Managing Heart Failure at Home With Point-of-Care Diagnostics

Effect of Perceived Dyspnea on Attitude Toward Death From the Perspective of COPD Patients

In this study, it was aimed to examine attitudes toward dyspnea and death from the perspective of Chronic Obstructive Pulmonary Disease (COPD) patients and to determine the relationship between them. This descriptive research was carried out in the chest diseases clinic of a public hospital and with the participation of COPD patients (n = 124). The data were obtained from the Personal Information Form, Death Attitude Profile-Revised, and Medical Research Council Scale. The neutral acceptance and approach acceptance subscale is explained as believing that death is an inevitable part of life and a transition to life after death. The escape acceptance subscale is explained as believing that life will save from physical or psychological harms. It was determined that the Neutral Acceptance and Approach Acceptance sub-dimension of the predictors of dyspnea, comorbid diseases, and COPD had a significant effect at a rate of 33% (p = 0.000). Dyspnea, Comorbid diseases, and the predictors of the severity of COPD affect the Escape Acceptance sub-dimension by 57% (p = 0.000). This research has shown that fear of death is high in COPD patients with high perceived dyspnea. The psychological support provided to patients with COPD should be considered to relieve the fear of death. New studies are needed in which these should be reevaluated in the same context.

One-Step Photochemical Immobilization of Aptamer on Graphene for Label-Free Detection of NT-proBNP

A novel photochemical technological route for one-step functionalization of a graphene surface with an azide-modified DNA aptamer for biomarkers is developed. The methodology is demonstrated for the functionalization of a DNA aptamer for an N-terminal B-type natriuretic peptide (NT-proBNP) heart failure biomarker on the surface of a graphene channel within a system based on a liquid-gated graphene field effect transistor (GFET). The limit of detection (LOD) of the aptamer-functionalized sensor is 0.01 pg/mL with short response time (75 s) for clinically relevant concentrations of the cardiac biomarker, which could be of relevance for point-of-care (POC) applications. The novel methodology could be applicable for the development of different graphene-based biosensors for fast, stable, real-time, and highly sensitive detection of disease markers.

Noble Metal Nanoparticles for Point-of-Care Testing: Recent Advancements and Social Impacts

Point-of-care (POC) tests for the diagnosis of diseases are critical to the improvement of the standard of living, especially for resource-limited areas or countries. In recent years, nanobiosensors based on noble metal nanoparticles (NM NPs) have emerged as a class of effective and versatile POC testing technology. The unique features of NM NPs ensure great performance of associated POC nanobiosensors. In particular, NM NPs offer various signal transduction principles, such as plasmonics, catalysis, photothermal effect, and so on. Significantly, the detectable signal from NM NPs can be tuned and optimized by controlling the physicochemical parameters (e.g., size, shape, and elemental composition) of NPs. In this article, we introduce the inherent merits of NM NPs that make them attractive for POC testing, discuss recent advancement of NM NPs-based POC tests, highlight their social impacts, and provide perspectives on challenges and opportunities in the field. We hope the review and insights provided in this article can inspire new fundamental and applied research in this emerging field.

Paper Biosensor for the Detection of NT-proBNP Using Silver Nanodisks as Electrochemical Labels

We report on the use of silver nanodisks (AgNDs), having a diameter of 50 ± 8 nm and a thickness of 8 ± 2 nm, as electrochemical labels for the detection of a model metalloimmunoassay for the heart failure biomarker NT-proBNP. The detection method is based on an electrochemically activated galvanic exchange (GE) followed by the detection of Ag using anodic stripping voltammetry (ASV). The AgNDs labels are superior to Ag nanocubes and Ag nanospheres in terms of the dynamic range for both the model and NT-proBNP metalloimmunoassays. The linear dynamic range for the model composite is 1.5 to 30.0 pM AgNDs. When AgND labels are used for the NT-proBNP assay, the dynamic range is 0.03-4.0 nM NT-proBNP. The latter range fully overlaps the risk stratification range for heart failure from 53 pM to 590 pM. The performance improvement of the AgNDs is a result of the specific GE mechanism for nanodisks. Specifically, GE is complete across the face of the AgNDs, leaving behind an incompletely exchanged ring structure composed of both Ag and Au.

Plastic-based lateral flow immunoassay device for electrochemical detection of NT-proBNP

Here we report an easily fabricated, plastic-based lateral flow device for carrying out metalloimmunoassays. The device is called ocFlow to emphasize the open-channel design. We have shown that the ocFlow is capable of magnetic microbead (MμB)-based metalloimmunoassays for the detection of two types of immunoconjugates: a model composite (MC) and a sandwich immunoassay for the heart failure marker NT-proBNP. In both assays, Ag nanoparticles (AgNPs) were used as electrochemically detectable labels. NT-proBNP and MC concentrations as low as 750.0 pM and 10.0 pM, respectively, could be detected using the ocFlow device. Four key conclusions can be drawn from the results presented herein. First, immunoconjugates attached to the MμBs can be transported in the flow channel using combined hydrodynamic and capillary pressure passive pumping. Second, the ocFlow device is capable of on-chip storage, resolvation, and conjugate formation of both the MC and NT-proBNP composites. Third, electrochemical detection can be conducted on analytes suspended in serum by rinsing the electrodes with a wash buffer. Finally, and perhaps most significantly, the assay is quantitative and has a detection limit for NT-proBNP in the high picomolar range when the necessary reagents are stored on the device in a dry form.

Detection Efficiency of Ag Nanoparticle Labels for a Heart Failure Marker Using Linear and Square-Wave Anodic Stripping Voltammetry

In this article, we compare linear sweep anodic stripping voltammetry (LASV) and square-wave anodic stripping voltammetry (SWASV) for detection of a nano metalloimmunoassay. Two separate immunoassays were examined: a model assay, based on interactions between antibodies, and a sandwich assay for the heart failure marker NT-proBNP. In both cases, one antibody is linked to a magnetic microbead, and one is linked to a spherical Ag nanoparticle label. Electrochemical detection is carried out on a paper device. The three analytical figures of merit studied were the precision of the measurements, the calibration sensitivity, and the limit of detection (LOD). For the NT-proBNP assay, the results show that after optimization of the pulse amplitude and frequency of the potential input for SWASV, the detection efficiency is substantially higher compared to LASV. Specifically, the calibration sensitivity increased by up to ~40 fold, the average coefficient of variation decreased by ~40%, and the (LOD) decreased to 300.0 pM. Finally, for a model immunoassay, a ~10-fold decrease in the LOD was observed for SWASV compared to LASV.

Dual-Shaped Silver Nanoparticle Labels for Electrochemical Detection of Bioassays

In this paper we demonstrate the use of dual-shaped silver nanoparticles (AgNPs) as detection labels for electrochemical bioassays. The key finding is that by using AgNP labels having two different shapes simultaneously, the limit of detection (LOD) for the assays is lowered compared to using either of the two shapes separately. The two shapes were silver nanocubes (AgNCs) having edge lengths of 40 ± 4 nm and spherical AgNPs (sAgNPs) having diameters of 20 ± 3 nm. Two different bioassays were examined. In both cases the Ag labels were functionalized with antibodies. In the one assay, the labels are directly linked to a second antibody immobilized on magnetic beads. In the second assay, the antibodies on the AgNP labels and the antibodies on the magnetic beads are linked via a peptide. The peptide is N-terminal prohormone brain natriuretic peptide (NT-proBNP), which is a heart failure marker. The efficacy of the two electrochemical assays as a function of the ratio of the two labels was investigated using a galvanic exchange/anodic stripping voltammetry method. The key finding is that by optimizing the ratio of the two types of AgNP labels, it is possible to decrease the LOD of the assays without compromising the dynamic range compared to using either of the two labels independently. This made it possible to achieve the clinically relevant range for NT-proBNP analysis used by physicians for heart failure risk stratification.

Effect of Serum on Electrochemical Detection of Bioassays Having Ag Nanoparticle Labels

The effect of serum on electrochemical detection of bioassays having silver nanoparticle (AgNP) detection labels was investigated. Both a model assay and an antigen-specific sandwich bioassay for the heart failure marker NT-proBNP were examined. In both cases, the AgNP labels were conjugated to a detection antibody. Electrochemical detection was carried out using a galvanic exchange/anodic stripping voltammetry method in which Au3+ exchanges with AgNP labels. The assays were carried out using a paper-based electrode platform. The bioassays were exposed to different serum conditions prior to and during detection. There are three important outcomes reported in this article. First, both the model- and antigen-specific assays could be formed in undiluted serum with no detectable interferences from the serum components. Second, to achieve the maximum possible electrochemical signal, the highest percentage of serum that can remain in an assay buffer during electrochemical detection is 0.25% when no washing is performed. The assay results are rendered inaccurate when 0.50% or more of serum is present. Third, the factors inhibiting galvanic exchange in serum probably relate to surface adsorption of biomolecules onto the AgNP labels, chelation of Au3+ by serum components, or both. The results reported here provide general guidance for using metal NP labels for electrochemical assays in biofluids.

Ag nanoparticles outperform Au nanoparticles for the use as label in electrochemical point-of-care sensors

Electrochemical immunosensors enable rapid analyte quantification in small sample volumes, and have been demonstrated to provide high sensitivity and selectivity, simple miniaturization, and easy sensor production strategies. As a point-of-care (POC) format, user-friendliness is equally important and most often not combinable with high sensitivity. As such, we demonstrate here that a sequence of metal oxidation and reduction, followed by stripping via differential pulse voltammetry (DPV), provides lowest limits of detection within a 2-min automatic measurement. In exchanging gold nanoparticles (AuNPs), which dominate in the development of POC sensors, with silver nanoparticles (AgNPs), not only better sensitivity was obtained, but more importantly, the assay protocol could be simplified to match POC requirements. Specifically, we studied both nanoparticles as reporter labels in a sandwich immunoassay with the blood protein biomarker NT-proBNP. For both kinds of nanoparticles, the dose-response curves easily covered the ng∙mL⁻¹ range. The mean standard deviation of all measurements of 17% (n ≥ 4) and a limit of detection of 26 ng∙mL⁻¹ were achieved using AuNPs, but their detection requires addition of HCl, which is impossible in a POC format. In contrast, since AgNPs are electrochemically less stable, they enabled a simplified assay protocol and provided even lower LODs of 4.0 ng∙mL⁻¹ in buffer and 4.7 ng∙mL⁻¹ in human serum while maintaining the same or even better assay reliability, storage stability, and easy antibody immobilization protocols. Thus, in direct comparison, AgNPs clearly outperform AuNPs in desirable POC electrochemical assays and should gain much more attention in the future development of such biosensors.

Silver Nanocubes as Electrochemical Labels for Bioassays

Here, we report on the use of 40 ± 4 nm silver nanocubes (AgNCs) as electrochemical labels in bioassays. The model metalloimmunoassay combines galvanic exchange (GE) and anodic stripping voltammetry (ASV). The results show that a lower limit of detection is achieved by simply changing the shape of the Ag label yielding improved GE with AgNCs when compared to GE with spherical silver nanoparticles (sAgNPs). Specifically, during GE between electrogenerated Au³⁺ and the Ag labels, a thin shell of Au forms on the surface of the NP. This shell is more porous when GE proceeds on AgNCs compared to sAgNPs, and therefore, more exchange occurs when using AgNCs. ASV results show that the Ag collection efficiency (AgCE%) is increased by up to ∼57% when using AgNCs. When the electrochemical system is fully optimized, the limit of detection is 0.1 pM AgNCs, which is an order of magnitude lower than that of sAgNP labels.

Hybrid paper and 3D-printed microfluidic device for electrochemical detection of Ag nanoparticle labels

In the present article we report a new hybrid microfluidic device (hyFlow) comprising a disposable paper electrode and a three-dimensional (3D) printed plastic chip for the electrochemical detection of a magnetic bead-silver nanoparticle (MB-AgNP) bioconjugate. This hybrid device evolved due to the difficulty of incorporating micron-scale MBs into paper-only fluidic devices. Specifically, paper fluidic devices can entrap MB-containing conjugates within their cellulose or nitrocellulose fiber matrix. The hyFlow system was designed to minimize such issues and transport MB conjugates more efficiently to the electrochemical detection zone of the device. The hyFlow system retains the benefit of fluid transport by pressure-driven flow, however, no pump is required for its operation. The hyFlow device is capable of detecting either pre-formed MB-AgNP conjugates or conjugates formed in situ. The detection limit of AgNPs using this device is 12 pM, which represents just 22 AgNPs per MB.

Electrochemical Detection of NT-proBNP Using a Metalloimmunoassay on a Paper Electrode Platform

In this paper, we demonstrate an electrochemical method for detection of the heart failure biomarker, N-terminal prohormone brain natriuretic peptide (NT-proBNP). The approach is based on a paper electrode assembly and a metalloimmunoassay; it is intended for eventual integration into a home-use sensor. Sensing of NT-proBNP relies on the formation of a sandwich immunoassay and electrochemical quantification of silver nanoparticle (AgNP) labels attached to the detection antibodies (Abs). There are four important outcomes reported in this article. First, compared to physisorption of the detection Abs on the AgNP labels, a 27-fold increase in signal is observed when a heterobifunctional cross-linker is used to facilitate this labeling. Second, the assay is selective in that it does not cross-react with other cardiac natriuretic peptides. Third, the assay forms in undiluted human serum (though the electrochemical analysis is carried out in buffer). Finally, and most important, the assay is able to detect NT-proBNP at concentrations between 0.58 and 2.33 nM. This performance approaches the critical NT-proBNP concentration threshold often used by physicians for risk stratification purposes: ∼0.116 nM.

Orientation-Controlled Bioconjugation of Antibodies to Silver Nanoparticles

Here we report on the use of heterobifunctional cross-linkers (HBCLs) to control the number, orientation, and activity of immunoglobulin G antibodies (Abs) conjugated to silver nanoparticles (AgNPs). A hydrazone conjugation method resulted in exclusive modification of the polysaccharide chains present on the fragment crystallizable region of the Abs, leaving the antigen-binding regions accessible. Two HBCLs, each having a hydrazide terminal group, were synthesized and tested for effectiveness. The two HBCLs differed in two respects, however: (1) either a thiol or a dithiolane group was used for attachment to the AgNP; and (2) the spacer arm was either a PEG chain or an alkyl chain. Both cross-linkers immobilized 5 ± 1 Abs on the surface of each 20-nm-diameter AgNP. Electrochemical results, obtained using a half-metalloimmunoassay, proved that Abs conjugated to AgNPs via either of the two HBCLs were 4 times more active than those conjugated by the more common physisorption technique. This finding confirmed that the HBCLs exerted orientational control over the Abs. We also demonstrated that the AgNP-HBCL-Ab conjugates were stable and active for at least 2 weeks. Finally, we found that the stability of the HBCLs themselves was related to the nature of their spacer arms. Specifically, the results showed that the HBCL having the alkyl chain is chemically stable for at least 90 days, making it the preferred cross-linker for bioassays.

Detection of Silver Nanoparticles by Electrochemically Activated Galvanic Exchange

Here we report on the seemingly simple process of galvanic exchange (GE) between electrogenerated AuCl₄^- and silver nanoparticles (AgNPs). The results were obtained in the specific context of using AgNPs as labels for bioassays in paper fluidic devices. Results obtained from a combined electrochemistry and microscopy study indicate that the GE process results in recovery of only ∼5% of the total equivalents of Ag present in the system. This low value is a consequence of two factors. First, after an initial fraction of each AgNP undergoes GE, a Au shell forms around the remaining AgNP core preventing further exchange. Second, to simulate a true biological fluid, the experiments were carried out in a Cl^--containing buffer. Consequently, some Ag⁺ formed during GE precipitates as AgCl, and it also serves to block additional GE. Following optimization of the GE process, it was possible to detect AgNP label concentrations as low as 2.6 fM despite these limitations.