Point-of-Care Technologies for Precision Cardiovascular Care and Clinical Research

King, Kevin R.; Grazette, Luanda; Paltoo, Dina N.; McDevitt, John T.; Sia, Samuel K.; Barrett, Paddy; Apple, Fred S.; Gurbel, Paul A.; Weissleder, Ralph; Leeds, Hilary S.; Iturriaga, Erin; Rao, Anupama; Adhikari, Bishow; Desvigne‐Nickens, Patrice; Galis, Zorina S.; Libby, Peter

doi:10.1016/j.jacbts.2016.01.008

Cited by 46 publications

(33 citation statements)

References 69 publications

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“…We need to develop and validate soluble and imaging biomarkers that reflect the underlying mechanism that yields acute ischemia. Point-of-care assessment of such biomarkers would help render their use clinically practical in the triage of patients who present with ACS, with the goal of sparing some the need for urgent invasive diagnostic or therapeutic measures 64, 95 . We then need rigorous clinical evaluation of targeted therapies guided by a more precise pathophysiologic classification of ACS that reach beyond our current dichotomous approach based on the EKG.…”

Section: Discussionmentioning

confidence: 99%

Acute Coronary Syndromes

2017

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Well into the 21st century, we still triage acute myocardial infarction based on the presence or absence of ST segment elevation, a century-old technology. Meanwhile, we have learned a great deal regarding the pathophysiology and mechanisms of acute coronary syndromes (ACS) at clinical, pathological, cellular, and molecular levels. Contemporary imaging studies have shed new light into the mechanisms of ACS. This review discusses these advances and their implications for clinical management of the ACS for the future. Plaque rupture has dominated our thinking about ACS pathophysiology for decades. Yet, current evidence suggests that a sole focus on plaque rupture vastly oversimplifies this complex collection of diseases, and obscures other mechanisms that may mandate different management strategies. We propose to segment coronary artery thrombosis due to plaque rupture into cases with or without signs of concomitant inflammation. This distinction may have substantial therapeutic implications as direct anti-inflammatory interventions for atherosclerosis emerge. Coronary artery thrombosis due to plaque erosion may be on the rise in an era of intense lipid lowering. Identification of patients with of ACS due to erosion may permit a less invasive approach to management than the current standard of care. We also now recognize ACS that occur without apparent epicardial coronary artery thrombus or stenosis. Such events may arise from spasm, microvascular disease, or other pathways. Emerging management strategies may likewise apply selectively to this category of ACS. We advocate this more mechanistic approach to the categorization of ACS to provide a framework for future tailoring, triage, and therapy for patients in a more personalized and precise manner.

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Section: Discussionmentioning

confidence: 99%

Acute Coronary Syndromes

2017

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“…In the field of medical diagnostics, these are common requirements for point-of-care (POC) systems [21]. Given the wide acceptance of SPR-based biosensors as characterization tools in the laboratory environment, several solutions aiming at the realization of POC systems are also based on plasmonic substrates with a variety of configurations [8].…”

Section: Compact Diagnostic Devicesmentioning

confidence: 99%

Emerging applications of label-free optical biosensors

et al. 2017

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Abstract:Innovative technical solutions to realize optical biosensors with improved performance are continuously proposed. Progress in material fabrication enables developing novel substrates with enhanced optical responses. At the same time, the increased spectrum of available biomolecular tools, ranging from highly specific receptors to engineered bioconjugated polymers, facilitates the preparation of sensing surfaces with controlled functionality. What remains often unclear is to which extent this continuous innovation provides effective breakthroughs for specific applications. In this review, we address this challenging question for the class of label-free optical biosensors, which can provide a direct signal upon molecular binding without using secondary probes. Label-free biosensors have become a consolidated approach for the characterization and screening of molecular interactions in research laboratories. However, in the last decade, several examples of other applications with high potential impact have been proposed. We review the recent advances in label-free optical biosensing technology by focusing on the potential competitive advantage provided in selected emerging applications, grouped on the basis of the target type. In particular, direct and real-time detection allows the development of simpler, compact, and rapid analytical methods for different kinds of targets, from proteins to DNA and viruses. The lack of secondary interactions facilitates the binding of small-molecule targets and minimizes the perturbation in single-molecule detection. Moreover, the intrinsic versatility of label-free sensing makes it an ideal platform to be integrated with biomolecular machinery with innovative functionality, as in case of the molecular tools provided by DNA nanotechnology.

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“…Portable devices digitally distribute the information, making the sensitive patient data vulnerable. To avoid any complications with patient privacy, regulatory measures from the Food and Drug Administration (FDA) should be met to comply with the “mobile medical application policy.”…”

Section: Analysis and Data Handling From Devicesmentioning

confidence: 99%

Portable Multiplex Optical Assays

Coşkun

Topkaya

Yetisen

et al. 2018

Advanced Optical Materials

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performed at home and results can be integrated by online interfaces. [5] The test results and diagnostic information can be analyzed by the medical professionals from remote locations, improving the connectivity of central hubs to the public venues.Numerous scientific discoveries have been made in advanced settings and wellequipped laboratories. The necessity and complexity of these environments limit access to research equipment worldwide. Thus, decentralization of research laboratories has become an alternative solution to improve access to experimentation in field conditions. For instance, a paper origami microscope [6] that fit into a palm of a student made a powerful investigation tool for environment and materials. A detailed analysis of sound recordings by smartphones enabled identification of distinct mosquitoes. [7] These fielddeployable devices and platforms have stimulated emergence of citizen scientists, a population that collectively performs scientific inquiries in public settings.Rich biomolecular measurements from field-portable devices improve the quality of results in terms of accuracy and depth. Monitoring multiple blood markers has enabled diagnostic precision and thorough scientific investigation of blood constituent in patients. Therefore, field-deployable devices should ideally have multiplexed detection of target specimens. Design of such multiplexed detection technologies requires decent complexity at low cost for wide-scale adoptability.In this article, we provide an overview of field-compatible devices with high parameter analysis capabilities for both health monitoring purposes and scientifically enlightening Global health issues are increasingly becoming critical with high fatality rate due to chronic and infectious diseases. Emerging technologies aim to address these problems by understanding the causes of lethal conditions and diagnosing symptoms at early stage. Existing commercial diagnostics primarily focus on single-plex assays due to ease-of-use, simplicity in analysis, and amenability to mass manufacturing. Many research grade devices have utilized only a few molecular and morphological signatures in bodily fluids. However, multiplex devices can improve accuracy, sensitivity, and scalability of research and diagnostic devices. This review presents multiplex assays that utilize optical, electrical, and chemical methods and materials that have the potential to improve portable point-of-care diagnostics. The critical role of emerging optical and complementary assays with multiple contrast mechanisms is investigated to enable highly multiplex analysis in field settings. Multiparameter portable devices for field applications toward health monitoring, food testing, air quality monitoring, and microanalysis in other extreme conditions are examined. Current trends indicate the need for validation of health diagnosis based on a large number of biomarkers in randomized clinical trials. Advanced digital analysis, crowdsourced solutions, and robust user interfaces will become an integral ...

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Point-of-Care Technologies for Precision Cardiovascular Care and Clinical Research

Cited by 46 publications

References 69 publications

Acute Coronary Syndromes

Acute Coronary Syndromes

Emerging applications of label-free optical biosensors

Portable Multiplex Optical Assays

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