(2 intermediate revisions by the same user not shown)
Line 1:
Line 1:
{{Use American English|date = March 2019}}
{{Short description|A diagnostic method that allows simultaneous testing for multiple analytes at the point of care.}}
{{Short description|bedside testing technology}}
[[File:Multiplexed point-of-care testing (xPOCT).jpg|thumb|Schematic of the different types of xPOCT|330x330px]]
[[File:Multiplexed point-of-care testing (xPOCT).jpg|thumb|Schematic of the different types of xPOCT|330x330px]]
'''Multiplexed [[point-of-care testing]]''' (xPOCT) is a more complex form of [[point-of-care testing]] (POCT), or bedside testing. Point-of-care testing is designed to provide diagnostic tests at or near the time and place that the patient is admitted. POCT uses the concentrations of [[analyte|analytes]] to provide the user with information on the physiological state of the patient.<ref name="Rusling">{{cite journal | vauthors = Rusling JF | title = Multiplexed electrochemical protein detection and translation to personalized cancer diagnostics | language = EN | journal = Analytical Chemistry | volume = 85 | issue = 11 | pages = 5304–10 | date = June 2013 | pmid = 23635325 | pmc = 3674208 | doi = 10.1021/ac401058v }}</ref> An analyte is a substance, chemical or biological, that is being analyzed using a certain instrument. While point-of-care testing is the quantification of one analyte from one [[in vitro]] (e.g. blood, plasma or urine) sample, multiplexed point-of-care testing is the simultaneous on-site quantification of various analytes from a single sample.<ref name="Dincer-Bruch" />
[[Multiplexed point-of-care testing]] (mPOCT) refers to diagnostic tests that are designed to detect multiple analytes or biomarkers simultaneously at the location where patient care is provided. This approach is particularly useful in settings where rapid decision-making is critical, such as in emergency departments, clinics, or remote locations.
==Principles of Multiplexed Testing==
Multiplexed testing involves the simultaneous analysis of multiple targets in a single assay. This is achieved through the use of various technologies, such as microarrays, bead-based assays, or lab-on-a-chip devices. These technologies allow for the detection of multiple [[biomarkers]] from a single sample, which can be a significant advantage in terms of time, cost, and sample volume.
Processing of one biological sample to yield multiple [[biomarker]] results allows for POCT testing to be done for patients who may have conditions that require the confirmation of multiple biomarkers and tests before diagnosis (e.g. many types of cancers<ref name="Rusling" />). xPOCT has important emerging applications in resource-limited settings, (e.g. in the [[developing countries]], in doctor's practices, or at home by non experts) xPOCT has recently become more important for [[In vitro diagnostics|''in vitro'' diagnostics]].<ref name="Dincer-Bruch">{{cite journal | vauthors = Dincer C, Bruch R, Kling A, Dittrich PS, Urban GA | title = Multiplexed Point-of-Care Testing - xPOCT | language = English | journal = Trends in Biotechnology | volume = 35 | issue = 8 | pages = 728–742 | date = August 2017 | pmid = 28456344 | pmc = 5538621 | doi = 10.1016/j.tibtech.2017.03.013 | url = http://www.cell.com/trends/biotechnology/fulltext/S0167-7799(17)30062-8?sf74178756=1 }}</ref>
==Technologies Used==
Several technologies are employed in multiplexed point-of-care testing:
== Background ==
* '''Microarrays''': These are platforms that can analyze thousands of biological samples simultaneously. They are used to detect [[DNA]], [[RNA]], or [[protein]]s.
Historically, medical testing has been a tedious, long and expensive process in a clinical setting. It usually involves taking a large sample from the patient (e.g. urine, blood, saliva, tissue swab), and processing it in a separate laboratory, which takes hours or sometimes days to complete. In that time frame, the patient needs to be provided with care, which is not favorable to do without the desired information from the laboratory test. As far back as the 1950s, [[radioimmunoassay]]s were first demonstrated for the sensitive detection of insulin and thyroxine levels in human plasma.<ref name="Araz-Tentori">{{cite journal | vauthors = Araz MK, Tentori AM, Herr AE | title = Microfluidic multiplexing in bioanalyses | journal = Journal of Laboratory Automation | volume = 18 | issue = 5 | pages = 350–66 | date = October 2013 | pmid = 23757343 | doi = 10.1177/2211068213491408 }}</ref> In the 1990s, research that was being conducted in the microelectronics industry was applied to the design of immunoassays and since then the applications for immunoassays have expanded.<ref name="Araz-Tentori" />
There has been a movement towards quicker, more simplistic and cost effective technologies that require small amounts of biological substances to yield results. This movement has been dubbed as [[Microfluidics|microfluidic]] and [[lab-on-a-chip]] technology and aims to bring the results of a test accurately, quickly, and conveniently back to the patient with low cost and complexity to ensure the best patient care. Multiplexed point-of-care testing aims to do all of these things, but with multiple [[biomarker]]s at once.<ref name="Dincer-Bruch" /> Microfluidics refers to the study and control of very small amounts of liquids and lab-on-a-chip is an electronic chip that is usually about 3 square millimeters that has the ability to perform various laboratory like [[capillary electrophoresis]] and [[Polymerase chain reaction|PCR]].<ref name="Volpatti-Yetisen">{{cite journal | vauthors = Volpatti LR, Yetisen AK | title = Commercialization of microfluidic devices | journal = Trends in Biotechnology | volume = 32 | issue = 7 | pages = 347–50 | date = July 2014 | pmid = 24954000 | doi = 10.1016/j.tibtech.2014.04.010 }}</ref>
* '''Bead-based assays''': These use microscopic beads coated with specific capture molecules. Each bead type is specific to a different analyte, allowing for the simultaneous detection of multiple targets.
== xPOCT technology characteristics ==
* '''Lab-on-a-chip''': These are miniaturized devices that integrate multiple laboratory functions on a single chip. They can perform complex analyses with small sample volumes.
An ideal device for multiplexed point-of-care testing should offer high [[Sensitivity (electronics)|sensitivity]] and the capability to process one sample using multiple types of tests. It should be capable of testing various kinds of substances, including [[protein]]s, [[drug]]s, [[RNA]]s and [[Cell (biology)|cells]], at the same time. A high sensor performance that requires small samples, short turnaround times, low system complexity for non experts, and low cost are some characteristics of xPOCT technology. Especially for the resource-limited settings (developing countries, doctors offices, directly at home), equipment-free or smartphone-based devices are very advantageous.<ref name=":4">{{cite journal | vauthors = Vashist SK, Luppa PB, Yeo LY, Ozcan A, Luong JH | title = Emerging Technologies for Next-Generation Point-of-Care Testing | language = English | journal = Trends in Biotechnology | volume = 33 | issue = 11 | pages = 692–705 | date = November 2015 | pmid = 26463722 | doi = 10.1016/j.tibtech.2015.09.001 | url = http://www.cell.com/trends/biotechnology/abstract/S0167-7799(15)00187-0 }}</ref>
xPOCT devices has to fulfill the following:<ref name="Dincer-Bruch" /><ref>{{cite journal | vauthors = Gauglitz G | title = Point-of-care platforms | journal = Annual Review of Analytical Chemistry | volume = 7 | pages = 297–315 | date = 2014-01-01 | pmid = 25014344 | doi = 10.1146/annurev-anchem-071213-020332 | bibcode = 2014ARAC....7..297G }}</ref>
==Applications==
Multiplexed point-of-care testing is used in various medical fields, including:
* Low sample consumption (e.g. blood from a finger prick) or the ability to measure in noninvasive samples (e.g. saliva, urine or exhaled breath condensate)
* '''Infectious diseases''': Rapid detection of multiple pathogens in a single test, such as respiratory viruses or sexually transmitted infections.
* Fast sample-to-result times enabling an immediate treatment
* Long shelf life with extended reagent storage
*Ease of storage
* Comparable test results with central laboratory findings ensuring international quality standards ([[ISO 15189]])
* Automatic or facile system operation with minimized user intervention
* Cheap and portable readout systems (e.g. handheld readers) along with disposable test strips or cartridges fulfilling the [[In vitro diagnostics|''in vitro'' diagnostics]] guideline ([[EU Directives]] or [[Food and Drug Administration|FDA]] regulations).
== Technologies ==
* '''Cardiology''': Simultaneous measurement of cardiac biomarkers to assess heart conditions.
Multianalyte detection is mostly achieved through three different approaches but the technology mainly aims to use a single or small set of biological samples to split or separate them to be read by various types of assays:
# Regional separation employing distinct sections of a channel network or array of electrodes
* '''Oncology''': Detection of multiple cancer markers to aid in diagnosis and treatment monitoring.
# Spatial separation of detection sites with the help of various wells or spots
# Application of multiple labels such as [[enzyme]]s, [[redox]] molecules, beads, and dyes
Other xPOCT devices use [[mass spectrometry]] (MS) to directly identify biomarkers<ref name="Dincer-Bruch" /> for example, [[matrix-assisted laser desorption/ionization]] (MALDI)-MS to rapidly identify pathogens, but devices that use this technology tend to be bulky and difficult to use. For the signal readout, optical and electrochemical detection methods are mainly employed.<ref name="Rusling" /><ref name="Araz-Tentori" />
* '''Endocrinology''': Monitoring of hormone levels for conditions like diabetes or thyroid disorders.
Current types of diagnostic devices<ref name="Dincer-Bruch" /> that are being used are:
==Advantages==
The main advantages of multiplexed point-of-care testing include:
* Paper-based systems - [[Lateral flow test|Lateral flow assays]] like pregnancy tests, which use samples that react with colored particles and require the device to read the color signature
* '''Speed''': Rapid results allow for immediate clinical decision-making.
* Array-based systems - Devices with electrodes or fluorescent molecules in them that are sensitive to certain analytes
* Bead-based systems - Systems that use beads as a material for the analytes to bind specifically to and those complexes are subsequently filtered or separates by size or color, for example bead based [[flow cytometry]]
== Benefits and challenges ==
* '''Efficiency''': Multiple tests from a single sample reduce the need for multiple procedures.
xPOCT has incredible benefits and applications for the healthcare and technology. It allows for a more cost effective, more rapid, portable, less painful, less complex yet accurate technology that can be used to test for indicators of conditions that previously required multiple samples and several hours or days to do. In addition to its implications in the clinical setting, the low complexity and portability of many multiplexed point-of-care test devices allows for its use by non experts at home both for those who require at home health monitoring systems and for other personalized medicinal uses. The incidence of false positives or false negatives seem to be low.<ref name="Rusling" />
Reaching the optimal space of high performance and low complexity, cost, and size has some challenges. Scientists, hospitals, manufacturers, and policy makers must ensure that the data gathered from these devices would be secure, and that the devices and the materials used in conjunction with it remain affordable and safe. In addition to these things, the devices themselves should be functional for long periods of time and should find ways to deal with their sensitivity to patient to patient variations, and the environment (humidity, temperature etc.).<ref name="Dincer-Bruch" /><ref name=":4" />
* '''Cost-effectiveness''': Reduces the overall cost of testing by consolidating multiple assays into one.
== Future research ==
* '''Portability''': Devices are often compact and can be used in a variety of settings.
Current research that is being done regarding xPOCT is focusing on making the requirements for something to be considered a xPOCT easier and cheaper to obtain.<ref name="Volpatti-Yetisen" /> Scientists are working to make multiplexed point-of-care devices smaller, more portable, and affordable. Research is also being done on the maximum number of analytes that can be tested at once, if smartphones are a good device to use to present the results of a test, and could there be a device that allows a patient to wear a xPOC device that continuously monitors biomarkers of interest.<ref name="Dincer-Bruch" />
== References ==
==Challenges==
{{Reflist}}
Despite its advantages, multiplexed point-of-care testing faces several challenges:
[[Category:Medical terminology]]
* '''Complexity''': Designing assays that accurately detect multiple targets without cross-reactivity can be difficult.
[[Category:Medical tests]]
{{dictionary-stub1}}
* '''Regulatory hurdles''': Ensuring that tests meet regulatory standards for accuracy and reliability.
* '''Cost of development''': High initial costs for developing multiplexed assays and devices.
==Future Directions==
The future of multiplexed point-of-care testing is promising, with ongoing research focused on improving the sensitivity, specificity, and affordability of these tests. Advances in [[nanotechnology]], [[bioinformatics]], and [[artificial intelligence]] are expected to further enhance the capabilities of mPOCT.
==Related pages==
* [[Point-of-care testing]]
* [[Microarray technology]]
* [[Lab-on-a-chip]]
* [[Biomarker]]
[[Category:Medical testing]]
[[Category:Point-of-care testing]]
Latest revision as of 03:36, 24 March 2025
A diagnostic method that allows simultaneous testing for multiple analytes at the point of care.
Schematic of the different types of xPOCT
Multiplexed point-of-care testing (mPOCT) refers to diagnostic tests that are designed to detect multiple analytes or biomarkers simultaneously at the location where patient care is provided. This approach is particularly useful in settings where rapid decision-making is critical, such as in emergency departments, clinics, or remote locations.
Multiplexed testing involves the simultaneous analysis of multiple targets in a single assay. This is achieved through the use of various technologies, such as microarrays, bead-based assays, or lab-on-a-chip devices. These technologies allow for the detection of multiple biomarkers from a single sample, which can be a significant advantage in terms of time, cost, and sample volume.
Several technologies are employed in multiplexed point-of-care testing:
Microarrays: These are platforms that can analyze thousands of biological samples simultaneously. They are used to detect DNA, RNA, or proteins.
Bead-based assays: These use microscopic beads coated with specific capture molecules. Each bead type is specific to a different analyte, allowing for the simultaneous detection of multiple targets.
Lab-on-a-chip: These are miniaturized devices that integrate multiple laboratory functions on a single chip. They can perform complex analyses with small sample volumes.
The future of multiplexed point-of-care testing is promising, with ongoing research focused on improving the sensitivity, specificity, and affordability of these tests. Advances in nanotechnology, bioinformatics, and artificial intelligence are expected to further enhance the capabilities of mPOCT.
.jpg)
