Highly sensitive detection of fungal antigens by ultrasound-enhanced latex agglutination

On-chip immuno-agglutination assay based on a dynamic magnetic bead clump and a sheath-less flow cytometry

Immunoagglutination assay is a promising approach for the detection of waterborne analytes like virus, cells, proteins with its advantages such as a smaller amount of reagents and easier operation. This paper presents a microfluidic agglutination assay on which all the assay processes including analyte capture, agglutination, and detection are performed. The chip integrates an on-chip pump for sample loading, a dynamic magnetic bead (MB) clump for analyte capture and agglutination, and a sheath-less flow cytometry for particle detection, sizing, and counting. The chip is tested with streptavidin-coated MBs and biotinylated bovine serum albumin as a model assay, which realizes a limit of detection (LOD) of 1 pM. Then, an antigen/antibody assay using rabbit IgG and goat anti-rabbit IgG coated MBs is tested and a LOD of 5.5 pM is achieved. At last, human ferritin in 10% fetal bovine serum is tested with Ab-functionalized MBs and the detection achieves a LOD of 8.5 pM. The whole procedure takes only 10 min in total.

High-Throughput Incubation and Quantification of Agglutination Assays in a Microfluidic System

In this paper, we present a two-phase microfluidic system capable of incubating and quantifying microbead-based agglutination assays. The microfluidic system is based on a simple fabrication solution, which requires only laboratory tubing filled with carrier oil, driven by negative pressure using a syringe pump. We provide a user-friendly interface, in which a pipette is used to insert single droplets of a 1.25-µL volume into a system that is continuously running and therefore works entirely on demand without the need for stopping, resetting or washing the system. These assays are incubated by highly efficient passive mixing with a sample-to-answer time of 2.5 min, a 5⁻10-fold improvement over traditional agglutination assays. We study system parameters such as channel length, incubation time and flow speed to select optimal assay conditions, using the streptavidin-biotin interaction as a model analyte quantified using optical image processing. We then investigate the effect of changing the concentration of both analyte and microbead concentrations, with a minimum detection limit of 100 ng/mL. The system can be both low- and high-throughput, depending on the rate at which assays are inserted. In our experiments, we were able to easily produce throughputs of 360 assays per hour by simple manual pipetting, which could be increased even further by automation and parallelization. Agglutination assays are a versatile tool, capable of detecting an ever-growing catalog of infectious diseases, proteins and metabolites. A system such as this one is a step towards being able to produce high-throughput microfluidic diagnostic solutions with widespread adoption. The development of analytical techniques in the microfluidic format, such as the one presented in this work, is an important step in being able to continuously monitor the performance and microfluidic outputs of organ-on-chip devices.

Ultrasonic enhancement of bead-based bioaffinity assays

Ultrasonic radiation forces can be used for non-intrusive manipulation and concentration of suspended micrometer-sized particles. For bioanalytical purposes, standing-wave ultrasound has long been used for rapid immuno-agglutination of functionalized latex beads. More recently, detection methods based on laser-scanning fluorometry and single-step homogeneous bead-based assays show promise for fast, easy and sensitive biochemical analysis. If such methods are combined with ultrasonic enhancement, detection limits in the femtomolar region are feasible. In this paper, we review the development of standing-wave ultrasonic manipulation for bioanalysis, with special emphasis on miniaturization and ultrasensitive bead-based immunoassays.

Comparison of non-culture-based methods for detection of systemic fungal infections, with an emphasis on invasive Candida infections

The accepted limitations associated with classic culture techniques for the diagnosis of invasive fungal infections have lead to the emergence of many non-culture-based methods. With superior sensitivities and quicker turnaround times, non-culture-based methods may aid the diagnosis of invasive fungal infections. In this review of the diagnostic service, we assessed the performances of two antigen detection techniques (enzyme-linked immunosorbent assay [ELISA] and latex agglutination) with a molecular method for the detection of invasive Candida infection and invasive aspergillosis. The specificities for all three assays were high (> or = 97%), although the Candida PCR method had enhanced sensitivity over both ELISA and latex agglutination with values of 95%, 75%, and 25%, respectively. However, calculating significant sensitivity values for the Aspergillus detection methods was not feasible due to a low number of proven/probable cases. Despite enhanced sensitivity, the PCR method failed to detect nucleic acid in a probable case of invasive Candida infection that was detected by ELISA. In conclusion, both PCR and ELISA techniques should be used in unison to aid the detection of invasive fungal infections.

Rotavirus detection using ultrasound enhanced latex agglutination and turbidimetry

Application of a non-cavitating ultrasonic standing wave to suspended microparticles brings the particles into close approximation and has been used previously to enhance the performance of several diagnostic agglutination tests. The sensitivity of rotavirus detection by ultrasound enhanced latex agglutination was compared with conventional test-card agglutination. Application of ultrasound gave a 32-fold improvement in the sensitivity of detection of rotavirus antigen in buffer compared with the test card method. A novel turbidimetric approach was used to measure agglutination occurring following the test-card procedure (in place of visual examination) and following exposure of commercial rotavirus latex reagents to a 4.5 MHz ultrasonic field (in place of microscopy). The sensitivity enhancement over the conventional method achievable through ultrasonic exposure was comparable whether agglutination measurements were made visually or turbidimetrically and demonstrates the potential for turbidimetry in combination with the ultrasonic method. Turbidimetry offers an alternative to visual assessment that may be more easily incorporated into automated systems.

Ultrasonic wave action upon the red blood cell agglutination in vitro

The ultrasonic wave action upon immune red blood cell (RBC) aggregation in vitro was investigated by means of the elastic light-scattering method. The RBC agglutination process in the ultrasonic wave presence was analysed as a function of irradiation time, the antiserum series, the whole blood and antiserum dilution degree and blood group types. It was experimentally shown that the ultrasonic irradiation accelerated the agglutination reaction in the blood and antiserum mixture. The sedimentation process showed a gain in the resolution of the optical method's ability to detect the induced RBC complex formation. It revealed that the ultrasonic application led to significant diagnostic test time shortening. The results may be used to develop new diagnostic techniques and devices.

Aspergillus Fumigatus antigen detection in sera from patients at risk for invasive aspergillosis

We have developed an inhibition enzyme immunoassay (inhibition-EIA) to monitor for the occurrence of invasive aspergillosis (IA) in sera from 45 immunocompromised (IC) patients. The test uses rabbit polyclonal antibodies and a mixture of components from Aspergillus fumigatus, containing three predominant antigens with molecular weights of 18,000, 33,000, and 56,000. Circulating antigens were found in five of seven proven cases of IA due to A. fumigatus. In two of the five positive cases, antigenemia was detected with inhibition-EIA earlier than with X ray or other biological methods. No antigens were detected in the sera from two patients with proven IA due to Aspergillus flavus and Aspergillus terreus nor in the sera from four patients with probable IA. Circulating antigens were not detected in the control group, composed of 30 healthy adult blood donors. Four of the 32 at-risk patients examined, though they displayed no definite evidence of IA, gave a positive result in this test. The sensitivity, specificity, and positive predictive value of inhibition-EIA were 71.4, 94.4, and 71.2%, respectively. The data were compared with those obtained by a latex agglutination assay of galactomannan (GM) that was positive in only one patient with probable IA. The higher sensitivity obtained by inhibition-EIA may well be due to its ability to detect circulating antigens other than GM in the sera of IC patients with IA. Detecting these antigens may improve the diagnosis of IA, as they may serve as markers of this infection.

Ultrasound-enhanced latex immunoagglutination and PCR as complementary methods for non-culture-based confirmation of meningococcal disease

Preadmission administration of antibiotics to patients with suspected meningococcal infection has decreased the likelihood of obtaining an isolate and has stimulated development of rapid and reliable non-culture-based diagnostic methods. The sensitivity of the conventional test card latex agglutination test (TCLAT) for detection of capsular polysaccharide has been reported to be suboptimal. In the United Kingdom meningococcal DNA detection by PCR has become readily available and is now used as a first-line investigation. Recently, the performance of latex antigen detection has been markedly improved by ultrasound enhancement. Three tests for laboratory confirmation of meningococcal infection, (i) PCR assays, (ii) TCLAT, and (iii) ultrasound-enhanced latex agglutination test (USELAT), were compared in a retrospective study of 125 specimens (serum, plasma, and cerebrospinal fluid specimens) from 90 patients in whom meningococcal disease was suspected on clinical grounds. Samples were from patients with (i) culture-confirmed meningococcal disease, (ii) culture-negative but PCR-confirmed meningococcal disease, and (iii) clinically suspected but non-laboratory-confirmed meningococcal disease. USELAT was found to be nearly five times more sensitive than TCLAT. Serogroup characterization was obtained by both PCR and USELAT for 44 samples; all results were concordant and agreed with the serogroups determined for the isolates when the serogroups were available. For 12 samples negative by USELAT, the serogroup was determined by PCR; however, for 12 other specimens for which PCR had failed to indicate the serogroup, USELAT gave a result. USELAT is a rapid, low-cost method which can confirm a diagnosis, identify serogroups, and guide appropriate management of meningococcal disease contacts. A complementary non-culture-based confirmation strategy of USELAT for local use supported by a centralized PCR assay service for detection of meningococci would give the benefits of timely information and improved epidemiological data.

Aspergillus fumigatus and aspergillosis

Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases in the number of immunosuppressed patients, however, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide. In this review, the focus is on the biology of A. fumigatus and the diseases it causes. Included are discussions of (i) genomic and molecular characterization of the organism, (ii) clinical and laboratory methods available for the diagnosis of aspergillosis in immunocompetent and immunocompromised hosts, (iii) identification of host and fungal factors that play a role in the establishment of the fungus in vivo, and (iv) problems associated with antifungal therapy.

Ultrasonic enhancement of coated particle agglutination immunoassays: influence of particle density and compressibility

The detection rate and sensitivity (analyte concentration limit) of coated particle agglutination immunoassays are increased in ultrasonic standing waves. The influence of particle volume, density and compressibility, properties that modify the ultrasonic radiation, and interaction forces the particles experience, on assay sensitivity with latex and silica particles in the range 0.25-1.0 microm is examined here. Streptavidin-coated 0.3-microm silica particles and 0.25-microm and 1.0-microm latex particles were examined for agglutination with biotinylated bovine serum albumin (bBSA) following exposure on axis in a 4.6-MHz radial standing wave. The lowest detection limit, 2 ng/mL bBSA, was achieved with the 0.3-microm silica. The detection limit decreased with increasing latex particle size. The limit of an ultrasound-enhanced agglutination immunoassay of rabbit antimouse immunoglobulin was 6-fold better with 1.0-microm coated silica than with equal-sized latex particles. Calculations show that the particle density-dependent ultrasonic interaction force dominates the particle compressibility force for the present case. The density-dependent force on silica, but not on latex particles, is shown to be comparable in magnitude to both the long-range van der Waal's attractive force and the electrostatic repulsion between the particles. This density-dependent force may explain the improved enhancement of analyte detection by coated silica compared with latex particles.

Preliminary clinical evaluation of meningococcal disease and bacterial meningitis by ultrasonic enhancement

Antigen detection in the urine and serum may be useful in the diagnosis of suspected meningococcal disease, especially after previous antibiotic treatment. Current test card procedures using commercial agglutination kits are often too insensitive to contribute to diagnosis. Diagnosis of meningococcal disease rose from 37% with the test card procedure to 74% following ultrasonic enhancement.

Ultrasonic separations in analytical biotechnology

Cells in megahertz-frequency noncavitating ultrasonic standing waves concentrate at submillimetre distances and are, as large clumps, easily removed from suspension in flow or batch systems. An ultrasonic filter for perfusion hybridoma culture is now available. Results from small-volume prototype analytical-scale systems can inform the design of effective filter or batch-clarification systems for a wide range of cell sizes, concentrations and sample volumes. Large increases in the rates of aqueous biphasic separations and of the rates and sensitivities of analytical immunocoated particle-agglutination assays occur in standing waves. Ultrasonic manipulation is briefly compared with immunomagnetic and dielectrophoretic separations.

Detection of meningitis antigens in buffer and body fluids by ultrasound-enhanced particle agglutination

The standard test card agglutination of antibody-coated latex by Neisseria meningitidis. Streptococcus group B, Haemophilus influenzae type b and Streptococcus pneumoniae antigens has been compared with a technique involving local concentration of the coated latex in an ultrasonic standing wave. The detection of positive control antigen was enhanced, compared with the test-card procedure, over a 16 to 64 fold range on exposure to ultrasound. Sample filtration eliminated non-specific agglutination on ultrasonic exposure of latex in control serum, urine or concentrated urine. Tests of meningitis patient body fluids showed increased detection of antigen with ultrasound for CSF (11/14 > 7/14) serum (8/13 > 3/13) and concentrated urine (8/17 > 2/17) compared to test card assays. The ultrasound detection of antigen in serum or concentrated urine was comparable to that achieved with CSF on test cards. Serum dilution experiments showed that ultrasound could detect antigen in serum over a 1000 fold concentration range.

Serum Aspergillus galactomannan antigen testing by sandwich ELISA: practical use in neutropenic patients

The double sandwich ELISA detecting Aspergillus galactomannan (GM) was prospectively evaluated for the diagnosis of invasive aspergillosis (IA) in 50 haematological patients at risk for IA. Serum samples were collected once weekly as long as the risk factors persisted. Six patients had proven or probable IA (3 A. fumigatus, 1 A. flavus, 1 A. niger, 1 A. ustus) and the GM titres were parallel to the clinical evolution of IA. Six of nine patients with suspected IA had at least two consecutive serum GM titres above 1 ng/ml and died with increasing titres, whereas the GM-negative patients survived. Positive GM titres did not anticipate the isolation of fungi. Unfortunately, positive GM titres did not anticipate the initiation of antifungal therapy, based on clinical suspicion. Moreover, if a true-positive result was defined as two consecutive positive serum samples, four patients out of 35 without proven, probable or suspected IA were positive. Then, the rate of false-positive results was high (12%) in the range previously reported. Nevertheless, the GM ELISA appears useful to assess IA and to follow the efficacy of antifungal treatment.

Measurement of antigen concentration by an ultrasound-enhanced latex immunoagglutination assay

A novel ultrasonic technique that increases the rate and sensitivity of latex agglutination tests (LATs) has recently been described. The technique is based on the fact that suspended latex particles become concentrated in an ultrasonic standing wavefield, thereby increasing the rate of particle-particle collisions compared to the standard LAT procedure. The present work extends earlier qualitative assessments of agglutination and seeks to establish whether quantitative measurement of agglutinate size may be used as an indicator of antigen concentration. The agglutination of latex microparticles coated with antibody to C-reactive protein (CRP) is studied here as a model system to determine the dependence of agglutinate size on analyte (CRP) concentration. Agglutinate size is characterised by image analysis techniques. The results show that agglutinate size decreases with decreasing CRP concentration. A near linear relationship is shown between analyte concentration and the size of agglutinate formed over a 100-fold dilution range. The threshold concentration of 230 pg/mL for detection of CRP in the ultrasonic test is 2560 times lower than that required for a conventional test-card CRP latex agglutination assay.