Advancing Precision in Vascularized Composite Allografts through Multiplex Sensing of Predictive Biomarkers

Abstract

Vascularized Composite Allotransplantation (VCA) is a promising option for extensive tissue reconstruction. Successful graft outcomes in VCA surgeries require close monitoring of immunological reactions and the progression of ischemic conditions. Excessive immunosuppression may lead to chronic infections and dangerous side effects, while inadequate immunosuppression can result in acute or chronic rejection episodes, jeopardizing graft function. Monitoring the immunological status of an allograft becomes critical when exploring innovative tolerance induction protocols or transitioning patients from conventional therapies. Currently, confirming clinical rejection involves invasive biopsies, which are suboptimal for routine monitoring due to associated risks. Thus, developing non-invasive technologies capable of detecting changes in the immunological status of the graft before apparent clinical signs of inflammation and tissue damage become imperative. To address these limitations, this study proposes a low-cost, portable, flexible, miniaturized, and site-of-care (SOC) platform for multiplex sensing of predictive biomarkers (e.g., interleukin 6 (IL6), lactate) and pH to detect instances of VCA rejection before apparent clinical signs of immunogenic reactions such as inflammation and tissue damage.The sensor fabrication was performed on in-house fabricated porous laser-engraved graphene (PLEG)-electrode, utilizing the laser-induced carbonization (LIC) technique on a thin (12.5 µm) polyimide (PI) surface at optimized laser parameters (laser power-22%, speed-5.2%, and gas flow-50%). The PI sheet was laminated on a polyethylene terephthalate (PET) sheet with silicone adhesive in the middle, helping to dissipate the heat generated during the carbonization process. Compared to conventional screen-printed platforms, the PLEG electrode provides higher surface area, receptor loading, electrical conductivity, ease of surface modification, and improved sensitivity with an average resistance of 40 ± 3 Ω/cm. Subsequently, the connection pad and reference electrodes (RE) were coated with silver/silver chloride (Ag/AgCl) conductive paste for improved connection. The RE was stabilized by coating it with polyvinyl butyrate (PVB) and sodium chloride polymeric cocktail. Three working electrodes (WE) were designated as WE-1 (for IL6), WE-2 (for lactate), and WE-3 (for pH). The sensor construction was initiated with surface activation WEs in 0.50 M H2SO4 containing 0.10 M KCl as a supporting electrolyte by sweeping potential between 1.0 and -1.2 V vs. Ag/AgCl reference electrode. For IL-6 sensing, the WEs were incubated with freshly prepared 1-pyrenebutyric acid N-hydroxysuccinimide (PBASE) as a non-covalent crosslinker (10.0 mM) in dimethylformamide (DMF) for 3 hrs., followed by buffer wash (3 times) to remove any unbound crosslinker. Later, a monoclonal antibody to IL6 was immobilized using peptide bond formation between PBASE and the recognition element, passivated by incubating in Bovine serum albumin (BSA) to block non-specific binding. Upon binding, the antigen-antibody complex's formation results in a decrease in voltammetric signal of the redox signal, generating an IL6-dependent change in current. For lactate detection, an amperometric method utilizes a two-electrode electrochemical setup. The WE comprise a composite Glutaraldehyde/BSA/Lactate-Oxidase/Prussian Blue/PLEG-electrode (GA/BSA/LOx/PB/ PLEG). An Ag/AgCl-coated electrode serves as the RE, and counter electrodes (CE). For the pH sensor (PANI/PLEG), polyaniline (PANI) was electrodeposited at 0.80 V for 600 sec on an activated PLEG electrode washed with distilled water and coated with Nafion (0.25% v/v). For pH measurements, the open-circuit potential (OCP) was measured between the PANI/PLEG electrode and the RE.Post characterization, the sensor’s electrochemical measurements to detect IL6, lactate, and pH were performed in buffer, artificial interstitial fluid, porcine blood, and serum samples with portable potentiostat. Under optimal experimental conditions, the devised platform showed a sensitivity of 2.59 µA/(log10IL6), 0.021 µA/mM, and ~49.39 ± 2 mV in spiked serum for IL6, lactate, and pH, respectively. Subsequently, serum samples of porcine VCA recipients were collected on postoperative days (POD) 0, 2, and 6 and tested using the IL-6, lactate, and pH sensors, respectively. The sensors can successfully track the change in the levels of IL6 (increasing) and lactate (increasing) and the change in pH post-surgery and align with clinical observations of inflammation and ischemia post-allograft on POD6. The sensor results were also validated using commercial IL6 ELISA and lactate kits using the same samples and showed a correlation (r) of r = 0.9885 (n=3, for IL6) and r = 0.9896 (n=3, for lactate). Our results demonstrate that the developed miniaturized platform offers a portable, low-cost, robust, and multiplex sensing platform capable of quantifying predictive biomarkers post-VCA surgeries. This platform presents a promising, miniaturized, and cost-effective solution for the real-time monitoring of biomarkers in VCA models. KEYWORDS: Vascularized Composite Allotransplantation (VCA), Ischemia, Interleukin-6, Lactate, Electrochemical sensor, Porous laser engraved graphene, Multiplex sensing