Point-of-care Testing Platform Research Articles

Pop-Up Paper-Based Biosensor for a Dual-Mode Lung Cancer ctDNA Assay Based on Novel CoB Nanosheets with Dual-Enzyme Activities and a Portable Smartphone/Barometer for Readout.

Timely monitoring of circulating tumor DNA (ctDNA) in serum is meaningful for personalized diagnosis and treatment for lung cancer. Cheap and efficient point-of-care testing (POCT) has emerged as a promising method, especially in a low-resource setting. Herein, (i) a 3D pop-up paper-based POCT device was designed and manufactured via a cheap method; it was used for saving time and efficiently building a biosensor; (ii) a novel cobalt boride nanosheet (CoB NS) nanozyme with abundant groups was used for POCT dual-mode signal transduction and then a portable smartphone/pressure meter to readout; (iii) a user-friendly smartphone app was fabricated for achieving more convenient POCT. Detailly, the dual-mode signal generated was based on the CoB NS with peroxidase activity to catalyze a chromogenic agent to develop color and with catalase activity to catalyze decomposition of H2O2 to O2. Density functional theory (DFT) and experimental results showed a good catalysis performance of the CoB NS via studying its five possible catalytic pathways, in which the metal Co is the catalytic active site center that acts as the electron donor and promotes electron transfer between the CoB NS and the adsorbed substrates. Benefiting from that, the proposed method showed good analytical ability in detecting ctDNA. Besides, its accuracy was valued by comparing it with the standard qPCR method to detect real samples from tumor cells and tumor-bearing mice, which showed a consistent result and potential practical applicability of the proposed method for POCT ctDNA. In general, this work not only provided a dual-mode POCT platform that could also be applied for other analytes but also first revealed the nanozyme properties of the CoB NS and inspired its new application from electrocatalysis, energy, etc. to biomedicine.

Sample-to-answer point-of-care testing platform for quantitative detection of small molecules in blood using a smartphone-and microfluidic-based nanoplasmonic biosensor

Rapid and ultrasensitive detection of small molecules is of great significance in point-of-care testing (POCT) for health management and biomarker detection for many diseases. In this study, a novel POCT device integrated with a metasurface plasmon resonance (MetaSPR) chip with diffusion film enhancement was designed and controlled by a smartphone app for small molecule ultrasensitive detection based on competitive immunoassays. In this method, the sample competes with the antigen immobilized on the chip, and labeled antibodies are pumped from the sample pad to the chip for multiplexed and sample-to-answer analysis of blood. The entire process of detection is 14.3-fold less time (210 s in total) compared to an enzyme-linked immunosorbent assay (ELISA). For this assay, the limit of detection was 0.36 ppt and 1.05 ppt for testosterone and 25-hydroxyvitamin D3, respectively, and showed 100- to 1000-fold greater sensitivity than that of ELISA. Collectively, the data suggest that this novel POCT platform, based on a MetaSPR biosensor, provides ultrasensitive, rapid, regenerable, versatile, and real-time quantitative analysis for applications in health management and early diagnosis.

Enzyme-encapsulated metal-organic framework ZIF-8-mediated biosensor for ultrasensitive detection of urinary prostatic exosomal protein using a glucose meter.

A highly sensitive and efficient home-use method is impressive and promising in the self-monitoring of chronic prostatitis (CP). Herein, we developed a glucose oxidase-zeolitic imidazolate framework-8-antibody composite (GOx@ZIF-8@Ab2) to achieve highly sensitive point-of-care testing (POCT) of urinary prostatic exosomal protein (PSEP) by combining it with a personal glucometer (PGM). The developed GOx@ZIF-8@Ab2 was prepared through a simple but effective biomineralization reaction and a strong binding affinity between Zn2+ and Fc region of the antibody. This bifunctional material GOx@ZIF-8@Ab2 could not only specifically recognize the PSEP via immunoreaction but also wrap a large number of GOx molecules. Following the sandwich immunoreaction, the prepared GOx@ZIF-8@Ab2 facilitated hydrolysis of glucose in a one-to-many fashion, amplifying the detection signal and greatly improving the sensitivity of PGM detection. In comparison to those of the conventional enzyme-linked immunosorbent assay (ELISA), the detection time of the developed technique was shortened to 45 minutes and its limit of detection (0.23 pg mL-1) was reduced by 4-5 orders of magnitude. This technique was successfully utilized for detecting PSEP in human urine samples with a recovery rate of 96-116%. Owing to its rapid, ultrasensitive, specific and portable features, the as-designed platform based on GOx@ZIF-8@Ab2 and the PGM device holds great promise as a home-use POCT platform for self-monitoring of CP and other chronic diseases.

The potential promise and pitfalls of point-of-care viral load monitoring to expedite HIV treatment decision-making in rural Uganda: a qualitative study

BackgroundHIV treatment programs in Africa have implemented centralized testing for routine viral load monitoring (VLM), which may result in specimen processing delays inhibiting timely return of viral load results. Decentralized, point-of-care (PoC) VLM is a promising tool for expediting HIV clinical decision-making but remains unavailable in most African settings. We qualitatively explored the perceived feasibility and appropriateness of PoC VLM to address gaps along the viral load monitoring continuum in rural Uganda.MethodsBetween May and September 2022, we conducted 15 in-depth interviews with HIV clinicians (facility in-charges, clinical officers, nurses, counselors) and six focus group discussions with 47 peer health workers from three south-central Ugandan districts. Topics explored centralized VLM implementation and opportunities/challenges to optimizing routine VLM implementation with PoC testing platforms. We explored perspectives on PoC VLM suitability and feasibility using iterative thematic analysis. Applying the Framework Method, we then mapped salient constraints and enablers of PoC VLM to constructs from the Consolidated Framework for Implementation Research.ResultsClinicians and peers alike emphasized centralized viral load monitoring’s resource-intensiveness and susceptibility to procedural/infrastructural bottlenecks (e.g., supply stockouts, testing backlogs, community tracing of clients with delayed VLM results), inhibiting timely clinical decision-making. Participants reacted enthusiastically to the prospect of PoC VLM, anticipating accelerated turnarounds in specimen processing, shorter and/or fewer client encounters with treatment services, and streamlined efficiencies in HIV care provision (including expedited VLM-driven clinical decision-making). Anticipated constraints to PoC VLM implementation included human resource requirements for processing large quantities of specimens (especially when machinery require repair), procurement and maintenance costs, training needs in the existing health workforce for operating point-of-care technology, and insufficient space in lower-tier health facilities to accommodate installation of new laboratory equipment.ConclusionsAnticipated implementation challenges, primarily clustering around resource requirements, did not diminish enthusiasm for PoC VLM monitoring among rural Ugandan clinicians and peer health workers, who perceived PoC platforms as potential solutions to existing inefficiencies within the centralized VLM ecosystem. Prioritizing PoC VLM rollout in facilities with available resources for optimal implementation (e.g., adequate physical and fiscal infrastructure, capacity to manage high specimen volumes) could help overcome anticipated barriers to decentralizing viral load monitoring.

Tracking the Risk of Cardiovascular Disease after Almond and Oat Milk Intervene or Statin Medication with a Powerful Reflex SH-SAW POCT Platform.

Cardiovascular disease (CVD) represents the leading cause of death worldwide. For individuals at elevated risk for cardiovascular disease, early detection and monitoring of lipid status is imperative. The majority of lipid measurements conducted in hospital settings employ optical detection, which necessitates the use of relatively large-sized detection machines. It is, therefore, necessary to develop point-of-care testing (POCT) for lipoprotein in order to monitor CVD. To enhance the management and surveillance of CVD, this study sought to develop a POCT approach for apolipoprotein B (ApoB) utilizing a shear horizontal surface acoustic wave (SH-SAW) platform to assess the risk of heart disease. The platform employs a reflective SH-SAW sensor to reduce the sensor size and enhance the phase-shifted signals. In this study, the platform was utilized to monitor the impact of a weekly almond and oat milk or statins intervention on alterations in CVD risk. The SH-SAW ApoB test exhibited a linear range of 0 to 212 mg/dL, and a coefficient correlation (R) of 0.9912. Following a four-week intervention period, both the almond and oat milk intervention (-23.3%, p < 0.05) and statin treatment (-53.1%, p < 0.01) were observed to significantly reduce ApoB levels. These findings suggest that the SH-SAW POCT device may prove a valuable tool for monitoring CVD risk, particularly during routine daily or weekly follow-up visits.

Terminal Chemical Modifications of crRNAs Enable Improvement in the Performance of CRISPR-Cas for Point-of-Care Nucleic Acid Detection.

CRISPR-Cas systems, harnessing their precise nucleic acid recognition via CRISPR RNA (crRNA), offer promise for the accurate testing of nucleic acids in the field. However, the inherent susceptibility of crRNA to degradation poses challenges for accurate detection in low-resource settings. Here, we utilized the chemically modified crRNA for the CRISPR-Cas-based assay (CM-CRISPR). We found that the extension and chemical modification to crRNA significantly enhanced the trans-cleavage activity of LbCas12a. The chemically modified crRNA was resistant to degradation, and CM-CRISPR showed superior detection capability in complex environments. CM-CRISPR could be combined with recombinase polymerase amplification (RPA) and applied in a droplet digital platform, enabling attomolar-level sensitivity. We also developed a portable and automated device for a digital CRISPR assay, which is amenable to point-of-care testing (POCT). The extraction-free procedure was integrated with this assay to streamline the workflow, and clinical samples were successfully detected. This work finds a simple and efficient way to improve the performance of CRISPR-Cas and develops a portable platform for POCT, representing a significant advance toward practical applications of CRISPR-based diagnostics.

Nitrogen-doped polydopamine manganese nanoparticles with excellent oxidase-like activity for ultrafast detection of glutathione at room temperature

Glutathione (GSH) is an essential natural antioxidant, and plays a crucial role in the prevention of various diseases. Herein, a nitrogen-doped polydopamine manganese nanoparticle (N-PDA@Mn) was prepared and used as nanozyme sensor for the rapid and colorimetric detection of GSH. N-PDA@Mn demonstrated excellent oxidase-like activity (Km = 0.0841 mM and Vmax = 3.6 × 10-7 MS-1), exhibiting a rapid balance period of < 100 s. N-PDA@Mn could activate dissolved oxygen to primarily generate singlet-oxygen (1O2), which oxidized colorless 3,3′, 5, 5′-tetramethylbenzidine (TMB) to blue oxidized (ox-TMB). Because GSH could rapidly deplete 1O2, an ultrafast and colorimetric strategy was developed for GSH detection based on N-PDA@Mn. The GSH detection range was 0.5–100 μM, and the detection limit was 0.28 µM. Importantly, at room temperature, the detection time was only 30 s, which was short than that of previously reported GSH detection methods. Furthermore, a point-of-care testing (POCT) platform was designed by combining the N-PDA@Mn colorimetric sensor with a smartphone. Use the POCT platform, a broad linear detection range of 0.5–100 μM and a detection limit of 0.40 μM were obtained. Subsequently, the N-PDA@Mn colorimetric sensor and POCT platform were successfully used in the real-time and on-site quantification of GSH in human serum, achieving a high accuracy and good recovery. Therefore, the N-PDA@Mn-based methods could realize the rapid, on-site visualization, and economical detection of GSH, demonstrating their substantial potential for application in practical testing in fields of food and medicine.

MBene as novel and effective electrochemical material used to enhance paper-based biosensor for point-of-care testing ctDNA from mice serum

The development of sensitive point-of-care testing (POCT) circulating tumor DNA (ctDNA) is important for the non-invasive diagnosis of cancer and targeted therapy, especially in the low-resource areas. The electrochemical paper-based analytical device (ePAD) provides an ideal method that is few explored in ctDNA assay. Moreover, material with good electrochemical properties and sample pretreatment for effectively enriching target ctDNA could further improve the detection performance. Herein, we applied magnetic clutch probe to successfully pre-enrich ctDNA and established an ePAD for ctDNA detection, in which MBene/Au as sensing substrates for signal amplification and offering more probe binding sites. MBene with good electronic properties show its potential in electrode interface modification according to the DFT theory and experiments study via comparing with MXene. The introduction of MBene/Au synergistically improved the electron transfer and supplied more effective area. Two electrochemical assays strategies turn-off and turn-on were simultaneously applied to confirm the detection accuracy, and it exhibited a detection linear range in 1–50 pM and a limit in 178 fM and 216 fM respectively after 30 min incubation with extracted ctDNA. Moreover, the biosensor was studied in selectivity, reproducibility and stability with favorable results. In evaluation of detecting reliability, the assay results for ctDNA from tumor cell sample and mice serum were compared with conventional qPCR method and obtained high correlation (R2 = 0.993 and 0.995). Hence, this work broadens a new application of MBene into electrochemical sensing and provides a promising POCT platform for ctDNA or other analytes.

Performance evaluation and characterization of pre-analytical effects by sample types and storage conditions on tumor marker measurement by the point-of-care test platform IchromaTM II

Tumor markers should be measured regularly and accurately to prevent, diagnose, and monitor cancers efficiently. We aimed to characterize the pre-analytical factors effecting on the analytical performance of point-of-care test (POCT) platform IchromaTM II (Boditech Med Inc., Gangwon-do, Korea) for alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and prostate specific antigen (PSA) and evaluate their consequences in clinical practice. Based on comprehensive evaluation for the analytical performance of IchromaTM II including precision, linearity, and method comparison performed according to CLSI guidelines, pre-analytical factors of sample types and conditions were extensively analyzed. A total of five sample types [serum, plasma (PL) and whole blood (WB) from EDTA tube, PL and WB from sodium heparin tube] from 40 patients were used for comparing among specimen types. Additionally, stability was assessed up to 21 h at room temperature, refrigerated for 8 days, and frozen for 16 weeks by using 4 levels of pooled patient samples which were measured in triplicate. Precision, linearity and correlation with central laboratory analyzers observed in all three tumor markers were within acceptable criteria. However, variable degrees of percent deviations were observed according to sample type and storage conditions. Only EDTA PL samples presented clinically acceptable percentage biases for all three tumor markers when stored at room temperature or refrigerated condition. Positive bias of CEA and PSA in storage duration until 16 weeks were observed when stored in frozen condition. While IchromaTM II showed an adequate analytical performance as a POCT platform with simple operating procedures for the measurement of tumor markers, clinical laboratories should be aware of stability issues when different types of blood specimens are practically utilized.

LAMP assay coupled CRISPR/LbCas12a system in a single-tube method for visual detection of meat adulteration

Meat adulteration frequently infringes upon consumers' rights and interests, disrupts the market, and violates religious beliefs. However, implementing on-site detection of meat samples remains technically challenging for widespread applications. Here, we developed a point-of-care testing (POCT) platform for fast, highly sensitive, and on-site detection of meat adulteration, based on loop-mediated isothermal amplification (LAMP) coupled the clustered regularly interspaced short palindromic repeats (CRISPR) system in a single-tube. This platform integrates the efficient exponential amplification capacity of LAMP and the high specificity recognition capability of CRISPR, reducing the false positive results and minimizing LAMP aerosol contamination risk. Pork was selected as the target for adulteration detection, qualitative detection by the naked eye can be achieved within 1 h from sample collection to results with a sensitivity as high as 0.05 % to detect binary mixtures of pork in beef and the limit of DNA detection was at 50 pg/μL which 10 times higher than the individual LAMP assay. This work is expected to offer a powerful universal POCT platform for addressing a range of meat adulteration issues, suitable for enhancing food safety measures.

An enzyme-free fluorescence sensing platform based on multiplex toehold-mediated strand displacement for point-of-care testing of single nucleotide polymorphisms

Single nucleotide polymorphisms (SNPs) are biomarkers for the prediction and diagnosis of biomedical diseases, as well as important reference markers for intelligent design and breeding of animals and plants. Therefore, the development of high-sensitivity, practicability, and convenient SNPs sensing strategies and detection platforms is of great significance. In this study, we pioneered an ultra-sensitive universal sensing strategy for single base mutation detection and an enzyme-free FRET fluorescence sensing point-of-care testing (POCT) platform for SNP detection. Based on the thermodynamically regulated strand replacement mechanism, the system rationally introduced extra base mismatches and combined multiple toehold-mediated strand displacement (TMSD) reactions to achieve enzyme-free recognition of the single base mutation and double amplification of the detection signal. Finally, the biological signal of the mutant target (MT) was recognized, amplified, and transduced into a fluorescence resonance energy transfer (FRET) signal between Cy3 and Cy5 for output. Overall, the proposed biosensing strategy demonstrated high sensitivity for MT, with a detection limit as low as 0.37 fM, and could achieve detection of targets with mutant abundances as low as 0.1 %. Moreover, a portable detection system was assembled in conjunction with this sensing strategy to form a POCT platform for SNP genotyping. This POCT platform was validated to accurately identify SNPs from human cancer cells and soybean leaf genome extracts. In summary, this study will provide new insights into the design of enzyme-free biosensors for SNP detection, and will provide important technical support tools for the prevention and diagnosis of major diseases, animal and plant breeding, etc.

Rapid on-site amplification and visual detection of misfolded proteins via microfluidic quaking-induced conversion (Micro-QuIC)

Protein misfolding diseases, such as prion diseases, Alzheimer’s, and Parkinson’s, share a common molecular mechanism involving the misfolding and aggregation of specific proteins. There is an urgent need for point-of-care (POC) diagnostic technologies that can accurately detect these misfolded proteins, facilitating early diagnosis and intervention. Here, we introduce the microfluidic quaking-induced conversion (Micro-QuIC), a novel acoustofluidic platform for the rapid and sensitive detection of protein misfolding diseases. We demonstrate the utility of our technology using chronic wasting disease (CWD) as a model system, since samples from wild white-tailed deer are readily accessible, and CWD shares similarities with human protein misfolding diseases. Acoustofluidic mixing enables homogeneous mixing of reagents in a high-Reynolds-number regime, significantly accelerating the turnaround time for CWD diagnosis. Our Micro-QuIC assay amplifies prions significantly faster than the current gold standard, real-time quaking-induced conversion (RT-QuIC). Furthermore, we integrated Micro-QuIC with a gold nanoparticle-based, naked-eye detection method, which enables visual discrimination between CWD-positive and CWD-negative samples without the need for a bulky fluorescence detection module. This integration creates a rapid, POC testing platform capable of detecting misfolded proteins associated with a variety of protein misfolding diseases.

A miniaturized platform based on reciprocating-flowing immunobinding for ultrafast, highly-sensitive and on-site immunoassay

Immunoassays are considered important methods for detecting disease biomarkers for biomedical diagnosis. Particularly, enzyme-linked immunosorbent assay (ELISA) is a commonly-used immunoassay method due to its high reliability and low cost. Nowadays, automatic analyzers integrating all steps of ELISA can achieve detection without manual operation to save labor, increase detection efficiency and avoid manual error. However, most ELISA analyzers require more than 30 min for one detection, which are not fast enough for on-site point-of-care testing (POCT). Herein, based on the reciprocating-flowing immunobinding strategy, we developed a miniaturized reciprocating-flowing POCT platform (RF-POCT platform) for rapid immunodetection. RF-POCT platform, which included an electronic control module, a fluid control module, a mechanical control module and a detection module, enabled fast immunobinding of antigen and antibody. Taking ELISA as an example of immunoassay methods for RF-POCT platform, we developed a miniaturized reciprocating-flowing ELISA analyzer (RF-ELISA analyzer) to automatically detect SARS-CoV-2 nucleocapsid protein (SARS-CoV-2 N protein) and dust mite-specific immunoglobulin E (DM-IgE), with the LOD of 5.2–6.6 pg/mL and the CV less than 3 %. The detection required only 3.5 min. Afterwards, we detected the SARS-CoV-2 N protein in nasal swab samples and the DM-IgE in serum samples; the specificities were 85.7–100 %, the sensitivities were 96.3–100 %. The quantitative results from RF-ELISA analyzer were generally-consistent with those from large ELISA analyzers in hospitals. Therefore, RF-ELISA analyzer demonstrated excellent performance on ultrafast, highly-sensitive, and on-site immunoassay, with potential to support on-site POCT for primary hospitals and community clinics.

A Portable Automated Microfluidic Platform for Point-of-Care Testing for Multiple Mycotoxins in Wine.

Food safety requires point-of-care testing (POCT) for mycotoxins, since their presence in wine significantly impacts the wine industry and poses a severe threat to human life. Traditional detection methods are usually limited to detecting one mycotoxin and cannot achieve high-throughput, automated, and rapid quantitative analysis of multiple mycotoxins in real samples. Here, we propose a portable automated microfluidic platform (PAMP) integrating a chemiluminescence (CL) imaging system and a microfluidic chip to realize POCT for multiple mycotoxins in real samples, simplifying complex manual operations, shortening the detection time, and improving the detection sensitivity. Specially, silicone films were used as substrates on microfluidic chips to incubate mycotoxin conjugations, and the streptavidin-biotin (SA-B) system and an indirect immunoassay were implemented on silicone films to improve the sensitivity of reaction results. Interestingly, these methods significantly improved detection results, resulting in sensitive detection of mycotoxins, including zearalenone (ZEA) ranging from 1 to 32 ng/mL, aflatoxin B1 (AFB1) ranging from 0.2 to 6.4 ng/mL, and ochratoxin A (OTA) ranging from 2 to 64 ng/mL. The recovery of samples reached 91.39-109.14%, which verified the reliability and practicability of the PAMP. This PAMP enables sensitive and rapid detection of multiple mycotoxins in markets or wineries that lack advanced laboratory facilities. Therefore, it is essential to develop a portable microfluidic platform for POCT to detect mycotoxins in real samples.

Rapid identification and quantitative analysis of malachite green in fish via SERS and 1D convolutional neural network

Rapid and quantitative detection of malachite green (MG) in aquaculture products is very important for safety assurance in food supply. Here, we develop a point-of-care testing (POCT) platform that combines a flexible and transparent surface-enhanced Raman scattering (SERS) substrate with deep learning network for achieving rapid and quantitative detection of MG in fish. The flexible and transparent SERS substrate was prepared by depositing silver (Ag) film on the polydimethylsiloxane (PDMS) film using laser molecular beam epitaxy (LMBE) technique. The wrinkled Ag NPs@PDMS film exhibits high SERS activity, excellent reproducibility and good mechanical stability. Additionally, the fast in situ detection of MG residues onfishscales was achieved by using the wrinkled Ag NPs/PDMS film and a portable Raman spectrometer, with a minimum detectable concentration of 10-6 M. Subsequently, a one-dimensional convolutional neural network (1D CNN) model was constructed for rapid quantification of MG concentration. The results demonstrated that the 1D CNN quantitative analysis model possessed superior predictive performance, with a coefficient of determination (R2) of 0.9947 and a mean squared error (MSE) of 0.0104. The proposed POCT platform, integrating a transparent flexible SERS substrate, a portable Raman spectrometer and a 1D CNN model, provides an efficient strategy for rapid identification and quantitative analysis of MG in fish.

Nanoenzyme Hydrogel Film-Based Portable Point-of-Care Testing Platform for Double-Signal Visual Detection of PSA.

The development of the Point-of-Care Testing (POCT) platform that combines convenience and cost-effectiveness is crucial for enabling the visual detection of disease biomarkers. In this work, a POCT platform for the sensitive in situ detection of prostate specific antigen (PSA) with dual-signal output was constructed by functionalizing the Eppendorf (EP) tube. This was achieved through the modification of aptamer hairpin probes (AHPs) on the lid of the EP tube and the assembly of a nanoenzyme hydrogel film on its inner wall. The target could trigger the release of Ag+ by AHP and subsequently activate Ag+-dependent DNAzyme (Ag-DNAzyme). This would initiate the cleavage of the DNA-Au/Pt NP hydrogel network, leading to the release of Au/Pt NPs. The released Au/Pt NPs exhibit both peroxidase (POD)-like and catalase (CAT)-like activity to produce a colorimetric response and induce liquid flow under pressure. Therefore, the target can be measured visually and quantitatively through colorimetric analysis and the measurement of total dissolved solids (TDS) using a pressure-triggered liquid flow device integrated into the platform. The designed platform is distinguished by its simplicity, specificity, cost-effectiveness, and remarkable sensitivity. It allows for the visual detection of PSA within concentration ranges of 0.5-100 ng/L (colorimetric) and 3-100 ng/L (TDS reading), boasting detection limits as low as 0.15 ng/L (colorimetric) and 0.57 ng/L (TDS reading). The strategy of target-triggered nanoenzyme release significantly enhances sensitivity and provides a guiding approach for visual biomarker detection.

Tenofovir, emtricitabine, lamivudine and dolutegravir concentrations in plasma and urine following drug intake cessation in a randomized controlled directly observed pharmacokinetic trial to aid point-of-care testing.

Poor adherence to ART and pre-exposure prophylaxis (PrEP) can impact patient and public health. Point-of-care testing (POCT) may aid monitoring and adherence interventions. We report the pharmacokinetics of tenofovir [dosed as tenofovir disoproxil (TDF) and tenofovir alafenamide (TAF)], emtricitabine (FTC), lamivudine (3TC) and dolutegravir (DTG) in plasma and urine following drug cessation to evaluate adherence targets in urine for POCT. Subjects were randomized (1:1) to receive DTG/FTC/TAF or DTG/3TC/TDF for 15 days. Plasma and spot urine were collected on Day 15 (0-336 h post final dose). Drug concentrations were quantified using LC-MS, and non-linear mixed-effects models applied to determine drug disposition between matrices and relationship with relevant plasma [dolutegravir protein-adjusted 90% inhibitory concentration (PA-IC90 = 64 ng/mL) and minimum effective concentration (MEC = 324 ng/mL)] and urinary thresholds [tenofovir disoproxil fumarate 1500 ng/mL]. Of 30 individuals enrolled, 29 were included (72% female at birth, 90% Caucasian). Median (range) predicted time to plasma dolutegravir PA-IC90 and MEC were 83.5 (41.0-152) and 49.0 h (23.7-78.9), corresponding to geometric mean (90%) urine concentrations of 5.42 (4.37-6.46) and 27.4 ng/mL (22.1-32.7). Tenofovir in urine reached 1500 ng/mL by 101 h (58.6-205) with an equivalent plasma concentration of 6.20 ng/mL (4.21-8.18). These data support use of a urinary tenofovir threshold of <1500 ng/mL (tenofovir disoproxil fumarate-based regimens) as a marker of three or more missed doses for a POCT platform. However, due to low dolutegravir concentrations in urine, POCT would be limited to a readout of recent dolutegravir intake (one missed dose).

Special RCA based sensitive point‐of‐care detection of HPV mRNA for cervical cancer screening

AbstractDeveloping the sensitive point‐of‐care testing (POCT) of oncogenic nucleic acids from human papillomavirus (HPV) infection is essential in preventing cervical cancer, especially in resource‐limited settings. Rolling circle amplification (RCA) is attractive in achieving POCT via nucleic acid‐based aggregation under isothermal conditions. However, the influence of RCA product structure on the aggregation remains unexplored resulting in limited sensitivity. Here, a minimum secondary structured RCA technique (MSS‐RCA) is developed by designing a unique circular template, demonstrating significantly enhanced detection sensitivity with only one amplification step and one primer under isothermal conditions. The amplification efficiency of MSS‐RCA could be kinetically manipulated by controlling the secondary structure of the circular template. Introducing the invertase probe to MSS‐RCA, HPV16 E6/E7 nucleic acid target was detected with a personal glucose meter (PGM) with a sensitivity of 5 fm (50 zmol in 10 µL). This integrated MSS‐RCA‐PGM detection system was successfully applied to detect HPV16 E6/E7 mRNA extracted from 54 cervical swab samples reaching a positive predictive value of 100.00% and negative predictive values of 96.00% (77.77% to 99.40%, 95% CI). MSS‐RCA‐PGM provides a sensitive POCT platform for the detection of nucleic acid biomarkers for screening of cervical cancer or other diseases.

A “three-in-one” multifunctional palladium/platinum nanoparticles-driven multimodal lateral flow immunoassays for point-of-care testing of Staphylococcus aureus

Staphylococcus aureus (S. aureus) is a prevalent bacterium that affects patient recovery post-surgery and can cause postoperative complications. Consequently, detecting S. aureus in clinical settings is critical for ensuring patient well-being. In our work, a “visual-colorimetric-photothermal” three-in-one multimodal lateral flow immunoassays (LFIA) was developed for S. aureus detection to meet the growing demand for point-of-care testing (POCT) of bacteria in the field. The sensors relied on Pd/Pt@Ab1 NPs nanoprobes, created by decorating the surface of bimetallic nanoprobes (Pd/Pt NPs) with S. aureus antibodies (Ab1). A visual detection mode was realized by the Pd/Pt@Ab1 NPs being captured on the surface of test line (T line) using the sandwich method, offering a limit of detection (LOD) of 103 CFU/mL. Subsequently, Pd/Pt@Ab1 NPs catalyzed the TMB system into oxTMB to achieve colorimetric analysis, covering a detection range from 102 to 107 CFU/mL. Remarkably, the oxTMB exhibited the photothermal conversion efficiency under near-infrared (NIR) light, leading to temperature variations under 808 nm irradiation, correlating with different bacteria concentrations, with an LOD as low as 4 CFU/mL. The methodology enabled quantitative analysis of bacteria in clinical samples with satisfactory results. The diversity, complementarity, and synergy of the integrated output signals in this multimode LFIA improved the flexibility, utility, and accuracy of the assay, performing well as a POCT platform for various application scenarios.

Implementation of point-of-care molecular testing for respiratory viruses in congregate living settings.

To implement and evaluate a point-of-care (POC) molecular testing platform for respiratory viruses in congregate living settings (CLS). Prospective quality improvement study. Seven CLS, including three nursing homes and four independent-living facilities. Residents of CLS. A POC platform for COVID-19, influenza A and B, and respiratory syncytial virus was implemented at participating CLS from December 1, 2022 to April 15, 2023. Residents with respiratory symptoms underwent paired testing, with respiratory specimens tested first with the POC platform and then delivered to an off-site laboratory for multiplex respiratory virus panel (MRVP) polymerase chain reaction (PCR) as per standard protocol. Turn-around time and diagnostic accuracy of the POC platform were compared against MRVP PCR. In an exploratory analysis, time to outbreak declaration among participating CLS was compared against a convenience sample of 19 CLS that did not use the POC platform. A total of 290 specimens that underwent paired testing were included. Turn-around time to result was significantly shorter with the POC platform compared to MRVP PCR, with median difference of 36.2 hours (interquartile range 21.8-46.4 hours). The POC platform had excellent diagnostic accuracy compared to MRVP PCR, with area under the curve statistic of .96. Time to outbreak declaration was shorter in CLS that used the POC platform compared to CLS that did not. Rapid POC testing platforms for respiratory viruses can be implemented in CLS, with high diagnostic accuracy, expedited turn-around times, and shorter time to outbreak declaration.