Point-of-Care Compatibility of Ultra-Sensitive Detection Techniques for the Cardiac Biomarker Troponin I—Challenges and Potential Value

Abstract

Cardiac biomarkers are frequently measured to provide guidance on the well-being of a patient in relation to cardiac health with many assays having been developed and widely utilised in clinical assessment. Effectively treating and managing cardiovascular disease (CVD) relies on swiftly responding to signs of cardiac symptoms, thus providing a basis for enhanced patient management and an overall better health outcome. Ultra-sensitive cardiac biomarker detection techniques play a pivotal role in improving the diagnostic capacity of an assay and thus enabling a better-informed decision. However, currently, the typical approach taken within healthcare depends on centralised laboratories performing analysis of cardiac biomarkers, thus restricting the roll-out of rapid diagnostics. Point-of-care testing (POCT) involves conducting the diagnostic test in the presence of the patient, with a short turnaround time, requiring small sample volumes without compromising the sensitivity of the assay. This technology is ideal for combatting CVD, thus the formulation of ultra-sensitive assays and the design of biosensors will be critically evaluated, focusing on the feasibility of these techniques for point-of-care (POC) integration. Moreover, there are several key factors, which in combination, contribute to the development of ultra-sensitive techniques, namely the incorporation of nanomaterials for sensitivity enhancement and manipulation of labelling methods. This review will explore the latest developments in cardiac biomarker detection, primarily focusing on the detection of cardiac troponin I (cTnI). Highly sensitive detection of cTnI is of paramount importance regarding the rapid rule-in/rule-out of acute myocardial infarction (AMI). Thus the challenges encountered during cTnI measurements are outlined in detail to assist in demonstrating the drawbacks of current commercial assays and the obstructions to standardisation. Furthermore, the added benefits of introducing multi-biomarker panels are reviewed, several key biomarkers are evaluated and the analytical benefits provided by multimarkers-based methods are highlighted.

Sensitive and quantitative detection of cardiac troponin I with upconverting nanoparticle lateral flow test with minimized interference

“…Measurement of cTnI levels in point-of-care (POC) setting requires rapid assays with high sensitivity to determine whether an acute myocardial infarction (AMI) has occurred. Despite the advances in POCT technologies, detecting cTnI is still particularly challenging since cTnI assays are prone to interferences originating from biological compounds such as circulating antibodies 24 . Ideally, a POCT device for cTnI would confront these challenges, be usable outside of clinical laboratories and enable desired sensitivity and quantification.…”

Electrochemical Aptasensors: Current Status and Future Perspectives

“…Therefore, a portable, fast, and inexpensive biosensor device for the detection of cardiovascular diseases is a highly necessary element to monitor the onset and progression of cardiovascular disease quickly and accurately [ 66 ]. Troponin contains a combination of three protein subunits (troponin T (Tnt, ~35 kDa), troponin I (Tni, ~30 kDa) and troponin C (Tnc, ~18 kDa)) [ 67 , 68 ]. The increased troponin levels in patients, along with other clinical features, are the best tool for the rapid diagnosis of MI.…”

Evaluation of Molecularly Imprinted Polymers for Point-of-Care Testing for Cardiovascular Disease

“…In recent times, the vast majority of reported biosensors targeting cTnI employ electrochemical or luminescent-based detection techniques, with a large proportion of luminescent-based biosensors relying on secondary labelled antibodies [102]. Moreover, many commercially available POC platforms for the detection of cTnI also rely on the formation of sandwich complexes, with fluorescence detection being one of the most common techniques employed—similar to that depicted in Figure 2 [103].…”