Currently, SARS-CoV-2 diagnostic testing is primarily performed in a clinical setting, where either a nasal swab or blood sample is taken by a clinician and sent for further testing in a biosafety level 2 facility. Here, trained medical personnel characterizes the biospecimen mostly with respect to either SARS-CoV-2 related genetic material or associated antibodies with a PCR or ELISA test respectively3. In light of these highly reliable yet cumbersome methods, there is a clear benefit for devices and methods that can provide this information rapidly and cost-effectively without the need for specialized laboratories. Innovative testing solutions are even more needed taking into account that 30% of all SARS-CoV-2 infections are asymptomatic4. Additionally, the previously commercialized lateral flow assays (LFAs), despite their speed and cost advantages, have a limited sensitivity and reproducibility and only provide binary information (yes/no) on a possible previous infection5–7.
In this letter, we first introduce a 3D poly(methyl methacrylate) (PMMA) nanofluidic particle sorter fabricated by state-of-the-art nanofabrication methods. We, then, demonstrate the potential of the device to perform on-chip multiplexed serological assays for anti-spike (SARS-CoV-2) IgG while providing semi-quantitative data with a high degree of sensitivity and specificity. The proposed device is based on fluorescence measurements of trapped biofunctionalized nanoparticles, allowing for high sensitivity as well as point-of-care use8, in contrast to other on-bead or microfluidic methods9,10. The device’s versatility and performance are shown by simultaneous on-bead testing of different antibody sub-types as well as concurrent detection of SARS-CoV-2 and Influenza A antibodies. As both infections provoke similar symptoms11, this kind of differential testing would allow the treating physician to provide the correct diagnosis and treatment rapidly and accurately.
Our nanofluidic device is designed to be low-cost and easy to operate. It is entirely made of PMMA and contains only passive capillary microfluidic elements to control the fluid flow without the need for external loading mechanisms, such as syringes or pressure pumps. The critical feature of the device is a wedge that enables geometrical trapping of nanoparticles (Fig. 1a and j) at a predetermined location, allowing for particle size sorting and size determination (Table S1).
The chip’s inflow region consists of three parallel channels with separate inlets (three channels in the present case) to enable redundancy in testing or multiplexing (Fig. 1f). The applied liquid is passively aspirated into the 300-µm-wide inflow, enhanced pillars with a 20 µm diameter and 40 µm pitch (Fig. 1c). The channels containing various passive flow elements were optimized for a controlled and reproducible flow. More specifically, the size and pitch of the incorporated pillars were altered throughout the device (Fig. 1c-e) to modulate fluid flow rate and to provide necessary support during the bonding of these relatively broad, but extremely shallow channels (aspect ratio 375:1) (Fig. S.2). Furthermore, to minimize premature drying of the liquid inside the nanofluidic device and to ensure a constant fluid filling velocity, an inflow resistor was incorporated (Fig. 1b). This was achieved by narrowing the channel width after the inflow region to 100 µm and keeping it constant for a length of 500 µm. Afterward, the width is gradually increased to 300 µm (Fig. 1b – I.R.). The IR is followed by the trapping region (TR), i.e. a wedge-structure with a linearly decreasing the channel height from 3.4 to 0.8 µm over a distance of 1.2 mm.
After the TR, the channel height is kept constant at 0.8 µm for 100 µm before a secondary wedge increases the total height to 1 µm over 1 mm. This connecting wedge (CW) couples the active device region to a capillary pump containing 20 µm pillars with a 30 µm pitch (Fig. 1e). The TR and CW necessitate nanoscale topography control over several millimeters and simultaneous integration of various micro and nanofluidic components. To overcome these challenging fabrication requirements, high precision gray scale e-beam lithography (g-EBL) is employed to pattern the nanofluidic device following a process that we developed recently through extensive process optimization12. This high-resolution structure is subsequently replica-molded to obtain a negative polymeric stamp, enabling cost-effective upscaling of fabrication through nanoimprint lithography (Fig. S1).
The topography variation in the TR is linear and patterned with high accuracy (Fig. 1g-h). The interference colors (Fig. 1h – inset) visible after bonding evidence the preservation of the 3D profile inside the nanofluidic channel. Before proceeding with the particle trapping experiments, the devices were functionalized with poly(vinyl alcohol) (PVA). The application procedure of PVA was shown to influence the flow behavior of the particles in the nanofluidic channels and was extensively optimized to maintain a high flowrate during the entire particle trapping experiment (Sup. Video 1). The functionalization blocks non-specific binding sites on the PMMA13 (Fig. S3) and allows for more controlled surface wetting14. The latter is evidenced by the absence of corner flow in the capillary pump region and improvement of the filling front (Fig 1i; Fig. S4; Sup. Video 2). The device concept with various micro and nanofluidic components in combination with specific surface chemistry allows for facile device operation that can be used in various applications. This includes particle size determination, sorting, and immobilization, as well as paving the way for applications such as in point-of-care diagnostics.
The ease-of-use and the performance of the device was highlighted by passive size-dependent particle immobilization of five different fluorescent polystyrene calibration grade particles in the TR (Fig. 1 j-k). The relationship between the particle trapping position and its nominal diameter was shown to be highly linear (R2 = 0.998; Fig. 1l) and could be used to effortlessly determine particle sizes with nanometer accuracy (Table S1). Extrapolation from the linear fit (Fig. 1j), amounts to a minimal TR channel height of 720 nm, indicating a reduction of roughly 45 nm when compared to the unbonded height of 765 nm. This can be attributed to the surface selective bonding process15–17 and also highlights the necessity of supporting pillars inside the nanofluidic channel (Fig. 1h, inset; Fig. S2).
By using the size-dependent immobilization properties of our nanofluidic device, we developed an on-bead immunoassay for the detection of specific SARS-CoV-2 antibodies in human serum by concentrating the relevant nanoparticles at predetermined locations. Our immune system fights infection and eliminates foreign bodies using innate and adaptive mechanisms, where the latter requires growth and rearrangement of gene elements to produce antibodies that specifically bind to invading antigens. The most commonly found antibody type in human serum is immunoglobulin G (IgG)18, making it a valuable target for immune status characterization. One of the major antigens of SARS-CoV-2 associated IgG antibodies is the surface trimeric spike (S) protein, which plays a vital role in facilitating the entry of the SARS-CoV-2 into human cells19. The receptor-binding domain (RBD) of the S-protein (S-RBD) is an immunodominant target for SARS-CoV-2 antibodies20. To enable their on-chip detection, we used the high-affinity interaction between streptavidin and biotin to couple biotinylated S-RBD to the surface of 2.8 µm streptavidin-coated beads (Fig. 2b; top).
Once functionalized, the beads were mixed with human serum. If the patient was previously exposed to SARS-CoV-2, the serum will contain antibodies with a specific antigen-binding site for S-RBD and bind to the beads. The latter can be fluorescently visualized by conventional immunostaining procedures. In our case, a donkey-originating antibody conjugated with a red fluorescent dye (Cy5) was used that specifically binds to human IgG (Fig. 2a; left). To benchmark the serological immunoassay, the lowest detectable concentration of a purified humanized anti-S-RBD IgG antibody in human serum was determined. To evaluate the nanofluidic device function, non-functionalized 0.9 µm calibration-grade particles were added to the suspension, acting as a flow control before applying the particle mixture onto the device’s inflow region. Analysis of the corresponding fluorescent signal of the trapped beads revealed a limit-of-detection (LOD) around 1 nM (Fig. 2c). This sensitivity is comparable to the state-of-the-art microfluidic devices10,21,22, whereas the present device is more straightforward to use and has a low infrastructure requirement. Furthermore, in recent studies, the physiologically relevant concentration of this specific type of anti-spike IgG antibody in recovered COVID-19 infected patients has been shown to be in the range of 9.6 – 28 880 nM23. This shows that the developed on-bead and on-chip nanofluidic device operates well within the physiologically relevant concentrations.
Additionally, the assay was validated using a patient serum set containing both PCR positive (n = 19) and PCR negative (n = 10) patients (Fig. 2d). From the 29 different samples, 28 could be identified correctly according to infection status, with one false negative result. The signal distribution of positive cases is to be expected, as immune responses are highly individual and dependent on the infection history of the patient. This corresponds to a test sensitivity of 94.7% (99-65) with a specificity of 100% (100-72) and an area under the curve of 0.95 (σx̅ = 0.05) according to receiver operator characteristic (ROC) analysis. We note that the false negative was retested and showed a signal above the threshold value. Although we could not reconstruct the root cause of the initial false negative during the blind experimental run, the overall results show the performance of the devices in this early development phase and highlights the potential for further optimization. These findings evidence the applicability of the assay in a real-world setting for the IgG serological characterization of suspected COVID-19 patients24.
Even though IgG is the dominant immunoglobulin subtype in human serum, it is mainly associated with late-stage and memory-related immune responses. In the case of SARS-CoV-2 infection, specific IgG antibodies become prominent within 7 days post-infection. This hampers the applicability of IgG-specific antigen assays for early-stage disease detection. However, other antibody sub-types, such as immunoglobulin M (IgM), can be already found in human serum 4 days post infection25. Hence, the on-bead and on-chip assay was further developed to include color-multiplexing for simultaneous detection of both antibody subtypes (Fig. 2e; Fig. S5). More specifically, the immunostaining solution contained anti-human IgM antibodies conjugated with a green fluorescent dye (Alexa 488) as well as anti-human IgG antibodies conjugated with a red fluorescent dye (Cy5). The anti-IgG fluorescent signal of the COVID-19 positive patient was 25.5 times greater than that of the negative control. Similarly, the anti-IgM signal was 4.9 times higher (Fig. 2f). This difference between IgG and IgM is to be expected, given that the investigated COVID-19 positive serum was taken 33 days after symptom onset. As is well known, IgM antibody levels start to decline roughly 21 days after infection, explaining the findings26. This experiment shows the potential of color multiplexing to monitor the IgG and IgM response of suspected SARS-CoV-2 infected people.
Furthermore, it is of interest to perform simultaneous differential testing for the presence of antibodies against diseases with similar symptoms. In the case of COVID-19, one of the most symptomatically similar and prevalent viral infections is Influenza A. The latter causes yearly epidemics and it is one of the major targets of annual vaccination campaigns27. To demonstrate the on-chip multiplexing of disease-specific antibodies, 1-µm-size streptavidin-coated beads were labeled with biotinylated hemagglutinin, i.e., immunodominant influenza A-associated protein (Fig 2b; bottom)28. The surfaces of the 1 µm and 2.8 µm particles biofunctionalized with hemagglutinin and S-RBD, respectively, were saturated with free biotin before being added together. This successfully inhibited the aggregation of the SARS-CoV-2 and Influenza A functionalized particles (Fig. S5) and enabled size separation in the 3D nanofluidic device. As a proof-of-principle experiment, the multi-particle suspension was mixed with various combinations of purified polyclonal rabbit antibodies, targeting either the S-RBD or hemagglutinin protein (Fig 2g). The beads were subsequently immunostained with a Cy3 anti-rabbit antibody. The obtained signal at their trapping positions is shown to correlate very well with the presence or absence of the relevant antibodies for either S-RBD (SARS-CoV-2) or hemagglutinin (Influenza A), respectively (Fig. 2h). This proof-of-principle experiment further emphasizes the versatility of our 3D nanofluidic device within the framework of serological multiplexed immunoassays.
In conclusion, we have introduced a novel approach towards multiplexed antibody and disease testing by using a novel 3D PMMA-based nanofluidic device. Proof of principle was obtained by showing that calibration-grade particles can be size-dependently immobilized, and their size can be accurately determined from their trapping position. The size sorting capability of the device was used to concentrate and trap S-RBD-functionalized beads in an IgG SARS-CoV-2 serological assay with a detection limit well within the range of state-of-the-art immunoassays. The test was further cross-validated with PCR-tested patient samples, showing a high degree of sensitivity and specificity. Moreover, on-bead color multiplexing has demonstrated the potential to simultaneously monitor the presence of both IgG and IgM antibodies in human sera on single particles for future time-dependent antibody studies. Additionally, we have highlighted the versatility and applicability of the 3D nanofluidic device by detecting anti-S-RBD (SARS-CoV-2) and anti-hemagglutinin (Influenza A) antibodies in control samples using different bead sizes.
Here we showed multiplexing in two-dimensions, by varying particle size and the conjugated dye of the detection antibody. For future work, we aim to extend this by using various fluidic channels for different immunoassays and using color-coded beads of a similar size29. We believe that by this multiplexing in four dimensions, concurrent detection of more than 100 antibodies on a single-chip can be achieved. Moreover, we aim to transfer the fluorescence detection to a portable and compact microscope and eventually adaptable to smartphones, since the devices do not necessitate state-of-the-art infrastructure for immunoassay read-out. We note that the facile operation and cost-effective nature of the developed 3D nanofluidic device is not limited to on-chip serological immunoassays. Its applications could be further extended to various disciplines of biomedical sciences to address key research questions, ranging from mitochondrial size determination in Parkinson’s disease30 to nanoparticle-based cancer therapeutics31, sickle-cell diagnosis32 and many more.