High sensitive and broad-range detection of cortisol in human saliva using a trap lateral flow immunoassay (trapLFI) sensor

Ultrasensitive cortisol electrochemical immunosensor amplifying by Au single-atom nanozymes and HRP enzymes

Cortisol, a corticosteroid hormone as a primary stress hormone response to internal and external stress, has been regarded as a gold standard reliable biomarker to evaluate human mental stress. The double enzymes strategy, using nanozyme and enzyme amplifying the electrochemical signal, has been widely used to improve the performance of electrochemical biosensors. An ultra-sensitive electrochemical cortisol sensor based on Au single-atom nanozymes had been fabricated through HRP labeled anti-cortisol antibody binding with Au by Au-S bond. Based on the high catalytic activity of Au single-atom nanozymes and the high selectivity of HRP-labeled anti-cortisol antibodies, the cortisol electrochemical sensor-based Au single-atom nanozymes had an excellent response to cortisol, such as high electrochemical activity, high sensitivity, high selectivity, and wide linear range (0.15-300 ng mL-1) and low detection (0.48 pg mL-1) through the four-parameter logistic model with 95% confidence. The electrochemical cortisol sensor was used to determine the cortisol concentration of human saliva at different times.

Coupling Capillary-Driven Microfluidics with Lateral Flow Immunoassay for Signal Enhancement

Microfluidics has emerged as a versatile technology that is applied to enhance the performance of analytical techniques, among others. Pursuing this, we present a capillary-driven microfluidic device that improves the sensitivity of lateral flow immunoassay rapid tests thanks to offering an automated washing step. A novel multilevel microfluidic chip was 3D-printed with a photocurable black resin, sealed by an optically clear pressure-sensitive adhesive, and linked to the lateral flow strip. To depict the efficacy of microfluidics and the washing step, cortisol was measured quantitatively within the proposed device. Measuring cortisol levels is a way to capture physiological stress responses. Among biofluids, saliva is less infectious and easier to sample than others. However, higher sensitivity is demanded because the salivary cortisol concentrations are much lower than in blood. We carried out a competitive lateral flow immunoassay protocol with the difference that the microfluidic device applies an automated washing step after the sample is drained downstream. It washes the trapped quantum-dot-labeled antibodies out from nitrocellulose, diminishing background noise as these are bonded to cortisols and not to the immobilized receptors. Fluorescence spectroscopy, as a high-precision analysis, was successfully applied to determine clinically relevant salivary cortisol concentrations within a buffer quantitatively. The microfluidic design relied on a 3D valve that avoids reagent cross-contamination. This cross-contamination could make the washing buffer impure and undesirably dilute the sample. The proposed device is cost-effective, self-powered, robust, and ideal for non-expert users.

Recent developments in wearable & non-wearable point-of-care biosensors for cortisol detection

INTRODUCTION

Cortisol is one of the most prominent biomarkers used for the detection of psychological stress and related disorders. It plays an important role in many physiological processes including immunomodulation and fat metabolism. Thus, monitoring of cortisol levels can be used to indicate different pathological conditions including stress disorders. There has been a gradual rise in the development of point of care (PoC) biosensors for continuous cortisol monitoring.

AREAS COVERED

This review discusses recent breakthroughs toward the development of PoC sensors (wearable and non wearable) for cortisol monitoring. Challenges associated with them have also been summarized.

EXPERT OPINION

Electrochemical PoC devices have recently emerged as a powerful tools for continuous monitoring of cortisol that can be utilized for stress management and treatment of related disorders. However, there are many challenges that should be addressed before such devices can be deployed at mass level, such as inter-individual variability, changing the device calibration with the circadian rhythm, interference from other endocrine moieties, etc. [Figure: see text].

Biosensors for saliva biomarkers

The analysis of salivary biomarkers has gained interest and is advantageous for simple, safe, and non-invasive testing in diagnosis as well as treatment. This chapter explores the importance of saliva biomarkers and summarizes recent advances in biosensor fabrication. The identification of diagnostic, prognostic and therapeutic markers in this matrix enables more rapid and frequent testing when combined with the use of biosensor technology. Challenges and future goals are highlighted and examined.

Lateral flow assays for hormone detection

Endocrine diseases are the fifth most common cause of death and have a considerable impact on society given that they induce long-term morbidity in patients. For many decades, the measurement of hormones has been of great interest since this can be used to diagnose a plethora of pathological conditions. As a result, the endocrine testing market has experienced exponential growth. Several techniques have been utilised for the detection of hormones; however, they are expensive, laborious and require specialist training. Conversely, lateral flow assays (LFAs) are cheap (<£1) and rapid (<5 min) devices. LFAs typically rely on biochemical interactions between antibodies and antigens to produce coloured signals proportional to analyte concentrations, which can be visually inspected. Given their simplicity, LFAs are now considered the most attractive point-of-care device in medicine. However, the measurement of hormones in biofluids using LFAs faces many challenges including (i) the necessity for sensitive detection methods, (ii) the need for multiplexed devices for the confirmation of a diagnosis, and (iii) difficulties in sample preparation and pre-concentration. As such, most hormone LFAs remain in the research phase, and the few that have been commercialised require further optimisation before they can be employed for routine use. This review summarises the basic principles underlying lateral flow technology and provides an overview of recent advances, challenges, and potential solutions for the detection of hormone biomarkers via LFAs. Finally, hormone LFA kits available on the market are presented, with a look towards future developments and trends in the field.

Direct Use of a Saliva-Collected Cotton Swab in Lateral Flow Immunoassay for the Detection of Cotinine

The detection of salivary cotinine is useful for convenient smoking tests in spite of the high background effect of saliva. For precise results, the conventional salivary cotinine analysis for smoking detection requires complex pretreatment processes. Hence, in this study, we developed a modified paper-based lateral flow immunoassay (LFIA), termed “gap-LFIA”, for the direct application of saliva collected using cotton swabs for on-site detection. The gap-LFIA was constructed by modifying a conventional LFIA sensor, where the sample pad was divided to have a 3 mm gap. A saliva-collected cotton swab was inserted into the gap, and then, a buffer solution was added to the outer sample pad to dilute the saliva automatically. The gap-LFIA reduced the interference in salivary samples and showed improved signals, allowing for using the whole saliva directly without additional steps. Further, the deviation of results using a strip was less than that when the saliva was not diluted in a conventional cotinine kit, and it helped to distinguish between smokers and non-smokers more clearly in 15 min. This method of automatic dilution may apply to various clinical samples, including blood and serum, for direct application in future detections.

Advanced trap lateral flow immunoassay sensor for the detection of cortisol in human bodily fluids

Paper-based biosensors based on lateral flow immunoassay (LFI) are promising candidates for POC diagnosis because of their ease of use and rapid target detection. However, the low sensitivity of LFI limits its application, and signal amplification has been used in numerous studies to increase its sensitivity. We developed an advanced trap LFI (α-trapLFI), a simple-to-use sensor, with an additional step for signal amplification. Here, signal amplification is automatically implemented following delayed release of enhancement solution induced by water-soluble polyvinyl alcohol tape. As the polyvinyl alcohol tape is exposed to water, its polymer structure is perturbed (within 5 min), allowing ions to pass through. This new sensor was designed to have a short time delay between the flow of solutions used for the immunoassay and signal amplification. The α-trapLFI was subsequently used to detect cortisol with high sensitivity (9.1 pg∙mL^-1) over a broad detection range (0.01-1000 ng∙mL^-1) in bodily fluids. Furthermore, an excellent correlation was obtained by analyzing 20 human real saliva samples using this sensor and a conventional ELISA (R² = 0.90). The new sensor will be helpful in detecting various small molecules for simple, rapid, and portable POC diagnosis of stress disorders.

Portable Chemiluminescence-Based Lateral Flow Assay Platform for the Detection of Cortisol in Human Serum

In this study, we developed the portable chemiluminescence (CL)-based lateral flow assay (LFA) platform for the detection of cortisol in human serum. Cortisol is well-known as a stress hormone due to its high relevancy for human mental and physical health, such as hypertension or depression. To date, a number of optical devices have provided the sensitive determination of levels of analytes. However, this modality type still requires costly optical modules. The developed CL platform is simply composed of two detection modules along with a loading part for the LFA strip. The LFA membrane contains gold nanoparticle probes conjugated with antibodies against cortisol and horseradish peroxidase (HRP), which can also efficiently increase the luminescent signal by providing many areas for anti-cortisol antibody and HRP. The measured voltage signals coming from the photodiode in a CL reader were compared with a standard microplate reader for the evaluation of accuracy. The linear range observed for cortisol was measured to be 0.78–12.5 μg/dL (R² = 0.99) with a limit of detection (LOD) of 0.342 μg/dL. In addition, the CL-LFA reader showed a high correlation (R² = 0.96) with the standard cortisol console (COBAS 8000, Roche), suggesting that our developed CL-based LFA platform can be usable in situ.

Recent Advancements in Enzyme-Based Lateral Flow Immunoassays

Paper-based lateral-flow immunoassays (LFIAs) have achieved considerable commercial success and their impact in diagnostics is continuously growing. LFIA results are often obtained by visualizing by the naked eye color changes in given areas, providing a qualitative information about the presence/absence of the target analyte in the sample. However, this platform has the potential to provide ultrasensitive quantitative analysis for several applications. Indeed, LFIA is based on well-established immunological techniques, which have known in the last year great advances due to the combination of highly sensitive tracers, innovative signal amplification strategies and last-generation instrumental detectors. All these available progresses can be applied also to the LFIA platform by adapting them to a portable and miniaturized format. This possibility opens countless strategies for definitively turning the LFIA technique into an ultrasensitive quantitative method. Among the different proposals for achieving this goal, the use of enzyme-based immunoassay is very well known and widespread for routine analysis and it can represent a valid approach for improving LFIA performances. Several examples have been recently reported in literature exploiting enzymes properties and features for obtaining significative advances in this field. In this review, we aim to provide a critical overview of the recent progresses in highly sensitive LFIA detection technologies, involving the exploitation of enzyme-based amplification strategies. The features and applications of the technologies, along with future developments and challenges, are also discussed.

Tailor-Made Immunochromatographic Test for the Detection of Multiple 17α-Methylated Anabolics in Dietary Supplements

In recent years, the undeclared presence of various anabolic androgenic steroids (AAS) in commercial supplements has been confirmed. This fact can be a potential threat to all athletes using these supplements, and therefore, there is of increased interest in the implementation of rapid methods for the detection of AAS. The presented study describes the development of an immunostrip test for the detection of multiple 17α-methylated AAS based on direct and indirect competitive principle using gold nanoparticles as a label. As a capture reagent on test lines conjugated stanazolol to rabbit serum albumin (RSA/ST-3) was used, the intensity of color formed in the test line of the AAS-positive sample was visually distinguishable from that of negative sample within 10 min. The optimized closed direct and indirect format of the test provided a similar visual detection limit (0.7 and 0.9 ng/mL, respectively). The most commonly orally abused AAS (17α-methyltestosterone, methandienone, methyldihydrotestosterone, oxandrolone and oxymetholone) showed a strong cross-reaction. Developed immunostrips were successfully applied to analysis of artificially contaminated dietary supplements with 17α-methylated AASs. The developed immunostrips offer potential as a useful user-friendly method for capturing suspicious dietary supplement samples with different contents of AAS at levels far below the usually used concentrations of AAS.

Aptamer-Based Lateral Flow Biosensor for Rapid Detection of Salivary Cortisol

We have developed a disposable point-of-care (POC) aptamer-based biosensor for the detection of salivary cortisol. Nonstressful and noninvasive sampling of saliva compared to that of blood makes saliva an attractive biological matrix in developing POC devices for biomarker monitoring. Aptamers are attractive as recognition elements for multiple reasons, including their specific chemical synthesis, high stability, lack of immunogenicity, and cell-free evolution. A duplex aptamer conjugated to the surface of Au nanoparticles (AuNPs) by Au-S bonds is utilized as the sensor probe in a lateral flow assay (LFA) device. The addition of saliva samples containing cortisol makes the cortisol-aptamer undergo conformational changes and dissociate from the capture probe. Increasing cortisol concentration in the dispensed saliva sample results in increased dissociation and leads to increased binding of AuNP conjugate on the test line. Therefore, the color intensity of the test line on the LFA is a direct function of the concentration of cortisol in saliva. This simple and fast method provides detection in the cortisol range of ∼0.5-15 ng/mL, which is in the clinically accepted range for salivary cortisol. The limit of detection was 0.37 ng/mL, and the accuracy was confirmed by enzyme-linked immunosorbent assay (ELISA) testing results. High selectivity was observed for salivary cortisol against other closely related steroids and stress biomarkers present in saliva.

Tutorial: design and fabrication of nanoparticle-based lateral-flow immunoassays

Lateral-flow assays (LFAs) are quick, simple and cheap assays to analyze various samples at the point of care or in the field, making them one of the most widespread biosensors currently available. They have been successfully employed for the detection of a myriad of different targets (ranging from atoms up to whole cells) in all type of samples (including water, blood, foodstuff and environmental samples). Their operation relies on the capillary flow of the sample throughout a series of sequential pads, each with different functionalities aiming to generate a signal to indicate the absence/presence (and, in some cases, the concentration) of the analyte of interest. To have a user-friendly operation, their development requires the optimization of multiple, interconnected parameters that may overwhelm new developers. In this tutorial, we provide the readers with: (i) the basic knowledge to understand the principles governing an LFA and to take informed decisions during lateral flow strip design and fabrication, (ii) a roadmap for optimal LFA development independent of the specific application, (iii) a step-by-step example procedure for the assembly and operation of an LF strip for the detection of human IgG and (iv) an extensive troubleshooting section addressing the most frequent issues in designing, assembling and using LFAs. By changing only the receptors, the provided example procedure can easily be adapted for cost-efficient detection of a broad variety of targets.

A new polymer lab-on-a-chip (LOC) based on a microfluidic capillary flow assay (MCFA) for detecting unbound cortisol in saliva

Unbound cortisol in saliva, which can be detected with non-invasive sampling, is now considered as one of the most effective biomarkers for the biochemical evaluation of common mental disorders. In this work, a new polymer lab-on-a-chip (LOC) based on a microfluidic capillary flow assay (MCFA) with on-chip dried reagents was newly developed and fully characterized for the detection of unbound cortisol in saliva. The new MCFA device consisted of serially connected microchannels for sample loading, dried detection antibodies, time delay for incubation time control, a spiral reaction chamber for testing, positive and negative controls, and a capillary pump for waste fluid collection. In addition, a portable fluorescence analyzer was also developed for the rapid quantitative measurement of salivary cortisol with high accuracy. A linear dynamic range of 7.0 pg mL-1-16.0 ng mL-1 was achieved from spiked artificial saliva samples with an inter-chip CV of around 4.0% using the developed LOC and fluorescence analyzer. The achieved results support the effective biochemical analysis of common mental disorders such as chronic stress, depression, anxiety and post traumatic stress disorder (PTSD). The new LOC based on a microfluidic capillary flow assay (MCFA) developed in this work can be one of the most promising LOC platforms for high-sensitivity and quantitative POCT with saliva and blood plasma/serum samples.

Sensitivity enhancement in lateral flow assays: a systems perspective

Lateral flow assays (LFAs) are rapid, inexpensive, easy-to-manufacture and -use tests widely employed in medical and environmental applications, particularly in low resource settings. Historically, LFAs have been stigmatized as having limited sensitivity. However, as their global usage expands, extensive research has demonstrated that it is possible to substantially improve LFA sensitivity without sacrificing their advantages. In this critical review, we have compiled state-of-the-art approaches to LFA sensitivity enhancement. Moreover, we have organized and evaluated these approaches from a system-level perspective, as we have observed that the advantages and disadvantages of each approach have arisen from the integrated and tightly interconnected chemical, physical, and optical properties of LFAs.