Paper and flexible substrates as materials for biosensing platforms to detect multiple biotargets

Fast detection of bacterial gut pathogens on miniaturized devices: an overview

INTRODUCTION

Gut microbes pose challenges like colon inflammation, deadly diarrhea, antimicrobial resistance dissemination, and chronic disease onset. Development of early, rapid and specific diagnosis tools is essential for improving infection control. Point-of-care testing (POCT) systems offer rapid, sensitive, low-cost and sample-to-answer methods for microbe detection from various clinical and environmental samples, bringing the advantages of portability, automation, and simple operation.

AREAS COVERED

Rapid detection of gut microbes can be done using a wide array of techniques including biosensors, immunological assays, electrochemical impedance spectroscopy, mass spectrometry and molecular biology. Inclusion of Internet of Things, machine learning, and smartphone-based point-of-care applications is an important aspect of POCT. In this review, the authors discuss various fast diagnostic platforms for gut pathogens and their main challenges.

EXPERT OPINION

Developing effective assays for microbe detection can be complex. Assay design must consider factors like target selection, real-time and multiplex detection, sample type, reagent stability and storage, primer/probe design, and optimizing reaction conditions for accuracy and sensitivity. Mitigating these challenges requires interdisciplinary collaboration among scientists, clinicians, engineers, and industry partners. Future efforts are essential to enhance sensitivity, specificity, and versatility of POCT systems for gut microbe detection and quantification, advancing infectious disease diagnostics and management.

Multiplex solid-phase RPA coupled CRISPR-based visual detection of SARS-CoV-2

The COVID-19 pandemic has presented a significant challenge to the world's public health and led to over 6.9 million deaths reported to date. A rapid, sensitive, and cost-effective point-of-care virus detection device is essential for the control and surveillance of the contagious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. The study presented here aimed to demonstrate a solid-phase isothermal recombinase polymerase amplification coupled CRISPR-based (spRPA-CRISPR) assay for on-chip multiplexed, sensitive and visual COVID-19 DNA detection. The assay targets the SARS-CoV-2 structure protein encoded genomes and can simultaneously detect two specific genes without cross-interaction. The amplified target sequences were immobilized on the one-pot device surface and detected using the mixed Cas12a-crRNA collateral cleavage of reporter-released fluorescent signal when specific genes were recognized. The endpoint signal can be directly visualized for rapid detection of COVID-19. The system was tested with samples of a broad range of concentrations (20 to 2 × 104 copies) and showed analytical sensitivity down to 20 copies per microliter. Furthermore, a low-cost blue LED flashlight (~$12) was used to provide a visible SARS-CoV-2 detection signal of the spRPA-CRISPR assay which could be purchased online easily. Thus, our platform provides a sensitive and easy-to-read multiplexed gene detection method that can specifically identify low concentration genes.

Recent Advances in Colorimetric Tests for the Detection of Infectious Diseases and Antimicrobial Resistance

Diagnosis of infection-causing microorganisms with sensitive, rapid, selective and economical diagnostic tests is critical to start the right treatment. With these tests, the spread of infections can be prevented. In addition to that, the detection of antimicrobial resistance also makes a significant contribution to public health. In recent years, different types of diagnostic tests have been developed as alternatives to traditional diagnostic tests used in clinics. In particular, colorimetric tests, which minimize the need for an instrument, have advantages owing to their cost effectiveness, rapid response and naked-eye detection and practical use. In this review, we especially focused on pH indicators and nanomaterial-based colorimetric tests in detection of infection-causing microorganisms and antimicrobial resistance.

Aptamer-Based Point-of-Care Devices: Emerging Technologies and Integration of Computational Methods

Recent innovations in point-of-care (POC) diagnostic technologies have paved a critical road for the improved application of biomedicine through the deployment of accurate and affordable programs into resource-scarce settings. The utilization of antibodies as a bio-recognition element in POC devices is currently limited due to obstacles associated with cost and production, impeding its widespread adoption. One promising alternative, on the other hand, is aptamer integration, i.e., short sequences of single-stranded DNA and RNA structures. The advantageous properties of these molecules are as follows: small molecular size, amenability to chemical modification, low- or nonimmunogenic characteristics, and their reproducibility within a short generation time. The utilization of these aforementioned features is critical in developing sensitive and portable POC systems. Furthermore, the deficiencies related to past experimental efforts to improve biosensor schematics, including the design of biorecognition elements, can be tackled with the integration of computational tools. These complementary tools enable the prediction of the reliability and functionality of the molecular structure of aptamers. In this review, we have overviewed the usage of aptamers in the development of novel and portable POC devices, in addition to highlighting the insights that simulations and other computational methods can provide into the use of aptamer modeling for POC integration.

Effective Optical Image Assessment of Cellulose Paper Immunostrips for Blood Typing

Novel high-performance biosensing devices, based on a microporous cellulose matrix, have been of great interest due to their high sensitivity, low cost, and simple operation. Herein, we report on the design and testing of portable paper-based immunostrips (IMS) for in-field blood typing in emergencies requiring blood transfusion. Cellulose fibrils of a paper membrane were functionalized with antibodies via supramolecular interactions. The formation of hydrogen bonds between IgM pentamer and cellulose fibers was corroborated using quantum mechanical calculations with a model cellulose chain and a representative amino acid sequence. In the proposed immunostrips, paper with a pore size of 3 µm dia. was used to enable functionalization of its channels with antibody molecules while blocking the red blood cells (RBC) from channel entering. Under the optimized test conditions, all blood types of AB0 and Rh system could be determined by naked eye examination, requiring only a small blood sample (3.5 µL). The durability of IgM immunostrips against storing has been tested. A new method of statistical evaluation of digitized blood agglutination images, compatible with a clinical five-level system, has been proposed. Critical parameters of the agglutination process have been established to enable future development of automatic blood typing with machine vision and digital data processing.

Selection of healthy sperm based on positive rheotaxis using a microfluidic device

For conception, sperm cells travel towards the oocyte. This journey is accomplished by only a few sperm cells, following various guidance mechanisms. Of these mechanisms, rheotaxis plays a significant role in guiding the sperm over a long distance. By taking advantage of this natural rheotaxis behavior of sperm, we have developed a microfluidic chip that isolates healthy sperm cells. The developed chip consists of different chambers separated by microchannels that facilitate separation of motile sperm cells from unprocessed semen samples with the help of fluid flow. The sperm cells are subjected to different velocities in different parts of the chip that direct functional sperm towards the collection chamber utilizing positive rheotaxis. The results from the developed microfluidic chip (with 0.5 μL min^-1 flow rate) have shown almost 100% motility, a significantly higher percentage of morphologically normal sperm cells with lesser sperm DNA fragmentation than the control (no-flow) and raw semen sample. This chip satisfies the need of a clinical setting as it is low-cost, easy to operate and uses a small semen volume for sperm sorting.

Diagnostic assay and technology advancement for detecting SARS-CoV-2 infections causing the COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-caused COVID-19 pandemic has transmitted to humans in practically all parts of the world, producing socio-economic turmoil. There is an urgent need for precise, fast, and affordable diagnostic testing to be widely available for detecting SARS-CoV-2 and its mutations in various phases of the disease. Early diagnosis with great precision has been achieved using real-time polymerase chain reaction (RT-PCR) and similar other molecular methods, but theseapproaches are costly and involve rigorous processes that are not easily obtainable. Conversely, immunoassays that detect a small number of antibodies have been employed for quick, low-cost tests, but their efficiency in diagnosing infected people has been restricted. The use of biosensors in the detection of SARS-CoV-2 is vital for the COVID-19 pandemic’s control. This review gives an overview of COVID-19 diagnostic approaches that are currently being developed as well as nanomaterial-based biosensor technologies, to aid future technological advancement and innovation. These approaches can be integrated into point-of-care (POC) devices to quickly identify a large number of infected patients and asymptomatic carriers. The ongoing research endeavors and developments in complementary technologies will play a significant role in curbing the spread of the COVID-19 pandemic and fill the knowledge gaps in current diagnostic accuracy and capacity.

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

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

Development of a Microfluidic Device for CD4+ T Cell Isolation and Automated Enumeration from Whole Blood

The development of point-of-care, cost-effective, and easy-to-use assays for the accurate counting of CD4⁺ T cells remains an important focus for HIV-1 disease management. The CD4⁺ T cell count provides an indication regarding the overall success of HIV-1 treatments. The CD4⁺ T count information is equally important for both resource-constrained regions and areas with extensive resources. Hospitals and other allied facilities may be overwhelmed by epidemics or other disasters. An assay for a physician’s office or other home-based setting is becoming increasingly popular. We have developed a technology for the rapid quantification of CD4⁺ T cells. A double antibody selection process, utilizing anti-CD4 and anti-CD3 antibodies, is tested and provides a high specificity. The assay utilizes a microfluidic chip coated with the anti-CD3 antibody, having an improved antibody avidity. As a result of enhanced binding, a higher flow rate can be applied that enables an improved channel washing to reduce non-specific bindings. A wide-field optical imaging system is also developed that provides the rapid quantification of cells. The designed optical setup is portable and low-cost. An ImageJ-based program is developed for the automatic counting of CD4⁺ T cells. We have successfully isolated and counted CD4⁺ T cells with high specificity and efficiency greater than 90%.

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.

Hand-drawn electrode based disposable paper chip for artificial sweat analysis using impedance spectroscopy

Low cost, disposable paper based electrical sensor to examine the analyte concentration in an extremely small volume of sample solution is essential for environmental and healthcare applications. For the development of paper based devices, sophisticated instruments are essential to pattern electrode on the top surface of the paper. In most cases, such fabricated device results in direct contact with the analyte solution on the surface of the electrode during electrical detection and leads to high electrical double layer capacitance. In this work, we have focused to reduce the double layer capacitance by fabricating hand drawn electrode paper sensor utilising the reverse side of the paper. This design acts as a sample storage and facilitate impedimetric sensing of ionic concentration of analyte solution using a few microlitre. Droplet formation at the bottom of the paper in the confined area is visually monitored to reduce sample wastage. The interaction between two different electrode materials (graphite and silver) on the paper substrate with the different volume and concentration of the electrolyte is analysed to improve the robustness and sensitivity of the measurement. Simultaneously, we observed a reduction in the electrical double layer effect on the low sample volumes. The proposed paper based sensor shows the enhanced impedance stability on silver electrode patterned paper chip than graphite electrode paper chip to detect the different ionic concentration of artificial sweat sample. Finally, it demonstrates that paper chip has great potential as a disposable diagnostics sensor in healthcare applications.

Effectiveness of high curvature segmentation on the curved flexible surface plasmon resonance

In this report, we explore a segmentation-based approach for the calculation of surface plasmon resonance (SPR) on the curved surface with high curvature by modeling it as a contiguous array of finite segments. The approach would significantly facilitate the calculation with good accuracy because of the inherent nature that transfer matrix analysis can be used. Using the segmentation model, resonance characteristics at SPR were obtained as the curvature radius was varied. For validation of the segmentation, resonance wavelength (λ_SPR), reflectance at resonance (R_SPR), and resonance width (δλ_SPR) were compared with the finite element method in the parallel and perpendicular light incidence. It was found that the results from the segmentation were in excellent agreement, λ_SPR in particular, while R_SPR and δλ_SPR under parallel incidence showed disparity between the two models due to the short segmentation. Resonance of curved surface on the rigid and flexible substrate was compared and the overall trend was found to be almost identical. The segmentation is expected to provide a simple, fast, and efficient way for studying plasmonic devices with high curvature in flexible and wearable applications.

Recent progress in smartphone-based techniques for food safety and the detection of heavy metal ions in environmental water

Emerging smartphone-based point-of-care tests (POCTs) are cost-effective, precise, and easy to implement in resource-limited areas. Thus, they are considered a potential alternative to conventional diagnostic testing. This review explores food safety and the detection of metal ions in environmental water based on unprecedented smartphone technology. Specifically, we provide an overview of various methods used for target analyte detection (antibiotics, enzymes, mycotoxins, pathogens, pesticides, small molecules, and metal ions), such as colorimetric, fluorescence, microscopic imaging, and electrochemical methods. This paper performs a comprehensive review of smartphone-based POCTs developed in the last three years (2018-2020) and evaluates their relative advantages and limitations. Moreover, we discuss the imperative role of new technology in the progress of POCTs. Sensor materials (metal nanoparticles, carbon dots, quantum dots, organic substrates, etc.) and detection techniques (paper-based, later flow assay, microfluidic platform, etc.) involved in POCTs based on smartphones, and the challenges faced by these techniques, are addressed.

Dengue Detection: Advances in Diagnostic Tools from Conventional Technology to Point of Care

The dengue virus (DENV) is a vector-borne flavivirus that infects around 390 million individuals each year with 2.5 billion being in danger. Having access to testing is paramount in preventing future infections and receiving adequate treatment. Currently, there are numerous conventional methods for DENV testing, such as NS1 based antigen testing, IgM/IgG antibody testing, and Polymerase Chain Reaction (PCR). In addition, novel methods are emerging that can cut both cost and time. Such methods can be effective in rural and low-income areas throughout the world. In this paper, we discuss the structural evolution of the virus followed by a comprehensive review of current dengue detection strategies and methods that are being developed or commercialized. We also discuss the state of art biosensing technologies, evaluated their performance and outline strategies to address challenges posed by the disease. Further, we outline future guidelines for the improved usage of diagnostic tools during recurrence or future outbreaks of DENV.

Development and Application of Mobile Apps for Molecular Sensing: A Review

Modern smartphone-based sensing devices are generally standalone detection platforms that can transduce signals (via the built-in USB port, audio jack, or camera), perform analysis through mobile applications (apps), and display results on the screen/user interface. The advancement toward this ultimate form of on-site chemical analysis and point-of-care diagnosis is tied closely with the evolution of mobile technology. Previous reviews in the field mainly focused on the physical platforms while overlooking the role of mobile apps in such devices. There exist three general stages throughout the development: (1) early generation telemedicine, (2) mobile phone-assisted clinical diagnosis (without apps), and (3) mobile app-based sensing devices for various analytes. This review presents the key breakthroughs during each stage, recent development, remaining challenges, and future perspectives of the field. Representative examples, spanning from the pioneering point-of-care testing to the latest devices with integrated mobile apps, are classified by their sensing mechanisms. The review also discusses the scarcity of open-source apps dedicated to molecular sensing. With the introduction of more open-source and commercial apps, the mobile app-based detection system is anticipated to dominate point-of-care diagnosis and on-site molecular sensing in our opinion.

Development of a Point-of-Care Assay for HIV-1 Viral Load Using Higher Refractive Index Antibody-Coated Microbeads

The detection of viruses using imaging techniques is challenging because of the weak scattering of light generated by the targets of sizes in the nanometer range. The system we have developed overcomes the light scattering problems by utilizing antibody-coated microbeads of higher index of refraction that can specifically bind with viruses and increase the acceptance angle. Using the new technology, we have developed a portable, cost-effective, and field-deployable platform for the rapid quantification of HIV-1 viral load for point-of-care (POC) settings. The system combines microfluidics with a wide field of view lensless imaging technology. Highly specific antibodies are functionalized to a glass slide inside a microchip to capture HIV-1 virions. The captured virions are then bound by antibody-conjugated microbeads, which have a higher refraction index. The microbeads-HIV-1 virions complexes generate diffraction patterns that are detected with a custom-built imaging setup and rapidly and accurately quantified by computational analysis. This platform technology enables fast nanoscale virus imaging and quantification from biological samples and thus can play a significant role in the detection and management of viral diseases.

Lysis and direct detection of coliforms on printed paper-based microfluidic devices

Coliforms are one of the most common families of bacteria responsible for water contamination. Certain coliform strains can be extremely toxic, and even fatal if consumed. Current technologies for coliform detection are expensive, require multiple complicated steps, and can take up to 24 hours to produce accurate results. Recently, open-channel, paper-based microfluidic devices have become popular for rapid, inexpensive, and accurate bioassays. In this work, we have created an integrated microfluidic coliform lysis and detection device by fabricating customizable omniphilic regions via direct printing of omniphilic channels on an omniphobic, fluorinated paper. This paper-based device is the first of its kind to demonstrate successful cell lysing on-chip, as it can allow for the flow and control of both high and low surface tension liquids, including different cell lysing agents. The fabricated microfluidic device was able to successfully detect E. coli, via the presence of the coliform-specific enzyme, β-galactosidase, at a concentration as low as ∼104 CFU mL-1. Further, E. coli at an initial concentration of 1 CFU mL-1 could be detected after only 6 hours of incubation. We believe that these devices can be readily utilized for real world E. coli contamination detection in multiple applications, including food and water safety.

Printed Electrochemical Biosensors: Opportunities and Metrological Challenges

Printed electrochemical biosensors have recently gained increasing relevance in fields ranging from basic research to home-based point-of-care. Thus, they represent a unique opportunity to enable low-cost, fast, non-invasive and/or continuous monitoring of cells and biomolecules, exploiting their electrical properties. Printing technologies represent powerful tools to combine simpler and more customizable fabrication of biosensors with high resolution, miniaturization and integration with more complex microfluidic and electronics systems. The metrological aspects of those biosensors, such as sensitivity, repeatability and stability, represent very challenging aspects that are required for the assessment of the sensor itself. This review provides an overview of the opportunities of printed electrochemical biosensors in terms of transducing principles, metrological characteristics and the enlargement of the application field. A critical discussion on metrological challenges is then provided, deepening our understanding of the most promising trends in order to overcome them: printed nanostructures to improve the limit of detection, sensitivity and repeatability; printing strategies to improve organic biosensor integration in biological environments; emerging printing methods for non-conventional substrates; microfluidic dispensing to improve repeatability. Finally, an up-to-date analysis of the most recent examples of printed electrochemical biosensors for the main classes of target analytes (live cells, nucleic acids, proteins, metabolites and electrolytes) is reported.

Detection of Bacterial and Viral Pathogens Using Photonic Point-of-Care Devices

Infectious diseases caused by bacteria and viruses are highly contagious and can easily be transmitted via air, water, body fluids, etc. Throughout human civilization, there have been several pandemic outbreaks, such as the Plague, Spanish Flu, Swine-Flu, and, recently, COVID-19, amongst many others. Early diagnosis not only increases the chance of quick recovery but also helps prevent the spread of infections. Conventional diagnostic techniques can provide reliable results but have several drawbacks, including costly devices, lengthy wait time, and requirement of trained professionals to operate the devices, making them inaccessible in low-resource settings. Thus, a significant effort has been directed towards point-of-care (POC) devices that enable rapid diagnosis of bacterial and viral infections. A majority of the POC devices are based on plasmonics and/or microfluidics-based platforms integrated with mobile readers and imaging systems. These techniques have been shown to provide rapid, sensitive detection of pathogens. The advantages of POC devices include low-cost, rapid results, and portability, which enables on-site testing anywhere across the globe. Here we aim to review the recent advances in novel POC technologies in detecting bacteria and viruses that led to a breakthrough in the modern healthcare industry.

Nanomaterial-mediated paper-based biosensors for colorimetric pathogen detection

The pervasive spread of infectious diseases and pandemics, such as the 2019 coronavirus disease (COVID-19), are becoming increasingly serious and urgent threats to human health. Preventing the spread of such diseases prioritizes the development of sensing devices that can rapidly, selectively, and reliably detect pathogens at minimal cost. Paper-based analytical devices (PADs) are promising tools that satisfy those criteria. Numerous paper-based biosensors have been established that rival conventional pathogen detection methods. Among them, colorimetric strategies are promising since results can be interpreted by eye, and are simple to operate, which is advantageous for point-of-care testing (POCT). Particularly, the application of nanomaterials on paper-based biosensors has become important as these materials are capable of converting signals from pathogens through unique mechanisms to yield an amplified colorimetric readout. To highlight the research progress on using nanomaterials in colorimetric paper-based biosensor for pathogen detection, we discuss the sensing mechanisms of how they work, structural and analytical characteristics of the devices, and representative recent applications. Current challenges and future directions of using PADs and nanomaterial-mediated strategies are also discussed.

CytoPAN-Portable cellular analyses for rapid point-of-care cancer diagnosis

Rapid, automated, point-of-care cellular diagnosis of cancer remains difficult in remote settings due to lack of specialists and medical infrastructure. To address the need for same-day diagnosis, we developed an automated image cytometry system (CytoPAN) that allows rapid breast cancer diagnosis of scant cellular specimens obtained by fine needle aspiration (FNA) of palpable mass lesions. The system is devoid of moving parts for stable operations, harnesses optimized antibody kits for multiplexed analysis, and offers a user-friendly interface with automated analysis for rapid diagnoses. Through extensive optimization and validation using cell lines and mouse models, we established breast cancer diagnosis and receptor subtyping in 1 hour using as few as 50 harvested cells. In a prospective patient cohort study (n = 68), we showed that the diagnostic accuracy was 100% for cancer detection and the receptor subtyping accuracy was 96% for human epidermal growth factor receptor 2 and 93% for hormonal receptors (ER/PR), two key biomarkers associated with breast cancer. A combination of FNA and CytoPAN offers faster, less invasive cancer diagnoses than the current standard (core biopsy and histopathology). This approach should enable the ability to more rapidly diagnose breast cancer in global and remote settings.

Paper-Based Platform with an In Situ Molecularly Imprinted Polymer for β-Amyloid

Alzheimer's disease (AD) is one of the most common forms of dementia affecting millions of people worldwide. Currently, an easy and effective form of diagnosis is missing, which significantly hinders a possible improvement of the patient's quality of life. In this context, biosensors emerge as a future solution, opening the doors for preventive medicine and allowing the premature diagnosis of numerous pathologies. This work presents a pioneering biosensor that combines a bottom-up design approach using paper as a platform for the electrochemical recognition of peptide amyloid β-42 (Aβ-42), a biomarker for AD present in blood, associated with visible differences in the brain tissue and responsible for the formation of senile plaques. The sensor layer relies on a molecularly imprinted polymer as a biorecognition element, created on the carbon ink electrode's surface by electropolymerizing a mixture of the target analyte (Aβ-42) and a monomer (O-phenylenediamine) at neutral pH 7.2. Next, the template molecule was removed from the polymeric network by enzymatic and acidic treatments. The vacant sites so obtained preserved the shape of the imprinted protein and were able to rebind the target analyte. Morphological and chemical analyses were performed in order to control the surface modification of the materials. The analytical performance of the biosensor was evaluated by an electroanalytical technique, namely, square wave voltammetry. For this purpose, the analytical response of the biosensor was tested with standard solutions ranging from 0.1 ng/mL to 1 μg/mL of Aβ-42. The linear response of the biosensor went down to 0.1 ng/mL. Overall, the developed biosensor offered numerous benefits, such as simplicity, low cost, reproducibility, fast response, and repeatability less than 10%. All together, these features may have a strong impact in the early detection of AD.

Advances in HIV diagnosis and monitoring

Although highly active antiretroviral therapy (HAART) has been introduced over twenty years ago to treat Human Immunodeficiency Virus (HIV) positive patients, acquired immunodeficiency syndrome (AIDS) is still one of the deadliest diseases found worldwide. AIDS prevalence and mortality rates are usually more pronounced in resource-constrained countries than in the developed world. The lack of trained medical technicians, sophisticated diagnostic equipment, and the overall scarcity of medical infrastructures have severely impacted HIV/AIDS diagnostics, which hinders the initiation and periodic monitoring of antiretroviral therapy (ART). Currently, available HIV viral load assays are not well-suited for resource-limited settings due to their high cost and a requirement for medical/technical infrastructures. In this paper, we review current and emerging diagnostic assays for HIV detection, with a focus on point-of-care (POC) based immunoassays for viral load measurement, drug resistance, and HIV recurrence. We also discuss the limitations of the available HIV assays and highlight the technological advancements in cellphone, paper, and flexible material-based assays which have the potential to improve HIV diagnosis and monitoring, thus assisting with the management of the disease.

Magnetic Particles: Their Applications from Sample Preparations to Biosensing Platforms

The growing interest in magnetic materials as a universal tool has been shown by an increasing number of scientific publications regarding magnetic materials and its various applications. Substantial progress has been recently made on the synthesis of magnetic iron oxide particles in terms of size, chemical composition, and surface chemistry. In addition, surface layers of polymers, silica, biomolecules, etc., on magnetic particles, can be modified to obtain affinity to target molecules. The developed magnetic iron oxide particles have been significantly utilized for diagnostic applications, such as sample preparations and biosensing platforms, leading to the selectivity and sensitivity against target molecules and the ease of use in the sensing systems. For the process of sample preparations, the magnetic particles do assist in target isolation from biological environments, having non-specific molecules and undesired molecules. Moreover, the magnetic particles can be easily applied for various methods of biosensing devices, such as optical, electrochemical, and magnetic phenomena-based methods, and also any methods combined with microfluidic systems. Here we review the utilization of magnetic materials in the isolation/preconcentration of various molecules and cells, and their use in various techniques for diagnostic biosensors that may greatly contribute to future innovation in point-of-care and high-throughput automation systems.

Flexible potentiometric pH sensors for wearable systems

There is a growing demand for developing wearable sensors that can non-invasively detect the signs of chronic diseases early on to possibly enable self-health management. Among these the flexible and stretchable electrochemical pH sensors are particularly important as the pH levels influence most chemical and biological reactions in materials, life and environmental sciences. In this review, we discuss the most recent developments in wearable electrochemical potentiometric pH sensors, covering the key topics such as (i) suitability of potentiometric pH sensors in wearable systems; (ii) designs of flexible potentiometric pH sensors, which may vary with target applications; (iii) materials for various components of the sensor such as substrates, reference and sensitive electrode; (iv) applications of flexible potentiometric pH sensors, and (v) the challenges relating to flexible potentiometric pH sensors.

Emerging Nanotechnologies for Liquid Biopsy: The Detection of Circulating Tumor Cells and Extracellular Vesicles

Liquid biopsy enables noninvasive and dynamic analysis of molecular or cellular biomarkers, and therefore holds great potential for the diagnosis, prognosis, monitoring of disease progress and treatment efficacy, understanding of disease mechanisms, and identification of therapeutic targets for drug development. In this review, the recent progress in nanomaterials, nanostructures, nanodevices, and nanosensors for liquid biopsy is summarized, with a focus on the detection and molecular characterization of circulating tumor cells (CTCs) and extracellular vesicles (EVs). The developments and advances of nanomaterials and nanostructures in enhancing the sensitivity, specificity, and purity for the detection of CTCs and EVs are discussed. Sensing techniques for signal transduction and amplification as well as visualization strategies are also discussed. New technologies for the reversible release of the isolated CTCs and EVs and for single-CTC/EV analysis are summarized. Emerging microfluidic platforms for the integral on-chip isolation, detection, and molecular analysis are also included. The opportunities, challenges, and prospects of these innovative materials and technologies, especially with regard to their feasibility in clinical applications, are discussed. The applications of nanotechnology-based liquid biopsy will bring new insight into the clinical practice in monitoring and treatment of tumor and other significant diseases.

"Three-in-One" SERS Adhesive Tape for Rapid Sampling, Release, and Detection of Wound Infectious Pathogens

The traditional colony culture method for detection of pathogens is subjected to the laborious and tedious experimental procedure, which limits its application in point-of-care (POC) testing and quick diagnosis. This work designs an intelligent adhesive tape as a "three-in-one" platform for rapid sampling, photocontrolled release, and surface-enhanced Raman scattering (SERS) detection of pathogens from infected wounds. This tape is constructed by encapsulating densely packed gold nanostars as SERS substrates between two pieces of graphene and modified with a synthetic o-nitrobenzyl derivative molecule to form an artificial biointerface for highly efficient pathogen capture via electrostatic interaction. The captured targets can be conveniently released onto a solid culture medium by UV cleavage of o-nitrobenzyl moiety for pathogen growth and in situ SERS detection. As a proof of strategy, this "three-in-one" platform has been used for detecting the concurrent infection of Pseudomonas aeruginosa and Staphylococcus aureus by pasting the tape on a skin burn wound. The impressive detection performance with an analytical time of only several hours for these pathogens at an early growth stage demonstrates its great potential as a POC testing device for health care.

Development of a multiplex fully automated assay for rapid quantification of CD4+ T cells from whole blood

The development of cost-effective and rapid assays for the accurate counting of CD4 cells has remained prime focus for disease management. The lack of such assays has severely affected people living in resource-limited disease prevalent areas. CD4 count information plays a vital role in the effective management of HIV disease. There is an unmet need to develop rapid, cost-effective, portable and user-friendly point-of-care (POC) disease diagnostic platform technology for CD4+ T cell counting. Here, we have developed a flow-free magnetic actuation platform that uses antibody-coated magnetic beads to efficiently capture CD4+ T cells from a 30 μL drop of whole blood. On-chip cell lysate electrical impedance spectroscopy has been utilized to quantify the isolated CD4 cells. The developed assay has a limit of detection of 25 cells per μL and provides accurate CD4 counts in the range of 25-800 cells per μL. The whole immunoassay along with the enumeration process is very rapid and provides CD4 quantification results within 5 min time frame. The assay does not require off-chip sample preparation steps and minimizes human involvement to a greater extent. The developed impedance-based immunoassay has potential to significantly improve the CD4 enumeration process especially for POC settings.

Plasmonic-based platforms for diagnosis of infectious diseases at the point-of-care

Infectious diseases such as HIV-1/AIDS, tuberculosis (TB), hepatitis B (HBV), and malaria still exert a tremendous health burden on the developing world, requiring rapid, simple and inexpensive diagnostics for on-site diagnosis and treatment monitoring. However, traditional diagnostic methods such as nucleic acid tests (NATs) and enzyme linked immunosorbent assays (ELISA) cannot be readily implemented in point-of-care (POC) settings. Recently, plasmonic-based biosensors have emerged, offering an attractive solution to manage infectious diseases in the developing world since they can achieve rapid, real-time and label-free detection of various pathogenic biomarkers. Via the principle of plasmonic-based optical detection, a variety of biosensing technologies such as surface plasmon resonance (SPR), localized surface plasmon resonance (LSPR), colorimetric plasmonic assays, and surface enhanced Raman spectroscopy (SERS) have emerged for early diagnosis of HIV-1, TB, HBV and malaria. Similarly, plasmonic-based colorimetric assays have also been developed with the capability of multiplexing and cellphone integration, which is well suited for POC testing in the developing world. Herein, we present a comprehensive review on recent advances in surface chemistry, substrate fabrication, and microfluidic integration for the development of plasmonic-based biosensors, aiming at rapid management of infectious diseases at the POC, and thus improving global health.

Fabrication of laser printed microfluidic paper-based analytical devices (LP-µPADs) for point-of-care applications

Microfluidic paper-based analytical devices (µPADs) have provided a breakthrough in portable and low-cost point-of-care diagnostics. Despite their significant scope, the complexity of fabrication and reliance on expensive and sophisticated tools, have limited their outreach and possibility of commercialization. Herein, we report for the first time, a facile method to fabricate µPADs using a commonly available laser printer which drastically reduces the cost and complexity of fabrication. Toner ink is used to pattern the µPADs by printing, without modifying any factory configuration of the laser printer. Hydrophobic barriers are created by heating the patterned paper which melts the toner ink, facilitating its wicking into the cross-section of the substrate. Further, we demonstrate the utilization of the fabricated device by performing two assays. The proposed technique provides a versatile platform for rapid prototyping of µPADs with significant prospect in both developed and resource constrained region.

Flexible electrochemical glucose biosensor based on GOx/gold/MoS2/gold nanofilm on the polymer electrode

The need for flexible biosensors has increased because of their potential applications for point-of-care diagnosis and wearable biosensors. However, flexible biosensors have low sensitivity due to the flexibility of the electrode, and their fabrication involves complex processes. To overcome these limitations, a flexible electrochemical enzyme biosensor was developed in this study by immobilizing an enzyme on the flexible polymer electrode modified with a gold/MoS₂/gold nanofilm. The fabrication process involved sputter deposition of gold, spin coating of MoS₂, and sputter deposition of gold on the flexible polymer electrode (commercially available Kapton^® polyimide film). The flexible glucose biosensor was made by immobilization of glucose oxidase on a flexible electrode by using a chemical linker. The detection limit for glucose was estimated to be 10 nM, which indicates more sensitivity as compared with a previously reported flexible glucose sensor. This sensitivity is due to the facilitation of electron transfer by MoS₂. The flexure extension of this biosensor was estimated at 3.48 mm, which is much higher than that of the rigid sensor using a gold-coated silicon electrode (0.09 mm), according to measurements with a micro-fatigue tester. The proposed flexible biosensor composed of the enzyme/gold/MoS₂/gold nanofilm on the polymer electrode can be used as a flexible sensing platform for developing wearable biosensing systems because of its high sensitivity, high flexibility, and simple fabrication process.

Development of a Flow-Free Magnetic Actuation Platform for an Automated Microfluidic ELISA

There is a need to create an easily deployable and point-of-care (POC) diagnostic platform for disease outbreaks and for monitoring and maintenance of chronic illnesses. Such platforms are useful in regions where access to clinical laboratories may be limited or constrained using cost-effective solutions to quickly process high numbers of samples. Using oil and water liquid–liquid interphase separation, immunoassays developed for microfluidic chips can potentially meet this need when leveraged with electromagnetic actuation and antibody-coated superparamagnetic beads. We have developed a microfluidic immunoassay detection platform, which enables assay automation and maintains successful liquid containment for future use in the field. The assay was studied through a series of magnetic and fluid simulations to demonstrate these optimizations, and an optimized chip was tested using a target model for HIV-1, the p24 capsid antigen. The use of minimal reagents further lowers the cost of each assay and lowers the required sample volume for testing (<50 μL), that can offer easy turnaround for sample collection and assay results. The developed microfluidic immunoassay platform can be easily scaled for multiplex or multi-panel specific testing at the POC.

A flow-free device is developed for automated and rapid ELISA testing at the point-of-care settings.

Recent Developments in Printing Flexible and Wearable Sensing Electronics for Healthcare Applications

Wearable biosensors attract significant interest for their capabilities in real-time monitoring of wearers' health status, as well as the surrounding environment. Sensor patches are embedded onto the human epidermis accompanied by data readout and signal conditioning circuits with wireless communication modules for transmitting data to the computing devices. Wearable sensors designed for recognition of various biomarkers in human epidermis fluids, such as glucose, lactate, pH, cholesterol, etc., as well as physiological indicators, i.e., pulse rate, temperature, breath rate, respiration, alcohol, activity monitoring, etc., have potential applications both in medical diagnostics and fitness monitoring. The rapid developments in solution-based nanomaterials offered a promising perspective to the field of wearable sensors by enabling their cost-efficient manufacturing through printing on a wide range of flexible polymeric substrates. This review highlights the latest key developments made in the field of wearable sensors involving advanced nanomaterials, manufacturing processes, substrates, sensor type, sensing mechanism, and readout circuits, and ends with challenges in the future scope of the field. Sensors are categorized as biological and fluidic, mounted directly on the human body, or physiological, integrated onto wearable substrates/gadgets separately for monitoring of human-body-related analytes, as well as external stimuli. Special focus is given to printable materials and sensors, which are key enablers for wearable electronics.

Designing Paper-Based Immunoassays for Biomedical Applications

Paper-based sensors and assays have been highly attractive for numerous biological applications, including rapid diagnostics and assays for disease detection, food safety, and clinical care. In particular, the paper immunoassay has helped drive many applications in global health due to its low cost and simplicity of operation. This review is aimed at examining the fundamentals of the technology, as well as different implementations of paper-based assays and discuss novel strategies for improving their sensitivity, performance, or enabling new capabilities. These innovations can be categorized into using unique nanoparticle materials and structures for detection via different techniques, novel biological species for recognizing biomarkers, or innovative device design and/or architecture.

The design, fabrication, and applications of flexible biosensing devices

Flexible biosensors form part of a rapidly growing research field that take advantage of a multidisciplinary approach involving materials, fabrication and design strategies to be able to function at biological interfaces that may be soft, intrinsically curvy, irregular, or elastic. Numerous exciting advancements are being proposed and developed each year towards applications in healthcare, fundamental biomedical research, food safety and environmental monitoring. In order to place these developments in perspective, this review is intended to present an overview on field of flexible biosensor development. We endeavor to show how this subset of the broader field of flexible and wearable devices presents unique characteristics inherent in their design. Initially, a discussion on the structure of flexible biosensors is presented to address the critical issues specific to their design. We then summarize the different materials as substrates that can resist mechanical deformation while retaining their function of the bioreceptors and active elements. Several examples of flexible biosensors are presented based on the different environments in which they may be deployed or on the basis of targeted biological analytes. Challenges and future perspectives pertinent to the current and future stages of development are presented. Through these summaries and discussion, this review is expected to provide insights towards a systematic and fundamental understanding for the fabrication and utilization of flexible biosensors, as well as inspire and improve designs for smart and effective devices in the future.

Smartphone-based clinical diagnostics: towards democratization of evidence-based health care

Recent advancements in bioanalytical techniques have led to the development of novel and robust diagnostic approaches that hold promise for providing optimal patient treatment, guiding prevention programs and widening the scope of personalized medicine. However, these advanced diagnostic techniques are still complex, expensive and limited to centralized healthcare facilities or research laboratories. This significantly hinders the use of evidence-based diagnostics for resource-limited settings and the primary care, thus creating a gap between healthcare providers and patients, leaving these populations without access to precision and quality medicine. Smartphone-based imaging and sensing platforms are emerging as promising alternatives for bridging this gap and decentralizing diagnostic tests offering practical features such as portability, cost-effectiveness and connectivity. Moreover, towards simplifying and automating bioanalytical techniques, biosensors and lab-on-a-chip technologies have become essential to interface and integrate these assays, bringing together the high precision and sensitivity of diagnostic techniques with the connectivity and computational power of smartphones. Here, we provide an overview of the emerging field of clinical smartphone diagnostics and its contributing technologies, as well as their wide range of areas of application, which span from haematology to digital pathology and rapid infectious disease diagnostics.

Nanomaterial-based biosensors for measurement of lipids and lipoproteins towards point-of-care of cardiovascular disease

Cardiovascular disease (CVD) has become the primary cause of global deaths and inflicts an enormous healthcare burden on both developed and developing countries. Frequent monitoring of CVD-associated risk factors such as the level of lipids (e.g., triglyceride (TG) and total cholesterol (TC)) and lipoproteins (e.g., low-density lipoprotein (LDL) and high-density lipoprotein (HDL)) can effectively help prevent disease progression and improve clinical outcomes. However, measurement of these risk factors is generally integrated into an automated analyzer, which is prohibitively expensive and highly instrument-dependent for routine testing in primary care settings. As such, a variety of rapid, simple and portable nanomaterial-based biosensors have been developed for measuring the level of lipids (TG and TC) and lipoproteins (LDL and HDL) towards the management of CVD at the point-of-care (POC). In this review, we first summarize traditional methods for measurement of lipids and lipoproteins, and then present the latest advances in developing nanomaterial-based biosensors that can potentially monitor the risk factors of CVD at the POC.

Advances in Diagnostic Methods for Zika Virus Infection

The Zika virus (ZIKV) is one of the most infamous mosquito-borne flavivirus on recent memory due to its potential association with high mortality rates in fetuses, microcephaly and neurological impairments in neonates, and autoimmune disorders. The severity of the disease, as well as its fast spread over several continents, has urged the World Health Organization (WHO) to declare ZIKV a global health concern. In consequence, over the past couple of years, there has been a significant effort for the development of ZIKV diagnostic methods, vaccine development, and prevention strategies. This review focuses on the most recent aspects of ZIKV research which includes the outbreaks, genome structure, multiplication and propagation of the virus, and more importantly, the development of serological and molecular detection tools such as Zika IgM antibody capture enzyme-linked immunosorbent assay (Zika MAC-ELISA), plaque reduction neutralization test (PRNT), reverse transcription quantitative real-time polymerase chain reaction (qRT-PCR), reverse transcription-loop mediated isothermal amplification (RT-LAMP), localized surface plasmon resonance (LSPR) biosensors, nucleic acid sequence-based amplification (NASBA), and recombinase polymerase amplification (RPA). Additionally, we discuss the limitations of currently available diagnostic methods, the potential of newly developed sensing technologies, and also provide insight into future areas of research.

Large-Area Silver-Stibnite Nanoporous Plasmonic Films for Label-Free Biosensing

The development of various plasmonic nanoporous materials has attracted much interest in different areas of research including bioengineering and biosensing because of their large surface area and versatile porous structure. Here, we introduce a novel technique for fabricating silver-stibnite nanoporous plasmonic films. Unlike conventional techniques that are usually used to fabricate nanoporous plasmonic films, we use a room-temperature growth method that is wet-chemistry free, which enables wafer-scale fabrication of nanoporous films on flexible substrates. We show the existence of propagating surface plasmon polaritons in nanoporous films and demonstrate the extreme bulk refractive index sensitivity of the films using the Goos-Hänchen shift interrogation scheme. In the proof-of-concept biosensing experiments, we functionalize the nanoporous films with biotin-thiol using a modified functionalization technique, to capture streptavidin. The fractal nature of the films increases the overlap between the local field and the immobilized biomolecules. The extreme sensitivity of the Goos-Hänchen shift allows femtomolar concentrations of streptavidin to be detected in real time, which is unprecedented using surface plasmons excited via the Kretschmann configuration.

Paper-based lateral flow strip assay for the detection of foodborne pathogens: principles, applications, technological challenges and opportunities

As a representative colorimetic biosnesor, paper-based LFSA have emerged as a promising and robust tool that can easily and instansly detect the presence of target biological components in food sample. Recently, LFSAs have gained a considerable attention as an alternative method for rapid diagnosis of foodborne pathogens to the conventional culture-based assays such as plate counting and PCR. One major drawback of the current LFSAs for the detection of pathogenic bacteria is the low sensitivity, limiting its practical applications in POCT. Not like many other protein-based biomarkers that are present in nM or pM range, the number of pathogenic bacteria that cause disease can be as low as few CFU/ml. Here, we review current advances in LFSAs for the detection of pathogenic bacteria in terms of chromatic agents and analyte types. Furthermore, recent approaches for signal enhancement and modifications of the LFSA architecture for multiplex detection of pathogenic bacteria are included in this review, together with the advantages and limitations of each techniques. Finally, the technological challenges and future prospect of LFSA-based POCT for the detection of pathogenic bacteria are discussed.

The potential of paper-based diagnostics to meet the ASSURED criteria

Paper-based diagnostics have already revolutionized point-of-care approaches for health and environmental applications, by providing low-cost, disposable tools that can be utilized in remote settings. These devices typically consist of microfluidic, chemical, and biological diagnostic components implemented on paper substrates, towards addressing the ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and Robust, Equipment free and Deliverable to end users) principles set out by the World Health Organization. Paper-based diagnostics primarily contribute to the affordable, equipment-free, and deliverable-to-end-user aspects. However, additional functionality must be integrated with paper-based diagnostic devices to achieve truly ASSURED solutions. Advances in printed electronics provide a fitting foundation for implementing augmented functionality, while maintaining the affordability and disposability of paper-based diagnostics. This paper reviews the printed functional building blocks that contribute towards achieving this goal, from individual printed electronic components to fully integrated solutions. Important modules for sensing, read-out of results, data processing and communication, and on-board power are explored, and solutions printed on flexible or paper-based substrates for integration with paper-based diagnostics are considered. Although many of the unit operations required to achieve the ASSURED criteria can be implemented using paper, basic system functionality is still lacking, and this requires a concerted effort in integration of the various components for truly ASSURED solutions to be realized. Beyond ASSURED, modern clinical practises and crisis readiness also require additional informational functionality, which a systems approach using paper-based solutions could ensure.

Molecular Fingerprints of Hemoglobin on a Nanofilm Chip

Hemoglobin is an iron carrying protein in erythrocytes and also an essential element to transfer oxygen from the lungs to the tissues. Abnormalities in hemoglobin concentration are closely correlated with health status and many diseases, including thalassemia, anemia, leukemia, heart disease, and excessive loss of blood. Particularly in resource-constrained settings existing blood analyzers are not readily applicable due to the need for high-level instrumentation and skilled personnel, thereby inexpensive, easy-to-use, and reliable detection methods are needed. Herein, a molecular fingerprints of hemoglobin on a nanofilm chip was obtained for real-time, sensitive, and selective hemoglobin detection using a surface plasmon resonance system. Briefly, through the photopolymerization technique, a template (hemoglobin) was imprinted on a monomeric (acrylamide) nanofilm on-chip using a cross-linker (methylenebisacrylamide) and an initiator-activator pair (ammonium persulfate-tetramethylethylenediamine). The molecularly imprinted nanofilm on-chip was characterized by atomic force microscopy and ellipsometry, followed by benchmarking detection performance of hemoglobin concentrations from 0.0005 mg mL⁻¹ to 1.0 mg mL⁻¹. Theoretical calculations and real-time detection implied that the molecularly imprinted nanofilm on-chip was able to detect as little as 0.00035 mg mL⁻¹ of hemoglobin. In addition, the experimental results of hemoglobin detection on the chip well-fitted with the Langmuir adsorption isotherm model with high correlation coefficient (0.99) and association and dissociation coefficients (39.1 mL mg⁻¹ and 0.03 mg mL⁻¹) suggesting a monolayer binding characteristic. Assessments on selectivity, reusability and storage stability indicated that the presented chip is an alternative approach to current hemoglobin-targeted assays in low-resource regions, as well as antibody-based detection procedures in the field. In the future, this molecularly imprinted nanofilm on-chip can easily be integrated with portable plasmonic detectors, improving its access to these regions, as well as it can be tailored to detect other proteins and biomarkers.

Flexible Localized Surface Plasmon Resonance Sensor with Metal-Insulator-Metal Nanodisks on PDMS Substrate

The small sized, flexible, high-performed and bio-compatible sensing devices are the critical elements to realize the bio-related detection or on-site health monitoring systems. In this work, the flexible localized surface plasmon resonance (LSPR) bio-sensors were demonstrated by integrating the metal-insulator-metal (MIM) nanodisks with bio-compatible polydimethylsiloxane (PDMS) substrate. The different geometries of MIM nanodisk sensors were investigated and optimized to enhance the spatial overlap of the LSPR waves with the environment, which lead to a high sensitivity of 1500 nm/RIU. The omni-directional characteristics of LSPR resonances were beneficial for maintaining the device sensitivity stable under various bending curvatures. Furthermore, the flexible MIM nanodisk LSPR sensor was applied to detect A549 cancer cells in PBS+ solution. The absorption peak of the MIM-disk LSPR sensor obviously redshift to easily distinguish between the phosphate buffered saline (PBS+) solution with A549 cancer cells and without cells. Therefore, the flexible MIM nanodisk LSPR sensor is suitable to develop on-chip microfluidic biosensors for detection of cancer cells on nonplanar surfaces.