Biosensors for Parkinson's Disease: Where Are We Now, and Where Do We Need to Go?

Parkinson's Disease is the second most common neurological disease in the United States, yet there is no cure, no pinpointed cause, and no definitive diagnostic procedure. Parkinson's is typically diagnosed when patients present with motor symptoms such as slowness of movement and tremors. However, none of these are specific to Parkinson's, and a confident diagnosis of Parkinson's is typically only achieved when 60-80% of dopaminergic neurons are no longer functioning, at which point much of the damage to the brain is irreversible. This Perspective details ongoing efforts and accomplishments in biosensor research with the goal of overcoming these issues for Parkinson's diagnosis and care, with a focus on the potential impact of early diagnosis and associated opportunities to pinpoint a cause and a cure. We critically analyze the strengths and shortcomings of current technologies and discuss the ideal characteristics of a diagnostic technology toolbox to guide future research decisions in this space. Finally, we assess what role biosensors can play in facilitating precision medicine for Parkinson's patients.

An innovative transportable immune device for the recognition of α-synuclein using KCC-1-nPr-CS2 modified silver nano-ink: integration of pen-on-paper technology with biosensing toward early-stage diagnosis of Parkinson's disease

Parkinson's disease (PD), the second most frequent neurodegenerative illness, is a neurological ailment that produces unintentional or uncontrolled body movements, which should be diagnosed in its early stages to hinder the progression. Monitoring the concentration of α-synuclein (α-Syn) in body fluids can be one of the most efficient ways for PD early detection. In this work, a paper-based electrochemical immunosensor was designed for α-Syn bio-assay in human plasma samples based on encapsulation of the biotinylated antibody on novel dendritic fibrous nanosilica ((KCC-1-nPr-CS2)-Ab). For this purpose, a three-electrode system was prepared using stabilization of silver nano-ink on photographic paper. Then, the (KCC-1-NH-CS2)-Ab was immobilized on its surface and used to detect the target antigen (α-Syn). After characterization of the prepared substrate by FE-SEM and EDS, the redox behavior of the biosensor was evaluated using chronoamperometry techniques. Under optimal experimental conditions and using a label-free strategy, the engineered immunosensor showed a linear relationship between peak current and antigen concentration in the linear range from 0.002 to 128 ng mL-1 with the lower limit of quantification of 0.002 ng mL-1. Moreover, this work involves unprecedented use of conductive nano-inks for the manufacture of α-Syn immunosensor, which is aided by the use of a mesoporous silicate dendrimer in encapsulating the α-Syn antibody, thus offering a robust and simple point-of-care device for early PD diagnosis. The ability of the proposed platform to detect small amounts of α-Syn offers a promising approach to developing low-cost, sensitive, and transportable biosensors for Parkinson's disease screening in its early stages.

Alpha-Synuclein in Peripheral Tissues as a Possible Marker for Neurological Diseases and Other Medical Conditions

The possible usefulness of alpha-synuclein (aSyn) determinations in peripheral tissues (blood cells, salivary gland biopsies, olfactory mucosa, digestive tract, skin) and in biological fluids, except for cerebrospinal fluid (serum, plasma, saliva, feces, urine), as a marker of several diseases, has been the subject of numerous publications. This narrative review summarizes data from studies trying to determine the role of total, oligomeric, and phosphorylated aSyn determinations as a marker of various diseases, especially PD and other alpha-synucleinopathies. In summary, the results of studies addressing the determinations of aSyn in its different forms in peripheral tissues (especially in platelets, skin, and digestive tract, but also salivary glands and olfactory mucosa), in combination with other potential biomarkers, could be a useful tool to discriminate PD from controls and from other causes of parkinsonisms, including synucleinopathies.

Sensitive electrochemical recognition of α-synuclein protein in human plasma samples using bioconjugated gold nanoparticles: An innovative immuno-platform to assist in the early stage identification of Parkinson's disease by biosensor technology

This research work explains the development of an electrochemical immunosensor for the selective recognition of SNCA in human biofluids. An innovative protocol was proposed for the green synthesis of gold nanoparticle-supported dimethylglyoxime (AuNPs@DMGO) using one-step electrogeneration method. Also, the application of AuNPs@DMGO for the sensitive quantification of α-Synuclein (SNCA) protein and its biomedical analysis. So, an innovative sandwich immunosensor was designed for the sensitive identification of SNCA antigen in an aqueous solution. The gold nanoparticles (AuNPs) were decorated on the surface of the glassy carbon electrode by chronoamperometry technique to provide appropriate immobilization surface with a large number of active sites for immobilization of specific biotinylated antibody (Ab1) and against SNCA protein. Then, the sandwich-type immuno-platform was completed by the attachment of secondary antibody (HRP conjugated Ab [Ab2]) to the primary complexes on the surface of the electrode. For the first time, α-Synuclein protein was measured with an acceptable linear range of 4-64 ng/mL and a lower limit of quantification of 4 ng/mL. Benefiting from the simplicity and high sensitivity, the proposed method shows a potential of employment in clinical applications and high-throughput screening of Parkinson's disease using POC.

Facile fabrication of highly sensitive and non-label aptasensors based on antifouling amyloid-like protein aggregates

In this paper, we present a robust and versatile method for developing non-label aptasensors with high sensitivity. Amyloid-like protein aggregates were facilely synthesized with the commonly used passivating agent bovine serum albumin (BSA) in developing biosensors, and the produced amyloid-like phase-transited BSA (PTB) exhibited excellent antifouling performances and robust interfacial adhesion with the electrode surface. In order to improve the detection sensitivity of electrochemical measurements, reduced graphene oxide was electrochemically deposited onto the electrode surface. Moreover, gold nanoparticles were introduced to enhance the conductivity of the PTB film and facilitate subsequent aptamer modification. Two common biological species, adenosine triphosphate (ATP) and cytochrome c (cyt c), were chosen as detection targets, and their corresponding aptasensors were successfully constructed and systematically evaluated. The proposed aptasensors based on the PTB-Au antifouling composite exhibited high sensitivity and specificity towards ATP and cyt c detection, and the detection limits were calculated to be 0.26 nM and 0.64 nM for ATP and cyt c, respectively. Hence, this work provides a simple approach to develop highly sensitive aptasensors without any labeling process, and thus promises its great application in biological analysis.

Alpha-Synuclein Autoimmune Decline in Prodromal Multiple System Atrophy and Parkinson's Disease

Multiple-system trophy (MSA) and Parkinson's Disease (PD) are both progressive, neurodegenerative diseases characterized by neuropathological deposition of aggregated alpha-synuclein (αSyn). The causes behind this aggregation are still unknown. We have reported aberrancies in MSA and PD patients in naturally occurring autoantibodies (nAbs) against αSyn (anti-αSyn-nAbs), which are important partakers in anti-aggregatory processes, immune-mediated clearance, and anti-inflammatory functions. To elaborate further on the timeline of autoimmune aberrancies towards αSyn, we investigated here the Immunoglobulin (Ig) affinity profile and subclass composition (IgG-total, IgG1-4 and IgM) of anti-αSyn-nAbs in serum samples from prodromal (p) phases of MSA and PD. Using an electrochemiluminescence competition immunoassay, we confirmed that the repertoire of high-affinity anti-αSyn-nAbs is significantly reduced in pMSA and pPD. Further, we demonstrated that pPD had increased anti-αSyn IgG-total levels compared to pMSA and controls, concordant with increased anti-αSyn IgG1 levels in pPD. Anti-αSyn IgG2 and IgG4 levels were reduced in pMSA and pPD compared with controls, whereas anti-αSyn IgG3 levels were reduced in pMSA compared to pPD and controls. The results indicate that the impaired reactivity towards αSyn occurs prior to disease onset. The apparent lack of high-affinity anti-αSyn nAbs may result in reduced clearance of αSyn, leading to aggregation of the protein. Thus, this study provides novel insights into possible causes behind the pathogenesis in synucleinopathies such as MSA and PD.

The relevance of synuclein autoantibodies as a biomarker for Parkinson's disease

Several studies have investigated if the levels of α-synuclein autoantibodies (α-syn AAb) differ in serum of Parkinson's disease (PD) patients and healthy subjects. Reproducible differences in their levels could serve as a biomarker for PD. The results of previous studies however remain inconclusive. With the largest sample size examined so far, we aimed to validate serum α-syn AAb levels as a biomarker for PD and investigated the presence of AAbs against other synucleins. We performed ELISA and immunoblots to determine synuclein AAb levels in the serum of 295 subjects comprising 157 PD patients from two independent cohorts, 46 healthy subjects, and 92 patients with other neurodegenerative disorders. Although serum α- and β-syn AAb levels were significantly reduced in patients with PD and other neurodegenerative disorders as compared to controls, the AAb levels displayed high inter-and intra-cohort variability. Furthermore, α-syn AAb levels showed no correlation to clinical parameters like age, disease duration, disease severity, and gender, that might also be directed against beta- and gamma-syn. In conclusion, serum synuclein AAb levels do allow the separation of PD from healthy subjects but not from other neurodegenerative disorders. Thus, synuclein AAbs cannot be regarded as a reliable biomarker for PD.

Rational design of smart nano-platforms based on antifouling-nanomaterials toward multifunctional bioanalysis

The ability to design nanoprobe devices with the capability of quantitative/qualitative operation in complex media will probably underpin the main upcoming progress in healthcare research and development. However, the biomolecules abundances in real samples can considerably alter the interface performance, where unwanted adsorption/adhesion can block signal response and significantly decrease the specificity of the assay. Herein, this review firstly offers a brief outline of several significances of fabricating high-sensitivity and low-background interfaces to adjust various targets' behaviors induced via bioactive molecules on the surface. Besides, some important strategies to resist non-specific protein adsorption and cell adhesion, followed by imperative categories of antifouling reagents utilized in the construction of high-performance solid sensory interfaces, are discussed. The next section specifically highlights the various nanocomposite probes based on antifouling-nanomaterials for electrode modification containing carbon nanomaterials, noble metal nanoparticles, magnetic nanoparticles, polymer, and silicon-based materials in terms of nanoparticles, rods, or porous materials through optical or chemical strategies. We specially outline those nanoprobes that are capable of identification in complex media or those using new constructions/methods. Finally, the necessity and requirements for future advances in this emerging field are also presented, followed by opportunities and challenges.

Sensitive immunosensing of α-synuclein protein in human plasma samples using gold nanoparticles conjugated with graphene: an innovative immuno-platform towards early stage identification of Parkinson's disease using point of care (POC) analysis

Parkinson's disease (PD) or simply Parkinson's is a long-term degenerative disorder of the central nervous system, which mainly affects the motor system. Consequently, the detection and quantification of related biomarkers play vital roles in the early-stage diagnosis of PD. In the present study, an innovative electrochemical immunosensor based on gold nanoparticle-modified graphene towards bioconjugation with biotinylated antibody (bioreceptor) was developed for the ultra-sensitive and specific monitoring of the alpha-synuclein (α-synuclein) protein. The synergistic effects between the gold nanoparticles (AuNPs) and graphene drastically enhanced the electrochemical activity of the resulting materials. The enhanced conductivity of the substrate together with the increase in its surface area improved the sensitivity and lowered the detection limit of the capture layer. For the first time, the α-synuclein protein was measured in human plasma samples using bioconjugated AuNP-Gr bioconjugated specific antibody with an acceptable linear range of 4 to 128 ng mL-1 and a lower limit of quantification (LLOQ) of 4 ng mL-1. Accordingly, it is expected that this diagnostic method may be produced in the near future for clinical applications and high-throughput screening of PD using point of care (POC) analysis.

Chemoselective Bioconjugation of Amyloidogenic Protein Antigens to PEGylated Microspheres Enables Detection of α-Synuclein Autoantibodies in Human Plasma

The misfolding and subsequent aggregation of amyloidogenic proteins is a classic pathological hallmark of neurodegenerative diseases. Aggregates of the α-synuclein protein (αS) are implicated in Parkinson's disease (PD) pathogenesis, and naturally occurring autoantibodies to these aggregates are proposed to be potential early-stage biomarkers to facilitate the diagnosis of PD. However, upon misfolding, αS forms a multitude of quaternary structures of varying functions that are unstable ex vivo. Thus, when used as a capture agent in enzyme-linked immunosorbent assays (ELISAs), significant variance among laboratories has prevented the development of these valuable diagnostic tests. We reasoned that those conflicting results arise due to the high nonspecific binding and amyloid nucleation that are typical of ELISA platforms. In this work, we describe a multiplexed, easy-to-operate immunoassay that is generally applicable to quantify the levels of amyloid proteins and their binding partners, named Oxaziridine-Assisted Solid-phase Immunosorbent (OASIS) assay. The assay is built on a hydrophilic poly(ethylene glycol) scaffold that inhibits aggregate nucleation, which we show reduces assay variance when compared to similar ELISA measurements. To validate our OASIS assay in patient-derived samples, we measured the levels of naturally occurring antibodies against the αS monomer and oligomers in a cohort of donor plasma from patients diagnosed with PD. Using OASIS assays, we observed significantly higher titers of immunoglobulin G antibody recognizing αS oligomers in PD patients compared to those in healthy controls, while there was no significant difference in naturally occurring antibodies against the αS monomer. In addition to its development into a blood test to potentially predict or monitor PD, we anticipate that the OASIS assay will be of high utility for studies aimed at understanding protein misfolding, its pathology and symptomology in PD, and other neurodegenerative diseases.

Functional Molecular Interfaces for Impedance-Based Diagnostics

In seeking to develop and optimize reagentless electroanalytical assays, a consideration of the transducing interface features lies key to any subsequent sensitivity and selectivity. This review briefly summarizes some of the most commonly used receptive interfaces that have been employed within the development of impedimetric molecular sensors. We discuss the use of high surface area carbon, nanoparticles, and a range of bioreceptors that can subsequently be integrated. The review spans the most commonly utilized biorecognition elements, such as antibodies, antibody fragments, aptamers, and nucleic acids, and touches on some novel emerging alternatives such as nanofragments, molecularly imprinted polymers, and bacteriophages. Reference is made to the immobilization chemistries available along with a consideration of both optimal packing density and recognition probe orientation. We also discuss assay-relevant mechanistic details and applications in real sample analysis.

Electrochemical biosensors for the detection and study of α-synuclein related to Parkinson's disease - A review

Parkinson's disease (PD) is a long-term degenerative disorder that affects predominately dopaminergic neurons in the substantia nigra, which mainly control movement. Alpha-synuclein (α-syn) is a major constituent of Lewy bodies that are reported to be the most important toxic species in the brain of PD patients. In this critical review, we highlight novel electrochemical biosensors that have been recently developed utilizing aptamers and antibodies in connection with various nanomaterials to study biomarkers related to PD such as α-syn. We also review several research articles that have utilized electrochemical biosensors to study the interaction of α-syn with biometals as well as small molecules such as clioquinol, (-)-epigallocatechin-3-gallate (EGCG) and baicalein. Due to the significant advances in nanomaterials in the past decade, electrochemical biosensors capable of detecting multiple biomarkers in clinically relevant samples in real-time have been achieved. This may facilitate the path towards commercialization of electrochemical biosensors for clinical applications and high-throughput screening of small molecules for structure-activity relationship (SAR) studies.

Immune system and new avenues in Parkinson’s disease research and treatment

Parkinson’s disease (PD) is a progressive neurological disorder characterized by degeneration of dopaminergic neurons in the substantia nigra. However, although 200 years have now passed since the primary clinical description of PD by James Parkinson, the etiology and mechanisms of neuronal loss in this disease are still not fully understood. In addition to genetic and environmental factors, activation of immunologic responses seems to have a crucial role in PD pathology. Intraneuronal accumulation of α-synuclein (α-Syn), as the main pathological hallmark of PD, potentially mediates initiation of the autoimmune and inflammatory events through, possibly, auto-reactive T cells. While current therapeutic regimens are mainly used to symptomatically suppress PD signs, application of the disease-modifying therapies including immunomodulatory strategies may slow down the progressive neurodegeneration process of PD. The aim of this review is to summarize knowledge regarding previous studies on the relationships between autoimmune reactions and PD pathology as well as to discuss current opportunities for immunomodulatory therapy.

A Systematic Review and Meta-Analysis of Alpha Synuclein Auto-Antibodies in Parkinson's Disease

Immune dysfunction has been associated with Parkinson's disease (PD) and its progression. Antibodies play an important role in both innate and adaptive responses, acting as powerful effector molecules that can propagate inflammation by activating innate immune cells. Alpha synuclein binding antibodies have been described in PD patients with conflicting associations. In this article, we consider the potential mechanistic basis of alpha synuclein auto-antibody development and function in PD. We present a systematic review and meta-analysis of antibody studies in PD cohorts showing that there is weak evidence for an increase in alpha synuclein auto-antibodies in PD patients particularly in early disease. The confidence with which this conclusion can be drawn is limited by the heterogeneity of the clinical cohorts used, inclusion of unmatched controls, inadequate power and assay related variability. We have therefore made some recommendations for the design of future studies.

Immunochemical Detection of α-Synuclein Autoantibodies in Parkinson's Disease: Correlation between Plasma and Cerebrospinal Fluid Levels

Autoantibodies to Parkinson's disease (PD) amyloidogenic protein, α-synuclein, were recognized as a prospective biomarker for early disease diagnostics, yet there is inconsistency in previous reports, potentially related to PD status. Therefore, plasma and cerebrospinal fluid (CSF) of the cross-sectional cohort of 60 individuals, including recently diagnosed PD patients with mild and moderate PD and age-matched controls, were examined by enzyme-linked immunosorbent assay (ELISA). Nonparametric statistics was used for data analysis. We found significantly elevated levels of α-synuclein autoantibodies in both plasma and CSF in mild PD compared to controls, followed by some decrease in moderate PD. Receiver operating characteristic and effect size analyses confirmed the diagnostic power of α-synuclein antibodies in both plasma and CSF. For the first time, we showed the correlation between plasma and CSF α-synuclein antibody levels for mild, moderate, and combined PD groups. This indicates the potentiality of α-synuclein antibodies as PD biomarker and the increased diagnostic power of their simultaneous analysis in plasma and CSF.

Optimization of the Small Glycan Presentation for Binding a Tumor-Associated Antibody: Application to the Construction of an Ultrasensitive Glycan Biosensor

The main aim of the study was to optimize the interfacial presentation of a small antigen-a Tn antigen (N-acetylgalactosamine)-for binding to its analyte anti-Tn antibody. Three different methods for the interfacial display of a small glycan are compared here, including two methods based on the immobilization of the Tn antigen on a mixed self-assembled monolayer (SAM) (2D biosensor) and the third one utilizing a layer of a human serum albumin (HSA) for the immobilization of a glycan forming a 3D interface. Results showed that the 3D interface with the immobilized Tn antigen is the most effective bioreceptive surface for binding its analyte. The 3D impedimetric glycan biosensor exhibited a limit of detection of 1.4 aM, a wide linear range (6 orders of magnitude), and high assay reproducibility with an average relative standard deviation of 4%. The buildup of an interface was optimized using various techniques with the visualization of the glycans on the biosensor surface by atomic force microscopy. The study showed that the 3D biosensor is not only the most sensitive compared to other two biosensor platforms but that the Tn antigen on the 3D biosensor surface is more accessible for antibody binding with better kinetics of binding (t_50% = 137 s, t_50% = the time needed to attain 50% of a steady-state signal) compared to the 2D biosensor configuration with t_50% = 354 s. The 3D glycan biosensor was finally applied for the analysis of a human serum sample spiked with an analyte.