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Shahriari S, Selvaganapathy PR. Integration of hydrogels into microfluidic devices with porous membranes as scaffolds enables their drying and reconstitution. BIOMICROFLUIDICS 2022; 16:054108. [PMID: 36313189 PMCID: PMC9616609 DOI: 10.1063/5.0100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Hydrogels are a critical component of many microfluidic devices. They have been used in cell culture applications, biosensors, gradient generators, separation microdevices, micro-actuators, and microvalves. Various techniques have been utilized to integrate hydrogels into microfluidic devices such as flow confinement and gel photopolymerization. However, in these methods, hydrogels are typically introduced in post processing steps which add complexity, cost, and extensive fabrication steps to the integration process and can be prone to user induced variations. Here, we introduce an inexpensive method to locally integrate hydrogels into microfluidic devices during the fabrication process without the need for post-processing. In this method, porous and fibrous membranes such as electrospun membranes are used as scaffolds to hold gels and they are patterned using xurography. Hydrogels in various shapes as small as 200 μm can be patterned using this method in a scalable manner. The electrospun scaffold facilitates drying and reconstitution of these gels without loss of shape or leakage that is beneficial in a number of applications. Such reconstitution is not feasible using other hydrogel integration techniques. Therefore, this method is suitable for long time storage of hydrogels in devices which is useful in point-of-care (POC) devices. This hydrogel integration method was used to demonstrate gel electrophoretic concentration and quantification of short DNA (150 bp) with different concentrations in rehydrated agarose embedded in electrospun polycaprolactone (PCL) membrane. This can be developed further to create a POC device to quantify cell-free DNA, which is a prognostic biomarker for severe sepsis patients.
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Affiliation(s)
- Shadi Shahriari
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario L8S 4L7, Canada
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2
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He S, Yang Y, Xu Z, Ling H, Wang Y, Wan L, Huang N, Ye Q, Liu Y. Development of Enzyme-Free DNA Amplifier Based on Chain Reaction Principle. Acta Biomater 2022; 149:213-219. [PMID: 35811071 DOI: 10.1016/j.actbio.2022.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
Enzyme-free DNA amplifiers can amplify the signal of nucleic acid molecules. They can be applied to DNA molecular operation and nucleic acid detection. The reaction speed is the core index to evaluate DNA amplifiers. In this study, we designed a DNA amplifier based on an enzyme-free chain reaction. This DNA amplifier can release one more signal molecule in each round of reaction and trigger the next round, which significantly improved reaction speed. Moreover, because the amplifier used a stable DNA structure, the reaction can occur at room temperature. To integrate the amplifier into other DNA molecular operations, we performed the amplification reaction in a microfluidic chip module. The results showed that the amplifier can realize real-time signal feedback at a proper input molecule concentration and reach the endpoint in 40 s, even at a low relative concentration. To apply the amplifier for nucleic acid detection, we also used a conventional fluorescent polymerase chain reaction instrument for the reaction. The results showed that the amplifier specifically detected trace DNA single-stranded molecules. To solve the leakage problem of existing amplifiers, we designed a DNA molecule as the chain reaction's inhibitor, which was crucial in controlling the reaction speed and preventing leakage. STATEMENT OF SIGNIFICANCE: Traditional amplifier strategies of enzyme-free DNA amplifiers relied on a constant number of cycling molecules to catalyze the amplifier molecules' changing structure and release fluorescent signals, which lead low reaction speed. Based on an enzyme-free chain reaction, we designed a DNA amplifier which can release one more cycling molecule in each loop and trigger the next loop and significantly improve reaction speed in this study. Our analysis on microfluidic chip module and PCR instrument verifies high sensitivity and selectivity. And this strategy of DNA amplifier realizes the control of reaction and prevents leakage. We believe that this automated amplification strategy could have great applications in vivo signal detection, imaging, and signal molecule translation.
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Affiliation(s)
- Songlin He
- School of Medicine, Nankai University, Tianjin 300071, China; Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yongkang Yang
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Ziheng Xu
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Hongkun Ling
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Yu Wang
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Li Wan
- School of Medicine, Nankai University, Tianjin 300071, China; Nankai University Eye Institute, Nankai University, Tianjin 300071, China
| | - Ningning Huang
- Key Laboratory of Weak-Light Nonlinear Photonics, Ministry of Education, School of Physics and TEDA Applied Physics, Nankai University, Tianjin 300071, China
| | - Qing Ye
- Key Laboratory of Weak-Light Nonlinear Photonics, Ministry of Education, School of Physics and TEDA Applied Physics, Nankai University, Tianjin 300071, China; Nankai University Eye Institute, Nankai University, Tianjin 300071, China.
| | - Yin Liu
- School of Medicine, Nankai University, Tianjin 300071, China; Nankai University Eye Institute, Nankai University, Tianjin 300071, China.
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Abdollahi A, Shokouhmand H. Electrokinetic separation of cfDNA in insulator-based dielectrophoresis systems: a linear model of cfDNA and investigation of effective parameters. JOURNAL OF PHYSICS. CONDENSED MATTER : AN INSTITUTE OF PHYSICS JOURNAL 2022; 34:355101. [PMID: 35381587 DOI: 10.1088/1361-648x/ac6476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
In this study, a comprehensive numerical simulation was done to investigate the electrokinetic translocation of cfDNA molecule as well as the possibility of its detection and separation in insulator based dielectrophoresis (iDEP) systems. Modeling was done for the first time by solving the Poisson equation for the electrical potential, Naiver-Stokes (NS) equation for the fluid flow and energy equation for the heat transfer in the system and considering a coarse-grained bead-spring model to describe the conformational and geometrical changes of cfDNA molecule. The effect of the geometrical parameters of the system, the initial orientation of the molecule, electrical conductivity of the solution and zeta potential of the wall was investigated on the translocation and the minimum voltage required for cfDNA trapping. When the ratio of the inlet height to the constriction zone height is large enough, cfDNA molecules cannot pass through the nanopore and trap in the constriction zone. Also, it was found that the electrical conductivity of the solution is a limiting parameter to directly isolate cfDNA from pure plasma without dilution due to significant increase in the temperature of the system. Our results demonstrate the enormous potential of iDEP systems for rapid detection of cfDNA from diluted plasma under special electrical potential and geometrical parameters of the iDEP systems.
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Affiliation(s)
- Azita Abdollahi
- School of Mechanical Engineering, College of Engineering, University of Tehran, PO Box: 11155-4563, Tehran, Iran
| | - Hossein Shokouhmand
- School of Mechanical Engineering, College of Engineering, University of Tehran, PO Box: 11155-4563, Tehran, Iran
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4
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Damodara S, Arora J, Dwivedi DJ, Liaw PC, Fox-Robichaud AE, Selvaganapathy PR. Microfluidic device for single step measurement of protein C in plasma samples for sepsis prognosis. LAB ON A CHIP 2022; 22:2566-2577. [PMID: 35678179 DOI: 10.1039/d1lc01084k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Protein C is a vitamin K dependant protein in plasma that plays an essential role in regulating the coagulation cascade and inflammatory response. As a result of its importance in these roles, it has been suggested as a biomarker for prognosis of patients affected by sepsis. Sepsis is a dysregulated host response to an infection that is the leading cause of mortality in U.S. hospitals and results in the highest cost of hospitalization. It was found that protein C concentration in non-surviving sepsis patients is significantly lower (1.8 μg mL-1) than in survivors and healthy patients who have a protein C concentration of 3.9-5.9 μg mL-1. Current methods for diagnosing sepsis rely on expensive immunoassays or functional assays that require multiple steps for isolation and activation of protein C. We demonstrate in this paper a low cost, single step assay for detection of protein C in blood plasma. This was done by combining isoelectric gates with barium-immobilized metal affinity trapping. The electric field was optimized for use with immobilized metal affinity using COMSOL simulation. The integrated device was tested with samples containing buffered protein C, protein C in the presence of high concentration bovine serum albumin and alpha 1-proteinase inhibitor, and in blood plasma with spiked protein C. The stability of the measured values was tested by monitoring the intensity of a mixture of protein C with BSA and A1PI every minute to determine that measurement after 40 minutes was optimal. The results showed that the device could be used to distinguish a reduction in protein C from 4.46 μg mL-1 to 1.96 μg mL-1 with greater than 98% confidence in plasma making it suitable for sepsis prognosis.
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Affiliation(s)
- Sreekant Damodara
- Department of Mechanical Engineering, McMaster University, Hamilton, Canada.
| | - Jaskirat Arora
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Patricia C Liaw
- Department of Medicine, McMaster University, Hamilton, Canada
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Damodara S, Arora J, Liaw PC, Fox-Robichaud AE, Selvaganapathy PR. Single-step measurement of cell-free DNA for sepsis prognosis using a thread-based microfluidic device. Mikrochim Acta 2022; 189:146. [PMID: 35298718 DOI: 10.1007/s00604-022-05245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
Cell-free DNA (cfDNA) content in plasma has been studied as a biomarker for sepsis. Recent publications show that the cfDNA content in sepsis patients entering intensive care unit who were likely to survive had a total cfDNA concentration of 1.16 ± 0.13 μg/mL compared to 4.65 ± 0.48 μg/mL of non-survivors. Current methods for measuring cfDNA content in plasma were designed to amplify and measure low concentrations of specific DNA, making them unsuitable for low-cost measurement of total cfDNA content in plasma. Here, we have developed a point of care (POC) device that uses a thread silicone device as a medium to store a fluorescent dye which eliminates the need for preparatory steps, external aliquoting and dispensing of reagents, preconcentration, and external mixing while reducing the detection cost. The device was paired with a portable imaging system with an excitation filter at 472 ± 10 nm and an emission filter of 520 ± 10 nm that can be operated with just 100 mA current supply. The device was demonstrated for use in the quantification of buffered cfDNA samples in a range 1-6 μg/mL with a sensitivity of 5.72 AU/μg/mL and with cfDNA spiked in plasma with a range of 1-3 μg/mL and a sensitivity of 5.43 AU/μg/mL. The results showed that the device could be used as a low-cost, rapid, and portable POC device for differentiating between survivors and non-survivors of sepsis within 20 min.
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Affiliation(s)
- Sreekant Damodara
- Department of Mechanical Engineering, McMaster University, Hamilton, Canada
| | - Jaskirat Arora
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Patricia C Liaw
- Department of Medicine, McMaster University, Hamilton, Canada
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Schneider L, Usherwood T, Tripathi A. A microfluidic platform for high-purity cell free DNA extraction from plasma for non-invasive prenatal testing. Prenat Diagn 2022; 42:240-253. [PMID: 35032044 DOI: 10.1002/pd.6092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Increase the yield and purity of cell-free DNA (cfDNA) extracted from plasma for non-invasive prenatal testing (NIPT) as inefficiencies in this extraction and purification can dramatically affect the sensitivity and specificity of the test. METHODS This work integrates cfDNA extraction from plasma with a microfluidic chip platform by combining magnetic bead-based extraction and electroosmotic flow on the microfluidic chip. Various wash buffers and voltage conditions were simulated using COMSOL Multiphysics Modeling and tested experimentally. RESULTS When performing the first wash step of this assay on the microfluidic chip with 300 V applied across the channel there was a six-fold increase in the A260 /A230 ratio showing a significant improvement (p value 0.0005) in the purity of the extracted sample all while maintaining a yield of 68.19%. These values are critical as a high yield results in more sample to analyze and an increase in A260 /A230 ratio corresponds to a decrease in salt contaminants such as guanidinium thiocyanate which can interfere with downstream processes during DNA library preparation and potentially hinder the NIPT screening results. CONCLUSIONS This technique has the potential to improve NIPT outcomes and other clinically relevant workflows that use cfDNA as an analyte such as cancer detection.
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Affiliation(s)
- Lindsay Schneider
- Center for Biomedical Engineering, Brown University, Providence, Rhode Island, USA
| | - Thomas Usherwood
- Center for Biomedical Engineering, Brown University, Providence, Rhode Island, USA
| | - Anubhav Tripathi
- Center for Biomedical Engineering, Brown University, Providence, Rhode Island, USA
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Abouali H, Hosseini SA, Purcell E, Nagrath S, Poudineh M. Recent Advances in Device Engineering and Computational Analysis for Characterization of Cell-Released Cancer Biomarkers. Cancers (Basel) 2022; 14:288. [PMID: 35053452 PMCID: PMC8774172 DOI: 10.3390/cancers14020288] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
During cancer progression, tumors shed different biomarkers into the bloodstream, including circulating tumor cells (CTCs), extracellular vesicles (EVs), circulating cell-free DNA (cfDNA), and circulating tumor DNA (ctDNA). The analysis of these biomarkers in the blood, known as 'liquid biopsy' (LB), is a promising approach for early cancer detection and treatment monitoring, and more recently, as a means for cancer therapy. Previous reviews have discussed the role of CTCs and ctDNA in cancer progression; however, ctDNA and EVs are rapidly evolving with technological advancements and computational analysis and are the subject of enormous recent studies in cancer biomarkers. In this review, first, we introduce these cell-released cancer biomarkers and briefly discuss their clinical significance in cancer diagnosis and treatment monitoring. Second, we present conventional and novel approaches for the isolation, profiling, and characterization of these markers. We then investigate the mathematical and in silico models that are developed to investigate the function of ctDNA and EVs in cancer progression. We convey our views on what is needed to pave the way to translate the emerging technologies and models into the clinic and make the case that optimized next-generation techniques and models are needed to precisely evaluate the clinical relevance of these LB markers.
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Affiliation(s)
- Hesam Abouali
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (H.A.); (S.A.H.)
| | - Seied Ali Hosseini
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (H.A.); (S.A.H.)
| | - Emma Purcell
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109-2800, USA; (E.P.); (S.N.)
| | - Sunitha Nagrath
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109-2800, USA; (E.P.); (S.N.)
| | - Mahla Poudineh
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (H.A.); (S.A.H.)
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8
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Teixeira A, Carneiro A, Piairo P, Xavier M, Ainla A, Lopes C, Sousa-Silva M, Dias A, Martins AS, Rodrigues C, Pereira R, Pires LR, Abalde-Cela S, Diéguez L. Advances in Microfluidics for the Implementation of Liquid Biopsy in Clinical Routine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1379:553-590. [DOI: 10.1007/978-3-031-04039-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Shi L, Esfandiari L. Emerging on-chip electrokinetic based technologies for purification of circulating cancer biomarkers towards liquid biopsy: A review. Electrophoresis 2021; 43:288-308. [PMID: 34791687 DOI: 10.1002/elps.202100234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 12/11/2022]
Abstract
Early detection of cancer can significantly reduce mortality and save lives. However, the current cancer diagnosis is highly dependent on costly, complex, and invasive procedures. Thus, a great deal of effort has been devoted to exploring new technologies based on liquid biopsy. Since liquid biopsy relies on detection of circulating biomarkers from biofluids, it is critical to isolate highly purified cancer-related biomarkers, including circulating tumor cells (CTCs), cell-free nucleic acids (cell-free DNA and cell-free RNA), small extracellular vesicles (exosomes), and proteins. The current clinical purification techniques are facing a number of drawbacks including low purity, long processing time, high cost, and difficulties in standardization. Here, we review a promising solution, on-chip electrokinetic-based methods, that have the advantage of small sample volume requirement, minimal damage to the biomarkers, rapid, and label-free criteria. We have also discussed the existing challenges of current on-chip electrokinetic technologies and suggested potential solutions that may be worthy of future studies.
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Affiliation(s)
- Leilei Shi
- Department of Electrical Engineering and Computer Science, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leyla Esfandiari
- Department of Electrical Engineering and Computer Science, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Biomedical Engineering, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio, USA
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10
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Campos CDM, Childers K, Gamage SST, Wijerathne H, Zhao Z, Soper SA. Analytical Technologies for Liquid Biopsy of Subcellular Materials. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2021; 14:207-229. [PMID: 33974805 PMCID: PMC8601690 DOI: 10.1146/annurev-anchem-091520-093931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Liquid biopsy markers, which can be secured from a simple blood draw or other biological samples, are used to manage a variety of diseases and even monitor for bacterial or viral infections. Although there are several different types of liquid biopsy markers, the subcellular ones, including cell-free DNA, microRNA, extracellular vesicles, and viral particles, are evolving in terms of their utility. A challenge with liquid biopsy markers is that they must be enriched from the biological sample prior to analysis because they are a vast minority in a mixed population, and potential interferences may be present in the sample matrix that can inhibit profiling the molecular cargo from the subcellular marker. In this article, we discuss existing and developing analytical enrichment platforms used to isolate subcellular liquid biopsy markers, and discuss their figures of merit such as recovery, throughput, and purity.
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Affiliation(s)
- Camila D M Campos
- Life Science Department, Imec, 3001 Leuven, Belgium
- Department of Electrical Engineering, KU Leuven, 3001 Leuven, Belgium
| | - Katie Childers
- Bioengineering Program, University of Kansas, Lawrence, Kansas 66045, USA;
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, Kansas 66045, USA
| | - Sachindra S T Gamage
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, Kansas 66045, USA
- Department of Chemistry, University of Kansas, Lawrence, Kansas 66045, USA
| | - Harshani Wijerathne
- Department of Mechanical Engineering, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - Zheng Zhao
- Bioengineering Program, University of Kansas, Lawrence, Kansas 66045, USA;
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, Kansas 66045, USA
| | - Steven A Soper
- Bioengineering Program, University of Kansas, Lawrence, Kansas 66045, USA;
- Center of BioModular Multiscale Systems for Precision Medicine, Lawrence, Kansas 66045, USA
- Department of Chemistry, University of Kansas, Lawrence, Kansas 66045, USA
- Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas 66045, USA
- KU Cancer Center, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
- Ulsan National Institute of Science and Technology, Ulsan 44919, South Korea
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11
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Jyoti A, Kumar S, Kumar Srivastava V, Kaushik S, Govind Singh S. Neonatal sepsis at point of care. Clin Chim Acta 2021; 521:45-58. [PMID: 34153274 DOI: 10.1016/j.cca.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/03/2023]
Abstract
Sepsis, which includes infection followed by inflammation, is one of the leading causes of death among neonates worldwide. The major attribute of this disease process is dysregulated host response to infection leading to organ dysfunction and potentially death. A comprehensive understanding of the host response as well as the pathogen itself are important factors contributing to outcome. Early diagnosis is paramount, as it leads to accurate assessment and improved clinical management. Accordingly, a number of diagnostic platforms have been introduced to assess the presence of blood stream pathogens in septic neonates. Unfortunately, current point-of-care (POC) methods rely on a single parameter/biomarker and thus lack a comprehensive evaluation. The emerging field of biosensing has, however, resulted in the development of a wide range of analytical devices that may be useful at POC. This review discusses currently available methods to screen the inflammatory process in neonatal sepsis. We describe POC sensor-based methods for single platform multi-analyte detection and highlight the latest advances in this evolving technology. Finally, we critically evaluate the applicability of these POC devices clinically for early diagnosis of sepsis in neonates.
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Affiliation(s)
- Anupam Jyoti
- Amity Institute of Biotechnology, Amity University, Jaipur, Rajasthan 303002, India; Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Bajhol, Solan, Himachal Pradesh, 173229, India.
| | - Sanni Kumar
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, Telangana 502285, India.
| | | | - Sanket Kaushik
- Amity Institute of Biotechnology, Amity University, Jaipur, Rajasthan 303002, India.
| | - Shiv Govind Singh
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, Telangana 502285, India.
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12
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Mendelson AA, Lansdell C, Fox-Robichaud AE, Liaw P, Arora J, Cailhier JF, Cepinskas G, Charbonney E, Dos Santos C, Dwivedi D, Ellis CG, Fergusson D, Fiest K, Gill SE, Hendrick K, Hunniford VT, Kowalewska PM, Krewulak K, Lehmann C, Macala K, Marshall JC, Mawdsley L, McDonald B, McDonald E, Medeiros SK, Muniz VS, Osuchowski M, Presseau J, Sharma N, Sohrabipour S, Sunohara-Neilson J, Vázquez-Grande G, Veldhuizen RAW, Welsh D, Winston BW, Zarychanski R, Zhang H, Zhou J, Lalu MM. National Preclinical Sepsis Platform: developing a framework for accelerating innovation in Canadian sepsis research. Intensive Care Med Exp 2021; 9:14. [PMID: 33738642 PMCID: PMC7973346 DOI: 10.1186/s40635-020-00366-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/13/2020] [Indexed: 12/28/2022] Open
Abstract
Despite decades of preclinical research, no experimentally derived therapies for sepsis have been successfully adopted into routine clinical practice. Factors that contribute to this crisis of translation include poor representation by preclinical models of the complex human condition of sepsis, bias in preclinical studies, as well as limitations of single-laboratory methodology. To overcome some of these shortcomings, multicentre preclinical studies—defined as a research experiment conducted in two or more research laboratories with a common protocol and analysis—are expected to maximize transparency, improve reproducibility, and enhance generalizability. The ultimate objective is to increase the efficiency and efficacy of bench-to-bedside translation for preclinical sepsis research and improve outcomes for patients with life-threatening infection. To this end, we organized the first meeting of the National Preclinical Sepsis Platform (NPSP). This multicentre preclinical research collaboration of Canadian sepsis researchers and stakeholders was established to study the pathophysiology of sepsis and accelerate movement of promising therapeutics into early phase clinical trials. Integrated knowledge translation and shared decision-making were emphasized to ensure the goals of the platform align with clinical researchers and patient partners. 29 participants from 10 independent labs attended and discussed four main topics: (1) objectives of the platform; (2) animal models of sepsis; (3) multicentre methodology and (4) outcomes for evaluation. A PIRO model (predisposition, insult, response, organ dysfunction) for experimental design was proposed to strengthen linkages with interdisciplinary researchers and key stakeholders. This platform represents an important resource for maximizing translational impact of preclinical sepsis research.
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Affiliation(s)
- Asher A Mendelson
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada
| | - Casey Lansdell
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alison E Fox-Robichaud
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Patricia Liaw
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Jaskirat Arora
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Jean-François Cailhier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Département de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Gediminas Cepinskas
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada
| | - Emmanuel Charbonney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Département de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Claudia Dos Santos
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dhruva Dwivedi
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Christopher G Ellis
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean E Gill
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Kathryn Hendrick
- Department of Communications, Global Sepsis Alliance, Canada Sector, Toronto, ON, Canada
| | - Victoria T Hunniford
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Karla Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kimberly Macala
- Department of Critical Care Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - John C Marshall
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Mawdsley
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Braedon McDonald
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ellen McDonald
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Sarah K Medeiros
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Valdirene S Muniz
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Neha Sharma
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Sahar Sohrabipour
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.,Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Gloria Vázquez-Grande
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Ruud A W Veldhuizen
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Donald Welsh
- Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Brent W Winston
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Section of Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Haibo Zhang
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Juan Zhou
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.
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13
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Zhao PJ, Gan R, Huang L. A microfluidic flow meter with micromachined thermal sensing elements. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2020; 91:105006. [PMID: 33138556 DOI: 10.1063/1.5131662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
The design, fabrication, operation, calibration, and performance of a microfluidic flow meter utilizing a micromachined (MEMS) thermal time-of-flight sensing chip are presented. The MEMS sensing chip integrates multiple sensing elements (thermistors) on a silicon substrate. This sensing chip works on the principle of thermal excitation with a modulated power source from the microheater while the responses of the sensing elements at both upstream and downstream of the modulated thermal source are processed for both the time differences and the amplitudes of the heat transfer in the microfluidic flow. Unlike most of the current flow meter products based on the thermal sensing principle that only offer the calorimetric mass flow rates, this flow meter can measure not only the mass flow rate but also the flow media properties. Experimental results for water and isopropyl alcohol are discussed, which demonstrate the capability and performance of the novel microfluidic flow meter.
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Affiliation(s)
- Pu-Jun Zhao
- National Institute of Measurement and Testing Technology, Chengdu 610021, China
| | - Rong Gan
- National Institute of Measurement and Testing Technology, Chengdu 610021, China
| | - Liji Huang
- Siargo Ltd., Santa Clara, California 95054, USA
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14
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Jin CE, Koo B, Lee HJ, Park IJ, Kim SH, Shin Y. Bis(sulfosuccinimidyl)suberate-Based Helix-Shaped Microchannels as Enhancers of Biomolecule Isolation from Liquid Biopsies. Anal Chem 2020; 92:11994-12001. [PMID: 32867489 DOI: 10.1021/acs.analchem.0c02503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Most studies of ultrasensitive diagnosis of biomolecules from liquid specimens are limited by problems during sample preparation steps, including enrichment and isolation of biomolecules. Here we report a novel platform combining bis(sulfosuccinimidyl)suberate (BS3) and helix-shaped microchannels (BSH) to change the sample preparation paradigm. This BSH system is composed of BS3 for pathogen enrichment and nucleic acid isolation by electrostatic and covalent interaction, and helix-shaped microchannels to minimize sample loss and remove bubbles in large liquid specimens without pH change. The system detected Mycobacterium tuberculosis following enrichment and isolation of 10 mL of liquefied sputum from 11 patients with tuberculosis. Moreover, the system identified KRAS mutations following cell-free DNA isolation of blood plasma from 10 patients with colorectal cancer. This system allows ultrasensitive diagnosis in various disease applications with large volumes of liquid samples.
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Affiliation(s)
- Choong Eun Jin
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Biomedical Engineering Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
| | - Bonhan Koo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Biomedical Engineering Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
| | - Hyo Joo Lee
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Biomedical Engineering Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
| | - In Ja Park
- Division of Colon & Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
| | - Yong Shin
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Biomedical Engineering Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
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15
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Kye HG, Ahrberg CD, Park BS, Lee JM, Chung BG. Separation, Purification, and Detection of cfDNA in a Microfluidic Device. BIOCHIP JOURNAL 2020. [DOI: 10.1007/s13206-020-4208-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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16
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Abstract
Electrokinetic separation techniques in microfluidics are a powerful analytical chemistry tool, although an inherent limitation of microfluidics is their low sample throughput. In this article we report a free-flow variant of an electrokinetic focusing method, namely ion concentration polarization focusing (ICPF). The analytes flow continuously through the system via pressure driven flow while they separate and concentrate perpendicularly to the flow by ICPF. We demonstrate free flow ion concentration polarization focusing (FF-ICPF) in two operating modes, namely peak and plateau modes. Additionally, we showed the separation resolution could be improved by the use of an electrophoretic spacer. We report a concentration factor of 10 in human blood plasma in continuous flow at a flow rate of 15 μL min-1.
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Affiliation(s)
- Vasileios A Papadimitriou
- BIOS Lab on a Chip group, MESA+ Institute for Nanotechnology, Max Planck Centre for Complex Fluid Dynamics and Technical Medical Centre, University of Twente, Enschede 7500 AE, The Netherlands
| | - Loes I Segerink
- BIOS Lab on a Chip group, MESA+ Institute for Nanotechnology, Max Planck Centre for Complex Fluid Dynamics and Technical Medical Centre, University of Twente, Enschede 7500 AE, The Netherlands
| | - Jan C T Eijkel
- BIOS Lab on a Chip group, MESA+ Institute for Nanotechnology, Max Planck Centre for Complex Fluid Dynamics and Technical Medical Centre, University of Twente, Enschede 7500 AE, The Netherlands
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17
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Davaran S, Sadeghinia M, Jamalpoor Z, Raeisdasteh Hokmabad V, Doosti-Telgerd M, Karimian A, Sadeghinia Z, Khalilifard J, Keramt A, Moradikhah F, Sadeghinia A. Multiple functions of microfluidic platforms: Characterization and applications in tissue engineering and diagnosis of cancer. Electrophoresis 2020; 41:1081-1094. [PMID: 32103511 DOI: 10.1002/elps.201900341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 12/13/2022]
Abstract
Microfluidic system, or lab-on-a-chip, has grown explosively. This system has been used in research for the first time and then entered in the clinical section. Due to economic reasons, this technique has been used for screening of laboratory and clinical indices. The microfluidic system solves some difficulties accompanied by clinical and biological applications. In this review, the interpretation and analysis of some recent developments in microfluidic systems in biomedical applications with more emphasis on tissue engineering and cancer will be discussed. Moreover, we try to discuss the features and functions of microfluidic systems.
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Affiliation(s)
- Soodabeh Davaran
- Department of Pharmaceutical Chemistry, Faculty of pharmacy, Tabriz University of Medical Science, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Sadeghinia
- School of Chemistry, University College of Science, University of Tehran, Tehran, Iran
| | - Zahra Jamalpoor
- Trauma Research Center, Aja University of Medical Science, Tehran, Iran
| | - Vahideh Raeisdasteh Hokmabad
- Drug Applied Research Center and Department of Medical Nanotechnology, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Doosti-Telgerd
- Department of Pharmaceutical Biomaterials, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ansar Karimian
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Sadeghinia
- Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Javad Khalilifard
- Hepatitis Research Center, Lorestan University of Medical Sciences, Kohorramabad, Iran
| | - Akram Keramt
- Department of Pharmaceutical Chemistry, Faculty of pharmacy, Tabriz University of Medical Science, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Farzad Moradikhah
- Department of Biomedical Engineering, Amirkabir, University of Technology, Tehran, Iran
| | - Ali Sadeghinia
- Department of Pharmaceutical Chemistry, Faculty of pharmacy, Tabriz University of Medical Science, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Science, Tabriz, Iran.,Drug Applied Research Center and Department of Medical Nanotechnology, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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18
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Mohammadzadeh A, Fox-Robichaud A, Selvaganapathy PR. Electroplating of Multiple Materials in Parallel Using Patterned Gels with Applications in Electrochemical Sensing. SENSORS 2020; 20:s20030886. [PMID: 32046024 PMCID: PMC7039289 DOI: 10.3390/s20030886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
Electrodeposition is a versatile technique for the fabrication of electrodes in micro-electroanalytical devices. Conductive but low-cost materials, such as copper, can be coated with functional yet higher-cost materials such as gold or silver using electrodeposition to lower the overall cost while maintaining functionality. When the electrodeposition of multiple materials is required, current methods use a multistep process that deposits one material at a time, which requires a significant amount of time and a significant number of steps. Additionally, they use a large volume of electrolytes suitable for coating large objects, which is wasteful and unnecessary for the prototyping or coating of microelectrodes with a small area. In this paper, a new method of electroplating is introduced in which we used gels to immobilize and pattern electroplating electrolytes on a substrate surface. Agarose, as an immobilizing medium, enables the immersion of the substrate in a common working electrolyte without cross-mixing different electrolytes. We demonstrate the printing of jelly electrolytes by using spot-dispensing or microfluidic flow. Xurographically patterned films laminated on the substrate function as a mask and confine the printed gels to desired locations. After printing, the substrate is placed in a common working electrolyte container, and multimaterial patterns are produced through the application of an electrical current in a single step.
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Affiliation(s)
| | | | - P. Ravi Selvaganapathy
- Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7, Canada
- Correspondence:
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19
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20
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Das J, Kelley SO. High-Performance Nucleic Acid Sensors for Liquid Biopsy Applications. Angew Chem Int Ed Engl 2019; 59:2554-2564. [PMID: 31332937 DOI: 10.1002/anie.201905005] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/21/2019] [Indexed: 12/18/2022]
Abstract
Circulating tumour nucleic acids (ctNAs) are released from tumours cells and can be detected in blood samples, providing a way to track tumors without requiring a tissue sample. This "liquid biopsy" approach has the potential to replace invasive, painful, and costly tissue biopsies in cancer diagnosis and management. However, a very sensitive and specific approach is required to detect relatively low amounts of mutant sequences linked to cancer because they are masked by the high levels of wild-type sequences. This review discusses high-performance nucleic acid biosensors for ctNA analysis in patient samples. We compare sequencing- and amplification-based methods to next-generation sensors for ctDNA and ctRNA (including microRNA) profiling, such as electrochemical methods, surface plasmon resonance, Raman spectroscopy, and microfluidics and dielectrophoresis-based assays. We present an overview of the analytical sensitivity and accuracy of these methods as well as the biological and technical challenges they present.
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Affiliation(s)
- Jagotamoy Das
- Department of Pharmaceutical Sciences, Department of Chemistry, University of Toronto, Toronto, ON, M5S 3M2, Canada
| | - Shana O Kelley
- Department of Pharmaceutical Sciences, Department of Chemistry, University of Toronto, Toronto, ON, M5S 3M2, Canada
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21
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Xu Z, Qiao Y, Tu J. Microfluidic Technologies for cfDNA Isolation and Analysis. MICROMACHINES 2019; 10:mi10100672. [PMID: 31623361 PMCID: PMC6843514 DOI: 10.3390/mi10100672] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 12/18/2022]
Abstract
Cell-free DNA (cfDNA), which promotes precision oncology, has received extensive concern because of its abilities to inform genomic mutations, tumor burden and drug resistance. The absolute quantification of cfDNA concentration has been proved as an independent prognostic biomarker of overall survival. However, the properties of low abundance and high fragmentation hinder the isolation and further analysis of cfDNA. Microfluidic technologies and lab-on-a-chip (LOC) devices provide an opportunity to deal with cfDNA sample at a micrometer scale, which reduces required sample volume and makes rapid isolation possible. Microfluidic platform also allow for high degree of automation and high-throughput screening without liquid transfer, where rapid and precise examination and quantification could be performed at the same time. Microfluidic technologies applied in cfDNA isolation and analysis are limited and remains to be further explored. This paper reviewed the existing and potential applications of microfluidic technologies in collection and enrichment of cfDNA, quantification, mutation detection and sequencing library construction, followed by discussion of future perspectives.
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Affiliation(s)
- Zheyun Xu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Yi Qiao
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Jing Tu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
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22
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Mohamed AA, Ragab AS, Rashed RA. Plasma mitochondrial DNA at admission can predict the outcome of acute trauma patients admitted to ICU. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Ahmed Shaker Ragab
- Department of Anesthesiology & ICU, National Cancer Institute, Cairo University, Egypt
| | - Reham Ahmed Rashed
- Department of Clinical Pathology Department, National Cancer Institute, Cairo University, Egypt
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23
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Gwak H, Kim J, Cha S, Cheon Y, Kim SI, Kwak B, Hyun KA, Jung HI. On-chip isolation and enrichment of circulating cell-free DNA using microfluidic device. BIOMICROFLUIDICS 2019; 13:024113. [PMID: 31110597 PMCID: PMC6491348 DOI: 10.1063/1.5100009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
Circulating cell-free DNA (cfDNA), containing cancer-specific DNAs derived from tumor cells, plays an important role in real-time monitoring of disease progression. Due to the abnormal growth of cancer and the promotion of cancer cell apoptosis by chemotherapy, the higher cfDNA concentration than healthy individuals is closely correlated with the diagnosis and treatment of cancer. Also, the mutation detection in tumor cell-derived cfDNA can be used to predict tumor progression. Human blood contains many blood cells (red blood cells, white blood cells, and platelets), proteins, extracellular vesicles, and so on. These blood components act as the inhibitors when the cfDNA is analyzed using polymerase chain reaction. So, analysis of cfDNA using whole blood directly may affect the sensitivity of the analysis or result in false-negative. The conventional methods of cfDNA isolation, such as silica absorption and polymer-mediated enrichment, are labor-intensive and time-consuming processes that can also lead to the loss of cfDNA in cumbersome procedures. Here, we designed an integrated microfluidic chip capable of on-chip cfDNA extracting to reduce sample loss and processing time. Our proposed device minimizes the number of experimental steps from 5 to 1, the total processing time from 42 to 19 min, and the required volume of washing reagents from 2 to 0.4 ml for cfDNA enrichment compared to the conventional method.
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Affiliation(s)
- Hogyeong Gwak
- School of Mechanical Engineering, Yonsei University, Seoul 03722, South Korea
| | - Junmoo Kim
- School of Mechanical Engineering, Yonsei University, Seoul 03722, South Korea
| | - Sunyeong Cha
- School of Biological Sciences and Chemistry, Sungshin Women’s University, Seoul 01133, South Korea
| | - Yong–Pil Cheon
- School of Biological Sciences and Chemistry, Sungshin Women’s University, Seoul 01133, South Korea
| | - Seung-Il Kim
- College of Medicine, Yonsei University, Seoul 03722, South Korea
| | - Bongseop Kwak
- College of Medicine, Dongguk University, Goyangsi, Gyeonggi-do 10326, South Korea
| | - Kyung-A Hyun
- School of Mechanical Engineering, Yonsei University, Seoul 03722, South Korea
| | - Hyo-Il Jung
- School of Mechanical Engineering, Yonsei University, Seoul 03722, South Korea
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24
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From traditional biochemical signals to molecular markers for detection of sepsis after burn injuries. Burns 2019; 45:16-31. [DOI: 10.1016/j.burns.2018.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 12/22/2022]
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25
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Campos CDM, Gamage SST, Jackson JM, Witek MA, Park DS, Murphy MC, Godwin AK, Soper SA. Microfluidic-based solid phase extraction of cell free DNA. LAB ON A CHIP 2018; 18:3459-3470. [PMID: 30339164 PMCID: PMC6391159 DOI: 10.1039/c8lc00716k] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Cell-free DNA (cfDNA) is a liquid biopsy marker that can carry signatures (i.e., mutations) associated with certain pathological conditions. Therefore, the extraction of cfDNA from a variety of clinical samples can be an effective and minimally invasive source of markers for disease detection and subsequent management. In the oncological diseases, circulating tumor DNA (ctDNA), a cfDNA sub-class, can carry clinically actionable mutations and coupled with next generation sequencing or other mutation detection methods provide a venue for effective in vitro diagnostics. However, cfDNA mutational analyses require high quality inputs. This necessitates extraction platforms that provide high recovery over the entire ctDNA size range (50 → 150 bp) with minimal interferences (i.e., co-extraction of genomic DNA), and high reproducibility with a simple workflow. Herein, we present a novel microfluidic solid-phase extraction device (μSPE) consisting of a plastic chip that is activated with UV/O3 to generate surface-confined carboxylic acid functionalities for the μSPE of cfDNA. The μSPE uses an immobilization buffer (IB) consisting of polyethylene glycol and salts that induce cfDNA condensation onto the activated plastic microfluidic surface. The μSPE consists of an array of micropillars to increase extraction bed load (scalable to loads >700 ng of cfDNA) and can be produced at low-cost using replication-based techniques. The entire μSPE can be fabricated in a single molding step negating the need for adding additional extraction supports to the device simplifying production and keeping device and assay cost low. The μSPE allowed for recoveries >90% of model cfDNA fragments across a range of sizes (100-700 bp) and even the ability to extract efficiently short cfDNA fragments (50 bp, >70%). In addition, the composition of the IB allowed for reducing the interference of co-extracted genomic DNA. We demonstrated the clinical utility of the μSPE by quantifying the levels of cfDNA in healthy donors and patients with non-small-cell lung and colorectal cancers. μSPE extracted cfDNA from plasma samples was also subjected to a ligase detection reaction (LDR) for determining the presence of mutations in the KRAS gene for colorectal and non-small cell lung cancer patients.
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Affiliation(s)
- Camila D. M. Campos
- Department of Chemistry, University of Kansas, Lawrence, KS, USA.
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
| | - Sachindra S. T. Gamage
- Department of Chemistry, University of Kansas, Lawrence, KS, USA.
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
| | - Joshua M. Jackson
- Department of Chemistry, University of Kansas, Lawrence, KS, USA.
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
| | - Malgorzata A. Witek
- Department of Chemistry, University of Kansas, Lawrence, KS, USA.
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
- Department of Biomedical Engineering, The University of North Carolina, Chapel Hill, NC 27599, USA
| | - Daniel S. Park
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
- Department of Mechanical Engineering, Louisiana State University, Baton Rouge, LA, USA
| | - Michael C. Murphy
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
- Department of Mechanical Engineering, Louisiana State University, Baton Rouge, LA, USA
| | - Andrew K. Godwin
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Steven A. Soper
- Department of Chemistry, University of Kansas, Lawrence, KS, USA.
- Center of Biomodular Multi-scale Systems for Precision Medicine, USA
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS, USA
- BioEngineering Program, The University of Kansas, Lawrence, KS 66047, USA
- Department of Mechanical Engineering, The University of Kansas, Lawrence, KS 66047, USA
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
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26
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Jin CE, Koo B, Lee TY, Han K, Lim SB, Park IJ, Shin Y. Simple and Low-Cost Sampling of Cell-Free Nucleic Acids from Blood Plasma for Rapid and Sensitive Detection of Circulating Tumor DNA. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2018; 5:1800614. [PMID: 30356899 PMCID: PMC6193143 DOI: 10.1002/advs.201800614] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/05/2018] [Indexed: 05/07/2023]
Abstract
Cell-free nucleic acids (cfNAs) are emerging diagnostic biomarkers for monitoring the treatment and recurrence of cancers. In particular, the biological role and clinical usefulness of cfNAs obtained from the plasma of patients with various cancers are popular and still intensely explored, yet most studies are limited by technical problems during cfNA isolation. A dimethyl dithiobispropionimidate (DTBP)-based microchannel platform that enables spontaneous cfNA capture in 15 min with minimal cellular background and no requirements for use of bulky instruments is reported first. This platform identified KRAS and BRAF hot-spot mutations following cfDNA isolation from the blood plasma and tissues obtained from 30 colorectal cancer patients. The correlation of mutations between the primary tissues and plasma from the patients was high using this platform with whole genome sequencing compared to the spin-column method. This platform can also be combined with various detection approaches (biooptical sensor, Sanger sequencing, and polymerase chain reaction (PCR)) for rapid, simple, low-cost, and sensitive circulating tumor DNA detection in blood plasma. The efficiency and versatility of this platform in isolating cfNAs from liquid biopsies has applications in cancer treatment and precision medicine.
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Affiliation(s)
- Choong Eun Jin
- Department of Convergence MedicineAsan Medical CenterUniversity of Ulsan College of Medicine88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
- Biomedical Engineering Research CenterAsan Institute of Life SciencesAsan Medical Center88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
| | - Bonhan Koo
- Department of Convergence MedicineAsan Medical CenterUniversity of Ulsan College of Medicine88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
- Biomedical Engineering Research CenterAsan Institute of Life SciencesAsan Medical Center88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
| | - Tae Yoon Lee
- Department of Technology Education and Department of Biomedical EngineeringChungnam National University99 Daehak‐ro, Yuseong‐guDaejeon34134Republic of Korea
| | - Kyudong Han
- Department of Nanobiomedical Science & BK21 PLUS NBM Global Research Center for Regenerative MedicineDankook UniversityCheonan31116Republic of Korea
| | - Seok Byung Lim
- Department of Colon & Rectal SurgeryAsan Medical CenterUniversity of Ulsan College of Medicine88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
| | - In Ja Park
- Department of Colon & Rectal SurgeryAsan Medical CenterUniversity of Ulsan College of Medicine88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
| | - Yong Shin
- Department of Convergence MedicineAsan Medical CenterUniversity of Ulsan College of Medicine88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
- Biomedical Engineering Research CenterAsan Institute of Life SciencesAsan Medical Center88 Olympicro‐43gil, Songpa‐gu,05505SeoulRepublic of Korea
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Gorgannezhad L, Umer M, Islam MN, Nguyen NT, Shiddiky MJA. Circulating tumor DNA and liquid biopsy: opportunities, challenges, and recent advances in detection technologies. LAB ON A CHIP 2018; 18:1174-1196. [PMID: 29569666 DOI: 10.1039/c8lc00100f] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Cell-free DNA (cfDNA) refers to short fragments of acellular nucleic acids detectable in almost all body fluids, including blood, and is involved in various physiological and pathological phenomena such as immunity, coagulation, aging, and cancer. In cancer patients, a fraction of hematogenous cfDNA originates from tumors, termed circulating tumor DNA (ctDNA), and may carry the same mutations and genetic alterations as those of a primary tumor. Thus, ctDNA potentially provides an opportunity for noninvasive assessment of cancer. Recent advances in ctDNA analysis methods will potentially lead to the development of a liquid biopsy tool for the diagnosis, prognosis, therapy response monitoring, and tracking the rise of new mutant sub-clones in cancer patients. Over the past few decades, cancer-specific mutations in ctDNA have been detected using a variety of untargeted methods such as digital karyotyping, personalized analysis of rearranged ends (PARE), whole-genome sequencing of ctDNA, and targeted approaches such as conventional and digital PCR-based methods and deep sequencing-based technologies. More recently, several chip-based electrochemical sensors have been developed for the analysis of ctDNA in patient samples. This paper aims to comprehensively review the diagnostic, prognostic, and predictive potential of ctDNA as a minimally invasive liquid biopsy for cancer patients. We also present an overview of current advances in the analytical sensitivity and accuracy of ctDNA analysis methods as well as biological and technical challenges, which need to be resolved for the integration of ctDNA analysis into routine clinical practice.
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Affiliation(s)
- Lena Gorgannezhad
- School of Environment and Science, Griffith University, Nathan Campus, QLD 4111, Australia. and Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Muhammad Umer
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Md Nazmul Islam
- School of Environment and Science, Griffith University, Nathan Campus, QLD 4111, Australia. and Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Nam-Trung Nguyen
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Muhammad J A Shiddiky
- School of Environment and Science, Griffith University, Nathan Campus, QLD 4111, Australia. and Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
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Review: Microfluidics technologies for blood-based cancer liquid biopsies. Anal Chim Acta 2018; 1012:10-29. [PMID: 29475470 DOI: 10.1016/j.aca.2017.12.050] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/29/2017] [Accepted: 12/30/2017] [Indexed: 12/19/2022]
Abstract
Blood-based liquid biopsies provide a minimally invasive alternative to identify cellular and molecular signatures that can be used as biomarkers to detect early-stage cancer, predict disease progression, longitudinally monitor response to chemotherapeutic drugs, and provide personalized treatment options. Specific targets in blood that can be used for detailed molecular analysis to develop highly specific and sensitive biomarkers include circulating tumor cells (CTCs), exosomes shed from tumor cells, cell-free circulating tumor DNA (cfDNA), and circulating RNA. Given the low abundance of CTCs and other tumor-derived products in blood, clinical evaluation of liquid biopsies is extremely challenging. Microfluidics technologies for cellular and molecular separations have great potential to either outperform conventional methods or enable completely new approaches for efficient separation of targets from complex samples like blood. In this article, we provide a comprehensive overview of blood-based targets that can be used for analysis of cancer, review microfluidic technologies that are currently used for isolation of CTCs, tumor derived exosomes, cfDNA, and circulating RNA, and provide a detailed discussion regarding potential opportunities for microfluidics-based approaches in cancer diagnostics.
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Zarei M. Infectious pathogens meet point-of-care diagnostics. Biosens Bioelectron 2018; 106:193-203. [PMID: 29428589 DOI: 10.1016/j.bios.2018.02.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Abstract
The field of point-of-care (POC) diagnostics provides the rapid diagnosis of infectious diseases which is essential and critical for improving the general public health in resource-limited settings. POC platforms offer many advantages for detection of various pathogens including portability, automation, speed, cost, and efficiency. In this review, we provide an overview of the recent trends for POC diagnostics of infectious diseases with focus on portable platforms. We review here the present status of POC platforms, emphasizing in period of the past three years, then extrapolate their advance into the future applications for diagnosis of infectious pathogens.
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Affiliation(s)
- Mohammad Zarei
- Department of Chemical and Civil Engineering, University of Kurdistan, Sanandaj, P.O. Box 66177, Kurdistan Province 66618-36336, Iran.
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Rana A, Zhang Y, Esfandiari L. Advancements in microfluidic technologies for isolation and early detection of circulating cancer-related biomarkers. Analyst 2018; 143:2971-2991. [DOI: 10.1039/c7an01965c] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Isolation of circulating biomarkers using microfluidic devices for cancer diagnosis.
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Affiliation(s)
- Ankit Rana
- Department of Electrical Engineering and Computer Science
- College of Engineering and Applied Sciences
- University of Cincinnati
- Cincinnati
- USA
| | - Yuqian Zhang
- Department of Electrical Engineering and Computer Science
- College of Engineering and Applied Sciences
- University of Cincinnati
- Cincinnati
- USA
| | - Leyla Esfandiari
- Department of Electrical Engineering and Computer Science
- College of Engineering and Applied Sciences
- University of Cincinnati
- Cincinnati
- USA
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31
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Nolan K, O'Leary R, Bos LDJ, Martin-Loeches I. Integrative research agenda for diagnosis in sepsis. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:454. [PMID: 29266127 DOI: 10.21037/atm.2017.06.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Katie Nolan
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital Dublin, Trinity Centre for Health Sciences, Trinity College (TCD), Irish Centre for Vascular Biology (ICVB), Dublin, Eire
| | - Ruth O'Leary
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital Dublin, Trinity Centre for Health Sciences, Trinity College (TCD), Irish Centre for Vascular Biology (ICVB), Dublin, Eire
| | - Lieuwe D J Bos
- Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital Dublin, Trinity Centre for Health Sciences, Trinity College (TCD), Irish Centre for Vascular Biology (ICVB), Dublin, Eire
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Nayak S, Blumenfeld NR, Laksanasopin T, Sia SK. Point-of-Care Diagnostics: Recent Developments in a Connected Age. Anal Chem 2017; 89:102-123. [PMID: 27958710 PMCID: PMC5793870 DOI: 10.1021/acs.analchem.6b04630] [Citation(s) in RCA: 281] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Samiksha Nayak
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Nicole R. Blumenfeld
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Tassaneewan Laksanasopin
- Biological Engineering Program, Faculty of Engineering, King Mongkut’s University of Technology Thonburi, 126 Pracha Uthit Rd., Bang Mod, Thung Khru, Bangkok 10140, Thailand
| | - Samuel K. Sia
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
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Jacobs L, Wong HR. Emerging infection and sepsis biomarkers: will they change current therapies? Expert Rev Anti Infect Ther 2016; 14:929-41. [PMID: 27533847 PMCID: PMC5087989 DOI: 10.1080/14787210.2016.1222272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sepsis is a heterogeneous syndrome characterized by both immune hyperactivity and relative immune suppression. Biomarkers have the potential to improve recognition and management of sepsis through three main applications: diagnosis, monitoring response to treatment, and stratifying patients based on prognosis or underlying biological response. AREAS COVERED This review focuses on specific examples of well-studied, evidence-supported biomarkers, and discusses their role in clinical practice with special attention to antibiotic stewardship and cost-effectiveness. Biomarkers were selected based on availability of robust prospective trials and meta-analyses which supported their role as emerging tools to improve the clinical management of sepsis. Expert commentary: Great strides have been made in candidate sepsis biomarker discovery and testing, with the biomarkers in this review showing promise. Yet sepsis remains a dynamic illness with a great degree of biological heterogeneity - heterogeneity which may be further resolved by recently discovered gene expression-based endotypes in septic shock.
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Affiliation(s)
- Lauren Jacobs
- Department of Pediatrics, Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati OH, 45229, , Tel: 513-636-4529, Fax: 513-636-4267
| | - Hector R Wong
- Professor of Pediatrics, Director, Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, (corresponding author), Tel: 513-636-4529, Fax: 513-636-4267
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