Monitoring sepsis using electrical cell profiling

Label-free microfluidic cell sorting and detection for rapid blood analysis

Blood tests are considered as standard clinical procedures to screen for markers of diseases and health conditions. However, the complex cellular background (>99.9% RBCs) and biomolecular composition often pose significant technical challenges for accurate blood analysis. An emerging approach for point-of-care blood diagnostics is utilizing "label-free" microfluidic technologies that rely on intrinsic cell properties for blood fractionation and disease detection without any antibody binding. A growing body of clinical evidence has also reported that cellular dysfunction and their biophysical phenotypes are complementary to standard hematoanalyzer analysis (complete blood count) and can provide a more comprehensive health profiling. In this review, we will summarize recent advances in microfluidic label-free separation of different blood cell components including circulating tumor cells, leukocytes, platelets and nanoscale extracellular vesicles. Label-free single cell analysis of intrinsic cell morphology, spectrochemical properties, dielectric parameters and biophysical characteristics as novel blood-based biomarkers will also be presented. Next, we will highlight research efforts that combine label-free microfluidics with machine learning approaches to enhance detection sensitivity and specificity in clinical studies, as well as innovative microfluidic solutions which are capable of fully integrated and label-free blood cell sorting and analysis. Lastly, we will envisage the current challenges and future outlook of label-free microfluidics platforms for high throughput multi-dimensional blood cell analysis to identify non-traditional circulating biomarkers for clinical diagnostics.

Electroporation Parameters for Human Cardiomyocyte Ablation In Vitro

Cardiac ablation with irreversible electroporation (IRE) is quickly being established as a modality of choice for atrial fibrillation treatment. While it has not yet been optimised, IRE has the potential to significantly limit collateral damage and improve cell-specific targeting associated with other energy sources. However, more tissue and cell-specific evidence is required to demonstrate the selective threshold parameters for human cells. The aim here is to determine the optimal ablation threshold parameters related to lesion size for human cardiomyocytes in 2D culture. Conventional biphasic pulses of different field strengths and on-times were delivered in a monolayer culture system of human AC16 cardiomyocytes. The dynamics of cell death and lesion dimensions were examined at different time points. Human cardiomyocytes are susceptible to significant electroporation and cell death at a field strength of 750 V/cm or higher with 100 μs pulses. Increasing the IRE on-time from 3 ms to 60 ms reduces the effective field threshold to 250 V/cm. Using very short pulses of 2 μs and 5 μs also causes significant cell death, but only at fields higher than 1000 V/cm. A longer on-time results in more cell death and induced greater lesion area in 2D models. In addition, different forms of cell death are predicted based on the evolution of cell death over time. This study presents important findings on the ability of different IRE parameters to induce human cardiomyocyte cell death. Lesion size can be tuned by appropriate choice of IRE parameters and cardiomyocytes display an upregulation of delayed cell death 24 h after electroporation, which is an important consideration for clinical practice.

Measurement of the low-frequency charge noise of bacteria

Bacteria meticulously regulate their intracellular ion concentrations and create ionic concentration gradients across the bacterial membrane. These ionic concentration gradients provide free energy for many cellular processes and are maintained by transmembrane transport. Given the physical dimensions of a bacterium and the stochasticity in transmembrane transport, intracellular ion concentrations and hence the charge state of a bacterium are bound to fluctuate. Here we investigate the charge noise of hundreds of nonmotile bacteria by combining electrical measurement techniques from condensed matter physics with microfluidics. In our experiments, bacteria in a microchannel generate charge density fluctuations in the embedding electrolyte due to random influx and efflux of ions. Detected as electrical resistance noise, these charge density fluctuations display a power spectral density proportional to 1/f^{2} for frequencies 0.05Hz≤f≤1Hz. Fits to a simple noise model suggest that the steady-state charge of a bacterium fluctuates by ±1.30×10^{6}e(e≈1.60×10^{-19}C), indicating that bacterial ion homeostasis is highly dynamic and dominated by strong charge noise. The rms charge noise can then be used to estimate the fluctuations in the membrane potential; however, the estimates are unreliable due to our limited understanding of the intracellular concentration gradients.

Advance of microfluidic constriction channel system of measuring single-cell cortical tension/specific capacitance of membrane and conductivity of cytoplasm

This paper reported a microfluidic platform which realized the characterization of inherent single-cell biomechanical and bioelectrical parameters simultaneously. Individual cells traveled through a constriction channel with deformation images and impedance variations captured and processed into cortical tension T_c , specific membrane capacitance C_sm , and cytoplasmic conductivity σ_cy based on an equivalent biophysical model. These properties of thousands of individual cells of K562, Jurkat, HL-60, HL-60 treated with paraformaldehyde (PA)/cytochalasin D (CD)/concanavalin A (ConA), granulocytes of Donor 1, Donor 2, and Donor 3 were quantified for the first time. Leveraging T_c , C_sm , and σ_cy , (1) high accuracies of classifying wild-type and processed HL-60 cells (e.g., 93.5% of PA treated vs. CD treated HL-60 cells) were realized, revealing the effectiveness of using these three biophysical parameters in cell-type classification; (2) low accuracies of classifying normal granulocytes from three donors (e.g., 56.4% of Donor 1 vs. 2), indicating comparable parameters for normal granulocytes. In conclusion, this platform can characterize single-cell T_c , C_sm , and σ_cy concurrently and quantify multiple parameters in single-cell analysis.

Inertial microfluidics for high-throughput cell analysis and detection: a review

Since it was first proposed in 2007, inertial microfluidics has been extensively studied in terms of theory, design, fabrication, and application. In recent years, with the rapid development of microfabrication technologies, a variety of channel structures that can focus, concentrate, separate, and capture bioparticles or fluids have been designed and manufactured to extend the range of potential biomedical applications of inertial microfluidics. Due to the advantages of high throughput, simplicity, and low device cost, inertial microfluidics is a promising candidate for rapid sample processing, especially for large-volume samples with low-abundance targets. As an approach to cellular sample pretreatment, inertial microfluidics has been widely employed to ensure downstream cell analysis and detection. In this review, a comprehensive summary of the application of inertial microfluidics for high-throughput cell analysis and detection is presented. According to application areas, the recent advances can be sorted into label-free cell mechanical phenotyping, sheathless flow cytometric counting, electrical impedance cytometer, high-throughput cellular image analysis, and other methods. Finally, the challenges and prospects of inertial microfluidics for cell analysis and detection are summarized.

A review: Dielectrophoresis for characterizing and separating similar cell subpopulations based on bioelectric property changes due to disease progression and therapy assessment

This paper reviews the use of dielectrophoresis for high-fidelity separations and characterizations of subpopulations to highlight the recent advances in the electrokinetic field as well as provide insight into its progress toward commercialization. The role of cell subpopulations in heterogeneous clinical samples has been studied to deduce their role in disease progression and therapy resistance for instances such as cancer, tissue regeneration, and bacterial infection. Dielectrophoresis (DEP), a label-free electrokinetic technique, has been used to characterize and separate target subpopulations from mixed samples to determine disease severity, cell stemness, and drug efficacy. Despite its high sensitivity to characterize similar or related cells based on their differing bioelectric signatures, DEP has been slowly adopted both commercially and clinically. This review addresses the use of dielectrophoresis for the identification of target cell subtypes in stem cells, cancer cells, blood cells, and bacterial cells dependent on cell state and therapy exposure and addresses commercialization efforts in light of its sensitivity and future perspectives of the technology, both commercially and academically.

Lipid-Derived Mediators are Pivotal to Leukocyte and Lung Cell Responses in Sepsis and ARDS

Acute inflammation in the lung is essential for host defense against pathogens and other injuries but chronic or excessive inflammation can contribute to several common respiratory diseases. In health, the inflammatory response is controlled by several cellular and molecular mechanisms. In addition to anti-inflammatory processes, there are non-phlogistic pro-resolving mechanisms that are engaged to promote the resolution of inflammation and a return to homeostasis. Defects in the production or actions of specialized pro-resolving mediators are associated with diseases characterized by excess or chronic inflammation. In this article, we review cellular and biochemical mechanisms for specialized pro-resolving mediators in health and in sepsis and the acute respiratory distress syndrome as examples of unrestrained inflammatory responses that result in life-threatening pathology. We are honored to contribute to this special edition of the Journal to help celebrate Professor Viswanathan Natarajan's contributions to our understanding of lipid-derived mediators and metabolism in lung cell responses to inflammatory, infectious, or mechanical insults; his foundational discoveries in cell biochemistry and biophysics are continuing to catalyze further advances by the field to uncover the mechanistic underpinnings of important human diseases.

Fully Automated, Sample-to-Answer Leukocyte Functional Assessment Platform for Continuous Sepsis Monitoring via Microliters of Blood

We report a fully automated, sample-to-answer, and label-free leukocyte activation analysis platform for monitoring immune responses in sepsis, by integrating the multidimensional double spiral (MDDS) and isodielectric separation (IDS) subplatforms. The integrated platform can provide rapid and fully automated identification of clinically diagnosed sepsis patients from only 50 μL of peripheral blood volume within 25 min. Many critical innovations were implemented in direct interconnection between the two subplatforms, such as intermediate sample storage and sample transfer, addressing flow rate mismatch (from mL/min to μL/min), and integration of a ridge array for upstream cell focusing in the IDS subplatform. The ridge array in the IDS subplatform can prevent the distortion of electrical profiling due to the residual red blood cells even after the MDDS process. We showed that the integrated platform can separate leukocytes (up to >99.9% red blood cell removal) in the MDDS subplatform and automatically transfer them to the downstream ridge-integrated IDS subplatform for their activation analysis without any apparent ex vivo cell activation and any human intervention. We also demonstrated that the integrated platform can identify differences between leukocytes from human sepsis and healthy subjects significantly (p = 0.0024, 95% confidence interval) by looking into differences in the intrinsic electrical properties of leukocytes. The integrated platform could enable monitoring of host leukocyte function daily or even hourly as a bedside assessment tool, which is currently a critical yet unmet need for managing many critical care patients.

Microfluidics for sepsis early diagnosis and prognosis: a review of recent methods

Sepsis is a complex disorder of immune system response to infections that can be caused by a wide range of clinical contexts. Traditional methods for sepsis detection include molecular diagnosis, biomarkers either based on protein concentration or cell surface expression, and microbiological cultures. Development of point-of-care (POC) instruments, which can provide high accuracy and consume less time, is in unprecedented demand. Within the past few years, applications of microfluidic systems for sepsis detection have achieved excellent performance. In this review, we discuss the most recent microfluidic applications specifically in sepsis detection, and propose their advantages and disadvantages. We also present a comprehensive review of other traditional and current sepsis diagnosis methods to obtain a general understanding of the present conditions, which can hopefully direct the development of a new sepsis roadmap.

Leukocyte function assessed via serial microlitre sampling of peripheral blood from sepsis patients correlates with disease severity

Dysregulated leukocyte responses underlie the pathobiology of sepsis, which is a leading cause of death. However, measures of leukocyte function are not routinely available in clinical care. Here we report the development and testing of an inertial microfluidic system for the label-free isolation and downstream functional assessment of leukocytes from 50 μl of peripheral blood. We used the system to assess leukocyte phenotype and function in serial samples from 18 hospitalized patients with sepsis and 10 healthy subjects. The sepsis samples had significantly higher levels of CD16^dim and CD16⁻ neutrophils and CD16⁺ ‘intermediate’ monocytes, as well as significantly lower levels of neutrophil-elastase release, O₂⁻ production and phagolysosome formation. Repeated sampling of sepsis patients over 7 days showed that leukocyte activation (measured by isodielectric separation) and leukocyte phenotype and function were significantly more predictive of the clinical course than complete-blood-count parameters. We conclude that the serial assessment of leukocyte function in microlitre blood volumes is feasible and that it provides significantly more prognostic information than leukocyte counting.

The serial assessment of the functional parameters of leukocytes isolated via an inertial microfluidic system from 50 μl of peripheral blood from sepsis patients provides significantly more prognostic information than leukocyte counting.

Impacts of low concentration surfactant on red blood cell dielectrophoretic responses

Cell dielectrophoretic responses have been extensively studied for biomarker expression, blood typing, sepsis, circulating tumor cell separations, and others. Surfactants are often added to the analytical buffer in electrokinetic cellular microfluidic systems to lower surface/interfacial tensions. In nonelectrokinetic systems, surfactants influence cell size, shape, and agglomeration; this has not been systematically documented in electrokinetic systems. In the present work, the impacts of the Triton X-100 surfactant on human red blood cells (RBCs) were explored via ultraviolet-visible spectroscopy (UV-Vis) and dielectrophoresis (DEP) to compare nonelectrokinetic and electrokinetic responses, respectively. The UV-Vis spectra of Triton X-100 treated RBCs were dramatically different from that of native RBCs. DEP responses of RBCs were compared to RBCs treated with low concentrations of Triton X-100 (0.07-0.17 mM) to ascertain surfactant effects on dielectric properties. A star-shaped electrode design was used to quantify RBC dielectric properties by fitting a single-shell oblate cell model to experimentally-derived DEP spectra. The presence of 0.07 and 0.11 mM of Triton X-100 shifted the RBC's DEP spectra yielding lower crossover frequencies ( f C O ) . The single-shell oblate model revealed that cell radius and membrane permittivity are the dominant influencers of DEP spectral shifts. The trends observed were similar for 0.11 mM and 0.07 mM Triton X-100 treated cells. However, a further increase of Triton X-100 to 0.17 mM caused cells to only exhibit negative DEP. The magnitude of the DEP force increased with Triton X-100 concentration. This work indicates that dynamic surfactant interactions with cell membranes alter cell dielectric responses and properties.

Crossing constriction channel-based microfluidic cytometry capable of electrically phenotyping large populations of single cells

This paper presents a crossing constriction channel-based microfluidic system for high-throughput characterization of specific membrane capacitance (Csm) and cytoplasm conductivity (σcy) of single cells. In operations, cells in suspension were forced through the major constriction channel and instead of invading the side constriction channel, they effectively sealed the side constriction channel, which led to variations in impedance data. Based on an equivalent circuit model, these raw impedance data were translated into Csm and σcy. As a demonstration, the developed microfluidic system quantified Csm (3.01 ± 0.92 μF cm-2) and σcy (0.36 ± 0.08 S m-1) of 100 000 A549 cells, which could generate reliable results by properly controlling cell positions during their traveling in the crossing constriction channels. Furthermore, the developed microfluidic impedance cytometry was used to distinguish paired low- and high-metastatic carcinoma cell types of SACC-83 (ncell = ∼100 000) and SACC-LM cells (ncell = ∼100 000), distinguishing significant differences in both Csm (3.16 ± 0.90 vs. 2.79 ± 0.67 μF cm-2) and σcy (0.36 ± 0.06 vs.0.41 ± 0.08 S m-1). As high-throughput microfluidic impedance cytometry, this technique may add a new marker-free dimension to flow cytometry in single-cell analysis.

Microfluidic Immunoaffinity Basophil Activation Test for Point-of-Care Allergy Diagnosis

BACKGROUND

The flow cytometry-based basophil activation test (BAT) is used for the diagnosis of allergic response. However, flow cytometry is time-consuming, requiring skilled personnel and cumbersome processing, which has limited its use in the clinic. Here, we introduce a novel microfluidic-based immunoaffinity BAT (miBAT) method.

METHODS

The microfluidic device, coated with anti-CD203c, was designed to capture basophils directly from whole blood. The captured basophils are activated by anti-FcεRI antibody followed by optical detection of CD63 expression (degranulation marker). The device was first characterized using a basophil cell line followed by whole blood experiments. We evaluated the device with ex vivo stimulation of basophils in whole blood from healthy controls and patients with allergies and compared it with flow cytometry.

RESULTS

The microfluidic device was capable of capturing basophils directly from whole blood followed by in vitro activation and quantification of CD63 expression. CD63 expression was significantly higher (P = 0.0002) in on-chip activated basophils compared with nonactivated cells. The difference in CD63 expression on anti-FcεRI-activated captured basophils in microfluidic chip was significantly higher (P = 0.03) in patients with allergies compared with healthy controls, and the results were comparable with flow cytometry analysis (P = 0.04). Furthermore, there was no significant difference of CD63% expression in anti-FcεRI-activated captured basophils in microfluidic chip compared with flow cytometry.

CONCLUSIONS

We report on the miBAT. This device is capable of isolating basophils directly from whole blood for on-chip activation and detection. The new miBAT method awaits validation in larger patient populations to assess performance in diagnosis and monitoring of patients with allergies at the point of care.

Point of care technologies for sepsis diagnosis and treatment

Sepsis is a rapidly progressing, life threatening immune response triggered by infection that affects millions worldwide each year. Current clinical diagnosis relies on broad physiological parameters and time consuming lab-based cell culture. If proper treatment is not provided, cases of sepsis can drastically increase in severity over the course of a few hours. Development of new point of care tools for sepsis has the potential to improve diagnostic speed and accuracy, leading to prompt administration of appropriate therapeutics, thereby reducing healthcare costs and improving patient outcomes. In this review we examine developing and commercially available technologies to assess the feasibility of rapid, accurate sepsis diagnosis, with emphasis on point of care.

Analysis of Leukocyte Behaviors on Microfluidic Chips

The orchestration of massive leukocytes in the immune system protects humans from invading pathogens and abnormal cells in the body. So far, researches focusing on leukocyte behaviors are performed based on both in vivo and in vitro models. The in vivo animal models are usually less controllable due to their extreme complexity and nonignorable species issue. Therefore, many researchers turn to in vitro models. With the advances in micro/nanofabrication, the microfluidic chip has emerged as a novel platform for model construction in multiple biomedical research fields. Specifically, the microfluidic chip is used to study leukocyte behaviors, due to its incomparable advantages in high throughput, precise control, and flexible integration. Moreover, the small size of the microstructures on the microfluidic chip can better mimic the native microenvironment of leukocytes, which contributes to a more reliable recapitulation. Herein are reviewed the recent advances in microfluidic chip-based leukocyte behavior analysis to provide an overview of this field. Detailed discussions are specifically focused on host defense against pathogens, immunodiagnosis, and immunotherapy studies on microfluidic chips. Finally, the current technical challenges are discussed, as well as possible innovations in this field to improve the related applications.

Integrating molecular pathogenesis and clinical translation in sepsis-induced acute respiratory distress syndrome

Sepsis-induced acute respiratory distress syndrome (ARDS) has high morbidity and mortality and arises after lung infection or infection at extrapulmonary sites. An aberrant host response to infection leads to disruption of the pulmonary alveolar-capillary barrier, resulting in lung injury characterized by hypoxemia, inflammation, and noncardiogenic pulmonary edema. Despite increased understanding of the molecular biology underlying sepsis-induced ARDS, there are no targeted pharmacologic therapies for this devastating condition. Here, we review the molecular underpinnings of sepsis-induced ARDS with a focus on relevant clinical and translational studies that point toward novel therapeutic strategies.

A current appraisal of evidence for the approach to sepsis and septic shock

Sepsis is a life-threatening syndrome of a dysregulated host response to infection. Despite advances in diagnosis and treatment, sepsis remains a significant cause of morbidity and mortality. Many aspects of the diagnosis and clinical management of sepsis require further study and remain controversial. This review aims to summarize relevant literature and controversies regarding the evaluation and management of sepsis and septic shock.

Multi-frequency dielectrophoretic characterization of single cells

We explore the use of dielectrophoresis to discern the electrical properties of single cells by observing them at multiple frequencies. We first simulate experimental conditions to show that as we increase the number of measured frequencies, we are able to better discriminate among different cells. Furthermore, we use the simulation to find the optimal number and value of frequencies to use to best discriminate among different cells in general. We then fabricate a microfluidic device, calibrate it with polystyrene beads, and characterize it with BA/F3 cells. With this device, we test three different activation levels of HL60 cells treated with cytochalasin D using the optimal frequency sequence obtained in simulation to determine the differences in discrimination abilities depending on the number of frequencies used. We quantify the discrimination abilities of the optimal one, two, and three frequencies by minimizing 0-1 loss.

3D cell electrorotation and imaging for measuring multiple cellular biophysical properties

3D rotation is one of many fundamental manipulations to cells and imperative in a wide range of applications in single cell analysis involving biology, chemistry, physics and medicine. In this article, we report a dielectrophoresis-based, on-chip manipulation method that can load and rotate a single cell for 3D cell imaging and multiple biophysical property measurements. To achieve this, we trapped a single cell in constriction and subsequently released it to a rotation chamber formed by four sidewall electrodes and one transparent bottom electrode. In the rotation chamber, rotating electric fields were generated by applying appropriate AC signals to the electrodes for driving the single cell to rotate in 3D under control. The rotation spectrum for in-plane rotation was used to extract the cellular dielectric properties based on a spherical single-shell model, and the stacked images of out-of-plane cell rotation were used to reconstruct the 3D cell morphology to determine its geometric parameters. We have tested the capabilities of our method by rotating four representative mammalian cells including HeLa, C3H10, B lymphocyte, and HepaRG. Using our device, we quantified the area-specific membrane capacitance and cytoplasm conductivity for the four cells, and revealed the subtle difference of geometric parameters (i.e., surface area, volume, and roughness) by 3D cell imaging of cancer cells and normal leukocytes. Combining microfluidics, dielectrophoresis, and microscopic imaging techniques, our electrorotation-on-chip (EOC) technique is a versatile method for manipulating single cells under investigation and measuring their multiple biophysical properties.

Development of microfluidic impedance cytometry enabling the quantification of specific membrane capacitance and cytoplasm conductivity from 100,000 single cells

This paper presents a new microfluidic impedance cytometry with crossing constriction microchannels, enabling the characterization of cellular electrical markers (e.g., specific membrane capacitance (C_sm) and cytoplasm conductivity (σ_cy)) in large cell populations (~ 100,000 cells) at a rate greater than 100 cells/s. Single cells were aspirated continuously through the major constriction channel with a proper sealing of the side constriction channel. An equivalent circuit model was developed and the measured impedance values were translated to C_sm and σ_cy. Neural network was used to classify different cell populations where classification success rates were calculated. To evaluate the developed technique, different tumour cell lines, and the effects of epithelial-mesenchymal transitions on tumour cells were examined. Significant differences in both C_sm and σ_cy were found for H1299 and HeLa cell lines with a classification success rate of 90.9% in combination of the two parameters. Meanwhile, tumour cells A549 showed significant decreases in both C_sm and σ_cy after epithelial-mesenchymal transitions with a classification success rate of 76.5%. As a high-throughput microfluidic impedance cytometry, this technique can add a new marker-free dimension to flow cytometry in single-cell analysis.

Detection of sepsis in patient blood samples using CD64 expression in a microfluidic cell separation device

A microfluidic affinity separation device was developed for the detection of sepsis in critical care patients.

Miniaturized Impedance Flow Cytometer: Design Rules and Integrated Readout

A dual-channel credit-card-sized impedance cell counter featuring a throughput of 2000 cell/s and detection of single yeast cells (5 μm) with a signal-to-noise ratio of 20 dB is presented. Its compactness is achieved by a CMOS ASIC combining a lock-in impedance demodulator with an oversampling 20-bit ΣΔ ADC and real-time peak detection embedded in field-programmable gate array. The module is coupled to a dielectrophoretic cell-sorting microfluidic device, offering compact and label-free electrical readout that replaces the need for a fluorescence microscope and, thus, is suitable for point-of-care diagnostics. The independent role of each dimension of the planar sensing microelectrodes is demonstrated, with simulations and experiments, along with its relevant effect on the spectrum of thin channels, deriving useful design guidelines.