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Sardesai AU, Tanak AS, Krishnan S, Striegel DA, Schully KL, Clark DV, Muthukumar S, Prasad S. An approach to rapidly assess sepsis through multi-biomarker host response using machine learning algorithm. Sci Rep 2021; 11:16905. [PMID: 34413363 PMCID: PMC8377018 DOI: 10.1038/s41598-021-96081-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
Sepsis is a life-threatening condition and understanding the disease pathophysiology through the use of host immune response biomarkers is critical for patient stratification. Lack of accurate sepsis endotyping impedes clinicians from making timely decisions alongside insufficiencies in appropriate sepsis management. This work aims to demonstrate the potential feasibility of a data-driven validation model for supporting clinical decisions to predict sepsis host-immune response. Herein, we used a machine learning approach to determine the predictive potential of identifying sepsis host immune response for patient stratification by combining multiple biomarker measurements from a single plasma sample. Results were obtained using the following cytokines and chemokines IL-6, IL-8, IL-10, IP-10 and TRAIL where the test dataset was 70%. Supervised machine learning algorithm naïve Bayes and decision tree algorithm showed good accuracy of 96.64% and 94.64%. These promising findings indicate the proposed AI approach could be a valuable testing resource for promoting clinical decision making.
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Affiliation(s)
- Abha Umesh Sardesai
- Department of Computer Engineering, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, USA
| | - Ambalika Sanjeev Tanak
- Department of Bioengineering, University of Texas at Dallas, 800 W. Campbell Rd. BSB 11, Richardson, TX, USA
| | - Subramaniam Krishnan
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Deborah A Striegel
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Kevin L Schully
- Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, MD, 21702, USA
| | - Danielle V Clark
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Sriram Muthukumar
- Department of Bioengineering, University of Texas at Dallas, 800 W. Campbell Rd. BSB 11, Richardson, TX, USA.
- EnLiSense LLC, 1813 Audubon Pondway, 1813 Audubon Pond Way, Allen, TX, 75013, USA.
| | - Shalini Prasad
- Department of Bioengineering, University of Texas at Dallas, 800 W. Campbell Rd. BSB 11, Richardson, TX, USA.
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Tanak AS, Muthukumar S, Krishnan S, Schully KL, Clark DV, Prasad S. Multiplexed cytokine detection using electrochemical point-of-care sensing device towards rapid sepsis endotyping. Biosens Bioelectron 2021; 171:112726. [PMID: 33113386 PMCID: PMC7569407 DOI: 10.1016/j.bios.2020.112726] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022]
Abstract
The implementation of endotype-driven effective intervention strategies is now considered as an essential component for sepsis management. Rapid screening and frequent monitoring of immune responses are critical for evidence-based informed decisions in the early hours of patient arrival. Current technologies focus on pathogen identification that lack rapid testing of the patient immune response, impeding clinicians from providing appropriate sepsis treatment. Herein, we demonstrate a first-of-its-kind novel point-of-care device that uses a unique approach by directly monitoring a panel of five cytokine biomarkers (IL-6, IL-8, IL-10, TRAIL & IP-10), that is attributed as a sign of the body's host immune response to sepsis. The developed point-of-care device encompasses a disposable sensor cartridge attached to an electrochemical reader. High sensitivity is achieved owing to the unique sensor design with an array of nanofilm semiconducting/metal electrode interface, functionalized with specific capture probes to measure target biomarkers simultaneously using non-faradaic electrochemical impedance spectroscopy. The sensor has a detection limit of ~1 pg/mL and provides results in less than five minutes from a single drop of undiluted plasma sample. Furthermore, the sensor demonstrates an excellent correlation (Pearson's r > 0.90) with the reference method for a total n = 40 clinical samples, and the sensor's performance is ~30 times faster compared to the standard reference technique. We have demonstrated the sensor's effectiveness to enhance diagnosis with a mechanistic biomarker-guided approach that can help disease endotypying for effective clinical management of sepsis at the patient bedside.
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Affiliation(s)
- Ambalika S Tanak
- Department of Bioengineering, The University of Texas at Dallas, TX, USA
| | | | - Subramaniam Krishnan
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kevin L Schully
- Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, MD, USA
| | - Danielle V Clark
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Shalini Prasad
- Department of Bioengineering, The University of Texas at Dallas, TX, USA.
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Evidence-based point-of-care technology development during the COVID-19 pandemic. Biotechniques 2020; 70:58-67. [PMID: 33161729 PMCID: PMC7651990 DOI: 10.2144/btn-2020-0096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since December 2019, the SARS-CoV-2 outbreak that began in Wuhan, China has spread to nearly every continent and become a global health concern. Although much has been discovered about COVID-19 and its pathogenesis, the WHO has identified an immediate need to increase the levels of testing for COVID-19 and identify the stages of the disease accurately for appropriate action to be taken by clinicians and emergency care units. Harnessing technology for accurate diagnosis and staging will improve patient outcomes and minimize serious consequences of false-positive test results. Point-of-care technologies aim to intervene at every stage of the disease to quickly identify infected patients and asymptomatic carriers and stratify them for timely treatment. This requires the tests to be rapid, accurate, sensitive, simple to use and compatible with many body fluids. Mobile platforms are optimal for remote, small-scale deployment, whereas facility-based platforms at hospital centers and laboratory settings offer higher throughput. Here we review evidence-based point-of-care technologies in the context of the entire continuum of COVID-19, from early screening to treatment, and discuss their impact on improving patient outcomes.
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Tanak AS, Muthukumar S, Hashim IA, Prasad S. Establish pre-clinical diagnostic efficacy for parathyroid hormone as a point-of-surgery-testing-device (POST). Sci Rep 2020; 10:18804. [PMID: 33139830 PMCID: PMC7606438 DOI: 10.1038/s41598-020-75856-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
Measuring the Parathyroid hormone (PTH) levels assists in the investigation and management of patients with parathyroid disorders. Rapid PTH monitoring is a valid tool for accurate assessment intraoperatively. Rapid Electro-Analytical Device (READ) is a point-of-care device that uses impedance change between target and capture probe to assess the PTH concentration in undiluted patient plasma samples. The aim of this work focuses on evaluating the analytical performance of READ platform to Roche analyzer as a prospective clinical validation method. The coefficient of variation (CV) for intra-assay imprecision was < 5% and inter-assay imprecision CV was < 10% for high (942 pg/mL) and low (38.2 pg/mL) PTH concentration. Functional sensitivity defined at 15% CV was 1.9 pg/mL. Results obtained from READ platform correlated well (r = 0.99) with commercially available clinical laboratory method (Roche Diagnostics) to measure PTH concentrations with a turn-around time of less than 15 min. Furthermore, the mean bias of 7.6 pg/mL determined by Bland–Altman analysis, showed good agreement between the two methods. We envision such a sensing system would allow medical practitioners to facilitate targeted interventions, thereby, offering an immediate prognostic approach as the cornerstone to delivering successful treatment for patients suffering from primary hyperparathyroidism.
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Affiliation(s)
- Ambalika S Tanak
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Rd. BSB 11, Richardson, TX, 75080, USA
| | | | - Ibrahim A Hashim
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Shalini Prasad
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Rd. BSB 11, Richardson, TX, 75080, USA.
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Jagannath B, Lin KC, Pali M, Sankhala D, Muthukumar S, Prasad S. A Sweat-based Wearable Enabling Technology for Real-time Monitoring of IL-1β and CRP as Potential Markers for Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:1533-1542. [PMID: 32720974 DOI: 10.1093/ibd/izaa191] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 1.2 million people in the United States are affected by inflammatory bowel disease (IBD). Inflammatory bowel disease has a natural course characterized by alternating periods of remission and relapse. Currently, disease flares are unpredictable as they occur in a random way. Further, current testing methods and practices lack the ability for real-time tracking of flares. There exists no technology that can be utilized for continuous monitoring of biomarkers, as most of these rely on samples such as blood, feces, and testing methods by which continuous monitoring is not feasible. Cytokines play a key role in IBD; the development, recurrence, and exacerbation of the inflammatory process are orchestrated by their levels in time and space. Cytokines are also present in sweat. We hypothesize that demonstrating real-time continuous monitoring of interleukin-1β (IL-1β) and C-reactive protein (CRP) may help create an enabling technology to track inflammation in IBD patients and identify flare-ups and assess efficacy of therapy. METHODS A multiplexed SWEATSENSER was used for noninvasive continuous monitoring of interleukin-1β and C-reactive protein in human eccrine sweat. Impedance spectroscopy was used to measure the sensor response. Sweat was collected using an FDA-approved PharmChek patch from 26 healthy human subjects to determine the levels of the 2 study inflammatory markers. Correlation analysis was performed for preclinical validation of the SWEATSENSER with ELISA as the reference method. On-body continuous monitoring measurements were performed on 20 human subjects using EnLiSense's SWEATSENSER wearable device for real-time monitoring studies. RESULTS The sensor device can detect interleukin-1β and C-reactive protein in sweat over a dynamic range of 3 log orders. Pearson correlation of r = 0.99 and r = 0.95 was achieved for IL-1β and CRP, respectively, for the SWEATSENSER with ELISA. Bland-Altman results further confirmed a good agreement (mean bias of -0.25 and -3.9 pg/mL for IL-1β and CRP, respectively) of the device with the reference method, demonstrating applicability of the device for real-time monitoring. Continuous on-body measurements were performed in 20 healthy human subjects for the detection of IL-1β to establish the preclinical utility of the sensor device. The continuous on-body measurements in healthy cohort reported a mean IL-1β concentration of ~28 pg/mL. Stable measurements for over continuous 30 hours was reported by the device. CONCLUSION This work demonstrates the first proof-of-feasibility of multiplexed cytokine and inflammatory marker detection in passively expressed eccrine sweat in a wearable form-factor that can be utilized toward better management of inflammatory bowel disease. This is a first step toward demonstrating a noninvasive enabling technology that can enable baseline tracking of an inflammatory response. Furthermore, this is the first study to report and quantify the presence of CRP in human eccrine sweat.
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Affiliation(s)
- Badrinath Jagannath
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
| | - Kai-Chun Lin
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
| | - Madhavi Pali
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
| | - Devang Sankhala
- Department of Electrical Engineering, The University of Texas at Dallas, Richardson, TX, USA
| | | | - Shalini Prasad
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
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Sardesai AU, Dhamu VN, Paul A, Muthukumar S, Prasad S. Design and Electrochemical Characterization of Spiral Electrochemical Notification Coupled Electrode (SENCE) Platform for Biosensing Application. MICROMACHINES 2020; 11:E333. [PMID: 32213807 PMCID: PMC7143249 DOI: 10.3390/mi11030333] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023]
Abstract
C-reactive protein (CRP) is considered to be an important biomarker associated with many diseases. During any physiological inflammation, the level of CRP reaches its peak at 48 h, whereas its half-life is around 19 h. Hence, the detection of low-level CRP is an important task for the prognostic management of diseases like cancer, stress, metabolic disorders, cardiovascular diseases, and so on. There are various techniques available in the market to detect low-level CRP like ELISA, Western blot, etc. An electrochemical biosensor is one of the important miniaturized platforms which provides sensitivity along with ease of operation. The most important element of an electrochemical biosensor platform is the electrode which, upon functionalization with a probe, captures the selective antibody-antigen interaction and produces a digital signal in the form of potential/current. Optimization of the electrode design can increase the sensitivity of the sensor by 5-10-fold. Herein, we come up with a new sensor design called the spiral electrochemical notification coupled electrode (SENCE) where the working electrode (WE) is concentric in nature, which shows better response than the market-available standard screen-printed electrode. The sensor is thoroughly characterized using a standard Ferro/Ferri couple. The sensing performance of the fabricated platform is also characterized by the detection of standard H2O2 using a diffusion-driven technique, and a low detection limit of 15 µM was achieved. Furthermore, we utilized the platform to detect a low level (100 ng/mL) of CRP in synthetic sweat. The manuscript provides emphasis on the design of a sensor that can offer good sensitivity in electrochemical biosensing applications.
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Affiliation(s)
- Abha Umesh Sardesai
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Vikram Narayanan Dhamu
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Anirban Paul
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Sriram Muthukumar
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA
- EnLiSense LLC, 1813 Audubon Pondway, Allen, TX 75013, USA
| | - Shalini Prasad
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX 75080, USA
- EnLiSense LLC, 1813 Audubon Pondway, Allen, TX 75013, USA
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