Microfluidic paper-based analytical devices (µPADs) for fast and ultrasensitive sensing of biomarkers and monitoring of diseases

Direct Printing of an Electrochemical Device and Its Interface with Paper for Uric Acid Detection in Human Sweat

Using a laser-scribed (direct printing) technique, we have fabricated an enzymeless, mediatorless, and paper-interfaced electrochemical device (P-LSG) for uric acid detection on a flexible polyimide sheet. Various paper substrates were investigated, and it was found that Whatman filter paper-1 is promising to obtain the best electrochemical signals at the small volume of electrolyte, i.e., 20 μL. Furthermore, the Whatman filter paper-1 was modified with gold nanoparticles (AuNPs) to improve the electrocatalytic activity of the P-LSG device. The fabricated AuNP-modified P-LSG biosensor exhibited excellent electrocatalytic activity for the detection of uric acid over a wide range of 10 to 750 μM, with sensitivity of ∼0.214 μA μM-1 cm-2, and a limit of detection of ∼1.4 μM. The sensor was further validated by using the UHPLC-ESI-MS/MS technique, and the observed percentage recovery was less than 10%. This work opens the window to modified paper substrates with various nanomaterials to improve the sensing parameters. The electrolyte storage capacity and rich chemistry of paper additionally provide an efficient immobilization platform for biorecognition elements to diagnose other metabolites. Furthermore, it has the potential to analyze the volume of small samples (like sweat, tears, urine, etc.) using paper to develop noninvasive wearable biosensors.

ZnO based 0-3D diverse nano-architectures, films and coatings for biomedical applications

Thin-film nano-architecting is a promising approach that controls the properties of nanoscale surfaces to increase their interdisciplinary applications in a variety of fields. In this context, zinc oxide (ZnO)-based various nano-architectures (0-3D) such as quantum dots, nanorods/nanotubes, nanothin films, tetrapods, nanoflowers, hollow structures, etc. have been extensively researched by the scientific community in the past decade. Owing to its unique surface charge transport properties, optoelectronic properties and reported biomedical applications, ZnO has been considered as one of the most important futuristic bio-nanomaterials. This review is focused on the design/synthesis and engineering of 0-3D nano-architecture ZnO-based thin films and coatings with tunable characteristics for multifunctional biomedical applications. Although ZnO has been extensively researched, ZnO thin films composed of 0-3D nanoarchitectures with promising thin film device bio-nanotechnology applications have rarely been reviewed. The current review focuses on important details about the technologies used to make ZnO-based thin films, as well as the customization of properties related to bioactivities, characterization, and device fabrication for modern biomedical uses that are relevant. It features biosensing, tissue engineering/wound healing, antibacterial, antiviral, and anticancer activity, as well as biomedical diagnosis and therapy with an emphasis on a better understanding of the mechanisms of action. Eventually, key issues, experimental parameters and factors, open challenges, etc. in thin film device fabrications and applications, and future prospects will be discussed, followed by a summary and conclusion.

The use of biological fluids in microfluidic paper-based analytical devices (μPADs): Recent advances, challenges and future perspectives

The use of microfluidic paper-based analytical devices (μPADs) for aiding medical diagnosis is a growing trend in the literature mainly due to their low cost, easy use, simple manufacturing, and great potential for application in low-resource settings. Many important biomarkers (proteins, ions, lipids, hormones, DNA, RNA, drugs, whole cells, and more) and biofluids are available for precise detection and diagnosis. We have reviewed the advances μPADs in medical diagnostics have achieved in the last few years, focusing on the most common human biofluids (whole blood/plasma, sweat, urine, tears, and saliva). The challenges of detecting specific biomarkers in each sample are discussed, along with innovative techniques that overcome such limitations. Finally, the difficulties of commercializing μPADs are considered, and future trends are presented, including wearable devices and integrating multiple steps in a single platform.

Paper-based biosensors as point-of-care diagnostic devices for the detection of cancers: a review of innovative techniques and clinical applications

The development and rapid progression of cancer are major social problems. Medical diagnostic techniques and smooth clinical care of cancer are new necessities that must be supported by innovative diagnostic methods and technologies. Current molecular diagnostic tools based on the detection of blood protein markers are the most common tools for cancer diagnosis. Biosensors have already proven to be a cost-effective and accessible diagnostic tool that can be used where conventional laboratory methods are not readily available. Paper-based biosensors offer a new look at the world of analytical techniques by overcoming limitations through the creation of a simple device with significant advantages such as adaptability, biocompatibility, biodegradability, ease of use, large surface-to-volume ratio, and cost-effectiveness. In this review, we covered the characteristics of exosomes and their role in tumor growth and clinical diagnosis, followed by a discussion of various paper-based biosensors for exosome detection, such as dipsticks, lateral flow assays (LFA), and microfluidic paper-based devices (µPADs). We also discussed the various clinical studies on paper-based biosensors for exosome detection.

Detection of SARS-CoV-2 Based on Nucleic Acid Amplification Tests (NAATs) and Its Integration into Nanomedicine and Microfluidic Devices as Point-of-Care Testing (POCT)

The coronavirus SARS-CoV-2 has highlighted the criticality of an accurate and rapid diagnosis in order to contain the spread of the virus. Knowledge of the viral structure and its genome is essential for diagnosis development. The virus is still quickly evolving and the global scenario could easily change. Thus, a greater range of diagnostic options is essential to face this threat to public health. In response to the global demand, there has been a rapid advancement in the understanding of current diagnostic methods. In fact, innovative approaches have emerged, leveraging the benefits of nanomedicine and microfluidic technologies. Although this development has been incredibly fast, several key areas require further investigation and optimization, such as sample collection and preparation, assay optimization and sensitivity, cost effectiveness, scalability device miniaturization, and portability and integration with smartphones. Addressing these gaps in the knowledge and these technological challenges will contribute to the development of reliable, sensitive, and user-friendly NAAT-based POCTs for the diagnosis of SARS-CoV-2 and other infectious diseases, facilitating rapid and effective patient management. This review aims to provide an overview of current SARS-CoV-2 detection methods based on nucleic acid detection tests (NAATs). Additionally, it explores promising approaches that combine nanomedicine and microfluidic devices with high sensitivity and relatively fast 'time to answer' for integration into point-of-care testing (POCT).

Diagnosis of acute myocardial infarction: highlighting cardiac troponins as vital biomarkers

The molecular marker, cardiac troponin (cTn) is a complex protein that is attached to tropomyosin on the actin filament. It is an essential biomolecule in terms of the calcium-mediated regulation of the contractile apparatus in myofibrils, the release of which is an indication of the dysfunction of cardiomyocytes and hence the initiation of ischemic phenomena in the heart tissue. Fast and accurate analysis of cTn may help the diagnosis and management of acute myocardial infarction (AMI), for which electrochemical biosensors and microfluidics devices can be of great benefit. This editorial aims to highlight the importance of cTn as vital biomarkers in AMI diagnosis.

Development of Lateral Flow Assays for Rapid Detection of Troponin I: A Review

Troponin I as a particular and major biomarker of cardiac failure is released to blood demonstrating hurt of myocardial cells. Unfortunately, troponin I detection in the first hours of acute myocardial infarction usually faces with most negligence. Therefore, developments of point of care devices such as lateral flow strips are highly required for timely diagnosis and prognosis. Lateral flow assays are low-cost paper-based detection platforms relying on specific diagnostic agents such as aptamers and antibodies for a rapid, selective, quantitative and semi-quantitative detection of the analyte in a complex mixture. Moreover, lateral flow assay devices are portable, and their simplicity of use eliminates the need for experts or any complicated equipment to operate and interpret the test results. Additionally, by coupling the lateral flow assay technology with nanotechnology, for labeling and signal amplification, many breakthroughs in the field of diagnostics have been achieved. The present study reviews the use of lateral flow assays in early stage, quantitative, and sensitive detection of cardiac troponin I and mainly focuses on the structure of each type of developed lateral flow assays. Finally, this review summarized the improvements, detection time, and limit of detection of each study as well as the advantages and disadvantages.

Self-amplifying mRNA vaccines: Mode of action, design, development and optimization

The mRNA-based vaccines are quality-by-design (QbD) immunotherapies that provide safe, tunable, scalable, streamlined and potent treatment possibilities against different types of diseases. The self-amplifying mRNA (saRNA) vaccines, as a highly advantageous class of mRNA vaccines, are inspired by the intracellular self-multiplication nature of some positive-sense RNA viruses. Such vaccine platforms provide a relatively increased expression level of vaccine antigen(s) together with self-adjuvanticity properties. Lined with the QbD saRNA vaccines, essential optimizations improve the stability, safety, and immunogenicity of the vaccine constructs. Here, we elaborate on the concepts and mode-of-action of mRNA and saRNA vaccines, articulate the potential limitations or technical bottlenecks, and explain possible solutions or optimization methods in the process of their design and development.

Simultaneous colorimetric and electrochemical detection of trace mercury (Hg2+) using a portable and miniaturized aptasensor

We report a novel aptasensor for the simultaneous colorimetric and electrochemical detection of mercury (Hg²⁺). This device consists of a paper-based microfluidic component (μ-PAD) incorporated into a miniaturized three-electrode system fabricated through printed circuit board (PCB) technology. This biosensor is portable, rapid, versatile, and can detect Hg²⁺ down to 0.01 ppm based on 3σ of the blank/slope criteria. Moreover, it is highly selective against As²⁺, Cu²⁺, Zn²⁺, Pb²⁺, Cd²⁺, Mg²⁺, and Fe²⁺, reaching up to 13 times more of the input signal than the other heavy metals. The colorimetric detection mechanism uses aptamer functionalized polystyrene (PS)-AgNPs and Ps-AuNPs microparticles' specific aggregation. The Ps-AuNPs-based system allows qualitative detection (LOD 5 ppm) and stability over seven days (up to 97.59% signal retention). For the Ps-AgNPs-based system, the detection limit is 0.5 ppm with a linear range from 0.5 to 20 ppm (adjusted R²= 0.986) and stability over 30 days (up to 94.95% signal retention). The electrochemical component measures changes in charge transfer resistance upon target-aptamer hybridization using a [Ru (NH₃)₆]³⁺Cl₃] redox probe. The latest component presents a linear range from 0.01 to 1 ppm (adjusted R²= 0.935) with a LOD of 0.01 ppm and performance stability over seven days (up to 102.52 ± 11.7 signal retention). This device offers a universal dual detection platform with multiplexing, multi-replication, quantitative color analysis, and minimization of false results. Furthermore, detection results in river samples showed recoveries up to 91.12% (RSD 0.85) and 105.61% (RSD 1.62) for the electrochemical and colorimetric components, respectively. The proposed system is highly selective with no false-positive or false-negative results in an overall wide linear range and can safeguard the accuracy of detection results in aptasensing platforms in general.

Laser-patterned paper-based flow-through filters and lateral flow immunoassays to enable the detection of C-reactive protein

We report the use of a laser-based fabrication process in the creation of paper-based flow-through filters that when combined with a traditional lateral flow immunoassay provide an alternative pathway for the detection of a pre-determined analyte over a wide concentration range. The laser-patterned approach was used to create polymeric structures that alter the porosity of the paper to produce porous flow-through filters, with controllable levels of porosity. When located on the top of the front end of a lateral flow immunoassay the flow-through filters were shown to block particles (of known sizes of 200 nm, 500 nm, 1000 nm and 3000 nm) that exceed the effective pore size of the filter while allowing smaller particles to flow through onto a lateral flow immunoassay. The analyte detection is based on the use of a size-exclusive filter that retains a complex (∼3 μm in size) formed by the binding of the target analyte with two antibodies each of which is tagged with different-sized labels (40 nm Au-nanoparticles and 3 μm latex beads), and which is larger than the effective pore size of the filter. This method was tested for the detection of C-reactive protein in a broad concentration range from 10 ng/ml to 100,000 ng/ml with a limit-of-detection found at 13 ng/ml and unlike other reported methods used for analyte detection, with this technique we are able to counter the Hook effect which is a limiting factor in many lateral flow immunoassays.

A Distance-Based Microfluidic Paper-Based Biosensor for Glucose Measurements in Tear Range

The prevalence of diabetes has increased over the past years. Therefore, developing minimally invasive, user-friendly, and cost-effective glucose biosensors is necessary especially in low-income and developing countries. Cellulose paper-based analytical devices have attracted the attention of many researchers due to affordability, not requiring trained personnel, and complex equipment. This paper describes a microfluidic paper-based analytical device (μPAD) for detecting glucose concentration in tear range with the naked eye. The paper-based biosensor fabricated by laser CO2; and glucose oxidase/horseradish peroxidase (GOx/HRP) enzyme solution coupled with tetramethylbenzidine (TMB) were utilized as reagents. A sample volume of 10 μl was needed for the biosensor operation and the results were observable within 5 min. The color intensity-based and distance-based results were analyzed by ImageJ and Tracker to evaluate the device performance. Distance-based results showed a linear behavior in 0.1-1.2 mM with an R² = 0.9962 and limit of detection (LOD) of 0.1 mM. The results could be perceived by the naked eye without needing additional equipment or trained personnel in a relatively short time (3-5 min).

Current Challenges and Future Trends of Enzymatic Paper-Based Point-of-Care Testing for Diabetes Mellitus Type 2

A point-of-care (POC) can be defined as an in vitro diagnostic test that can provide results within minutes. It has gained enormous attention as a promising tool for biomarkers detection and diagnosis, as well as for screening of chronic noncommunicable diseases such as diabetes mellitus. Diabetes mellitus type 2 is one of the metabolic disorders that has grown exponentially in recent years, becoming one of the greatest challenges to health systems. Early detection and accurate diagnosis of this disorder are essential to provide adequate treatments. However, efforts to reduce incidence should remain not only in these stages but in developing continuous monitoring strategies. Diabetes-monitoring tools must be accessible and affordable; thus, POC platforms are attractive, especially paper-based ones. Paper-based POCs are simple and portable, can use different matrixes, do not require highly trained staff, and are less expensive than other platforms. These advantages enhance the viability of its application in low-income countries and hard-to-reach zones. This review aims to present a critical summary of the main components required to create a sensitive and affordable enzymatic paper-based POC, as well as an oriented analysis to highlight the main limitations and challenges of current POC devices for diabetes type 2 monitoring and future research opportunities in the field.

Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises

The simplification of current hepatitis C diagnostic algorithms and the emergence of digital diagnostic devices will be very crucial to achieving the WHO's set goals of hepatitis C diagnosis (i.e., 90%) by 2030. From the last decade, hepatitis C diagnosis has been revolutionized by the advent and approval of state-of-the-art HCV diagnostic platforms which have been efficiently implemented in high-risk HCV populations in developed nations as well as in some low-to-middle income countries (LMICs) to identify millions of undiagnosed hepatitis C-infected individuals. Point-of-care (POC) rapid diagnostic tests (RDTs; POC-RDTs), RNA reflex testing, hepatitis C self-test assays, and dried blood spot (DBS) sample analysis have been proven their diagnostic worth in real-world clinical experiences both at centralized and decentralized diagnostic settings, in mass hepatitis C screening campaigns, and hard-to-reach aboriginal hepatitis C populations in remote areas. The present review article overviews the significance of current and emerging hepatitis C diagnostic packages to subvert the public health care burden of this 'silent epidemic' worldwide. We also highlight the challenges that remain to be met about the affordability, accessibility, and health system-related barriers to overcome while modulating the hepatitis C care cascade to adopt a 'test and treat' strategy for every hepatitis C-affected individual. We also elaborate some key measures and strategies in terms of policy and progress to be part of hepatitis C care plans to effectively link diagnosis to care cascade for rapid treatment uptake and, consequently, hepatitis C cure.

Low-Cost Optical Assays for Point-of-Care Diagnosis in Resource-Limited Settings

Readily deployable, low-cost point-of-care medical devices such as lateral flow assays (LFAs), microfluidic paper-based analytical devices (μPADs), and microfluidic thread-based analytical devices (μTADs) are urgently needed in resource-poor settings. Governed by the ASSURED criteria (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverability) set by the World Health Organization, these reliable platforms can screen a myriad of chemical and biological analytes including viruses, bacteria, proteins, electrolytes, and narcotics. The Ebola epidemic in 2014 and the ongoing pandemic of SARS-CoV-2 have exemplified the ever-increasing importance of timely diagnostics to limit the spread of diseases. This review provides a comprehensive survey of LFAs, μPADs, and μTADs that can be deployed in resource-limited settings. The subsequent commercialization of these technologies will benefit the public health, especially in areas where access to healthcare is limited.

Point-of-care diagnostics approaches for detection of lung cancer-associated circulating miRNAs

Circulating cell-free miRNAs (ccf-miRs) have gained significant interest as biomarkers for lung cancer (LC) diagnosis. However, the clinical application of ccf-miRs is mainly limited by time, cost, and expertise-related problems of existing detection strategies. Recently, the development of different point-of-care (POC) approaches offers useful on-site platforms, because these technologies have important features such as portability, rapid turnaround time, minimal sample requirement, and cost-effectiveness. In this review, we discuss different POC approaches for detecting ccf-miRs and highlight the utility of incorporating nanomaterials for enhanced biorecognition and signal transduction, further improving their diagnostic applicability in LC settings.