U.S. patent application number 13/647325 was filed with the patent office on 2013-05-09 for point-of-care fluidic systems and uses thereof.
The applicant listed for this patent is Ian Gibbons, Elizabeth A. Holmes, John Howard, Timothy M. Kemp, Shize Daniel Qi, Shaunak Roy, Chengwang Wang. Invention is credited to Ian Gibbons, Elizabeth A. Holmes, John Howard, Timothy M. Kemp, Shize Daniel Qi, Shaunak Roy, Chengwang Wang.
Application Number | 20130115685 13/647325 |
Document ID | / |
Family ID | 37397025 |
Filed Date | 2013-05-09 |
United States Patent
Application |
20130115685 |
Kind Code |
A1 |
Holmes; Elizabeth A. ; et
al. |
May 9, 2013 |
POINT-OF-CARE FLUIDIC SYSTEMS AND USES THEREOF
Abstract
This invention is in the field of medical devices. Specifically,
the present invention provides portable medical devices that allow
real-time detection of analytes from a biological fluid. The
methods and devices are particularly useful for providing
point-of-care testing for a variety of medical applications.
Inventors: |
Holmes; Elizabeth A.; (Palo
Alto, CA) ; Roy; Shaunak; (San Mateo, CA) ;
Howard; John; (Saratoga, CA) ; Wang; Chengwang;
(Mountain View, CA) ; Gibbons; Ian; (Portola
Valley, CA) ; Kemp; Timothy M.; (San Jose, CA)
; Qi; Shize Daniel; (Arcadia, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Holmes; Elizabeth A.
Roy; Shaunak
Howard; John
Wang; Chengwang
Gibbons; Ian
Kemp; Timothy M.
Qi; Shize Daniel |
Palo Alto
San Mateo
Saratoga
Mountain View
Portola Valley
San Jose
Arcadia |
CA
CA
CA
CA
CA
CA
CA |
US
US
US
US
US
US
US |
|
|
Family ID: |
37397025 |
Appl. No.: |
13/647325 |
Filed: |
October 8, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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12576197 |
Oct 8, 2009 |
8283155 |
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13647325 |
|
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|
11389409 |
Mar 24, 2006 |
7635594 |
|
|
12576197 |
|
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|
60678801 |
May 9, 2005 |
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60705489 |
Aug 5, 2005 |
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60717192 |
Sep 16, 2005 |
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60721097 |
Sep 28, 2005 |
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Current U.S.
Class: |
435/287.2 ;
422/52; 422/68.1; 422/69; 422/82.05 |
Current CPC
Class: |
G01N 33/5302 20130101;
A61B 5/14546 20130101; B01L 2300/021 20130101; B01L 2300/0877
20130101; G01N 33/50 20130101; Y10T 436/115831 20150115; B01L
2300/023 20130101; G01N 33/53 20130101; A61B 5/157 20130101; B01L
2300/087 20130101; A61B 5/14532 20130101; B01L 3/50273 20130101;
B01L 2300/0867 20130101; A61B 5/1411 20130101; B01L 2300/044
20130101; B01L 2300/0883 20130101; G16H 40/63 20180101; B01L
2300/0887 20130101; A61B 5/150251 20130101; G01N 2500/00 20130101;
A61B 5/1427 20130101; A61B 5/150022 20130101; Y02A 90/10 20180101;
B01L 2300/0636 20130101; B01L 2300/0816 20130101; G01N 21/76
20130101; Y10T 436/12 20150115; A61B 5/150099 20130101; A61B 5/417
20130101; Y10T 436/11 20150115; G01N 33/54386 20130101; Y10T 436/10
20150115; A61B 5/412 20130101; A61B 5/150854 20130101; A61B 5/1495
20130101; A61B 5/150763 20130101; A61B 5/15142 20130101; Y10T
436/143333 20150115 |
Class at
Publication: |
435/287.2 ;
422/68.1; 422/69; 422/82.05; 422/52 |
International
Class: |
G01N 33/50 20060101
G01N033/50 |
Claims
1. A system for detecting an analyte in a bodily fluid from a
subject, the system comprising: a reader assembly comprising at
least one communication interface operable to receive an assay
protocol from an external device; and an assay device configured to
be coupled to the reader assembly, said assay device comprising: i)
at least one structure for receiving at least a portion of the
bodily fluid; ii) at least one reactant that reacts with the bodily
fluid based on the assay protocol transmitted from said external
device to yield a detectable signal indicative of said analyte; and
iii) an information storage unit; wherein the reader assembly
comprises a detection assembly for detecting the detectable signal;
wherein the assay protocol effects selection of a detection method
for detecting said signal; wherein the information storage unit has
information to be used in selection of the assay protocol.
2. A system as in claim 1 wherein the communication interface is
configured to receive said protocol wirelessly from said external
device.
3. A system as in claim 1 wherein the communication interface is
configured to receive said protocol via a wired connection from
said external device.
4. A system as in claim 1 wherein the assay device comprises a
cartridge.
5. A system as in claim 1 wherein said reactant comprises an
immunoassay or a nucleic acid reagent immobilized within the assay
device.
6. A system as in claim 1 wherein the information storage unit
comprise a bar code.
7. A system as in claim 1 wherein the information storage unit
comprise a semiconductor memory device.
8. A system as in claim 1 wherein the information comprises an
identifier for the assay unit.
9. A system as in claim 1 wherein the reader assembly is configured
to detect a plurality of analytes and said assay device comprises
immunoassay or nucleic acid reagents for said plurality of
analytes.
10. A system as in claim 11 wherein the detection assembly is
configured to detect a plurality of analytes that generate distinct
signals, wherein the intensities of said distinct signals vary over
a range of 3 orders of magnitude.
11. A system as in claim 1 wherein the detection assembly is
configured to detect luminescent signals from said plurality of
reactions.
12. A system as in claim 1 wherein the detection assembly is
configured to detect chemiluminescent signals from said plurality
of reactions.
13. A system as in claim 1 wherein the detection assembly comprises
sensors from one or more of the following sensor types:
temperature, conductivity, potentiometric, or amperometric.
14. A system as in claim 1 wherein the reader assembly further
comprises a controller having computer-executable commands for
performing the reaction at a designated point-of-care location
remote from a location of the external device.
15. A system as in claim 1 wherein the reader assembly further
comprises a controller configured for executing having
computer-executable commands for performing on-board calibration of
said reader assembly.
16. A system as in claim 1 wherein said reader assembly comprises
an identifier detector that detects an identifier from the
information storage unit on the assay device.
17. A system as in claim 1 wherein the assay device is configured
to run a plurality of types of assays.
18. A system as in claim 1 wherein the reader assembly comprises a
communication assembly for transmitting data regarding the
detectable signal.
19. A system as in claim 1 wherein the system has a programmable
processor that compares the amount of said analyte determined from
the detectable signal to a predetermined amount of said
analyte.
20. A system as in claim 1 wherein the protocol dictates the
actuation of one or more elements of the device, thereby directing
fluid movement.
Description
CROSS-REFERENCE
[0001] This application is a continuation application of U.S.
application Ser. No. 12/576,197, filed on Oct. 8, 2009, which is a
continuation application of U.S. application Ser. No. 11/389,409,
filed on Mar. 24, 2006, now U.S. Pat. No. 7,635,594, which claims
the benefit of U.S. Provisional Application No. 60/678,801, filed
May 9, 2005 and U.S. Provisional Application No. 60/705,489, filed
Aug. 5, 2005 and U.S. Provisional Application No. 60/717,192, filed
Sep. 16, 2005, and U.S. Provisional Application No. 60/721,097,
filed Sep. 28, 2005, all of which are incorporated herein by
reference in their entirety.
TECHNICAL FIELD
[0002] This invention is in the field of medical devices.
Specifically, the present invention provides portable medical
devices that allow real-time detection of analytes from a
biological fluid. The methods and devices are particularly useful
for providing point-of-care testing for a variety of medical
applications.
BACKGROUND OF THE INVENTION
[0003] The discovery of a vast number of disease biomarkers and the
establishment of miniaturized microfluidic systems have opened up
new avenues to devise methods and systems for the prediction,
diagnosis and treatment of diseases in a point-of-care setting.
Point-of-care testing is particularly desirable because it rapidly
delivers results to medical practitioners and enables faster
consultation. Early diagnosis allows a practitioner to begin
treatment sooner and thus avoiding unattended deterioration of a
patient's condition. Examples of point-of-care analyses include
tests for glucose, drugs of abuse, serum cholesterol, pregnancy,
and ovulation. However, these and other currently available
point-of-care methods and systems do not provide an integrated
solution for sample acquisition, testing, analysis and
communication of results to medical practitioners or health
providers when needed. Thus, there remains a considerable need for
a portable, multi-parameter measurement instrument that provides
convenient and rapid data collection, transmission, analysis, as
well as on-line medical consultation or decision making.
[0004] New and improved point-of-care testing is also needed for
research and development of therapeutic agents as well as for
monitoring possible adverse drug reactions (ADRs), after a drug is
brought to the market place.
[0005] The safety and efficacy of a drug is determined by the
pharmacokinetic (what the body does to the drug) and
pharmacodynamic parameters (what the drug does to the body) of the
drug. Currently, the pharmacokinetic (PK) and pharmacodymanic (PD)
parameters of a drug are generally determined by first drawing
blood samples from a patient followed by laboratory analyses. Such
approach has numerous shortcomings. First, the patient is generally
required to visit a clinic to provide clinical samples such as
blood or urine samples at multiple time points. Second, most of the
analytical techniques for determining target analyte and biomarker
concentrations that reflect either the pharmacokinetic (PK) and
pharmacodymanic (PD) parameters require that the blood samples be
pre-processed before the parameters can be determined. This results
in delay of data response, variability in physiological drug
distribution and metabolism (warranting poor dosing), sparse
sampling, and the lack of dosing history. Notably, numerous
clinical trials often suffer from insufficient numbers of blood
tests because of poor patient compliance; the patients often fail
to return to a phlebotomist to provide the blood samples required
by the trial.
[0006] Similarly, the current techniques and systems for monitoring
ADRs are also inadequate. ADRs are one of the leading causes of
morbidity and mortality in health care. The Institute of Medicine
reported in January 2000 that 44,000 to 98,000 deaths occurred due
to medical errors, of which 7,000 deaths were due to ADRs. Other
studies conducted on hospitalized patient populations have
indicated an ever higher overall incidence of several ADRs. Several
reasons contribute to the prevalence of ADRs. First, there are more
combination therapies available to patients. Second, there is an
increasing trend towards chronic use of drugs (statins such as
Lipitor and Cox-2 inhibitors such as Vioxx). Chronic use of drugs
also increases the chance that changes in the patient's lifestyle,
health status and use of other medications will occur. In women,
the chronic use of drugs can result in unanticipated consequences
if the woman becomes pregnant. Such risks are of particular concern
to the fetus, which is especially susceptible to ADRs including
teratogenicity.
[0007] A further important factor in managing the risks and
benefits of drug therapy is patient compliance. Patients often fail
to take scheduled dose of drug, take more than the prescribed dose,
or fail to complete a course of drug therapy (especially common in
treatment for infectious disease). These behaviors (deliberate or
inadvertent) result in improper levels of drugs in the body which
can cause serious adverse effects. The patient is typically
oblivious to such consequences and the prescribing physician is
also unlikely to realize the problem before several consequences
occur.
[0008] Thus, there remains a pressing need for methods and
apparatus that allow real-time data transmission between patient
and medical practitioners to enable efficient communication and
high throughput point-of-care testing in an ambulatory context. A
beneficial system will detect ADRs, and efficacy and/or toxicity of
a therapeutic agent in real-time in an ambulatory setting. It may
also facilitate medical practitioners assessing patients'
physiological conditions in response to therapeutic agents during
the course of clinical trials or follow-on treatments. The present
invention satisfies these needs and provides related advantages as
well.
SUMMARY OF THE INVENTION
[0009] One aspect of the present invention is the design of a
system capable of providing real-time data transmission between a
patient and medical practitioners to facilitate high throughput
point-of-care testing in an ambulatory setting. The systems and
methods provided herein simplify the laborious and expensive
procedures of processing and analyzing the samples collected from a
subject (e.g., a patient) without the use of laboratory equipment
or facility. The systems and methods are particularly useful for
detection of an analyte from a small sample of bodily fluid to
effect diagnosis, prognosis, treatment, and development of
therapeutics.
[0010] Accordingly, in one embodiment, the present invention
provides a system for detecting an analyte in a bodily fluid from a
subject. The system comprises a) a fluidic device, said fluidic
device comprising a sample collection unit and an assay assembly,
wherein said sample collection unit allows a sample of bodily fluid
of less than 500 ul to react with reactants contained within said
assay assembly to yield a detectable signal indicative of the
presence of said analyte collected in said sample of bodily fluid;
b) a reader assembly comprising a detection assembly for detecting
said detectable signal; and c) a communication assembly for
transmitting said detected signal to an external device.
[0011] In another embodiment, the present invention provides a
system comprising a fluidic device. The fluidic device comprises
the following elements: a) a sample collection unit and an assay
assembly, wherein said sample collection unit allows a sample of
bodily fluid to react with reactants contained within said assay
assembly based on a protocol transmitted from an external device to
yield a detectable signal indicative of the presence of said
analyte; b) a reader assembly comprising a detection assembly for
detecting said detectable signal; and c) a communication assembly
for transmitting said detected signal to an external device.
[0012] In one aspect, the system employs a protocol transmitted
from an external device, preferably through a wirelessly device
such as a cell phone. In another aspect, the fluidic device further
comprises an identifier to provide the identity of said fluidic
device that is adapted to trigger the transmission of the protocol.
Where desired, the protocol may vary depending on the identify of
said fluidic device that is recognizable by an identifier
detector.
[0013] The present invention also provides a method of using the
systems and other devices provided herein. In one embodiment, the
present invention provides a method for detecting an analyte in a
bodily fluid of a subject. The method involves the steps of a)
providing the subject system, b) allowing a sample of bodily fluid
to react with the reactants contained within said assay assembly to
yield a detectable signal indicative of the presence of said
analyte; and c) detecting said detectable signal. Where desired,
the method may further comprise the step of quantifying the amount
of said analyte present in said bodily fluid. The method may also
comprise the step of comparing the amount of said analyte present
in said biologic fluid to a predetermined amount of said analyte.
Also optionally included in the method is taking a medical action
when the amount of said analyte present in said bodily fluid is
statistically different than said predetermined amount. The medical
action may involve notifying a pharmacy that a prescription for
such subject needs to be altered.
[0014] The present invention further provides a system for
monitoring more than one pharmacological parameter useful for
assessing efficacy and/or toxicity of a therapeutic agent. The
system typically comprises a) a fluidic device comprising a
cartridge, said cartridge comprising at least one sample collection
unit and an assembly; wherein said sample collection unit allows a
sample of bodily fluid comprising a plurality of analytes
indicative or said more than one pharmacological parameter to react
with reactants contained within said assay assembly, said reaction
yields detectable signals indicative of the values of the more than
one pharmacological parameter from said sample of bodily fluid; b)
a reader assembly comprising a detection assembly for detecting
said detectable signals; and c) a communication assembly for
transmitting said detected signals to an external device.
[0015] The present invention also provides a method of using such
system. In general, the method involves the steps of a) subjecting
a sample of bodily fluid from a subject administered with the
pharmaceutical agent to a fluidic device for profiling said more
than one pharmacological parameter, said fluidic medical device
comprising a cartridge, said cartridge comprising at least one
sample collection unit, and an assay assembly comprising reaction
reagents; b) actuating said fluidic device and directing said
immunoassay reagents within said fluidic device; c) allowing said
sample of bodily fluid to react with immunoassay reagents to yield
detectable signals indicative of the values of the more than one
pharmacological parameter from said sample; and d) detecting said
detectable signal generated from said sample of bodily fluid.
[0016] Further provided in the present invention is a method of
automatically monitoring patient compliance with a medical
treatment involving a therapeutic agent. The method involves a)
providing a sample of bodily fluid from said patient; b) allowing
the sample of bodily fluid to react with assay reagents in a
fluidic device to detect an analyte indicative of compliance or
non-compliance of the medical treatment; c) detect the presence or
absence of the analyte; and d) notifying said patient or a medical
practitioner of said compliance or noncompliance
[0017] Also included is a business method of assisting a clinician
in providing an individualized medical treatment. The method
involves the steps of a) collecting at least one pharmacological
parameter from an individual receiving a medication, said
collecting step is effected by subjecting a sample of bodily fluid
to reactants contained in a fluidic device, which is provided to
said individual to yield a detectable signal indicative of said at
least one pharmacological parameter; b) cross referencing with the
aid of a computer medical records of said individual with the at
least one pharmacological parameter of said individual, thereby
assisting said clinician in providing individualized medical
treatment.
[0018] The present invention provides a business method of
monitoring a clinical trial of a pharmaceutical agent. The method
typically comprises the steps of a) collecting at least one
pharmacological parameter from a subject in said clinical trial at
a plurality of time intervals, said collecting step is effected at
each time interval by subjecting a sample of bodily fluid from said
subject to reactants contained in a fluidic device, wherein said
fluidic device is provided to said subject to yield detectable
signals indicative of the values of said at least one
pharmacological parameter at a plurality of time intervals; b)
comparing the detected values to a threshold value predetermined
for said pharmacological parameter; c) notifying a clinician and/or
a sponsor involved in said clinical trial when a statistically
significant discrepancy exists between the detected values and the
threshold value.
[0019] In a separate embodiment, the present invention further
provides a method of obtaining pharmacological data useful for
assessing efficacy and/or toxicity of a therapeutical agent from a
test animal. The method typically involves the steps of a)
providing a fluidic device comprising at least one sample
collection unit, an assay assembly; and a plurality of channels in
fluid communication with said sample collection unit and/or said
assay assembly; b) allowing a sample of biological fluid of less
than about 50 ul to react with reactants contained within said
assay assembly to yield a detectable signal generated from an
analyte initially collected in said sample that is indicative of a
pharmacological parameter; and c) detecting said detectable signal;
and d) repeating the reaction and detection steps with a second
sample of biological fluid from the same test animal. In yet
another embodiment, the method utilizes test animals that are not
subjected to anesthesia.
[0020] The present invention provides a method of improving the
accuracy of calibrating a fluidic system, comprising: a) providing
a system for detecting an analyte in a bodily fluid from a subject
comprising a fluidic device for providing said bodily fluid, said
fluidic device having a calibration assembly and a reader assembly
for detecting the presence of said analyte; b) measuring one or
more parameters of a calibration curve associated with said fluidic
device; c) comparing said one or more parameters with predetermined
parameters associate with said fluidic device; d) adjusting a
signal output by the ratio of said one or more parameters and said
predetermined parameters. The present invention also provides a
method of improving the calibration of a fluidic system. The method
involves the steps of a) measuring a first signal in an original
sample comprising a known quantity of an analyte; b) measuring a
second signal after spiking said original sample with a known
quantity of said analyte; c) plotting the difference between said
first and second signals against a target value, wherein said
target value is a signal expected for said known quantity of said
analyte; and d) arriving at a best fit of parameters by minimizing
the sum of the square of the differences between said target value
and calculated analyte values.
[0021] Further provided by the present invention is a method of
assessing the reliability of an assay for an analyte in a bodily
fluid with the use of a fluidic device, comprising: a) providing a
system, said system comprising a fluidic device, said fluidic
device comprising a sample collection unit and an assay assembly,
wherein said sample collection unit allows a sample of bodily fluid
to react with reactants contained within said assay assembly, for
detecting the presence of an analyte in a bodily fluid from a
subject, and a reader assembly for detecting the presence of said
analyte; b) sensing with a sensor a change in operation parameters
under which the system normally operates
[0022] The present invention also provides a method of performing a
trend analysis on the concentration of an analyte in a subject. The
method involves the steps of a) providing a fluidic device
comprising at least one sample collection unit, an immunoassay
assembly containing immunoassay reagents, a plurality of channels
in fluid communication with said sample collection unit and/or said
immunoassay assembly; b) actuating said fluidic device and
directing said immunoassay reagents within said fluidic device; c)
allowing a sample of bodily fluid of less than about 500 ul to
react with said immunoassay reagents contained within said assay
immunoassay assembly to yield a detectable signal indicative of the
presence of said analyte in said sample; d) detecting said
detectable signal generated from said analyte collected in said
sample of bodily fluid; and e) repeating steps a) through d) for a
single patient over a period of time to detect concentrations of
said analyte, thereby performing said trend analysis.
[0023] The present invention provides an apparatus for detecting an
analyte in a biological fluid of a subject, wherein a plurality of
reaction sites comprises an optical barrier. In one aspect, the
bound reactants in at least one reaction site are unevenly
distributed, for example being localized around the center of said
reaction site. The present invention also provides a method of
using such apparatus.
[0024] Finally, the present invention provides a method of
manufacturing a fluidic device for detecting an analyte in a
biological fluid of a subject. The method involves the steps of a)
providing a plurality of layers of a fluidic device; b)
ultrasonically welding said layers together such that a fluidic
network exists between a sample collection unit, at least one
reactant chamber, at least one reaction site, and at least one
waste chamber.
[0025] In practice the subject invention, the reactants contained
in the devices may comprise immunoassay reagents. In one aspect,
the immunoassay reagents detect a microorganism selected from the
group consisting of bacterium, virus, fungus, and protozoa. In
another aspect, the immunoassay reagents may detect a polypeptide
glycoprotein, polysaccharide, lipid, nucleic acid, and a
combination thereof. In another aspect, the immunoassay reagents
detect a member selected from the group consisting of drug, drug
metabolite, biomarker indicative of a disease, tissue specific
marker, and biomarker specific for a cell or cell type. In yet
another aspect, the immunoassay generates luminescent signals,
preferably chemiluminescent signals. Where desired, the subject
fluidic device can be configured to detect a plurality of analytes.
The plurality of analytes can be identified by distinct signals
detectable over a range of 3 orders of magnitude. The detectable
signal can be a luminescent signal, including but not limited to
photoluminescence, electroluminescence, chemiluminescence,
fluorescence, phosphorescence.
INCORPORATION BY REFERENCE
[0026] All publications and patent applications mentioned in this
specification are herein incorporated by reference to the same
extent as if each individual publication or patent application was
specifically and individually indicated to be incorporated by
reference.
BRIEF DESCRIPTION OF THE DRAWINGS
[0027] The novel features of the invention are set forth with
particularity in the appended claims. A better understanding of the
features and advantages of the present invention will be obtained
by reference to the following detailed description that sets forth
illustrative embodiments, in which the principles of the invention
are utilized, and the accompanying drawings of which:
[0028] FIG. 1 is one embodiment showing multiple components of the
present system.
[0029] FIG. 2 shows different layers of an exemplary fluidic device
prior to assembly.
[0030] FIGS. 3 and 4 illustrate the fluidic network within an
exemplary fluidic device.
[0031] FIG. 5 shows a top, side, and bottom view of exemplary
reagent chambers of the present invention.
[0032] FIG. 6 illustrates an exemplary side view of a reagent
chamber in fluidic communication with a fluidic device.
[0033] FIG. 7 illustrates exemplary reagent chambers being filled
with reagents.
[0034] FIGS. 8 and 9 illustrate a side view of an exemplary fluidic
device is combination with actuating elements of the reader
assembly.
[0035] FIG. 10 compares a two-step assay with a competitive binding
assay.
[0036] FIG. 11 shows an exemplary two-step chemiluminescence enzyme
immunoassay.
[0037] FIG. 12 shows the increased sensitivity of the two-step
chemiluminescence enzyme immunoassay.
[0038] FIG. 13 shows the ability of TOSCA to assay less than ideal
samples and maintain desired sensitivity.
[0039] FIGS. 14A-C illustrate exemplary fluidic channels between
reaction sites.
[0040] FIGS. 15A and 15B illustrate reactions sites to reduce the
signal from unbound conjugates remaining in reaction sites.
[0041] FIG. 16 shows an exemplary bubble trapper or remover to
prevent bubbles from entering the reaction sites.
[0042] FIG. 17 shows the sensitivity enhancement achieved using
TOSCA as compared with competitive binding.
[0043] FIG. 18 shows two analytes, prostacyclin metabolite and
thromboxane metabolite, which have been identified and quantified
and their concentrations are different by more than 3 orders of
magnitude.
[0044] FIG. 19 shows an exemplary flow chart of a business method
of monitoring a clinical trial of a therapeutic agent.
[0045] FIG. 20 shows simultaneous sharing of the information
detected with a fluidic device with various interested parties.
[0046] FIG. 21 shows a typical assay dose-response data for a
two-step assay for TxB2.
[0047] FIG. 22 shows dose responses computed with and without
errors in calibration parameters.
[0048] FIG. 23 shows computed concentration errors produced by 1%
mis-estimation of A and D calibration values.
[0049] FIG. 24 illustrates calibration using a "differential"
approach.
[0050] FIG. 25 shows the verification of calibration using the
"1-point spike" method (log scale).
[0051] FIG. 26 shows the verification of calibration using the
"1-point spike" method (linear scale).
[0052] FIG. 27 shows dose-response of assays calibrated against a
plasma sample with a very low TxB2 concentration.
[0053] FIG. 28 shows use of spike recovery to eliminate calibration
errors of the "C" parameter.
[0054] FIG. 29 illustrates calculating differences in concentration
between two samples.
[0055] FIG. 30 illustrates an assay of plasma samples.
[0056] FIG. 31 shows the time course of assay signal
generation.
[0057] FIG. 32 shows the impact of change in calibration parameter
"A" on assay calibration.
[0058] FIG. 33 shows how a reference therapeutic index would be
computed.
[0059] FIG. 34 illustrates computing the therapeutic index.
[0060] FIG. 35 shows multiple regression analysis of the computed
therapeutic index.
[0061] FIG. 36 is an illustration of the relationship between
measured drug, analyte and biomarker concentration and therapeutic
index.
[0062] FIG. 37 is an illustration of the application of this
invention to minimize adverse drug reactions.
[0063] FIG. 38 shows exemplary patient input values.
[0064] FIG. 39 shows use of a therapeutic index to follow treatment
progression in an autism patient.
DETAILED DESCRIPTION OF THE INVENTION
System
[0065] One aspect of the present invention is a system for
detecting an analyte in a sample of bodily fluid. The system is
capable of detecting and/or quantifying analytes that are
associated with specific biological processes, physiological
conditions, disorders or stages of disorders.
[0066] The subject system comprises a fluidic device having one or
more of the following components: a sample collection unit, an
assay assembly, a reader assembly, and a communication assembly.
The sample collection unit typically allows a sample of bodily
fluid collected from a subject to react with reactants contained
within the assay assembly for generating a signal indicative of the
presence of the analyte of interest. The reader assembly detects
the signal, which is then transmitted via the communication
assembly to an external device for further processing.
[0067] Any bodily fluids suspected to contain an analyte of
interest can be used in conjunction with the subject system or
devices. Commonly employed bodily fluids include but are not
limited to blood, serum, saliva, urine, gastric and digestive
fluid, tears, stool, semen, vaginal fluid, interstitial fluids
derived from tumorous tissue, and cerebrospinal fluid. In a
preferred embodiment, the bodily fluids are used directly for
detecting the analytes present therein with the subject fluidic
device without further processing. Where desired, however, the
bodily fluids can be pre-treated before performing the analysis
with the subject fluidic devices. The choice of pre-treatments will
depend on the type of bodily fluid used and/or the nature of the
analyte under investigation. For instance, where the analyte is
present at low level in a sample of bodily fluid, the sample can be
concentrated via any conventional means to enrich the analyte.
Methods of concentrating an analyte include but are not limited to
drying, evaporation, centrifugation, sedimentation, precipitation,
and amplification. Where the analyte is a nucleic acid, it can be
extracted using various lytic enzymes or chemical solutions
according to the procedures set forth in Sambrook et al.
("Molecular Cloning: A Laboratory Manual"), or using nucleic acid
binding resins following the accompanying instructions provided by
manufactures. Where the analyte is a molecule present on or within
a cell, extraction can be performed using lysing agents including
but not limited to denaturing detergent such as SDS or
non-denaturing detergent such as thesit, sodium deoxylate, triton
X-100, and tween-20.
[0068] The volume of bodily fluid to be used with a fluidic device
of the present invention is generally less than about 500
microliters, typically between about 1 to 100 microliters. Where
desired, a sample of 1 to 50 microliters or 1 to 10 microliters can
be used for detecting an analyte using the subject fluidic
device.
[0069] A bodily fluid may be drawn from a patient and brought into
the fluidic device in a variety of ways, including but not limited
to, lancing, injection, or pipetting. In one embodiment, a lancet
punctures the skin and draws the sample into the fluidic device
using, for example, gravity, capillary action, aspiration, or
vacuum force. The lancet may be part of the fluidic device, or part
of a reader assembly, or as a stand alone component. Where needed,
the lancet may be activated by a variety of mechanical, electrical,
electromechanical, or any other known activation mechanism or any
combination of such methods. In another embodiment where no active
mechanism is required, a patient can simply provide a bodily fluid
to the fluidic device, as for example, could occur with a saliva
sample. The collected fluid can be placed in the sample collection
unit within the fluidic device. In yet another embodiment, the
fluidic device comprises at least one microneedle which punctures
the skin. The microneedle can be used with a fluidic device alone,
or can puncture the skin after the fluidic device is inserted into
a reader assembly.
[0070] In some embodiments a microneedle is about the size of a
human hair and has an integrated microreservoir or cuvette. The
microneedle may painlessly penetrate the skin and draw a small
blood sample. More preferably, the microneedle collects about 0.01
to about 1 microliter, preferably about 0.05 to about 0.5
microliters and more preferably about 0.1 to about 0.3 microliters
of capillary blood. In some embodiments a microneedle may be
constructed out of silicon and is about 10 to about 200 microns in
diameter, preferably about 50 to about 150 microns in diameter, and
most preferably about 100 microns in diameter, making their
application to the skin virtually painless. To ensure that a
capillary is actually struck by a needle, a plurality of
microneedles may be used for sample collection. Such microneedles
may be of the type marketed by Pelikan (Palo Alto, Calif.) and/or
Kumetrix (Union City, Calif.). U.S. Pat. No. 6,503,231 discloses
microneedles which may be used with the present invention.
[0071] Microfabrication processes that may be used in making the
microneedles disclosed herein include without limitation
lithography; etching techniques such as wet chemical, dry, and
photoresist removal; thermal oxidation of silicon; electroplating
and electroless plating; diffusion processes such as boron,
phosphorus, arsenic, and antimony diffusion; ion implantation; film
deposition such as evaporation (filament, electron beam, flash, and
shadowing and step coverage), sputtering, chemical vapor deposition
(CVD), epitaxy (vapor phase, liquid phase, and molecular beam),
electroplating, screen printing, and lamination. See generally
Jaeger, Introduction to Microelectronic Fabrication (Addison-Wesley
Publishing Co., Reading Mass. 1988); Runyan, et al., Semiconductor
Integrated Circuit Processing Technology (Addison-Wesley Publishing
Co., Reading Mass. 1990); Proceedings of the IEEE Micro Electro
Mechanical Systems Conference 1987-1998; Rai-Choudhury, ed.,
Handbook of Microlithography, Micromachining & Microfabrication
(SPIE Optical Engineering Press, Bellingham, Wash. 1997).
Alternatively, microneedles may be molded in silicon wafers and
then plated using conventional wire cutting techniques with nickel,
gold, titanium or various other biocompatible metals. In some
embodiments microneedles can be fashioned from biopolymers. In some
embodiments microneedles may be fabricated and employed for the
claimed devices according to the methods of Mukerjee et al.,
Sensors and Actuators A: Physical, Volume 114, Issues 2-3, 1 Sep.
2004, Pages 267-275.
[0072] In preferred embodiments a microneedle is only used once and
then discarded. In some embodiments a mechanical actuator can
insert and withdraw the microneedle from the patient, discard the
used needle, and reload a new microneedle. The mechanical
technologies developed and manufactured in very high volumes for
very small disk drives have a similar set of motion and low cost
requirements. In preferred embodiments the actuator is a MEMS
(micro machined electromechanical system) device fabricated using
semiconductor-like batch processes. Such actuators include without
limitation nickel titanium alloy, neumatic, or piezo electric
devices. In some embodiments the microneedles are about 1 micron to
about 10 microns in thickness, preferably about 2 microns to about
6 microns in thickness, and most preferably about 4 microns in
thickness. In some embodiments the microneedles are about 10
microns to about 100 microns in height, preferably about 30 microns
to about 60 microns in height, and most preferably about 40 microns
in height.
[0073] FIG. 1 illustrates an exemplary system of the present
invention. As illustrated, a fluidic device provides a bodily fluid
from a patient and can be inserted into a reader assembly. The
fluidic device may take a variety of configurations and in some
embodiments the fluidic device may be in the form of a cartridge.
An identifier (ID) detector may detect an identifier on the fluidic
device. The identifier detector communicates with a communication
assembly via a controller which transmits the identifier to an
external device. Where desired, the external device sends a
protocol stored on the external device to the communication
assembly based on the identifier. The protocol to be run on the
fluidic device may comprise instructions to the controller of the
reader assembly to perform the protocol on the fluidic device,
including but not limited to a particular assay to be run and a
detection method to be performed. Once the assay is performed on
the fluidic device, a signal indicative of an analyte in the bodily
fluid sample is generated and detected by a detection assembly. The
detected signal may then be communicated to the communications
assembly, where it can be transmitted to the external device for
processing, including without limitation, calculation of the
analyte concentration in the sample.
[0074] FIG. 2 illustrates exemplary layers of a fluidic device
according to the present invention prior to assembly of the fluidic
device which is disclosed in more detail below. FIGS. 3 and 4 show
a top and bottom view, respectively, of an exemplary fluidic device
after the device has been assembled. The different layers are
designed and assembled to form a three dimensional fluidic channel
network. A sample collection unit 4 provides a sample of bodily
fluid from a patient. As will be explained in further detail below
a reader assembly comprises actuating elements (not shown) can
actuate the fluidic device to start and direct the flow of a bodily
fluid sample and assay reagents in the fluidic device. In some
embodiments actuating elements first cause the flow of sample in
the fluidic device 2 from sample collection unit 4 to reaction
sites 6, move the sample upward in the fluidic device from point G'
to point G, and then to waste chamber 8. The actuating elements
then initiate the flow of reagents from reagent chambers 10 to
point B', point C', and point D', then upward to points B, C, and
D, respectively, then to point A, down to point A', and then to
waste chamber 8 in the same manner as the sample.
[0075] A sample collection unit 4 in a fluidic device 2 may provide
a bodily fluid sample from a patient by any of the methods
described above. If necessary, the sample may first be processed by
diluting the bodily fluid in a dilution chamber, and or may be
filtered by separating the plasma from the red blood cells in a
filtration chamber. In some embodiments the sample collection unit,
diluting chamber, and filtration chamber may be the same component,
and in some embodiments they may be different components, or any
two may be the same component and the other may be a separate
component. In some embodiments there may be more than one sample
collection unit in the fluidic device.
[0076] In some embodiments it may be desirable to detect the
presence of analytes on a cell surface, within a cell membrane, or
inside a cell. The difficulty of detecting such analytes is that
cells and other formed elements are particulate and components of
cells do not readily interact with traditional assay chemistries
which are designed to operate on analytes in solution. Cell-surface
analytes react slowly and inefficiently with surface bound probes,
and analytes inside the cell can not react at all with bound
probes. To allow the detection of such analytes, in some
embodiments the fluidic device may include a lysing assembly to
lyse cells present in the bodily fluid sample. The lysing assembly
may be incorporated with the sample collection unit, a dilution
chamber, and/or a filtration chamber. In some embodiments the
sample collection unit, dilution chamber, and lysing component are
within the same element in the fluidic device. In some embodiments
the lysing component may be incorporated with an assay reagent
described below.
[0077] Where desired, lysing agents may be impregnated and then
dried into porous mats, glass fiber mats, sintered frits or
particles such as Porex, paper, or other similar material. Lysing
agents may be dried onto flat surfaces. Lysing agents may also be
dissolved in liquid diluents or other liquid reagents. In preferred
embodiments porous materials are used to store the lysing agents
because they can store a lysing agent in dry form likely to be very
stable. They also facilitate the mixing of the bodily fluid sample
with the lysing agent by providing a tortuous path for the sample
as it moves through the porous material. In preferred embodiments
such porous materials have a disc shape with a diameter greater
than its thickness. In some embodiments lysing agents may be dried
onto porous materials using lyophilization, passive evaporation,
exposure to warm dry flowing gas, or other known methods.
[0078] A variety of lysing agents are available in the art and are
suitable for use in connection with the subject fluidic device.
Preferred lysing agents are non-denaturing, such as non-denaturing
detergents. Non-limiting examples of non-denaturing detergents
include thesit, sodium deoxylate, triton X-100, and tween-20. The
agents are preferably non-volatile in embodiments where the agents
are impregnated into a solid porous materials. In some embodiments
lysing agents are mixed together. Other materials may be mixed with
the lysing agents to modify the lytic effects. Such exemplary
materials may be, without limitation, buffers, salts, and proteins.
In preferred embodiments lysing agents will be used in amounts that
are in excess of the minimum amount required to lyse cells. In some
embodiments lysing agents will be used that can lyse both white and
red cells.
[0079] One of the advantages of the present invention is that any
reagents necessary to perform an assay on a fluidic device
according to the present invention are preferably on-board, or
housed within the fluidic device before, during, and after the
assay. In this way the only inlet or outlet from the fluidic device
is preferably the bodily fluid sample initially provided by the
fluidic device. This design also helps create an easily disposable
fluidic device where all fluids or liquids remain in the device.
The on-board design also prevents leakage from the fluidic device
into the reader assembly which should remain free from
contamination from the fluidic device.
[0080] In a preferred embodiment there is at least one reagent
chamber. In some embodiments there may be two, three, four, five,
six, or more, or any number of reagent chambers as are necessary to
fulfill the purposes of the invention. A reagent chamber is
preferably in fluid communication with at least one reaction site,
and when the fluidic device is actuated as described herein,
reagents contained in said reagent chambers are released into the
fluidic channels within the fluidic device.
[0081] Reagents according to the present invention include without
limitation wash buffers, enzyme substrates, dilution buffers,
conjugates, enzyme-labeled conjugates, DNA amplifiers, sample
diluents, wash solutions, sample pre-treatment reagents including
additives such as detergents, polymers, chelating agents,
albumin-binding reagents, enzyme inhibitors, enzymes,
anticoagulants, red-cell agglutinating agents, antibodies, or other
materials necessary to run an assay on a fluidic device. An enzyme
conjugate can be either a polyclonal antibody or monoclonal
antibody labeled with an enzyme that can yield a detectable signal
upon reaction with an appropriate substrate. Non-limiting examples
of such enzymes are alkaline phosphatase and horseradish
peroxidase. In some embodiments the reagents comprise immunoassay
reagents.
[0082] In some embodiments a reagent chamber contains approximately
about 50 .mu.l to about 1 ml of fluid. In some embodiments the
chamber may contain about 100 .mu.l of fluid. The volume of liquid
in a reagent chamber may vary depending on the type of assay being
run or the sample of bodily fluid provided. In some embodiments the
reagents are initially stored dry and liquified upon initiation of
the assay being run on the fluidic device.
[0083] FIGS. 5 and 6 illustrate an exemplary embodiment of a sealed
reagent chamber. FIG. 5 shows a top, side, and bottom view of a
reagent chamber. A top layer 11 contains a plurality of bubbles or
pouches 13. A bottom layer 15 has a bottom surface that is bonded
to the fluidic device base 17 as shown in FIG. 6. The bottom layer
15 has a plurality of fluidic channels 19 dispersed through the
entire surface, where each channel traverses the bottom layer 15.
The fluid in the reagent chamber is contained within the chamber by
pressure burstable seal 21 between the fluidic channel 19 and the
chamber 13. The burstable seal 21 is designed such that at a
pre-determined pressure the seal bursts allowing the fluid in the
chamber 13 to flow out into a fluidic channel 19.
[0084] FIG. 7 shows an exemplary process of filling the reagent
chambers 13 with, for example, reagents. Reagent chambers 13 may be
filled with fluid using a fill channel and a vacuum draw channel.
The process of filling the reagents involves first removing all the
air from the chamber. This is done by drawing a vacuum through the
vacuum draw channel. Once the vacuum is drawn, a permanent seal is
placed between the fill channel and the vacuum draw channel. Next,
required reagents are dispensed into the chamber through the fill
channel. Then, a permanent seal is placed between the chamber and
the fill channel. This ensures that when the chamber is compressed,
the fluid can flow in only one direction, towards the burstable
seal. If the compression imparts a pressure larger than the burst
pressure of seal, the seal bursts and the fluid flows into the
fluidic channel.
[0085] FIGS. 8 and 9 illustrate an embodiment of a fluidic device
in operation with actuating elements as described herein. Fluidic
device 2 contains a reagent chamber 10 and a layer of burstable
foil 12 enclosing the reagent chamber. Above the burstable foil 12
is a portion of the microfluidic circuit 14. A tough, but
elastomeric top cover 16 acts as the top layer of the fluidic
device 2. The reader assembly includes a valve actuation plate 18.
Securely attached to the plate 18 is a non-coring needle 20 such
that when the plate is lowered, the sharp edge of the needle
contacts the elastomeric cover 16. The top cover could also be made
of flexible silicone material that would act as a moisture
impermeable seal. This embodiment also provides a solution to
liquid evaporation and leakage from a fluidic device by isolating
any liquid reagents in the fluidic device from any dry reagents
until the assay is initiated.
[0086] In preferred embodiments the reagent chamber and sample
collection unit are fluidly connected to reaction sites where bound
probes can detect an analyte of interest in the bodily fluid sample
using the assay. A reaction site could then provide a signal
indicative of the presence of the analyte of interest, which can
then be detected by a detection device described in detail herein
below.
[0087] In some embodiments the reactions sites are flat but they
may take on a variety of alternative surface configurations. The
reaction site preferably forms a rigid support on which a reactant
can be immobilized. The reaction site surface is also chosen to
provide appropriate light-absorbing characteristics. For instance,
the reaction site may be functionalized glass, Si, Ge, GaAs, GaP,
SiO.sub.2, SiN.sub.4, modified silicon, or any one of a wide
variety of gels or polymers such as (poly)tetrafluoroethylene,
(poly)vinylidenedifluoride, polystyrene, polycarbonate,
polypropylene, or combinations thereof. Other appropriate materials
may be used in accordance with the present invention.
[0088] A reactant immobilized at a reaction site can be anything
useful for detecting an analyte of interest in a sample of bodily
fluid. For instance, such reactants include without limitation
nucleic acid probes, antibodies, cell membrane receptors,
monoclonal antibodies and antisera reactive with a specific
analyte. Various commercially available reactants such as a host of
polyclonal and monoclonal antibodies specifically developed for
specific analytes can be used.
[0089] One skilled in the art will appreciate that there are many
ways of immobilizing various reactants onto a support where
reaction can take place. The immobilization may be covalent or
noncovalent, via a linker moiety, or tethering them to an
immobilized moiety. These methods are well known in the field of
solid phase synthesis and micro-arrays (Beier et al., Nucleic Acids
Res. 27:1970-1-977 (1999). Non-limiting exemplary binding moieties
for attaching either nucleic acids or proteinaceous molecules such
as antibodies to a solid support include streptavidin or
avidin/biotin linkages, carbamate linkages, ester linkages, amide,
thiolester, (N)-functionalized thiourea, functionalized maleimide,
amino, disulfide, amide, hydrazone linkages, and among others. In
addition, a silyl moiety can be attached to a nucleic acid directly
to a substrate such as glass using methods known in the art.
[0090] In some embodiments there are more than one reaction sites
which can allow for detection of multiple analytes of interest from
the same sample of bodily fluid. In some embodiments there are 2,
3, 4, 5, 6, or more reaction sites, or any other number of reaction
sites as may be necessary to carry out the intent of the
invention.
[0091] In embodiments with multiple reaction sites on a fluidic
device, each reaction site may be immobilized with a reactant
different from a reactant on a different reaction site. In a
fluidic device with, for example, three reaction sites, there may
be three different probes, each bound to a different reaction site
to bind to three different analytes of interest in the sample. In
some embodiments there may be different reactants bound to a single
reaction site if, for example, a CCD with multiple detection areas
were used as the detection device, such that multiple different
analytes could be detected in a single reaction site. The
capability to use multiple reaction sites in addition to multiple
different probes on each reaction site enables the high-throughput
characteristics of the present invention.
[0092] The present invention allows for the detection of multiple
analytes on the same fluidic device. If assays with different
luminescent intensities are run in adjacent reaction sites, photons
(signals that emanate from the reactions) may travel from one
reaction site to an adjacent reaction site, as reaction sites may
be constructed of materials that allow photons to travel through
the fluidic channels that connect the sites. This optical cross
talk may compromise the accuracy of the detected photons. FIGS. 14B
and 14C illustrate different embodiments of this invention that can
eliminate or reduce the amount of optical cross-talk. Non-linear
channels 22 will not allow photons (light) to pass through. Hence,
embodiments such as those shown in FIGS. 14B and 14C would not
allow signals from a reaction site to contaminate a signal produced
from an adjacent site from which a detection device may be
detecting. Additionally, the edges or walls of a reaction site may
be constructed using optically opaque materials so that light will
not escape the wells. In some embodiments the reaction sites are
white or opaque.
[0093] In some embodiments, unbound conjugates may need to be
washed from a reaction site to prevent unbound conjugates from
activating the substrate and producing and inaccurate signal. It
may be difficult to remove conjugates sticking to the edges of the
reaction sites in such a fluidic device if, for example, there is
not an excess of a wash solution. To decrease the signal
contributed from unbound conjugates stuck to the edge of a reaction
site, it may be advantageous to expand the reaction site edge or
wall radius in order to distance stuck conjugate from the desired
actual detection area, represented by bound reactant. FIGS. 15A and
15B illustrates this concept. Reaction site 6 contains reaction
surface 24 and edge or wall surface 26. In FIG. 15B, an edge
surface 26 is shown at a greater distance from the center of the
reaction site 6 than is the edge surface of the prior art design.
This allows unbound conjugates to adhere to the edge surfaces and
be distanced from bound conjugates, which are concentrated closer
to the center of the reaction site 6.
[0094] In preferred embodiments of the invention the fluidic device
includes at least one waste chamber to trap or capture all liquids
after they have been used in the assay. In preferred embodiments,
there is more than one waste chamber, at least one of which is to
be used with a calibration assembly described herein below.
On-board waste chambers also allow the device to be easily
disposable. The waste chamber is preferably in fluidic
communication with at least one reaction site.
[0095] At least one of these channels will typically have small
cross sectional dimensions. In some embodiments the dimensions are
from about 0.01 mm to about 5 mm, preferably from about 0.03 mm to
about 3 mm, and more preferably from about 0.05 mm to about 2 mm
Fluidic channels in the fluidic device may be created by, for
example without limitation, precision injection molding, laser
etching, or any other technique known in the art to carry out the
intent of the invention.
[0096] One of the common problems encountered in a microfluidic
based assay system is the presence of air or gas bubbles. It is
extremely difficult to remove a bubble once it is trapped within a
fluidic channel. Bubbles present anywhere in the fluidic circuit,
particularly in the reaction sites can compromise the assay
capabilities. A bubble may end up occupying part of all of the
surface area of a reaction site. Consequently the reader may end up
reading a muted signal or no signal at all. FIG. 16 illustrates an
embodiment where a bubble could be trapped in a filter 28 before it
reaches a reaction site 6. A bubble trapper 28 can be positioned
between a sample collection unit 4 and reaction site 6. The bubble
trapper can have such a geometry that the bubbles tend to migrate
towards the edges of this surface and remain stuck at that service,
thereby not entering into the reaction sites.
[0097] To ensure that a given photon count produced at a reaction
site correlates with an accurate concentration of an analyte of
interest in a sample, it is preferably advantageous to calibrate
the fluidic device before detecting the photons. Calibrating a
fluidic device at the point of manufacturing for example may be
insufficient to ensure an accurate analyte concentration is
determined because a fluidic device may be shipped prior to use and
may undergo changes in temperature, for example, so that a
calibration performed at manufacturing does not take into effect
any subsequent changes to the structure of the fluidic device or
reagents contained therein. In a preferred embodiment of the
present invention, a fluidic device has a calibration assembly that
mimics the assay assembly in components and design except that a
sample is not introduced into the calibration assembly. Referring
to FIGS. 3 and 4, a calibration assembly occupies about half of the
fluidic device 2 and includes reagent chambers 32, reactions sites
34, a waste chamber 36, and fluidic channels 38. Similar to the
assay assembly, the number of reagent chambers and reaction sites
may vary depending on the assay being run on the fluidic device and
the number of analytes being detected.
[0098] Where desired, a sensor for assessing the reliability of an
assay for an analyte in a bodily fluid with the use of the subject
fluidic device can be provided together with the fluidic device,
the reader and/or within the packaging of the subject system. The
sensor is capable of detecting a change in operation parameters
under which the subject system normally operates. The operation
parameters include but are not limited to temperature, humidity,
and pressure, which may affect the performance of the present
system.
[0099] A fluidic device and reader assembly may, after
manufacturing, be shipped to the end user, together or
individually. As a reader assembly is repeatedly used with multiple
fluidic devices, it may be necessary to have sensors on both the
fluidic device and reader assembly to detect such changes during
shipping, for example. During shipping, pressure or temperature
changes can impact the performance of a number of components of the
present system, and as such a sensor located on either the fluidic
device or reader assembly can relay these changes to, for example,
the external device so that adjustments can be made during
calibration or during data processing on the external device. For
example, if the pressure of a fluidic device dropped to a certain
level during shipping, a sensor located on the fluidic device could
detect this change and convey this information to the reader
assembly when it is inserted into the reader assembly by the user.
There may be an additional detection device in the reader assembly
to perform this, or such a device may be incorporated into another
system component. In some embodiments this information may be
wirelessly transmitted to either the reader assembly or the
external device. Likewise, a sensor in the reader assembly can
detect similar changes. In some embodiments, it may be desirable to
have a sensor in the shipping packaging as well, either instead of
in the system components or in addition thereto.
[0100] Manufacturing of the fluidic channels may generally be
carried out by any number of microfabrication techniques that are
well known in the art. For example, lithographic techniques are
optionally employed in fabricating, for example, glass, quartz or
silicon substrates, using methods well known in the semiconductor
manufacturing industries such as photolithographic etching, plasma
etching or wet chemical etching. Alternatively, micromachining
methods such as laser drilling, micromilling and the like are
optionally employed. Similarly, for polymeric substrates, well
known manufacturing techniques may also be used. These techniques
include injection molding or stamp molding methods where large
numbers of substrates are optionally produced using, for example,
rolling stamps to produce large sheets of microscale substrates or
polymer microcasting techniques where the substrate is polymerized
within a micromachined mold.
[0101] In some embodiments at least one of the different layers of
the fluidic device may be constructed of polymeric substrates. Non
limiting examples of polymeric materials include polystyrene,
polycarbonate, polypropylene, polydimethysiloxanes (PDMS),
polyurethane, polyvinylchloride (PVC), and polysulfone.
[0102] The fluidic device may be manufactured by stamping, thermal
bonding, adhesives or, in the case of certain substrates, for
example, glass, or semi-rigid and non-rigid polymeric substrates, a
natural adhesion between the two components. In some embodiments
the fluidic device is manufactured by ultrasonic or acoustic
welding.
[0103] FIG. 2 shows one embodiment of the invention in which
fluidic device 2 is comprised of 7 layers. Features as shown are,
for example, cut in the polymeric substrate such that when the
layers are properly positioned when assembly will form a fluidic
network. In some embodiments more or fewer layers may be used to
construct a fluidic device to carry out the purpose of the
invention.
[0104] One objective of the present invention is to prevent fluid
inside a fluidic device from contacting the components of a reader
assembly which may need to remain dry and or uncontaminated, and
also to prevent contamination to a detection device within the
reader assembly. A leak in the fluidic device could result in
liquids, for example reagents or waste, escaping from the fluidic
device and contaminating the reader. In other embodiments a liquid
absorbing material, such as polymeric materials found in diapers,
could be placed within a portion of the fluidic channel or waste
chamber to absorb the waste liquid. A non-limiting example of such
a polymer is sodium polyacrylate. Such polymers can absorb fluids
hundreds of times their weight. Hence, only minute quantities of
such polymeric materials may be required to accomplish the goal of
absorbing leaked fluids. In some embodiments a waste chamber is
filled with a superabsorbent material. In some embodiments leaked
liquid may be converted into a gel or other solid or semi-solid
form.
[0105] Another objective of the present system is to provide a
fluidic device that can run a variety of assays on a fluidic
device, regardless of the analyte being detected from a bodily
fluid sample. A protocol dependent on the identity of the fluidic
device may be transferred from an external device where it can be
stored to a reader assembly to enable the reader assembly to carry
out the specific protocol on the fluidic device. In preferred
embodiments, the fluidic device has an identifier (ID) that is
detected or read by an identifier detector described herein. The
identifier can then be communicated to a communication assembly,
where it can then be transferred or transmitted to an external
device.
[0106] In some embodiments the identifier may be a bar code
identifier with a series of black and white lines, which can be
read by an identifier detector such as a bar code reader, which are
well known. Other identifiers could be a series of alphanumerical
values, colors, raised bumps, or any other identifier which can be
located on a fluidic device and be detected or read by an
identifier detector. In some embodiments the identifier may
comprise a storage or memory device and can transmit information to
an identification detector. In some embodiments both techniques may
be used.
[0107] Once a bodily fluid sample is provided to a fluidic device,
it is inserted in a reader assembly. In some embodiments the
fluidic device is partially inserted manually, and then a
mechanical switch in the reader assembly automatically properly
positions the fluidic device inside the reader assembly. Any other
mechanism known in the art for inserting a disk or cartridge into a
device may be used as well. In some embodiments only manual
insertion may be required.
[0108] In some embodiments the reader assembly comprises an
identifier detector for detecting or reading an identifier on the
fluidic device, a controller for automatically controlling the
detection assembly and also mechanical components of the reader
assembly, for example, pumps and/or valves for controlling or
directing fluid through the fluidic device, a detection device for
detecting a signal created by an assay run on the fluidic device,
and a communication assembly for communicating with an external
device.
[0109] An identifier detector detects an identifier on the fluidic
device which is communicated to a communication assembly. In some
embodiments the identifier detector can be a bar code scanner-like
device, reading a bar code on a fluidic device. The identifier
detector may also be an LED that emits light which can interact
with an identifier which reflects light and is measured by the
identifier detector to determine the identity of a fluidic
device.
[0110] In preferred embodiments the reader assembly houses a
controller which controls a pump and a series of valves to control
and direct the flow of liquid within the fluidic device. In some
embodiments the reader assembly may comprises multiple pumps. The
sample and reagents are preferably pulled through the fluidic
channels by a vacuum force created by sequentially opening and
closing at least one valve while activating a pump within the
reader assembly. Methods of using at least one valve and at least
one pump to create a vacuum force are well known. While a negative
pulling force may be used, a positive pushing force may also be
generated by at least one pump and valve according to the present
invention. In other embodiments movement of fluid on the fluidic
device may be by electro-osmotic, capillary, piezoelectric, or
microactuator action.
[0111] FIGS. 8 and 9 illustrate an exemplary sequence to initiate
the flow of a reagent within the fluidic device. An actuation plate
18 in the reader assembly comprises a non-coring needle or pin 20
which when lowered flexes the top cover 16, as it is preferably
made of strong, flexible elastomeric material. However, the easily
rupturable foil 12 then ruptures due to the stress induced by the
flexing of top cover 16. Valves located downstream to the reagent
chamber puncture different areas of foil in the fluidic device and
can then work in tandem with a pump within the reader assembly to
create a vacuum force to pull the reagent out of the reagent
chamber 6 into a fluidic channel and then direct the flow of the
reagent to a reaction site. At least one valve is preferably
fluidically connected to a pump housed within the reader assembly.
The non-coring needle or pin 20 is removed from the fluidic device
when the device is removed from the reader assembly. One of the
advantages of this embodiment is that no on-chip pump is required,
which, at least, decreases the size and cost of the fluidic device,
and allows the device to be disposable.
[0112] A reaction assembly preferably houses a detection assembly
for detecting a signal produced by at least one assay on the
fluidic device. FIG. 1 illustrates an exemplary position of a
detection device of the present invention in relation to the
fluidic device which is below the fluidic device. The detection
assembly may be above the fluidic device or at a different
orientation in relation to the fluidic device based on, for
example, the type of assay being performed and the detection
mechanism being employed.
[0113] In preferred embodiments an optical detector is used as the
detection device. Non-limiting examples include a photodiode,
photomultiplier tube (PMT), photon counting detector, or
charge-coupled device (CCD). In some embodiments a pin diode may be
used. In some embodiments a pin diode can be coupled to an
amplifier to create a detection device with a sensitivity
comperable to a PMT. Some assays may generate luminescence as
described herein. In some embodiments chemiluminescence is
detected. In some embodiments a detection assembly could include a
plurality of fiber optic cables connected as a bundle to a CCD
detector or to a PMT array. The fiber optic bundle could be
constructed of discrete fibers or of many small fibers fused
together to form a solid bundle. Such solid bundles are
commercially available and easily interfaced to CCD detectors.
[0114] In some embodiments, the detection system may comprise
non-optical detectors or sensors for detecting a particular
parameter of a patient. Such sensors may include temperature,
conductivity, potentiometric, and amperometric, for compounds that
are oxidized or reduced, for example, O.sub.2, H.sub.2O.sub.2, and
I.sub.2, or oxidizable/reducible organic compounds.
[0115] A communication assembly is preferably housed within the
reader assembly and is capable of transmitting and receiving
information wirelessly from an external device. Such wireless
communication may be bluetooth or RTM technology. Various
communication methods can be utilized, such as a dial-up wired
connection with a modem, a direct link such as a T1, ISDN, or cable
line. In preferred embodiments a wireless connection is established
using exemplary wireless networks such as cellular, satellite, or
pager networks, GPRS, or a local data transport system such as
Ethernet or token ring over a local area network. In some
embodiments the information is encrypted before it is transmitted
over a wireless network. In some embodiments the communication
assembly may contain a wireless infrared communication component
for sending and receiving information.
[0116] In some embodiments the communication assembly can have a
memory or storage device, for example localized RAM, in which the
information collected can be stored. A storage device may be
required if information can not be transmitted at a given time due
to, for example, a temporary inability to wirelessly connect to a
network. The information can be associated with the fluidic device
identifier in the storage device. In some embodiments the
communication assembly can retry sending the stored information
after a certain amount of time. In some embodiments the memory
device can store the information for a period of ten days before it
is erased.
[0117] In preferred embodiments an external device communicates
with the communication assembly within the readers assembly. An
external device can wirelessly communicate with a reader assembly,
but can also communicate with a third party, including without
limitation a patient, medical personnel, clinicians, laboratory
personnel, or others in the health care industry.
[0118] In some embodiments the external device can be a computer
system, server, or other electronic device capable of storing
information or processing information. In some embodiments the
external device includes one or more computer systems, servers, or
other electronic devices capable of storing information or
processing information. In some embodiments an external device may
include a database of patient information, for example but not
limited to, medical records or patient history, clinical trial
records, or preclinical trial records. In preferred embodiments, an
external device stores protocols to be run on a fluidic device
which can be transmitted to the communication assembly of a reader
assembly when it has received an identifier indicating which
fluidic device has been inserted in the reader assembly. In some
embodiments a protocol can be dependent on a fluidic device
identifier. In some embodiments the external device stores more
than one protocol for each fluidic device. In other embodiments
patient information on the external device includes more than one
protocol. In preferred embodiments the external server stores
mathematical algorithms to process a photon count sent from a
communication assembly and in some embodiments to calculate the
analyte concentration in a bodily fluid sample.
[0119] In some embodiment the external device can include one or
more servers as are known in the art and commercially available.
Such servers can provide load balancing, task management, and
backup capacity in the event of failure of one or more of the
servers or other components of the external device, to improve the
availability of the server. A server can also be implemented on a
distributed network of storage and processor units, as known in the
art, wherein the data processing according to the present invention
reside on workstations such as computers, thereby eliminating the
need for a server.
[0120] A server can includes a database and system processes. A
database can reside within the server, or it can reside on another
server system that is accessible to the server. As the information
in a database may contains sensitive information, a security system
can be implemented that prevents unauthorized users from gaining
access to the database.
[0121] One advantage of the present invention is that information
can be transmitted from the external device back to not only the
reader assembly, but to other parties or other external devices,
for example without limitation, a PDA or cell phone. Such
communication can be accomplished via a wireless network as
disclosed herein. In some embodiments a calculated analyte
concentration or other patient information can be sent to, for
example but not limited to, medical personal or the patient.
Method of Use
[0122] The subject apparatus and systems provide an effective means
for high throughput and real-time detection of analytes present in
a bodily fluid from a subject. The detection methods may be used in
a wide variety of circumstances including identification and
quantification of analytes that are associated with specific
biological processes, physiological conditions, disorders or stages
of disorders. As such, the subject apparatus and systems have a
broad spectrum of utility in, e.g. drug screening, disease
diagnosis, phylogenetic classification, parental and forensic
identification. The subject apparatus and systems are also
particularly useful for advancing preclinical and clinical stage of
development of therapeutics, improving patient compliance,
monitoring ADRs associated with a prescribed drug, and developing
individualized medicine.
[0123] Accordingly, in one embodiment, the present invention
provides a method of detecting an analyte in a bodily fluid from a
subject comprises providing a fluidic device comprising at least
one sample collection unit, an immunoassay assembly containing
immunoassay reagents, a plurality of channels in fluid
communication with said sample collection unit and/or said
immunoassay assembly; actuating said fluidic device and directing
said immunoassay reagents within said fluidic device; allowing a
sample of bodily fluid to react with said immunoassay reagents
contained within said assay immunoassay assembly to yield a
detectable signal indicative of the presence of said analyte in
said bodily fluid; and detecting said detectable signal generated
from said analyte initially collected in said sample of bodily
fluid. Preferably, a sample of bodily fluid of less than about 1
ml, preferably less than about 500 ul is used for one or more of
these applications.
[0124] As used herein, the term "subject" or "patient" is used
interchangeably herein, which refers to a vertebrate, preferably a
mammal, more preferably a human. Mammals include, but are not
limited to, murines, simians, humans, farm animals, sport animals,
and pets.
[0125] In some embodiments a sample of bodily fluid can first be
provided to the fluidic device by any of the methods described
herein. The fluidic device can then be inserted into the reader
assembly. An identification detector housed within the reader
assembly can detect an identifier of the fluidic device and
communicate the identifier to a communication assembly, which is
preferably housed within the reader assembly. The communication
assembly then transmits the identifier to an external device which
transmits a protocol to run on the fluidic device based on the
identifier to the communication assembly. A controller preferably
housed within the reader assembly controls actuating elements
including at least one pump and one valve which interact with the
fluidic device to control and direct fluid movement within the
device. In some embodiments the first step of the assay is a wash
cycle where all the surfaces within the fluidic device are wetted
using a wash buffer. The fluidic device is then calibrated using a
calibration assembly by running the same reagents as will be used
in the assay through the calibration reaction sites, and then a
luminescence signal from the reactions sites is detected by the
detection means, and the signal is used in calibrating the fluidic
device. The sample containing the analyte is introduced into the
fluidic channel. The sample may be diluted and further separated
into plasma or other desired component at a filter. The separated
sample now flows through the reaction sites and analytes present
therein will bind to reactants bound thereon. The plasma of sample
fluid is then flushed out of the reaction wells into a waste
chamber. Depending on the assay being run, appropriate reagents are
directed through the reaction sites to carry out the assay. All the
wash buffers and other reagents used in the various steps,
including the calibration step, are collected in wash tanks. The
signal produced in the reaction sites is then detected by any of
the methods described herein.
[0126] A variety of assays may be performed on a fluidic device
according to the present invention to detect an analyte of interest
in a sample. A wide diversity of labels are available in the art
that can be employed for conducting the subject assays. In some
embodiments labels are detectable by spectroscopic, photochemical,
biochemical, immunochemical, or chemical means. For example, useful
nucleic acid labels include 32P, 35S, fluorescent dyes,
electron-dense reagents, enzymes, biotin, dioxigenin, or haptens
and proteins for which antisera or monoclonal antibodies are
available. A wide variety of labels suitable for labeling
biological components are known and are reported extensively in
both the scientific and patent literature, and are generally
applicable to the present invention for the labeling of biological
components. Suitable labels include radionucleotides, enzymes,
substrates, cofactors, inhibitors, fluorescent moieties,
chemiluminescent moieties, bioluminescent labels, calorimetric
labels, or magnetic particles. Labeling agents optionally include,
for example, monoclonal antibodies, polyclonal antibodies,
proteins, or other polymers such as affinity matrices,
carbohydrates or lipids. Detection proceeds by any of a variety of
known methods, including spectrophotometric or optical tracking of
radioactive or fluorescent markers, or other methods which track a
molecule based upon size, charge or affinity. A detectable moiety
can be of any material having a detectable physical or chemical
property. Such detectable labels have been well-developed in the
field of gel electrophoresis, column chromatography, solid
substrates, spectroscopic techniques, and the like, and in general,
labels useful in such methods can be applied to the present
invention. Thus, a label includes without limitation any
composition detectable by spectroscopic, photochemical,
biochemical, immunochemical, electrical, optical thermal, or
chemical means.
[0127] In some embodiments the label is coupled directly or
indirectly to a molecule to be detected such as a product,
substrate, or enzyme, according to methods well known in the art.
As indicated above, a wide variety of labels are used, with the
choice of label depending on the sensitivity required, ease of
conjugation of the compound, stability requirements, available
instrumentation, and disposal provisions. Non radioactive labels
are often attached by indirect means. Generally, a ligand molecule
is covalently bound to a polymer. The ligand then binds to an
anti-ligand molecule which is either inherently detectable or
covalently bound to a signal system, such as a detectable enzyme, a
fluorescent compound, or a chemiluminescent compound. A number of
ligands and anti-ligands can be used. Where a ligand has a natural
anti-ligand, for example, biotin, thyroxine, and cortisol, it can
be used in conjunction with labeled, anti-ligands. Alternatively,
any haptenic or antigenic compound can be used in combination with
an antibody.
[0128] In some embodiments the label can also be conjugated
directly to signal generating compounds, for example, by
conjugation with an enzyme or fluorophore. Enzymes of interest as
labels will primarily be hydrolases, particularly phosphatases,
esterases and glycosidases, or oxidoreductases, particularly
peroxidases. Fluorescent compounds include fluorescein and its
derivatives, rhodamine and its derivatives, dansyl, and
umbelliferone. Chemiluminescent compounds include luciferin, and
2,3-dihydrophthalazinediones, such as luminol.
[0129] Methods of detecting labels are well known to those of skill
in the art. Thus, for example, where the label is a radioactive
label, means for detection include a scintillation counter or
photographic film as in autoradiography. Where the label is a
fluorescent label, it may be detected by exciting the fluorochrome
with the appropriate wavelength of light and detecting the
resulting fluorescence by, for example, microscopy, visual
inspection, via photographic film, by the use of electronic
detectors such as digital cameras, charge coupled devices (CCDs) or
photomultipliers and phototubes, or other detection device.
Similarly, enzymatic labels are detected by providing appropriate
substrates for the enzyme and detecting the resulting reaction
product. Finally, simple colorimetric labels are often detected
simply by observing the color associated with the label. For
example, conjugated gold often appears pink, while various
conjugated beads appear the color of the bead.
[0130] In some embodiments the detectable signal may be provided by
luminescence sources. "Luminescence" is the term commonly used to
refer to the emission of light from a substance for any reason
other than a rise in its temperature. In general, atoms or
molecules emit photons of electromagnetic energy (e.g., light) when
then move from an "excited state" to a lower energy state (usually
the ground state); this process is often referred to as
"radioactive decay". There are many causes of excitation. If
exciting cause is a photon, the luminescence process is referred to
as "photoluminescence". If the exciting cause is an electron, the
luminescence process is referred to as "electroluminescence". More
specifically, electroluminescence results from the direct injection
and removal of electrons to form an electron-hole pair, and
subsequent recombination of the electron-hole pair to emit a
photon. Luminescence which results from a chemical reaction is
usually referred to as "chemiluminescence". Luminescence produced
by a living organism is usually referred to as "bioluminescence".
If photoluminescence is the result of a spin-allowed transition
(e.g., a single-singlet transition, triplet-triplet transition),
the photoluminescence process is usually referred to as
"fluorescence". Typically, fluorescence emissions do not persist
after the exciting cause is removed as a result of short-lived
excited states which may rapidly relax through such spin-allowed
transitions. If photoluminescence is the result of a spin-forbidden
transition (e.g., a triplet-singlet transition), the
photoluminescence process is usually referred to as
"phosphorescence". Typically, phosphorescence emissions persist
long after the exciting cause is removed as a result of long-lived
excited states which may relax only through such spin-forbidden
transitions. A "luminescent label" may have any one of the
above-described properties.
[0131] Suitable chemiluminescent sources include a compound which
becomes electronically excited by a chemical reaction and may then
emit light which serves as the detectable signal or donates energy
to a fluorescent acceptor. A diverse number of families of
compounds have been found to provide chemiluminescence under a
variety or conditions. One family of compounds is
2,3-dihydro-1,4-phthalazinedione. A frequently used compound is
luminol, which is a 5-amino compound. Other members of the family
include the 5-amino-6,7,8-trimethoxy- and the dimethylamino[ca]benz
analog. These compounds can be made to luminesce with alkaline
hydrogen peroxide or calcium hypochlorite and base. Another family
of compounds is the 2,4,5-triphenylimidazoles, with lophine as the
common name for the parent product. Chemiluminescent analogs
include para-dimethylamino and -methoxy substituents.
Chemiluminescence may also be obtained with oxalates, usually
oxalyl active esters, for example, p-nitrophenyl and a peroxide
such as hydrogen peroxide, under basic conditions. Other useful
chemiluminescent compounds that are also known include --N-alkyl
acridinum esters and dioxetanes. Alternatively, luciferins may be
used in conjunction with luciferase or lucigenins to provide
bioluminescence.
[0132] In some embodiments immunoassays are run on the fluidic
device. While competitive binding assays, which are well known in
the art, may be run in some embodiments, in preferred embodiments a
two-step method is used which eliminates the need to mix a
conjugate and a sample before exposing the mixture to an antibody,
which may be desirable when very small volumes of sample and
conjugate are used, as in the fluidic device of the present
invention. A two-step assay has additional advantages over the
competitive binding assays when use with a fluidic device as
described herein. It combines the ease of use and high sensitivity
of a sandwich (competitive binding) immunoassay with the ability to
assay small molecules.
[0133] In an exemplary two-step assay shown in FIG. 10, the sample
containing analyte ("Ag") first flows over a reaction site
containing antibodies ("Ab"). The antibodies bind the analyte
present in the sample. After the sample passes over the surface, a
solution with analyte conjugated to a marker ("labeled Ag") at a
high concentration is passed over the surface. The conjugate
saturates any of the antibodies that have not yet bound the
analyte. Before equilibrium is reached and any displacement of
pre-bound unlabelled analyte occurs, the high-concentration
conjugate solution is washed off. The amount of conjugate bound to
the surface is then measured by the appropriate technique, and the
detected conjugate is inversely proportional to the amount of
analyte present in the sample.
[0134] An exemplary measuring technique for a two-step assay is a
chemiluminescence enzyme immunoassay as shown in FIG. 11. As is
known in the field, the marker can be a commercially available
marker such as dioxitane-phosphate, which is not luminescent but
becomes luminescent after hydrolysis by, for example, alkaline
phosphatase. An enzyme such as alkaline phosphatase is also passed
over the substrate to cause the marker to luminesce. In some
embodiments the substrate solution is supplemented with enhancing
agents such as, without limitation, fluorescein in mixed micelles,
soluble polymers, or PVC which create a much brighter signal than
the luminophore alone. Moreover, an alkaline phosphatase conjugate
with a higher turnover number than that used in the commercial
assay is employed. This allows signal generation to proceed much
more rapidly and a higher overall signal is achieved. The increased
sensitivity of the two-step chemiluminescent enzyme immunoassay
(TOSCA) is illustrated in FIG. 12. FIG. 12 shows that for analytes
in the picomolar concentration, TOSCA is able to provide a more
robust signal (higher sensitivity) than a competitive binding
assay. Use of a two-step binding assay thus contributes to higher
sensitivity capabilities of the present invention.
[0135] Additionally, TOSCA is less sensitive to matrix effects than
other methodologies. This allows one to work with samples that have
not been extensively pre-processed using standard laboratory
techniques such as, for example, solid phase extraction and
chromatography. The ability of TOSCA to assay less than ideal
samples and maintain desired sensitivity is illustrated in FIG. 13.
Compared to competitive binding assay, for all sample preparations
(and dilutions), TOSCA has better sensitivity than competitive
binding. This is also illustrated in FIG. 17 where the sensitivity
enhancement achieved using TOSCA is compared with the two-step
assay.
[0136] The term "analytes" according to the present invention
includes without limitation drugs, prodrugs, pharmaceutical agents,
drug metabolites, biomarkers such as expressed proteins and cell
markers, antibodies, serum proteins, cholesterol, polysaccharides,
nucleic acids, biological analytes, biomarker, gene, protein, or
hormone, or any combination thereof. At a molecular level, the
analytes can be polypeptide glycoprotein, polysaccharide, lipid,
nucleic acid, and a combination thereof.
[0137] Of particular interest are biomarkers are associated with a
particular disease or with a specific disease stage. Such analytes
include but are not limited to those associated with autoimmune
diseases, obesity, hypertension, diabetes, neuronal and/or muscular
degenerative diseases, cardiac diseases, endocrine disorders, any
combinations thereof.
[0138] Of also interest are biomarkers that are present in varying
abundance in one or more of the body tissues including heart,
liver, prostate, lung, kidney, bone marrow, blood, skin, bladder,
brain, muscles, nerves, and selected tissues that are affected by
various disease, such as different types of cancer (malignant or
non-metastatic), autoimmune diseases, inflammatory or degenerative
diseases.
[0139] Also of interest are analytes that are indicative of a
microorganism. Exemplary microorganisms include but are not limited
to bacterium, virus, fungus and protozoa. Analytes that can be
detected by the subject method also include blood-born pathogens
selected from a non-limiting group that consists of Staphylococcus
epidermidis, Escherichia coli, methicillin-resistant Staphylococcus
aureus (MSRA), Staphylococcus aureus, Staphylococcus hominis,
Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus
capitis, Staphylococcus warneri, Klebsiella pneumoniae, Haemophilus
influnzae, Staphylococcus simulans, Streptococcus pneumoniae and
Candida albicans.
[0140] Analytes that can be detected by the subject method also
encompass a variety of sexually transmitted diseases selected from
the following: gonorrhea (Neisseria gorrhoeae), syphilis (Treponena
pallidum), clamydia (Clamyda tracomitis), nongonococcal urethritis
(Ureaplasm urealyticum), yeast infection (Candida albicans),
chancroid (Haemophilus ducreyi), trichomoniasis (Trichomonas
vaginalis), genital herpes (HSV type I & II), HIV I, HIV II and
hepatitis A, B, C, G, as well as hepatitis caused by TTV.
[0141] Additional analytes that can be detected by the subject
methods encompass a diversity of respiratory pathogens including
but not limited to Pseudomonas aeruginosa, methicillin-resistant
Staphlococccus aureus (MSRA), Klebsiella pneumoniae, Haemophilis
influenzae, Staphlococcus aureus, Stenotrophomonas maltophilia,
Haemophilis parainfluenzae, Escherichia coli, Enterococcus
faecalis, Serratia marcescens, Haemophilis parahaemolyticus,
Enterococcus cloacae, Candida albicans, Moraxiella catarrhalis,
Streptococcus pneumoniae, Citrobacter freundii, Enterococcus
faecium, Klebsella oxytoca, Pseudomonas fluorscens, Neiseria
meningitidis, Streptococcus pyogenes, Pneumocystis carinii,
Klebsella pneumoniae Legionella pneumophila, Mycoplasma pneumoniae,
and Mycobacterium tuberculosis.
[0142] Listed below are additional exemplary markers according to
the present invention: Theophylline, CRP, CKMB, PSA, Myoglobin,
CA125, Progesterone, TxB2,6-keto-PGF-1-alpha, and Theophylline,
Estradiol, Lutenizing hormone, High sensitivity CRP, Triglycerides,
Tryptase, Low density lipoprotein Cholesterol, High density
lipoprotein Cholesterol, Cholesterol, IGFR.
[0143] Exemplary liver markers include without limitation LDH,
(LD5), (ALT), Arginase 1 (liver type), Alpha-fetoprotein (AFP),
Alkaline phosphatase, Alanine aminotransferase, Lactate
dehydrogenase, and Bilirubin.
[0144] Exemplary kidney markers include without limitation TNFa
Receptor, Cystatin C, Lipocalin-type urinary prostaglandin D,
synthatase (LPGDS), Hepatocyte growth factor receptor, Polycystin
2, Polycystin 1, Fibrocystin, Uromodulin, Alanine, aminopeptidase,
N-acetyl-B-D-glucosaminidase, Albumin, and Retinol-binding protein
(RBP).
[0145] Exemplary heart markes include without limitation Troponin I
(TnI), Troponin T (TnT), CK, CKMB, Myoglobin, Fatty acid binding
protein (FABP), CRP, D-dimer, S-100 protein, BNP, NT-proBNP,
PAPP-A, Myeloperoxidase (MPO), Glycogen phosphorylase isoenzyme BB
(GPBB), Thrombin Activatable Fibrinolysis Inhibitor (TAFI),
Fibrinogen, Ischemia modified albumin (IMA), Cardiotrophin-1, and
MLC-I (Myosin Light Chain-I).
[0146] Exemplary pancrease markers include without limitation
Amylase, Pancreatitis-Associated protein (PAP-1), and Regeneratein
proteins (REG).
[0147] Exemplary muscle tissue markers include without limitation
Myostatin.
[0148] Exemplary blood markers include without limitation
Erythopoeitin (EPO).
[0149] Exemplary bone markers include without limitation,
Cross-linked N-telopeptides of bone type I collagen (NTx)
Carboxyterminal cross-linking telopeptide of bone collagen,
Lysyl-pyridinoline (deoxypyridinoline), Pyridinoline,
Tartrate-resistant acid phosphatase, Procollagen type I C
propeptide, Procollagen type I N propeptide, Osteocalcin (bone
gla-protein), Alkaline phosphatase, Cathepsin K, COMP (Cartillage
Oligimeric Matrix Protein), Osteocrin Osteoprotegerin (OPG), RANKL,
sRANK, TRAP 5 (TRACP 5), Osteoblast Specific Factor 1 (OSF-1,
Pleiotrophin), Soluble cell adhesion molecules, sTfR, sCD4, sCD8,
sCD44, and Osteoblast Specific Factor 2 (OSF-2, Periostin).
[0150] In some embodiments markers according to the present
invention are disease specific. Exemplary cancer markers include
without limitation PSA (total prostate specific antigen),
Creatinine, Prostatic acid phosphatase, PSA complexes,
Prostrate-specific gene-1, CA 12-5, Carcinoembryonic Antigen (CEA),
Alpha feto protein (AFP), hCG (Human chorionic gonadotropin),
Inhibin, CAA Ovarian C1824, CA 27.29, CA 15-3, CAA Breast C1924,
Her-2, Pancreatic, CA 19-9, Carcinoembryonic Antigen, CAA
pancreatic, Neuron-specific enolase, Angiostatin
DcR3 (Soluble decoy receptor 3), Endostatin, Ep-CAM (MK-1), Free
Immunoglobulin Light Chain Kappa, Free Immunoglobulin Light Chain
Lambda, Herstatin, Chromogranin A, Adrenomedullin, Integrin,
Epidermal growth factor receptor, Epidermal growth factor
receptor-Tyrosine kinase, Pro-adrenomedullin N-terminal 20 peptide,
Vascular endothelial growth factor, Vascular endothelial growth
factor receptor, Stem cell factor receptor, c-kit/KDR, KDR, and
Midkine.
[0151] Exemplary infectious disease markers include without
limitation Viremia, Bacteremia, Sepsis, PMN Elastase, PMN
elastase/.alpha.1-PI complex, Surfactant Protein D (SP-D), HBVc
antigen, HBVs antigen, Anti-HBVc, Anti-HIV, T-supressor cell
antigen, T-cell antigen ratio, T-helper cell antigen, Anti-HCV,
Pyrogens, p24 antigen, Muramyl-dipeptide.
[0152] Exemplary diabetes markers include without limitation
C-Peptide, Hemoglobin A1c, Glycated albumin, Advanced glycosylation
end products (AGEs), 1,5-anhydroglucitol, Gastric Inhibitory
Polypeptide, Glucose, Hemoglobin, ANGPTL3 and 4.
[0153] Exemplary inflammation markers include without limitation
Rheumatoid factor (RF), Antinuclear Antibody (ANA), C-reactive
protein (CRP), Clara Cell Protein (Uteroglobin).
[0154] Exemplary allergy markers include without limitation Total
IgE and Specific IgE.
[0155] Exemplary autism markers include without limitation
Ceruloplasmin, Metalothioneine, Zinc, Copper, B6, B12, Glutathione,
Alkaline phosphatase, and Activation of apo-alkaline
phosphatase.
[0156] Exemplary coagulation disorders markers include without
limitation b-Thromboglobulin, Platelet factor 4, Von Willebrand
factor.
[0157] In some embodiments a marker may be therapy specific. COX
inhibitors include without limitation TxB2 (Cox-1),
6-keto-PGF-1-alpha (Cox 2), 11-Dehydro-TxB-1a (Cox-1).
[0158] Other markers of the present include without limitation
Leptin, Leptin receptor, and Procalcitonin, Brain S100 protein,
Substance P, 8-Iso-PGF-2a.
[0159] Exemplary geriatric markers include without limitation,
Neuron-specific enolase, GFAP, and S100B.
[0160] Exemplary markers of nutritional status include without
limitation Prealbumin, Albumin, Retinol-binding protein (RBP),
Transferrin, Acylation-Stimulating Protein (ASP), Adiponectin,
Agouti-Related Protein (AgRP), Angiopoietin-like Protein 4
(ANGPTL4, FIAF), C-peptide, AFABP (Adipocyte Fatty Acid Binding
Protein, FABP4)
Acylation-Stimulating Protein (ASP), EFABP (Epidermal Fatty Acid
Binding Protein, FABP5), Glicentin, Glucagon, Glucagon-Like
Peptide-1, Glucagon-Like Peptide-2, Ghrelin, Insulin, Leptin,
Leptin Receptor, PYY, RELMs, Resistin, and sTfR (soluble
Transferrin Receptor).
[0161] Exemplary markers of Lipid metabolism include without
limitation Apo-lipoproteins (several), Apo-A1, Apo-B, Apo-C-CII,
Apo-D, Apo-E.
[0162] Exemplary coagulation status markers include without
limitation Factor I: Fibrinogen, Factor II: Prothrombin, Factor
III: Tissue factor, Factor IV: Calcium, Factor V: Proaccelerin,
Factor VI, Factor VII: Proconvertin, Factor VIII:, Anti-hemolytic
factor, Factor IX: Christmas factor, Factor X: Stuart-Prower
factor, Factor XI: Plasma thromboplastin antecedent, Factor XII:
Hageman factor, Factor XIII: Fibrin-stabilizing factor,
Prekallikrein, High-molecular-weight kininogen, Protein C, Protein
S, D-dimer, Tissue plasminogen activator, Plasminogen,
a2-Antiplasmin, Plasminogen activator inhibitor 1 (PAI1).
[0163] Exemplary monoclonal antibodies include those for EGFR,
ErbB2, and IGF1R.
[0164] Exemplary tyrosine kinase inhibitors include without
limitation Ab1, Kit, PDGFR, Src, ErbB2, ErbB 4, EGFR, EphB,
VEGFR1-4, PDGFRb, FLt3, FGFR, PKC, Met, Tie2, RAF, and TrkA.
[0165] Exemplary Serine/Threoline Kinas Inhibitors include without
limitation AKT, Aurora A/B/B, CDK, CDK (pan), CDK1-2, VEGFR2,
PDGFRb, CDK4/6, MEK1-2, mTOR, and PKC-beta.
[0166] GPCR targets include without limitation Histamine Receptors,
Serotonin Receptors, Angiotensin Receptors, Adrenoreceptors,
Muscarinic Acetylcholine Receptors, GnRH Receptors, Dopamine
Receptors, Prostaglandin Receptors, and ADP Receptors.
[0167] In a separate embodiment, the present invention provides a
method of monitoring more than one pharmacological parameter useful
for assessing efficacy and/or toxicity of a therapeutic agent. The
method comprises subjecting a sample of bodily fluid from a subject
administered with the therapeutic agent to a fluidic device for
monitoring said more than one pharmacological parameter, said
fluidic device comprising at least one sample collection unit, and
an assay assembly comprising reaction reagents; actuating said
fluidic device and directing said immunoassay reagents within said
fluidic device; allowing said sample of bodily fluid to react with
immunoassay reagents to yield detectable signals indicative of the
values of the more than one pharmacological parameter from said
sample; and detecting said detectable signal generated from said
sample of bodily fluid. Where desired, the method further involves
repeating the steps at a time interval prompted by a wireless
signal communicated to the subject.
[0168] For the purposes of this invention, a "therapeutic agent" is
intended to include any substances that have therapeutic utility
and/or potential. Such substances include but are not limited to
biological or chemical compounds such as a simple or complex
organic or inorganic molecules, peptides, proteins (e.g.
antibodies) or a polynucleotides (e.g. anti-sense). A vast array of
compounds can be synthesized, for example polymers, such as
polypeptides and polynucleotides, and synthetic organic compounds
based on various core structures, and these are also included in
the term "therapeutic agent". In addition, various natural sources
can provide compounds for screening, such as plant or animal
extracts, and the like. It should be understood, although not
always explicitly stated that the agent is used alone or in
combination with another agent, having the same or different
biological activity as the agents identified by the inventive
screen. The agents and methods also are intended to be combined
with other therapies.
[0169] Pharmacodynamic (PD) parameters according to the present
invention include without limitation physical parameters such as
temperature, heart rate/pulse, blood pressure, and respiratory
rate, and biomarkers such as proteins, cells, and cell markers.
Biomarkers could be indicative of disease or could be a result of
the action of a drug. Pharmacokinetic (PK) parameters according to
the present invention include without limitation drug and drug
metabolite concentration. Identifying and quantifying the PK
parameters in real time from a sample volume is extremely desirable
for proper safety and efficacy of drugs. If the drug and metabolite
concentrations are outside a desired range and/or unexpected
metabolites are generated due to an unexpected reaction to the
drug, immediate action may be necessary to ensure the safety of the
patient. Similarly, if any of the pharmacodynamic (PD) parameters
fall outside the desired range during a treatment regime, immediate
action may have to be taken as well.
[0170] In preferred embodiments physical parameter data is stored
in or compared to store profiles of physical parameter data in a
bioinformatics system which may be on an external device
incorporating pharmacogenomic and pharmacokinetic data into its
models for the determination of toxicity and dosing. Not only does
this generate data for clinical trials years prior to current
processes but also enables the elimination of current disparities
between apparent efficacy and actual toxicity of drugs through
real-time continuous monitoring. During the go/no go decision
process in clinical studies, large scale comparative population
studies can be conducted with the data stored on the database. This
compilation of data and real-time monitoring allows more patients
to enter clinical trials in a safe fashion earlier than currently
allowed. In another embodiment biomarkers discovered in human
tissue studies can be targeted by the device for improved accuracy
in determining drug pathways and efficacy in cancer studies.
[0171] In another embodiment, the present invention provides a
method of detecting at least two distinct analytes of different
concentrations in a bodily fluid from a subject comprises providing
a fluidic device comprising a sample collection unit, an assay
assembly, and a plurality of channels in fluid communication with
said sample collection unit and/or said assay assembly; allowing a
sample of bodily fluid to react with a plurality of reactants
contained in said assay assembly to yield signals indicative of the
concentrations of said at least two analytes; and detecting said
signals that are indicative of the presence or absence of the at
least two distinct analytes, wherein said signals are detectable
over a range of 3 orders of magnitude.
[0172] Currently, a need exists for the detecting more than one
analyte where the analytes are present in widely varying
concentration range, for example, one analyte is in the pg/ml
concentration and another is in the ng/ml concentration. TOSCA
described herein has the ability to simultaneously assay analytes
that are present in the same sample in a wide concentration range.
FIG. 18 shows one embodiment where two analytes, prostacyclin
metabolite and thromboxane metabolite, have been identified and
quantified and their concentrations are different by more than 3
orders of magnitude. Another advantage for being able to detect
concentrations of different analytes present in a wide
concentration range is the ability to relate the ratios of the
concentration of these analytes to safety and efficacy of multiple
drugs administered to a patient. For example, unexpected drug-drug
interactions can be a common cause of adverse drug reactions. A
real-time, concurrent measurement technique for measuring different
analytes would help avoid the potentially disastrous consequence of
adverse drug-drug interactions.
[0173] Being able to monitoring the rate of change of an analyte
concentration or PD or PK over a period of time in a single
subject, or performing trend analysis on the concentration, PD, or
PK, whether they are concentrations of drugs or their metabolites,
can help prevent potentially dangerous situations. For example, if
glucose were the analyte of interest, the concentration of glucose
in a sample at a given time as well as the rate of change of the
glucose concentration over a given period of time could be highly
useful in predicting and avoiding, for example, hypoglycemic
events. Such trend analysis has widespread beneficial implications
in drug dosing regimen. When multiple drugs and their metabolites
are concerned, the ability to spot a trend and take proactive
measures is often desirable.
[0174] Accordingly, the present invention provides a method of
performing a trend analysis on the concentration of an analyte in a
subject. The method comprise a) providing a fluidic device
comprising at least one sample collection unit, an immunoassay
assembly containing immunoassay reagents, a plurality of channels
in fluid communication with said sample collection unit and/or said
immunoassay assembly; b) actuating said fluidic device and
directing said immunoassay reagents within said fluidic device; c)
allowing a sample of bodily fluid of less than about 500 ul to
react with said immunoassay reagents contained within said assay
immunoassay assembly to yield a detectable signal indicative of the
presence of said analyte in said sample; d) detecting said
detectable signal generated from said analyte collected in said
sample of bodily fluid; and e) repeating steps a) through d) for a
single patient over a period of time to detect concentrations of
said analyte, thereby performing said trend analysis.
[0175] In some embodiments, a method of detecting an analyte in a
bodily fluid from a subject using an assay transmitted from an
external device is provided. The method comprises providing a
fluidic device comprising at least one sample collection unit and
an immunoassay assembly containing immunoassay reagents; detecting
said fluidic device and wirelessly transmitting an immunoassay
protocol to said device; allowing a sample of bodily fluid to react
with immunoassay reagents to yield a detectable signal indicative
of the presence of said analyte using said transmitted immunoassay
protocol; and detecting said detectable signal.
[0176] Communication between a reader assembly and an external
storage device allows for a reader assembly of the present
invention to download a fluidic device-specific protocol to run on
the fluidic device based on the identity of the fluidic device.
This allows a reader assembly to be used interchangeably with any
appropriate fluidic device described herein. In addition, the
external device can store a plurality of protocols associated with
a given fluidic device, and depending on, for example, a subject's
treatment regime or plan, different protocols can be communicated
from the external device to the reader assembly to be run on the
fluidic device to detect a variety of analytes. The external device
can also store a plurality of protocols associated not only with a
fluidic device, but also with a particular subject or subjects,
such that a protocol can be associated with a subject as well as
with a fluidic device.
[0177] In some embodiments, the present invention provides a
business method of assisting a clinician in providing an
individualized medical treatment comprises collecting at least one
pharmacological parameter from an individual receiving a
medication, said collecting step is effected by subjecting a sample
of bodily fluid to reactants contained in a fluidic device, which
is provided to said individual to yield a detectable signal
indicative of said at least one pharmacological parameter; and
cross referencing with the aid of a computer medical records of
said individual with the at least one pharmacological parameter of
said individual, thereby assisting said clinician in providing
individualized medical treatment.
[0178] The present invention allows for automatic quantification of
a pharmacological parameter of a patient as well as automatic
comparison of the parameter with, for example, the patient's
medical records which may include a history of the monitored
parameter, or medical records of another group of subjects.
Coupling real-time analyte monitoring with an external device which
can store data as well as perform any type of data processing or
algorithm, for example, provides a device that can assist with
typical patient care which can include, for example, comparing
current patient data with past patient data. The present invention
therefore creates a business method which effectively performs at
least part of the monitoring of a patient that is currently
performed by medical personnel.
[0179] In some embodiments, the present invention provides a
business method of monitoring a clinical trial of a pharmaceutical
agent comprises collecting at least one pharmacological parameter
from a subject in said clinical trial at a plurality of time
intervals, said collecting step is effected at each time interval
by subjecting a sample of bodily fluid from said subject to
reactants contained in a fluidic device, wherein said fluidic
device is provided to said subject to yield detectable signals
indicative of the values of said at least one pharmacological
parameter at a plurality of time intervals; comparing the detected
values to a threshold value predetermined for said pharmacological
parameter; notifying a clinician and/or a sponsor involved in said
clinical trial when a statistically significant discrepancy exists
between the detected values and the threshold value.
[0180] FIG. 19 shows an exemplary flow chart of a business method
of monitoring a clinical trial of a pharmaceutical agent. As
disclosed herein, a fluidic device gathers PK and/or PD parameters
related to a patient of interest. The data is securely transmitted
over, for example, a cellular network or the internet, and
interpretations of the data are derived through computations in a
series of biostatistical algorithms on the external device which
correlate pharmacodynamic, pharmacokinetic, and pharmacogenetic
profiles. Additionally, the data can be compared with information
stored in databases. The stored information could be the patient's
own PK and PD data over a previous treatment regiment, data related
to placebo, pharmacogenomic data that are of relevance to the
particular patient, or data related to a group of subjects. If the
analysis done in Step 2 suggests that there are no significant
difference between the patient's data and the stored data, as
determined by using appropriate algorithms, then "No Action" is
taken. However, if there is a significant difference, then Step 4
determines the size of the difference. If the difference is large,
immediate action is taken. An exemplary type of immediate action
could be to provide an emergency alert to the patient's healthcare
provider. Another kind of immediate action could be to send
instructions to the fluidic device to alter the dosing of the
pharmaceutical agent. If in Step 4 the difference is small, then
the algorithm could determine whether to continue monitoring the
parameters and/or alter a dosage of the pharmaceutical agent. This
method provides for automatic notification to at least medical
personnel or a subject of a possible need to take additional
medical action.
[0181] Where a statistically significant discrepancy exists between
the detected values and the threshold value, a further action may
be taken by a medical practitioner. Such action may involve a
medical action such as adjusting dosage of the therapeutic agent;
it may also involve a business decision such as continuing,
modifying, or terminating the clinical trial.
[0182] One of the significant advantages of the envisioned network
is illustrated in FIG. 20. As all the information is securely
channeled through the internet, this allows the simultaneous
sharing of the information with various interested parties, while
satisfying the appropriate clinical, regulatory and business needs.
For example, the flowchart shows how the patient's clinical needs
are met. The ability of the company that is sponsoring a drug
study, for example a clinical trial or a post-market Phase IV
surveillance, to monitor in real-time the safety and efficacy of
the performance of the drug provides extremely valuable regulatory
and business information. Similarly, the ability of a payor to
monitor the efficacy, and perhaps cost-effectiveness, of a
treatment is greatly enhanced by their ability to obtain data in
real-time.
[0183] In some embodiments, the present invention provides a method
of transmitting a pharmacological parameter of a patient via a
handheld device comprises providing a fluidic device comprising at
least one sample collection unit and an assay assembly; allowing a
sample of bodily fluid to react with reactants contained within
said assay assembly to yield a detectable signal indicative of the
presence of said analyte; detecting said detectable signal;
transmitting said signal to an external device; processing said
signal in said external device; and transmitting said processed
signal via a handheld device.
[0184] One advantage of the current invention is that assay results
can be substantially immediately communicated to any third party
that may benefit from obtaining the results. For example, once the
analyte concentration is determined at the external device, it can
be transmitted to a patient or medical personnel who may need to
take further action. The communication step to a third party can be
performed wirelessly as described herein, and by transmitting the
data to a third party's hand held device, the third party can be
notified of the assay results virtually anytime and anywhere. Thus,
in a time-sensitive scenario, a patient may be contacted
immediately anywhere if urgent medical action may be required.
[0185] In some embodiments a method of automatically selecting a
protocol to be run on a fluidic device comprises providing a
fluidic device comprising an identifier detector and an identifier;
detecting said identifier with said identifier detector;
transferring said identifier to an external device; and selecting a
protocol to be run on said fluidic device from a plurality of
protocols on said external device associated with said
identifier.
[0186] By detecting each fluidic device based on an identifier
associated with the fluidic device after it is inserted in the
reader assembly, the system of the present invention allows for
fluidic device-specific protocols to be downloaded from an external
device and run on the fluidic device. In some embodiments the
external device can store a plurality of protocols associated with
the fluidic device or associated with a particular patient or group
of patients. For example, when the identifier is transmitted to the
external device, software on the external device can obtain the
identifier. Once obtained, software on the external device, such as
a database, can use the identifier to identify protocols stored in
the database associated with the identifier. If only one protocol
is associated with the identifier, for example, the database can
select the protocol and software on the external device can then
transmit the protocol to the communication assembly on the reader
assembly. The ability to use protocols specifically associated with
a fluidic device allows for any appropriate fluidic device to be
used with a single reader assembly, and thus virtually any analyte
of interest can be detected with a single reader assembly.
[0187] In some embodiments multiple protocols may be associated
with a single identifier. For example, if it is beneficial to
detect from the same patient an analyte once a week, and another
analyte twice a week, protocols on the external device associated
with the identifier can also each be associated with a different
day of the week, so that when the identifier is detected, the
software on the external device can select a specific protocol that
is associated with the day of the week.
[0188] In some embodiments a patient may be provided with a
plurality of fluidic devices to use to detect a variety of
analytes. A subject may, for example, use different fluidic devices
on different days of the week. In some embodiments the software on
the external device associating the identifier with a protocol may
include a process to compare the current day with the day the
fluidic device is to be used based on a clinical trial for example.
If for example, the two days of the week are not identical, the
external device can wirelessly send notification to the subject
using any of the methods described herein or known in the art to
notify them that an incorrect fluidic device is in the reader
assembly and also of the correct fluidic device to use that day.
This example is only illustrative and can easily be extended to,
for example, notifying a subject that a fluidic device is not being
used at the correct time of day.
[0189] In some embodiments, the present invention provides a method
of manufacturing a fluidic device for detecting an analyte in a
biological fluid of a subject comprises providing a plurality of
layers of a material. The method comprises providing a plurality of
layers of a fluidic device, and ultrasonically welding said layers
together such that a fluidic network exists between a sample
collection unit, at least one reactant chamber, at least one
reaction site, and at least one waste chamber. Where desired, the
fluidic device manufactured by this method comprise in at least one
of said layers a sample collection unit, at least one of said
layers comprises a filtration site, and at least one of said layers
comprises a reactant chamber, and at least one of said layers
comprises a fluidic channel, and at least one of said layers
comprises a reaction site, and at least one of said layers
comprises a waste chamber.
[0190] In preferred embodiments the different layers of the fluidic
device are ultrasonically welded together according to methods
known in the art. The layers may also be coupled together using
other methods, including without limitation stamping, thermal
bonding, adhesives or, in the case of certain substrates, e.g.,
glass, or semi-rigid and non-rigid polymeric substrates, a natural
adhesion between the two components.
[0191] In some embodiments, the present invention provides a method
of obtaining pharmacological data useful for assessing efficacy
and/or toxicity of a pharmaceutical agent from a test animal. The
method involves the steps of a) providing a fluidic device
comprising at least one sample collection unit, an assay assembly;
and a plurality of channels in fluid communication with said sample
collection unit and/or said assay assembly; b) allowing a sample of
biological fluid of less than about 50 ul to react with reactants
contained within said assay assembly to yield a detectable signal
generated from an analyte initially collected in said sample that
is indicative of a pharmacological parameter; and c) detecting said
detectable signal; and d) repeating the reaction and detection
steps with a second sample of biological fluid from the same test
animal. In a related embodiment, the present invention provides a
method comprising a) providing a fluidic device comprising at least
one sample collection unit, an assay assembly; and a plurality of
channels in fluid communication with said sample collection unit
and/or said assay assembly; b) allowing a sample of biological
fluid to react with reactants contained within said assay assembly
to yield a detectable signal generated from an analyte initially
collected in said sample that is indicative of a pharmacological
parameter; and c) detecting said detectable signal; and d)
repeating the reaction and detection steps with a second sample of
biological fluid from the same test animal, wherein the animal is
not subjected to anesthesia.
[0192] When using laboratory animals in preclinical testing of a
pharmaceutical agent, it is often necessary to kill the test
subject to extract enough blood to perform an assay to detect an
analyte of interest. This has both financial and ethical
implications, and as such it may be advantageous to be able to draw
an amount of blood from a test animal such that the animal does not
need to be killed. In addition, this can also allow the same test
animal to be tested with multiple pharmaceutical agents at
different times, thus allowing for a more effective preclinical
trial. On average, the total blood volume in a mouse, for example,
is 6-8 mL of blood per 100 gram of body weight. A benefit of the
current invention is that only a very small volume of blood is
required to perform preclinical trials on mice or other small
laboratory animals. In some embodiment between about 1 microliter
and about 50 microliters are drawn. In preferred embodiment between
about 1 microliter and 10 microliters are drawn. In preferred
embodiments about 5 microliters of blood are drawn.
[0193] A further advantage of keeping the test animal alive is
evident in a preclinical time course study. When multiple mice, for
example, are used to monitor the levels of an analyte in a test
subject's bodily fluid over time, the added variable of using
multiple subjects is introduced into the trial. When, however, a
single test animal can be used as its own control over a course of
time, a more accurate and beneficial preclinical trial can be
performed.
[0194] In some embodiments a method of automatically monitoring
patient compliance with a medical treatment using a fluidic device
comprises allowing a sample of bodily fluid to react with assay
reagents in a fluidic device to yield a detectable signal
indicative of the presence of an analyte in said sample; detecting
said signal with said fluidic device;
comparing said signal with a known profile associated with said
medical treatment to determine if said patient is compliant or
noncompliant with said medical treatment; and notifying a patient
of said compliance or noncompliance.
[0195] Noncompliance with a medical treatment, including a clinical
trial, can seriously undermine the efficacy of the treatment or
trial. As such, in some embodiments the system of the present
invention can be used to monitor patient compliance and notify the
patient or other medical personnel of such noncompliance. For
example, a patient taking a pharmaceutical agent as part of medical
treatment plan can take a bodily fluid sample which is assayed as
described herein, but a metabolite concentration, for example,
detected by the reader assembly may be at an elevated level
compared to a known profile that will indicate multiple doses of
the pharmaceutical agent have been taken. The patient or medical
personnel may be notified of such noncompliance via any or the
wireless methods discussed herein, including without limitation
notification via a handheld device such a PDA or cellphone. Such a
known profile may be located or stored on an external device
described herein.
[0196] In some embodiments noncompliance may include taking an
improper dose of a pharmaceutical agent including without
limitation multiple doses and no doses, or may include
inappropriately mixing pharmaceutical agents. In preferred
embodiments a patient is notified substantially immediately after
the signal is compared with a known profile.
[0197] A patient or subject of a clinical trial may forget to take
a bodily fluid sample as described herein. In some embodiments a
method of alerting a patient to test a sample of bodily fluid using
a fluidic device as described herein comprises providing a protocol
to be run on said fluid device, said protocol located on an
external device, associated with said patient, and comprising a
time and date to test said sample of bodily fluid; and notifying
patient to test said bodily fluid on said date and time if said
sample has not been tested. In some embodiments a patient can be
notified wirelessly as described herein.
[0198] A patient may be provided with a fluidic device or devices
when procuring a prescription of drugs by any common methods, for
example, at a pharmacy. Likewise, a clinical trial subject may be
provided with such devices when starting a clinical trial. The
patient or subject's contact information, including without
limitation cell phone, email address, text messaging address, or
other means of wireless communication, may at that time be entered
into the external device and associated with the patient or subject
as described herein, for example, in a database. Software on the
external device may include a script or other program that can
detect when a signal generated from a detection device has not yet
been sent to the external device, for example at a given time, and
the external device can then send an alert notifying the patient to
take a bodily fluid sample.
[0199] In some embodiments the present invention provides a method
of assessing the reliability of an assay for an analyte in a bodily
fluid with the use of a fluidic device. The method comprises the
steps of a) providing a system, said system comprising a fluidic
device, said fluidic device comprising a sample collection unit and
an assay assembly, wherein said sample collection unit allows a
sample of bodily fluid to react with reactants contained within
said assay assembly, for detecting the presence of an analyte in a
bodily fluid from a subject, and a reader assembly for detecting
the presence of said analyte; and b) sensing with a sensor a change
in operation parameters under which the system normally
operates.
[0200] In some aspects a sensor may be present either in the
fluidic device, the reader assembly, both, or in some cases it may
be advantageous to include a sensor in the packaging in which the
fluidic device and/or reader assembly are packaged. The sensor can,
for example without limitation, detect temperate or pressure
changes that may provide for an inaccurate analyte concentration
calculation. For example, if the temperature of reagents stored in
said fluidic device falls outside an acceptable temperature range,
this may indicate that the detection will not be accurate using the
then existing calibration and processing algorithms, for example.
Likewise, for example, the pressure in the pump in the reader
assembly may fall outside an acceptable range. In some embodiments
a moisture sensor is provided to detect the presence of moisture in
the cartridge before the assay begins. In some embodiments there
may be thiosyanate in one layer of the fluidic device and iron salt
in another layer, wherein a dye is formed when these are mixed,
whereby the dye is a visual indication of the presence of
moisture.
[0201] In some disposable systems, particularly in those where
sample acquisition is performed by the patient or end user,
measurement errors are not uncommon. Significant errors due to, for
example, patient handling of the sample, could be due to the sample
collection method. A patient may not collect the correct volume of
the sample, the collection may not be performed at the appropriate
time, or the sample may not be handled in an appropriate manner,
thus compromising the sample integrity. It may be advantageous when
using a disposable system in which the patient controls the initial
sample collection and handling to utilize methods for minimizing
the consequences of such errors by, for example, either alerting
the patient to repeat the test or use calibration steps to
compensate for such errors.
[0202] There is therefore a significant need for methods that would
improve the calibration in hand held or disposable assay units,
particularly in those units where the sample and reagent volumes
are in the microliter and nanoliter ranges, where maintaining a
controlled temperature is impractical, where the sample is not
"clean" such that errors are caused by interfering substances, such
as hematocrit, for example, or where it is difficult to maintain
the desired conditions such as temperature or reagent quality,
including the appropriate sample volume and handling by the
user.
[0203] Immunoassays have a characteristic response similar in form
to the well-known Scatchard binding isotherm (Bound/Maximum Bound
(B/B0)=Ligand Concentration/(K+Ligand Concentration) where B is the
amount of the labeled analyte bound to a solid phase when analyte
is present, B0 is the amount bound when no analyte is present and K
is the dissociation constant. The mathematical form of such assay
responses is hyperbolic.
[0204] Results of immunoassays of the types described above are
typically analyzed using the known (ln-logit) or (log-logit)
functions, in which the assay label (for example in a two-step
process, alkaline phosphatase-labeled analyte) bound to a solid
phase when analyte is present in the assay ("B") is compared with
the amount bound when no analyte is present ("B0)" to provide the
ratio B/B0. Then, the "logit" function (logit=Log[(B/B0)/(1-B/B0)])
is plotted against Log(Analyte Concentration) resulting in a
straight line. (Natural logarithms can also be used instead of
logarithms to base 10). The slope and intercept of this plot can be
used to derive simple equations that permit the calculation of (a)
assay signal as a function of analyte concentration, or (b) analyte
concentration as a function of assay signal. An example of such
analysis is shown in FIG. 21 using Thromboxane as the analyte of
interest. The best fit to the data is given by Equation 1:
Signal=(A-D)/(1+(Analyte conc./C) B)+D [Equation 1], where A is the
signal at zero analyte concentration, D is the signal at infinite
analyte concentration, C is the analyte concentration reached at a
signal level half way between A and D, and B is a shape parameter.
The relationship between analyte concentration and signal is given
by: Analyte concentration=C*((((A-D)/(Signal-D)-1) (1/B)) [Equation
2], where A, B, C and D are identical to the parameters used in
Equation 1.
[0205] It is possible to compute errors that occur from
mis-calibration using the equations described herein above. (The
Analyte Concentration function from Equation 2 is differentiated
with respect to each potential variable A, B, C, D and Signal).
Estimates of the difference between the ideal value of the variable
and the actual value in the system are used as .DELTA. values in
the calculation
(.DELTA.(concentration)=(d(Concentration)/d(Param.))*.DELTA.Param).
Errors in calibration are reflected in erroneous values of A, B, C
and D. Each of these parameters is influenced by a different
factor, For example, temperature effects on calibration of
immunoassays will have the strongest impact on the A, C and D
parameters of the ln-logit calibration, while likely having a
minimal impact on the shape parameter B. The detected signal, which
in turn can be used to determine the analyte concentration, is
biased by one or more of the following reader assembly and fluidic
device characteristics: optics used in the instrument for signal
measurement: temperature control: most chemical processes are
highly temperature sensitive, including enzyme reactions, and
equilibrium between antigens and antibodies; timing of assay steps;
calibration relative to an "ideal" instrument; the inability of the
patient to manually recalibrate the fluidic device when used;
dimensions of the fluidic device; volume of the assay assembly and
its shape; fluid movement within the device; timing and uniformity
of fluid movement; efficiency in mixing (most assay methods used in
disposables and employ microfluidics would involve some mixing).
The following reagent variations can also contribute to a biased
detected signal: reagent quantity; reagent dissolution (if it is in
dry form);changes in activity of reagents following manufacture
(instability) (This is particularly important for "distributed
systems" where the disposable useful life is typically determined
by reagents which can, for example, lose 20% of their activity. If
they can be used without significantly compromising assay
performance, the shelf-life of many expensive disposables could be
extended several fold and severe constraints on disposable storage
(refrigeration and the like) can be relaxed). In addition, when
calibration is performed at the factory, small errors in the
estimation of the calibration parameters can result in error in the
calculated analyte concentration.
[0206] The magnitudes of these calibration errors and consequently
errors introduced in estimating analyte concentrations can be quite
significant. FIG. 21 shows the dose-response data for a two-step
assay for Thromboxane. The top curve (Logit.test) in FIG. 22 shows
a typical (ln-logit) assay response. When we adjust the level of
the highest signal (A) and the lowest signal (D), shown as "Shift
zero signal" and "Shift 100% signal", respectively, the curves
shift as seen in FIG. 22. The corresponding computed values of
error in the concentration that would be calculated from Equation 2
were large (>20% across the entire range of the assay) as shown
in FIG. 23. In FIG. 22, the signal is normalized by subtracting the
D value from the signal and dividing the difference by
(A-D):(Signal-D)/(A-D). This yields what is usually described as
B/B.sub.0 (the ratio of bound label at a given analyte
concentration to that at zero analyte level). The In-logit function
was modified by adding 10% of (A-D) to D or subtracting 10% of
(A-D) from A before recalculating the normalized signals
(corresponding to two types of significant calibration error
(shifting the value of A or D respectively). At signal levels
intermediate between A and D the change made was adjusted by
10%*(Original signal-D)/(A-D). FIG. 23 shows that when
modifications of only 1%*(A-D) were made, and concentration of the
analyte was computed, errors in concentration were still
significant at certain parts of the analyte concentration
range.
[0207] In a laboratory setting, errors in measuring biochemical
parameters of blood and other bodily fluids due to calibration
errors are dealt with using many known compensation mechanisms. One
of the simplest techniques is to add a known quantity of a trace
amount of a radiolabeled analyte and construct a calibration curve
based on those readings. Other methods include adding a known
amount of a standard to the analyte solution that needs to be
analyzed. However, such techniques are impractical in a disposable,
handheld system for analysis, without particular adaptation of
those techniques for dealing with small sample volumes, lack of
large amounts of other solutions (such as buffers), and ability to
exercise precise controls over the volumes of the samples and their
dilutions.
[0208] Conventionally, a calibration exercise is performed in
parallel with assaying the sample. This is, however, impractical in
a self-contained, disposable assay system intended to be compact
and inexpensive. To address any calibration challenges that may
occur while assaying analytes using a fluidic device of the present
invention, in some embodiments parameters A, or in preferred
embodiments A and D, of Equation 1 described herein above, are
measured within the fluidic device rather than using manufacturer's
values or an external device. The value(s) is compared with the
parameter values estimated when the fluidic device was calibrated
by the manufacturer. Signal results are then adjusted using the
following equation: Signal.sub.adjusted=Signal*(A.sub.factory
calibration/A.sub.measured within the assay) and the original
calibration equation (Equation 1) is then used to calculate the
analyte concentration. Alternatively, A and D values measured at
the time of assay are substituted for the A and D values obtained
during factory calibration. Typically the (A/D) calibration
measurement would be made in a buffer sample, preferably for each
analyte (in a multiple analyte assay device), or one analyte only,
if each assay responds similarly to the various factors that alter
the calibration parameters.
[0209] In some embodiments of this invention, the calibration
parameters of Equation 1 are corrected using differential
calibration. The following example using Thromboxane B2 as the
analyte illustrates this approach. Thromboxane B2 (TxB2) (1.25 mg)
was dissolved in a mixture of dimethylsulfoxide (342 .mu.l) and
water (342 .mu.l). To this, 5 .mu.l of a solution of
1-(3-(dimethylamino)propyl)-3-ethyl-carbodiimide hydrochloride in
water (0.1 g/ml) and 10 .mu.l of a solution of
n-hydroxy-succinimide in water (0.1 g/ml) were added. After 1 hour
at room temperature the resulting NHS-ester of TxB2 was used in the
preparation of TxB2 labeled with alkaline phosphatase (described
below) without further purification. Alkaline phosphatase (bovine
intestine, Sigma-Aldrich) was dissolved in phosphate-buffered
saline at 1 mg/ml. To 1 ml of this solution 120 .mu.l of the
NHS-ester of TxB2 was added and the mixture allowed to react for 1
hour at room temperature. The enzyme-TxB2 conjugate was then
purified overnight by dialysis against tris-buffered saline
containing MgCl.sub.2.
[0210] Described is an example of a two-step enzyme immunoassay
where TxB2 is the analyte. Samples and mouse monoclonal anti-TxB2
(15 .mu.l of Cayman Chemical Kit Catalog number 10005065,
appropriately diluted into Assay Designs buffer) were added to
384-well plates to which anti-Mouse IgG had been immobilized
((Becton Dickenson 356177)). The sample was 30 .mu.l of plasma
diluted 1:4 with assay buffer (Assay Designs Correlate-CLIA.TM. kit
910-002) and supplemented with known concentrations of TxB2. Other
types of sample (for example TxB2 dissolved in assay buffer) can be
substituted.
[0211] Plates were covered to prevent evaporation and incubated at
room temperature with gentle mixing (100 rpm) on an orbital shaker
for 12 hours. The contents of the wells were then removed by
aspiration. Thromboxane-labeled with alkaline phosphatase (25 .mu.l
diluted 1:1500 with assay buffer) was added and incubated at room
temperature for 2 minutes. The contents of the wells were removed
by aspiration and wells washed thrice with 100 .mu.l wash buffer
(from the Assay Designs Kit 910-002).
[0212] Enzyme bound to the wells was then measured by addition of
40 .mu.l Lumiphos.TM. 530 substrate solution which contains
(4-methoxy-4-(3-phosphate-phenyl-spiro-[1,2-dioxetane-3,2'-adamantane])).
Incubation was allowed to proceed for 1 hour with orbital mixing
and the luminescent product measured in a Molecular Devices MD5
Spectrometer (0.5 second integration time).
[0213] FIG. 21 shows the typical assay dose-response data for a
two-step assay for TxB2. Using Equation 1, the parameters A, B, C
and D are fitted to the curve shown in FIG. 21. As described
herein, even small changes in values of the parameters A and D can
have a significant impact on the measured concentration. Thus, any
errors in computing A and D are magnified in the estimated analyte
(TxB2) concentration. This concept is illustrated in FIGS. 22 and
23, where even a 1% change in (A-D) resulted in significant errors
in estimating TxB2 concentrations in the samples. In FIG. 22, the
signal is normalized by subtracting the D value and dividing the
difference by (A-D) viz: (Signal-D)/(A-D). This calculates what is
commonly described as B/B0 (the ratio of bound label at a given
analyte concentration to that at zero analyte level). The
(ln-logit) function was modified by adding 10% of (A-D) to D or
subtracting 10% of (A-D) from A before recalculating the normalized
signals (corresponding to two types of significant calibration
error (shifting the value of A or D respectively). At signal levels
intermediate between A and D, the change made was adjusted by
10%*(Original signal-D)/(A-D). FIG. 23 shows the computed errors in
estimating the analyte concentrations for a 1% error in estimating
A and D. As can be seen for the low analyte concentrations, the
errors are pronounced even for small errors in the calibration
parameters A and D.
[0214] FIGS. 24-27 illustrate an embodiment of this invention where
the sample containing an unknown analyte concentration is spiked
with a known concentration of the analyte to minimize calibration
errors. Spiking can be achieved by a variety of methods, for
example, by incorporating analyte in known quantities to the assay
well during manufacture of the fluidic device. Separate spike wells
could also be accommodated in the fluidic device described herein.
FIG. 24 shows calibration using differences between signal response
between unspiked and spiked samples. The amount of the spiked
analyte is indicated by x2 and the original (endogenous
concentration in the sample) is denoted as original concentration
or x1 (pg/ml). The difference in signal between unspiked and spiked
sample is plotted against the signal for the original concentration
for various amounts of known amount of analyte (spike) introduced
into the sample. The (ln-logit) parameters (for the top curve in
FIG. 24) are shown in Table 1.
TABLE-US-00001 TABLE 1 Original Calibration Parameters for Data
Shown in FIG. 24 A 3.37E+04 B 1.01E+00 C 2.10E+02 D 3.56E+03
[0215] The data shown in the top curve in FIG. 24 were used in a
recalibration exercise by calibrating against the difference in
signal for each original concentration level and each level spiked
with 200 pg/ml analyte. Equation 3 shown below was empirically
derived and is useful in calculating the original endogenous
concentration of analyte. The best-fit parameter values in Table 2
were computed by minimization of the sum of the square of the
differences between target and calculated analyte values.
Concentration=C*((A-D)/((Signal-D) (1/B))+E [Equation 3].
TABLE-US-00002 TABLE 2 Calculated Parameter Values for 1-point
Spike Calibration A 1.20E+02 B 1.996189 C 292.7824 D -0.14393 E
-287.931
[0216] This calibration was verified as shown in FIG. 25 (log
scale) and FIG. 26 (linear scale). Note the regression equation was
calculated for data in linear form. The formula resulted in near
perfect results.
[0217] The results of one embodiment of this invention are shown in
FIG. 27, where the extent of the recovery of the spike signal is
used to correct for the concentration of the value of the unspiked
sample. This method has the advantage that changes in the parameter
C in the (ln-logit) equation due to, for example, reagent
instability, are accounted for. The method involves the following
steps: calculate x1 (endogenous conc.), and x2 (spike conc.) using
original calibration; calculate recovery of spike as %
(x2-x1)/spike [Equation 4]; correct x1 by recovery factor:
(x1*100/Spike recovery) [Equation 5].
[0218] This was tested with the calibration curve shown in FIG. 24
and the original calibration parameters of Table 1. As shown in
Table 3, it was possible to use spike concentration values from
100-500 pg/ml and C values that varied from 500 to 50 such that the
actual signals corresponding to the modified C values were changed
very significantly from what had been the case with the original C
value and the spike recovery (calculated with the original C value
ranged from 42-420% respectively, yet the recovery of the unspiked
sample (once corrected for the recovery of the spike) was 100% over
the entire calibration range. This effect is graphically
illustrated in FIG. 28, where the C parameter is varied between 50
and 500 (a ten fold range), but the corrected values for the
analyte concentration (x1) accurately reflects the expected analyte
concentration.
TABLE-US-00003 TABLE 3 Effects of changes in the C parameter on
spike and original analyte recovery at two original concentration
levels: x2 x1 x1 x2 S recovery recovery C Pg/ml S (x1) pg/ml (x1 +
x2) % % 500 100 2.88E+04 500 1.73E+06 42 100 210 100 2.40E+04 500
1.13E+04 100 100 50 100 1.36E+04 500 5.83E+03 420 100 500 316
2.21E+04 500 1.50E+04 42 100 210 316 1.56E+04 500 9.66E+03 100 100
50 316 7.61E+03 500 5.25E+03 420 100 500 100 2.88E+04 200 2.25E+04
42 100 210 100 2.40E+04 200 1.60E+04 100 100 50 100 1.36E+04 200
7.80E+03 420 100 500 316 2.21E+04 200 1.84E+04 42 100 210 316
1.56E+04 200 1.22E+04 100 100 50 316 7.61E+03 200 6.16E+03 420
100
[0219] In Table 3, x1 is the endogenous concentration and x2 is the
spike concentration; S is the signal level corresponding to the
designated analyte concentration; x2 recovery is the apparent
recovery of x2 and x1 recovery is calculated (using Equation 5)
after compensating for x2 recovery (using Equation 4).
[0220] The spike level must be carefully chosen. The optimal level
will be a compromise between the operating range of the assay and
the likely range of concentrations of samples. If it is too low,
the change in signal caused by the spike will be too small to be
reliably measured. If it is too high, the assay response will be
too shallow to reliably measure the spike. The ideal spike level
would change the measured signal by much more than the standard
deviation in the signal. In the above example, the assay range had
been adjusted to make measurements for sample with concentrations
in the range of about 0 to about 500 pg/ml and spikes of about 200
to about 1000 pg/ml would likely be useful.
[0221] In some embodiments the following various guidelines for
choosing spike levels can be followed: spikes should change the
observed signal across the desired range by at least 10%; spikes
should be in the same range as the anticipated mid range of sample
concentrations; spikes should be less than about three times the
original C value. Note that the useful part of the dose-response is
from about 0.2*C to about 5*C.
[0222] The following example illustrates the estimation of
endogenous TxB2 concentrations using spike recovery. Two citrated
human plasma samples were analyzed by the two-step assay. Aliquots
of the samples were also supplemented (spiked) with known
concentrations of TxB2 prior to assay. Some samples were also
supplemented with indomethacin (0.1 mM) and/or EDTA (5 mM). Samples
were stored either flash-frozen then thawed or refrigerated
unfrozen prior to assay. These procedures generated a set of
samples with various original endogenous concentrations (storage
and freezing and thawing tends to cause platelet activation and
production of TxB2; indomethacin inhibits TxB2 production).
[0223] The results of the above experiment are shown in FIG. 27.
Sample 5A was known to have a very low TxB2 concentration
(estimated to be <10 pg/ml). When the dose-response of the assay
in sample 5 was used to calibrate the assay, the concentration was
assumed to be zero. Dose responses for the other samples 4A, 4N, 5N
were then plotted and it was observed that their response
corresponded to higher concentrations of TxB2 and could be fitted
to the 5N response by moving each to the left (in the direction of
lower concentration) by an amount corresponding to removing a
certain fixed TxB2 concentration from each the known spike levels.
All the samples had responses that were almost identical in shape
to that of sample 5N. When the curves fitted as closely as possibly
to the A5 curve, the concentration of TxB2 notionally removed
corresponds to the estimate of the TxB2 concentration in the
sample.
[0224] The original data of FIG. 27 were represented in FIG. 29 by
the best fit (ln-logit) approximation. The Solver function in
Microsoft Excel was used to compute a value of TxB2 that caused the
A5 response to approximate that of the sample N5. As can be seen,
this generated a good fit and the computed value (471 pg/ml) is an
estimate of the concentration difference between TxB2 levels in the
two samples.
[0225] In another embodiment of our invention a single point can
could be used (all the points fit closely to the calibration curve,
so any single point could have been used) rather than a multi point
spike that was illustrated in the earlier FIGS. 24-27. The
following experiment illustrates this concept. Two plasma samples
were spiked to many levels of TxB2 and assayed by the two-step
method. Assays were calibrated using buffer calibrators rather than
plasma-based materials. Results are presented in FIG. 30. Plasma
was analyzed as described earlier. Data in FIG. 30 are plotted on a
log scale. The concentration of unspiked samples was calculated
from the calibration and the concentration of spiked samples taken
as "endogenous+spike." Results are plotted only for the spiked
samples. As can be seen, there was desirable correlation between
the calculated and known values over the range of about 50 to about
10,000 pg/ml. When recovery was estimated for spikes in the range
about 40 to about 2,500 pg/ml, the correlation was 99.7%.
[0226] Spike recovery method for correcting the calibration
parameters are useful for compensating temperature effects on
immunoassays in self-contained disposable analytical systems, also
some times referred to as handheld analytical systems or assay
systems. As is well known, instabilities in temperature during an
assay introduce significant errors in the estimated analyte
concentration. Temperature effects on calibration of immunoassays
have the strongest impact on the A, C and D parameters of the
(ln-logit) calibration. It is likely that the B (shape) parameter
is minimally affected by temperature changes. As shown above, the
spike recovery method can correct for errors introduced in the C
parameter and hence could be an excellent approach for correcting
temperature induced errors in computing the calibration parameters
of the (ln-logit) equation. Similarly, normalizing signal levels to
the zero analyte calibrator level, as described earlier, can
compensate for errors in the A and D parameters, which are again
negatively influenced by temperature changes.
[0227] Internal calibration and/or spike recovery means of
calibration have significant advantages over conventional
factory-calibration methods. One obvious advantage is that two
quantities of assay-related information are used to compute the
assay result rather than one, which improves the reliability of the
assay. A second advantage is that this approach compensates, to a
large extent, reagent instability. Another advantage is that
several instrument, assay environment, and procedural variables are
factored into the assay results.
[0228] Other uncontrolled changes in system response, besides
temperate change, can also negatively impact the computed A and D
parameters. For example, FIG. 31 shows the time course of the
signal generation during an assay. To correct for these errors, one
embodiment of the claimed invention is to compare assay signals B
in a fluidic device with the B0 signal so to eliminate errors due
to variation of the absolute value of assay signals due to
uncontrolled changes in system response. This concept was verified
by the following experiment.
[0229] A competitive immunoassay for TxB2 was set up using the
protocol described in Assay Designs Product Literature for their
corresponding Correlate-CLEIA kit (catalog 910-002). An alkaline
phosphatase conjugate was prepared as described earlier and was
diluted 1:112,000 and substituted for the kit conjugate. A and D
parameters are the calibration parameters used in the (log-logit)
fit to the assay response. Best fit values were obtained at each
time point. Note that at zero time the A and D parameters are not
measured, but all signal values would be (are known to be) zero.
The ratio D/A was multiplied by 1e6 so as to be presentable on the
same scale. The A and D values when plotted against time vary
significantly, particularly the A value (zero analyte). As seen
from the straight line with practically zero slope, the scaled D/A
remains constant over the time span.
[0230] The above experimental data were then analyzed by
normalizing the assay signal (B) to signal at zero analyte
concentration (B0). Using this normalized signal (B/B0),
(log-logit) best fits were obtained for each time point and
averaged. Concentrations of analyte were computed using these
calibration parameters for each time. FIG. 32 shows the derived
concentrations that were plotted against the A parameter derived
for each individual time point. Each line corresponds to different
analyte levels (pg/ml) ranging from about 39 to about 10,000 pg/ml.
As can be seen from FIG. 32, although signal values changed by
about 2-fold during the course of the experiment, the derived
analyte concentration was essentially constant over the analyte
concentration spanning a range of about 39 to about 10,000 pg/ml.
The variation of calculated concentration was computed and found to
average only 2.7% over the calibration range of 39-625 pg/ml (which
spans most of the range).
[0231] A calibration spike can be enabled by adding analyte to the
antibody (or other solid phase capture agent) during manufacturing,
and then drying. subsequently adding analyte to the appropriate
well during manufacturing (then drying), or adding analyte to a
portion of assay buffer which is then routed to the appropriate
well. Methods 1 and 2 have a risk which is that the spiked analyte
could be flushed from the well as sample or buffer enters. This may
be handled in one of several ways such as relying on the tightness
of the antigen: antibody interaction for the brief time the well is
subject to flowing sample or buffer (which exit from the well), or
careful management of liquid flow and placing the spike well as
that most distal to the incoming liquid (last well to fill has the
least flow through).
[0232] Errors in measuring analyte concentrations could also be due
to variability in the pre-analysis phase. The primary cause of this
type of errors is due to the patient collecting an incorrect volume
of sample or where the sample integrity has been compromised.
Errors due to incorrect sampling volume can by corrected by a
variety of means. One method is to measure the volume of the sample
during a pre-processing step. If the measured volume is
significantly different from the expected volume, the patient could
be instructed to provide a new sample. This could be accomplished
by, for example, the wireless communication with the external
device as described herein. Alternatively, the analytical methods
or algorithms on the external device could be recalibrated to
compensate for the change in the sample volume. The recalibration
could be using any of the standard calibration techniques or the
modifications to the calibration process, which have been described
herein.
[0233] The following is a description of one embodiment of a method
for determining the accuracy of the volume of the sample provided
to the sample collection unit of a fluidic device described herein.
The sample collection unit can be lined with conductive elements
spaced apart at known separations similar to the graduations on a
measuring cylinder or jar. The location of each conductor can
correspond to a specific sample volume. As fluid comes into contact
with the conductor, the measured conductivity of that conductor
would be markedly increased. By identifying the highest placed
conductor that has undergone the conductivity change, the volume of
the sample in the sample collection unit can be computed.
[0234] Alternatively, if the sample volume has to meet a minimum, a
conductive element could be placed at the appropriate level in the
well. When the cassette is introduced into the handheld (or the
sample holder is introduced in the analytical system), thereby the
patient has indicated that she has completed the sampling process,
and if the conductivity of the sensor remains at the baseline
level, it could be easily concluded that the patient has not
provided the required sample volume. The patient could be given the
appropriate feedback such as replacing the sample or replenishing
it. Alternatively, the back-end server or computer at the network
headquarters could be informed of the issue and appropriate
corrective measures taken. An alternative to the electrical sensing
for the correct volume could be using known optical sensing
means.
[0235] Sample integrity could be affected by many factors, some
intrinsic to the patient and some that are extrinsic. Following are
some of the sources of errors in sample integrity: (i) mixing of
interstitial fluid with blood; (ii) variability in the hematocrit
concentration; (iii) hemolysis; and (iv) activation of platelets
and sample clotting.
[0236] Occasionally, interstitial fluid may leak from a
finger-puncture wound and could mix with blood. Alternatively, if
the patient had liquid on her hands due to washing prior to
obtaining a blood sample, such liquid could also mix with blood
plasma. Both fluids mentioned, above, interstitial fluid and wash
liquid, contain no red cells and would mix with the blood plasma.
When the amount of interstitial fluid is large so that the
effective hematocrit is very low, the measured concentration of the
external standard (fluorescein) would be low. This signal could be
used to conclude that the sample is inappropriate for analysis and
that it could lead to incorrect results. When blood is contaminated
by water (which has low conductivity), it would be possible to
detect this by measuring the conductivity of the fluid part of the
sample (blood plasma has a characteristic high conductivity not
subject to variation from day-to-day or individual-to-individual).
If the measured conductivity of the sample is lower than the plasma
conductivity, it is likely that the sample has been
contaminated.
[0237] Errors could also be due to incorrect operation of the
instrument and means of detecting and compensating those errors are
described below. One source of error could be that the disposable
is not properly accommodated in the handheld system. Having a
sensor detect and report the proper mating of the disposable in the
handheld would be one means of avoiding this problem. Another
source of errors is from the fluidic system, where there may be an
issue with where the sample is applied in the sample well and the
volume of the applied sample. This could again be addressed by the
use of appropriate sensors which detect the application of a sample
and report on the adequacy of the volume that is applied. Other
fluidics related problems could be blocked channels, insufficient
reagents, bubbles, etc., all of which again could be detected and
reported by the use of appropriate sensors.
[0238] In some embodiments any of the errors described herein can
be measured using sensors located on either the fluidic device or
the reader assembly. In some embodiments an error messages could be
displayed on an LCD screen in the reader assembly using the
processing power of the microchip on the handheld. Alternatively, a
signal from the sensors could be communicated to the external
device which can then relay an error message to either the reader
assembly or a third device such as a PDA or cell phone. Such action
could be a message communicated to the patient in the form of an
audio, video or simple text message that the patient could receive.
In some embodiments the external server can transmit corrected
calibration parameters to the reader assembly to compensate for any
of the errors described herein.
[0239] In yet another embodiment, after the identifier is detected
by an identifier detector as described herein to determine, for
example, a protocol, if a signal transmitted by a sensor doesn't
match the expected value for the sensor signal, then the external
device can transmit a pre-programmed alert based on each cartridge
bar code and sensed signal to either, for example, an LCD display
on the reader assembly or to a handheld device, to take a
designated action. Nonlimiting examples of error alerts, the
problems they indicate, and required action to be taken are, for
example:
TABLE-US-00004 Error Code Symbol Problem Action Er1 Thermometer
Temperature out of Wait until Temp >10 or <35 C. range Er2
Blood drop Blood sample too small If detected w/in 15 minutes of
first sample add more blood, other wise use new cartridge Er3
Battery Power disruption Do not start test until power resumes Er4
Bar code symbol Cartridge expired Run test on a non expired
cartridge Er5 Line through fluidic device Cartridge already used
Run test on a new cartridge Er6 Phone receiver No Cell Phone Do not
start test until in coverage coverage area Er7 Line through a box
Reader malfunction Call Theranos Er8 Bottle with a "C" in the label
Calibration overdue Run Calibration standard, then run test
[0240] After the identifier detector detects the identifier to
determine a protocol and any sensed signals are detected and either
patient notification is complete or calibration parameter are
updated, the fluidic device calibration can occur, followed by the
appropriate assay.
[0241] Despite the corrective actions described here, the generated
analyte concentrations values could still be erroneous. For
example, the actual analyte concentration could be well outside the
expected range, and thus the calibration parameters used may be
incorrect. Values which are unlikely, impossible or inconsistent
with prior data for a particularly patient could be flagged and
subjected to a software review. Values with suspect accuracy can be
communicated to the appropriate decision maker, such as the
patient's physician.
[0242] The concept of the reference therapeutic index (TI) and how
it is computed is illustrated in FIGS. 33 and 34. A TI is computed
from a retrospective analysis of many measured parameters,
including the blood concentrations of drugs of interest, their
metabolites, other analytes and biomarkers in blood that change
concentrations due to the drugs the patient is consuming,
physiologic parameters (such as blood pressure, respiratory rate,
body temperature, heart rate, etc.), and clinical parameters that
indicate disease progression (such as angina, stroke, infarct,
etc.). Typically, many serial measurements would be made for the
many treated patient and corresponding controls (unmedicated or
placebo treated). The clinical parameter would be an "outcome
parameter" (OP). The other measured parameters can be "input
parameters" (IP).
[0243] For the retrospective analysis and TI computation, data from
many subjects and their respective output and input parameters,
including subject's relevant details such as height, weight, race,
sex, family history, etc., would be populated in a database. Each
candidate outcome parameter (stroke, infarct, angina, death, etc.)
will be subject to multiple regression analysis against input
parameters.
[0244] The multiple regression analysis is performed for each
candidate OP versus all available IPs. Database columns are
constructed by using each IP, each IP 2, and all cross-terms
(IPi*IPj). The analysis is then performed using the equation:
OPi=(a*IP1+b*IP2+ . . . n*IPn)+(aa*IP1 2+bb*IP2 2+ . . . +nn*IPn
2)+(aaa*IP1*IP2+bbb*IP1*IP3+ . . . +nnn*IPn-1*IPn), where a . . .
n,aa . . . nn,aaa . . . nnn are arbitrary constants.
[0245] Multiple regression analysis establishes the best fit to the
equation and indicates which IPs are strong candidates for
inclusion. Weakly correlated IPs are dropped and the analysis
repeated until each candidate OP has an optimal relation to the
remaining IPs. The therapeutic index will then have the form:
TI=a*IP+cc*IP3 2+nnn*IP3*IP5+ . . . (Equation 6).
[0246] FIG. 34 illustrates the computation of a TI and the use of
the TI concept for determining therapeutic efficacy (the
therapeutic index is also indicated by the term efficacy index).
The example illustrated in FIG. 34 shows the time course of
successful drug therapy of a disease state (such as
atherosclerosis) that is indicated by three biochemical analytes
represented by parameters A, B and C. The disease is treated (with
for example a Statin) starting on day zero.
[0247] Parameters A, B and C are measured daily using an ambulatory
system as described herein. At the outset, relative to "ideal
levels", Parameter A (for example LDL-cholesterol) is elevated,
Parameter B (for example HDL-cholesterol) is low and Parameter C
(for example, alanine aminotransferase, an indicator of liver
damage) is normal. All parameters (A, B, C) are presented
normalized to their respective ideal level. As therapy proceeds,
the drug causes the levels of A and B to approach normal values but
at different rates. Analyte C remains normal indicating the drug is
not causing liver damage. The relative risk of an outcome for the
patient is represented by an initially unknown TI. As described
above, TI is a surrogate to the outcome parameter that reflects the
physiological functions of the patient (blood pressure, etc.) or
other pre-identified factors in a patient record and can be
indicative of improvement in the patient's condition. We further
assume that parameter TI is influenced by parameters A and B. In
certain cases, at the beginning of the study this relationship
remains to be determined
[0248] Data from the monitoring system (device input) and the
patient input are analyzed by multiple regression of TI and
measured values A, B and C, as described above. In the example
shown, these data are analyzed using multiple regression analysis,
which fits parameter TI as a function of parameters A, B, C and
their squares and the pair-wise cross terms (A*B, etc.) As shown in
FIG. 35, for the simulated values shown in FIG. 34, an excellent
fit was obtained (R 2=0.99) when all parameters were included. It
is evident from inspection of the fit that most of the parameters
can be eliminated leaving only A and A*B. When this is done the fit
is still very good (R 2=0.95).
[0249] The multiple regression derived function is not identical to
the base function which generated the first candidate TI data, but
works well to compute an estimate of TI from (typically fewer)
measured parameters, prior to clinical validation, if necessary.
The appropriate threshold levels of TI, or the optimum TI is termed
as TI.sub.ref (or "action threshold value".) Expert review can then
determine the optimum therapeutic index for that particular patient
or patient class. If the computed TI exceeds the preset TI.sub.ref,
appropriate action can be taken. An appropriate action could be
alerting the physician, stopping the medication or the like. As can
be understood, the appropriate TI.sub.ref for a patient would be
decided based on the healthcare provider's judgment for that
individual patient. The form of the TI is derived as a one time
exercise using expert analysis of the data set derived from
clinical studies and/or existing clinical information.
[0250] Once the TI.sub.ref is identified, then the use of this
parameter is illustrated in FIG. 36. Methods of measuring drug,
analyte and biomarker concentrations and conducting a two-way
communication with a database using a fluidic device and reader
assembly are described in detail herein. The time course of various
measured and computed parameters are shown in FIG. 36. The curve
indicated CBX Dose illustrates the time course of a drug that is
taken on a regular basis. The plotted values are normalized to what
would be considered as "ideal levels" for that measurement. For
example, if the expected ideal blood concentration of CBX is 100
ng/ml and if the measured concentration in blood is 100 ng/ml, the
parameter value is 1.0 (with no offset) for CBX. Similarly, the
concentrations of CXB, a metabolite of CBX, biomarkers Tx-M and
PGI-M, which vary in response to the concentrations of the drug and
the disease state, are also normalized to their ideal values and
plotted. All the drug, analyte and biomarker concentrations could
be measured using a system as described herein. As explained above,
the TI.sub.ref for this particular patient is plotted on FIG. 36 as
a flat line. Using the parameter values (a . . . n, aa . . . nn,
aaa . . . nnn) of Equation 6 and the measured input parameters
(IP), the current TI for the patient is calculated. If the computed
TI exceeds the TI.sub.ref value, then an alert can be generated.
The alert could be targeted to the patient's healthcare provider,
who in turn can take the appropriate action. An appropriate action
could be to watch the patient closely for other clinical
indications and/or alter the dosage and drugs the patient is
taking.
[0251] FIGS. 36 and 37 illustrate the concept as to how when the
computed TI exceeds the TI.sub.ref a proactive action could avert
an ADR. In FIG. 36, the patient's TI exceeded TI.sub.ref about day
15. The patient is monitored closely and as the TI values continue
to increase after day 30, the physician intervenes and reduces the
dosage. This action starts lowering the TI for the patient and
ultimately retreats to an acceptable level about day 60.
[0252] One or more individuals or entities that are involved in the
care of the patient (nurses, physicians, pharmacist, etc.) can be
alerted when the computed TI exceeds the TI.sub.ref so that they
could take the appropriate action. Additionally, trends can be
discerned and appropriate action taken before a TI reaches a
particular value.
[0253] In some embodiments many different analytes can be measured
and construed as input parameters, IPs, while computing the TI.
Such analytes that may be used are described herein. Additionally,
the can be expanded or modified depending on the disease area as
well. The appropriate list of parameters relating to certain
diseases and drug treatments, for example, cancer and infectious
diseases and patient on NSAIDS, are disclosed herein.
[0254] In another aspect of this invention, the TI is calculated
using information derived from the patient's biological sample and
patient information that is non-drug related, the device input. For
example, in an ambulatory setting, information relating to
concentration of drug, metabolite and other biological markers can
be detected in blood as described herein. The patient can also
input many non-drug related personal parameters. This "patient
input" can relate to the patient's personal information, for
example, height, weight, gender, daily exercise status, food
intake, etc. The patient input could also be provided by the
patient's healthcare provider. An example of a patient input
parameter and the input means is shown in FIG. 38.
[0255] In some embodiments the device input and patient input are
used to compute the TI. A reference TI for the patient is already
known using retrospective analysis of the data contained in the
database. In formulating the TI using multiple regression analysis,
the parameters such as those shown in Equation 6 are used. The same
parameters are then used with the device input and patient input to
compute the TI. Comparing the TI to the TI.sub.ref, it is possible
to determine the efficacy of the therapy. If the TI falls within a
pre-determined range of TI.sub.ref, then the treatment is
considered to be efficacious. Values below that range indicate that
the treatment is ineffective and values higher then the range are
considered to be undesirable and could lead to adverse events.
[0256] Another example illustrates the implementation of this
invention for studying the efficacy of therapy in diseases where it
is difficult to make frequent measurements and the efficacy of the
treatment is difficult to quantify. An example is determining the
efficacy of drug therapy in children with autism. Frequent sampling
and concomitant laboratory analysis is impractical for children.
Abnormalities in blood concentrations of certain metals are
implicated in autism. Hence, following the blood concentration of
certain metals, e.g., zinc, in autistic children might shed light
on the efficacy of an intervention. However, it has been reported
that lowered concentrations of, say, Zn due to a treatment does not
imply that the therapy is working. It is an indicator, but not a
definitive surrogate for determining therapeutic efficacy.
Computing a TI and comparing it to a reference level would better
indicate the efficacy. This is illustrated in FIG. 39 by simulating
the concentration of various pertinent markers and their change due
to a drug intervention in an autistic child.
[0257] The program can involve monitoring subjects and matched
control individuals over time for toxic metals, surrogate markers
for metals (metallothionein, etc.), and other biochemical markers.
Subjects are those prone to, or afflicted with autism; controls are
situation-matched people. It is not mandatory that there be a
situation-matched control. The scenario assumes that during the
study a significant "event" occurs. Events could be movement into a
more or less risky environment or initiation of therapy. Subjects
could be frequently monitored for several parameters (device input)
using the ambulatory system described herein. Additional laboratory
assays that are not determinable in the ambulatory system could be
performed at a lower frequency using laboratory assays. Additional
data such as patient information, local environment, use of drugs,
diet, etc. would be logged (patient input). Of particular interest
to this scenario is information such as exposure to lead, mercury
etc.
[0258] The time course shown in FIG. 39 envisages an event
(initiation of therapy) at 33 days. The subject who is exhibiting
abnormal levels of CP and MT, gradually reverts to normal levels of
markers. The TI captures the risk or safety level of the subject
based on all information. The study will define the best inputs to
determine TI.
[0259] As described above, TI can be used for determining the
efficacy of drug treatment. A similar approach is also well suited
for determining the efficacy of drugs during clinical trials.
Additionally, this approach could be beneficially used to identify
sub-groups of patients who respond well or poorly to a given
treatment regimen. The ability to segregate responders from
non-responders is an extremely valuable tool. The concept of using
TI can be used not only during a therapeutic regimen, but for
performing diagnostic tests to determine, for example, whether or
not a patient is in need of a biopsy after a complete examination
of prostate specific markers.
TABLE-US-00005 TABLE 4 Exemplary Analyates Liver LDH, (LD5), (ALT),
Arginase 1 (liver type), Alpha-fetoprotein (AFP), Alkaline
phosphatase, Alanine aminotransferase, Lactate dehydrogenase, and
Bilirubin Kidney TNFa Receptor, Cystatin C, Lipocalin-type urinary
prostaglandin D, synthatase (LPGDS), Hepatocyte growth factor
receptor, Polycystin 2, Polycystin 1, Fibrocystin, Uromodulin,
Alanine, aminopeptidase, N- acetyl-B-D-glucosaminidase, Albumin,
and Retinol-binding protein (RBP) Heart Troponin I (TnI), Troponin
T (TnT), CK, CKMB, Myoglobin, Fatty acid binding protein (FABP),
CRP, D-dimer, S-100 protein, BNP, NT- proBNP, PAPP-A,
Myeloperoxidase (MPO), Glycogen phosphorylase isoenzyme BB (GPBB),
Thrombin Activatable Fibrinolysis Inhibitor (TAFI), Fibrinogen,
Ischemia modified albumin (IMA), Cardiotrophin-1, and MLC-I (Myosin
Light Chain-I) Pancrease Amylase, Pancreatitis-Assocoated protein
(PAP-1), and Regeneratein proteins (REG) Muscle tissue Myostatin
Blood Erythopoeitin (EPO) Bone Cross-linked N-telopeptides of bone
type I collagen (NTx) Carboxyterminal cross-linking telopeptide of
bone collagen, Lysyl- pyridinoline (deoxypyridinoline),
Pyridinoline, Tartrate-resistant acid phosphatase, Procollagen type
I C propeptide, Procollagen type I N propeptide, Osteocalcin (bone
gla-protein), Alkaline phosphatase, Cathepsin K, COMP (Cartillage
Oligimeric Matrix Protein), Osteocrin Osteoprotegerin (OPG), RANKL,
sRANK, TRAP 5 (TRACP 5), Osteoblast Specific Factor 1 (OSF-1,
Pleiotrophin), Soluble cell adhesion molecules (SCAMs), sTfR, sCD4,
sCD8, sCD44, and Osteoblast Specific Factor 2 (OSF-2, Periostin)
Cancer PSA (total prostate specific antigen), Creatinine, Prostatic
acid phosphatase, PSA complexes, Prostrate-specific gene-1, CA
12-5, Carcinoembryonic Antigen (CEA), Alpha feto protein (AFP), hCG
(Human chorionic gonadotropin), Inhibin, CAA Ovarian C1824, CA
27.29, CA 15-3, CAA Breast C1924, Her-2, Pancreatic, CA 19-9,
Carcinoembryonic Antigen, CAA pancreatic, Neuron-specific enolase,
Angiostatin DcR3 (Soluble decoy receptor 3), Endostatin, Ep-CAM
(MK-1), Free Immunoglobulin Light Chain Kappa, Free Immunoglobulin
Light Chain Lambda, Herstatin, Chromogranin A, Adrenomedullin,
Integrin, Epidermal growth factor receptor, Epidermal growth factor
receptor- Tyrosine kinase, Pro-adrenomedullin N-terminal 20
peptide, Vascular endothelial growth factor, Vascular endothelial
growth factor receptor, Stem cell factor receptor, c-kit, KDR or
Flt-1, KDR, AML, and Midkine Infectious disease Viremia,
Bacteremia, Sepsis, PMN Elastase, PMN elastase/.alpha.1-PI complex,
Surfactant Protein D (SP-D), HBVc antigen, HBVs antigen, Anti-HBVc,
Anti-HIV, T-supressor cell antigen, T-cell antigen ratio, T- helper
cell antigen, Anti-HCV, Pyrogens, p24 antigen, Muramyl- dipeptide
Diabetes C-Peptide, Hemoglobin A1c, Glycated albumin, Advanced
glycosylation end products (AGEs), 1,5-anhydroglucitol, Gastric
Inhibitory Polypeptide, Glucose, Hemoglobin, ANGPTL3 and 4
Inflamation Rheumatoid factor (RF), Antinuclear Antibody (ANA),
C-reactive protein (CRP), Clara Cell Protein (Uteroglobin) Allergy
Total IgE and Specific IgE Autism Ceruloplasmin, Metalothioneine,
Zinc, Copper, B6, B12, Glutathione, Alkaline phosphatase, and
activation of apo-alkaline phosphatase Coagulation
b-Thromboglobulin, Platelet factor 4, Von Willebrand factor
disorders COX inhibitors TxB2 (Cox-1), 6-keto-PGF-1-alpha (Cox 2),
11-Dehydro-TxB-1a (Cox-1) Geriatric Neuron-specific enolase, GFAP,
and S100B Nutritional status Prealbumin, Albumin, Retinol-binding
protein (RBP), Transferrin, Acylation-Stimulating Protein (ASP),
Adiponectin, Agouti-Related Protein (AgRP), Angiopoietin-like
Protein 4 (ANGPTL4, FIAF), C- peptide, AFABP (Adipocyte Fatty Acid
Binding Protein, FABP4) Acylation-Stimulating Protein (ASP), EFABP
(Epidermal Fatty Acid Binding Protein, FABP5), Glicentin, Glucagon,
Glucagon-Like Peptide-1, Glucagon-Like Peptide-2, Ghrelin, Insulin,
Leptin, Leptin Receptor, PYY, RELMs, Resistin, amd sTfR (soluble
Transferrin Receptor) Lipid metabolism Apo-lipoproteins (several),
Apo-A1, Apo-B, Apo-C-CII, Apo-D, Apo-E Coagulation status Factor I:
Fibrinogen, Factor II: Prothrombin, Factor III: Tissue factor,
Factor IV: Calcium, Factor V: Proaccelerin, Factor VI, Factor VII:
Proconvertin, Factor VIII:, Anti-hemolytic factor, Factor IX:
Christmas factor, Factor X: Stuart-Prower factor, Factor XI: Plasma
thromboplastin antecedent, Factor XII: Hageman factor, Factor XIII:
Fibrin-stabilizing factor, Prekallikrein, High-molecular-weight
kininogen, Protein C, Protein S, D-dimer, Tissue plasminogen
activator, Plasminogen, a2- Antiplasmin, Plasminogen activator
inhibitor 1 (PAI1). Monoclonal those for EGFR, ErbB2, and IGF1R
antibodies Tyrosine kinase Ab1, Kit, PDGFR, Src, ErbB2, ErbB 4,
EGFR, EphB, VEGFR1-4, inhibitors PDGFRb, FLt3, FGFR, PKC, Met Tie2,
RAF, and TrkA; VEGF Serine/Threoline AKT, Aurora A/B/B, CDK, CDK
(pan), CDK1-2, VEGFR2, PDGFRb, Kinase Inhibitors CDK4/6, MEK1-2,
mTOR, and PKC-beta GPCR targets Histamine Receptors, Serotonin
Receptors, Angiotensin Receptors, Adrenoreceptors, Muscarinic
Acetylcholine Receptors, GnRH Receptors, Dopamine Receptors,
Prostaglandin Receptors, and ADP Receptors Other Theophylline, CRP,
CKMB, PSA, Myoglobin, CA125, Progesterone, TxB2,
6-keto-PGF-1-alpha, and Theophylline, Estradiol, Lutenizing
hormone, High sensitivity CRP, Triglycerides, Tryptase, Low density
lipoprotein Cholesterol, High density lipoprotein Cholesterol,
Cholesterol, IGFR, Leptin, Leptin receptor, and Pro-calcitonin,
Brain S100 protein, Substance P, 8-Iso-PGF-2a; GIP; GLP-1
* * * * *