Today, approximately 5 million Americans are living with Congestive Heart Failure (CHF), and this burden is higher for African American communities, even for control groups. Implantable devices to measure pulmonary artery pressure are sometimes indicated as a surrogate measure for fluid retention in the lungs caused by worsening heart failure but are often inaccessible to underserved communities due to the prohibitive costs of the device and surgical procedure. Thus, we are implementing a sensitive immunoassay on a low-cost paper fluidic platform, to enable the frequent and easy measurements of B-type Natriuretic Peptide (BNP), an important biomarker secreted by cardiomyocytes in response to the increasing ventricular stretch and cardiac volume. BNP concentrations are often used to classify CHF into 4 levels of severity on the New York Heart Association (NYHA) scale. The paper fluidic cartridge is composed of thin, economical cotton, glass fiber and nitrocellulose membranes, that are modified to improve the flow of the sample volume. We incorporate a sandwich assay using surface-enhanced Raman scattering (SERS)-active gold nanoparticles for signal transduction, a BNP-specific aptamer for detection as well as stabilization of the nanoparticle conjugate, and a monoclonal antibody specific to BNP for the recognition element, onto this cartridge. By using a handheld Raman reader with a 638 nm excitation laser, we retrieve SERRS spectra for the malachite green isothiocyanate dye which corresponds to BNP capture ranging from 0.3 ng/mL (Stage II) to 1 ng/mL (Stage IV). We also show the visual, colorimetric detection of these concentrations using the RGB pixels from the test line, demonstrating the potential for a multi-modal approach for this diagnostic test.
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