, we developed a pump-free microfluidic device that enables rapid mixing by combining paper and plastic. The device was fabricated by laminating transparency film and double-sided adhesive and is composed of an overlapping inlet ending in a paper-based reaction area. The mixing performance of the developed device was confirmed experimentally using aqueous dyes and pH indicators. In addition, the absolute mixing index was evaluated by numerically calculating the concentration field across the microfluidic channels. To demonstrate the utility of the new approach, the detection of an organophosphate pesticide was carried out using a colorimetric enzymatic inhibition assay. The developed device and a smartphone application were used to detect organophosphate pesticide on food samples, demonstrating the potential for onsite analysis.

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

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

Cytokine and Cancer Biomarkers Detection: The Dawn of Electrochemical Paper-Based Biosensor

Although the established ELISA-based sensing platforms have many benefits, the importance of cytokine and cancer biomarkers detection for point-of-care diagnostics has propelled the search for more specific, sensitive, simple, accessible, yet economical sensor. Paper-based biosensor holds promise for future in-situ applications and can provide rapid analysis and data without the need to conduct in a laboratory. Electrochemical detection plays a vital role in interpreting results obtained from qualitative assessment to quantitative determination. In this review, various factors affecting the design of an electrochemical paper-based biosensor are highlighted and discussed in depth. Different detection methods, along with the latest development in utilizing them in cytokine and cancer biomarkers detection, are reviewed. Lastly, the fabrication of portable electrochemical paper-based biosensor is ideal in deliberating positive societal implications in developing countries with limited resources and accessibility to healthcare services.

Paper-based microfluidics for rapid diagnostics and drug delivery

Paper is a common material that is promising for constructing microfluidic chips (lab-on-a-paper) for diagnostics and drug delivery for biomedical applications. In the past decade, extensive research on paper-based microfluidics has accumulated a large number of scientific publications in the fields of biomedical diagnosis, food safety, environmental health, drug screening and delivery. This review focuses on the recent progress on paper-based microfluidic technology with an emphasis on the design, optimization and application of the technology platform, in particular for medical diagnostics and drug delivery. Novel advances have concentrated on engineering paper devices for point-of-care (POC) diagnostics, which could be integrated with nucleic acid-based tests and isothermal amplification experiments, enabling rapid sample-to-answer assays for field testing. Among the isothermal amplification experiments, loop-mediated isothermal amplification (LAMP), an extremely sensitive nucleic acid test, specifically identifies ultralow concentrations of DNA/RNA from practical samples for diagnosing diseases. We thus mainly focus on the paper device-based LAMP assay for the rapid infectious disease diagnosis, foodborne pathogen analysis, veterinary diagnosis, plant diagnosis, and environmental public health evaluation. We also outlined progress on paper microfluidic devices for drug delivery. The paper concludes with a discussion on the challenges of this technology and our insights into how to advance science and technology towards the development of fully functional paper devices in diagnostics and drug delivery.

Fully-automatic blood-typing chip exploiting bubbles for quick dilution and detection

A compact, fully-automatic blood-typing test device is developed. The device conducts sequential processes of whole-blood dilution, homogenization, and reaction with reagents. The lab-on-a-chip device can detect the weakest reaction between red blood cells (RBCs) and reagents even without using optics such as a camera and detector. This high sensitivity is achieved by implementing 50-μm-thick reaction chambers in which a clear contrast between the RBC agglutinations and non-reacted RBCs can be obtained. The dilution and the homogenization are enhanced by injecting bubbles into the microchannel so that the test result can be obtained 5 min after the test start. With an assumption that the device will be used by medical staffs, the device is designed to require minimum operation for the users, namely, loading whole blood, starting pumps, and looking inside the reaction chambers by their eyes to observe the test result. As the device is applicable to the cross-matching test by mixing RBCs with serum instead of the reagents, it is expected that the device provides not only the quick blood-typing but also a safer and quicker blood transfusion in emergency rooms.

Hybrid Three Dimensionally Printed Paper-Based Microfluidic Platform for Investigating a Cell's Apoptosis and Intracellular Cross-Talk

In this paper, we first proposed a novel hybrid three-dimensional (3D) printed and paper-based microfluidic platform and applied it for investigating the cell's apoptosis and intracellular cross-talk. The fabrication of a 3D-printed microfluidic chip is much easier than polydimethylsiloxane (PDMS) chip and can be applied in many common labs without soft lithogrophy fabrication equipment. Moreover, 3D printing can be perfectly combined with paper-based chips that can provide 3D scaffold for cell culture and analysis. In addition, these paper chips are disposable after use, greatly reducing the experimental cost. We integrated "Christmas Tree" structure with the top layer of the 3D-printed microfluidic chip to generate a continuous concentration gradient, and the bottom layer contained paper-based chips as cell culture area. The two-layer structure allows the concentration gradient forming layer to be separated from the cell culture layer, which can simplify the planting of cells in the microfluidic chip and make sure the cells stay in the culture chambers and don't clog the microfluidic channels. Applying this hybrid platform, we examined the effect of H₂S on cancer cells. Continuous exposure to a low concentration of H₂S inhibited cancer cell SMMC-7721 proliferation by inducing cell apoptosis. We also found that two gaseous molecules H₂S and NO have cross-talk in cancer cells; they formed bioactive intermediate polysulfides in cancer cells. It is expected that this novel hybrid 3D-printed and paper-based microfluidic platform will have widespread application prospects in cell investigation.

Colorimetric aggregation assay based on array of gold and silver nanoparticles for simultaneous analysis of aflatoxins, ochratoxin and zearalenone by using chemometric analysis and paper based analytical devices

A paper based sensor array is presented to discriminate and determine five mycotoxins classified into three categories, namely aflatoxins, ochratoxins and zearalenone. The gold and silver nanoparticles, synthesized by three different reducing or capping agents, were employed as sensing elements of the fabricated device. These nanoparticles were poured onto hydrophilic circular zones embedded on the hydrophobic substrate. The response of the assay is dependent on the aggregation of nanoparticles for interaction with mycotoxins. Due to aggregation, the gold and silver nanoparticles changed to purple and brown, respectively. Color changes provide unique colorimetric signatures conducive to recognizing the type of mycotoxin, identifying its chemical structure, and finding the fungi that produce it. The discrimination ability of the assay was investigated by both supervised (linear discriminate analysis) and unsupervised (principle component analysis and hierarchical cluster analysis) pattern recognition methods. The assay was applied to the point of need determination of aflatoxin B1, aflatoxin G1, aflatoxin M1, ochratoxin A and zearalenone with a detection limit of 2.7, 7.3, 2.1, 3.3 and 7.0 ng.mL^-1, respectively. The fabricated device has high potential of simultaneously determining the mycotoxins in pistachio, wheat, coffee and milk with the help of partial least square method. The root mean square errors for prediction of PLS model were 5.7, 5.2, 1.5, 7.2 and 2.9 for aflatoxin B1, aflatoxin G1, aflatoxin M1, ochratoxin A and zearalenone, respectively. Graphical abstractSchematic representation of paper based colorimetric sensor array based on gold and silver nanoparticles for both qualitative and quantitative analysis of aflatoxins, ochratoxin and zearalenone.

All-printed semiquantitative paper-based analytical devices relying on QR code array readout

Colorimetric assay enabling user independent semiquantitative result readout through an array of sequentially unmasked QR codes.

Quantification of Colorimetric Data for Paper-Based Analytical Devices

Colorimetric measurements by image analysis, giving RGB or HSV data, have become commonplace with optical indicator-based assays and as a readout for paper-based analytical devices (PADs). Yet, most works on PADs tend to ignore the quantitative relationship between color data and concentration, which may hamper their establishment as analytical devices and make it difficult to properly understand chemical or biological reactions on the paper substrate. This Perspective Article discusses how image color data are computed into colorimetric absorbance values that correlate linearly to dye concentration and compare well to traditional spectrophotometry. Thioflavin T (ThT), Neutral Red (NR), and Orange IV are used here as model systems. Absorbance measurements in solution correlate well to image data (and Beer's law) from the color channel of relevance if the gamma correction normally used to render the picture more natural to the human eye is removed. This approach also allows one to correct for color cast and variable background color, which may otherwise limit quantitation in field measurements. Reflectance measurements on paper color spots are equally found to correlate quantitatively between spectroscopy and imaging devices. In this way, deviations from Beer's law are identified that are explained with dye interactions on the paper substrate.

Lateral flow biosensors based on the use of micro- and nanomaterials: a review on recent developments

This review (with 187 refs.) summarizes the progress that has been made in the design of lateral flow biosensors (LFBs) based on the use of micro- and nano-materials. Following a short introduction into the field, a first section covers features related to the design of LFBs, with subsections on strip-based, cotton thread-based and vertical flow- and syringe-based LFBs. The next chapter summarizes methods for sample pretreatment, from simple method to membrane-based methods, pretreatment by magnetic methods to device-integrated sample preparation. Advances in flow control are treated next, with subsections on cross-flow strategies, delayed and controlled release and various other strategies. Detection conditionst and mathematical modelling are briefly introduced in the following chapter. A further chapter covers methods for reliability improvement, for example by adding other validation lines or adopting different detection methods. Signal readouts are summarized next, with subsections on color-based, luminescent, smartphone-based and SERS-based methods. A concluding section summarizes the current status and addresses challenges in future perspectives. Graphical abstractRecent development and breakthrough points of lateral flow biosensors.

Inkjet-printed pH-independent paper-based calcium sensor with fluorescence signal readout relying on a solvatochromic dye

A challenge for paper-based cation sensors relying on classical carrier-based ion-selective optodes (ISOs) is their pH-cross response caused by the use of H⁺-sensitive chromoionophores as optical signal transducers. This work demonstrates fully pH-independent fluorescence-based calcium detection with a paper-based plasticizer-free ISO. To achieve a pH-independent assay, a solvatochromic dye (SD) instead of a traditional H⁺-sensitive chromoionophore has been applied to the paper-based ISO by means of inkjet printing technology. The detection principle depends on an ionophore-driven phase-transfer ion-exchange reaction between target cations and the positively charged SD, which no longer involves H⁺ in the optical signal transduction process. The developed paper-based ISOs with the SD resulted in Ca²⁺ concentration-dependent response curves not affected by the sample pH (pH 6.0, 7.0, and 8.0). The dynamic range obtained for Ca²⁺ detection was from 10^-5 to 1 mol L^-1 with a detection limit of 19.3 μmol L^-1. Additionally, excellent selectivity derived from the used ionophore has been confirmed. As a simple practical application, the determination of Ca²⁺ in mineral water has been achieved without the pH-buffering process required for conventional cation-exchange ISOs.