Publikationsliste Dr. Konstantinos Mitsakakis

• Originalarbeiten in wissenschaftlichen Fachzeitschriften
• Reviews/Übersichtsartikel in wissenschaftlichen Fachzeitschriften
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Originalarbeiten in wissenschaftlichen Fachzeitschriften

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2023

• T. T. Bachmann, K. Mitsakakis, J. P. Hays, A. van Belkum, A. Russom, G. Luedke, G. Skov Simonsen, G. Abel, H. Peter, H. Goossens, J. Moran-Gilad, J. Vila, K. Becker, P. Moons, R. Sampath, R. W Peeling, S. Luz, T. van Staa, V. Di Gregori, JPIAMR AMR-RDT Working Group
  Expert guidance on target product profile development for AMR diagnostic tests
  2023 BMJ Glob Health, Band: 18, Nummer: 8, Seite: e012319
• B. Johannsen, D. Baumgartner, M. Karpíšek, D. Stejskal, N. Boillat-Blanco, J. Knüsli, M. Panning, N. Paust, R. Zengerle, K. Mitsakakis
  Patient Stratification for Antibiotic Prescriptions Based on the Bound-Free Phase Detection Immunoassay of C-Reactive Protein in Serum Samples
  2023 Biosensors, Band: 13, Seite: 1009

2022

• B. Johannsen, D. Baumgartner, L. Karkossa, N. Paust, M. Karpíšek, N. Bostanci, R. Zengerle, K. Mitsakakis
  ImmunoDisk - a fully automated bead-based immunoassay cartridge with all reagents pre-stored
  2022 Biosensors, Band: 12, Nummer: 6, Seite: 413
• S. Hin, N. Paust, M. Rombach, J. Lüddecke, M. Specht, R. Zengerle, K. Mitsakakis
  Magnetophoresis in Centrifugal Microfluidics at Continuous Rotation for Nucleic Acid Extraction
  2022 Micromachines, Band: 13, Seite: 2112
• B. Afacan, V. Özgen Öztürk, G. Emingil, T. Köse, K. Mitsakakis, N. Bostanci
  Salivary secretory leukocyte protease inhibitor levels in patients with stage 3 grade C periodontitis: a comparative cross-sectional study
  2022 Scientific Reports, Band: 12, Nummer: 1, Seite: 21267

2021

• S. Hin, B. Lopez-Jimena, M. Bakheit, V. Klein, S. Stack, C. Fall, A. Sall, K. Enan, M. Mustafa, V. Rusu, S. Goethel, N. Paust, R. Zengerle, L. Gillies, S. Frischmann, M. Weidmann, K. Mitsakakis
  Fully automated point-of-care differential diagnosis of acute febrile illness
  2021 PLoS Negl. Trop. Dis., Band: 15, Nummer: 2, Seite: e0009177
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  Kurzfassung

  In this work, a platform was developed and tested to allow to detect a variety of candidate viral, bacterial and parasitic pathogens, for acute fever of unknown origin. The platform is based on a centrifugal microfluidic cartridge, the LabDisk (“FeverDisk” for the specific application), which integrates all necessary reagents for sample-to-answer analysis and is processed by a compact, point-of-care compatible device...
• K. Mitsakakis
  Novel lab-on-a-disk platforms: a powerful tool for molecular fingerprinting of oral and respiratory tract infections
  2021 Expert Rev. Mol. Diagn., Band: 21, Nummer: 6, Seiten: 523 - 526
• B. Johannsen, M. Karpíšek, D. Baumgartner, V. Klein, N. Bostanci, N. Paust, S. M. Früh, R. Zengerle, K. Mitsakakis
  One-step, wash-free, bead-based immunoassay employing bound-free phase detection
  2021 Analytica Chimica Acta, Band: 1153, Seite: 338280
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  Kurzfassung

  We present a simple and fast one-step heterogeneous immunoassay, with performance characteristics that can enable easy and versatile adaptation to miniaturized, automated point-of-care systems. This novel analytical method uses magnetic and fluorescent beads as capture and detection agents respectively. Its main feature is the measurement of the fluorescent signal in the bound-free phase for (semi-)quantitative detection of analytes. Thus, no washing is required and the workflow consists only of sample and reagent supply, incubation, separation and detection. The immunoassay concept is demonstrated with C-reactive protein (CRP), a systemic inflammation marker. CRP in only 5 μL of undiluted serum was measured in the range 20-140 mg L-1 (includes clinically relevant cut-off values). The limit of detection (LOD) was 22.1 ± 6.3 mg L-1 (incubation 15 min). A CRP certified reference material was measured on five different days. Intra- and inter-assay coefficients of variation were 4.6 % ± 1.9 % and 5.6 % respectively. To demonstrate the compatibility of the assay concept with additional matrices and concentration ranges, three oral inflammation markers, namely matrix metalloproteinases 8 and 9 (MMP-8, MMP-9) and tissue inhibitor of metalloproteinases 1 (TIMP-1), were measured in saliva in the ranges 0.47-30 ng mL-1 for MMP-8 and MMP-9, and 0.69-44 ng mL-1 for TIMP-1. LODs were 0.24 ng mL-1, 0.38 ng mL-1 and 0.39 ng mL-1 respectively (incubation 20 min). Multiplexing capacity of the assay concept was also shown with these markers. The demonstrated excellent reproducibility of the results, combined with the versatility and low complexity of the introduced immunoassay concept, make it an attractive candidate for applied analytical chemistry and automated point-of-care testing.
• D. Baumgartner, B. Johannsen, M. Specht, J. Lüddecke, M. Rombach, S. Hin, N. Paust, F. von Stetten, R. Zengerle, C. Herz, J. R. Peham, P. N. Paqué, T. Attin, J. S. Jenzer, P. Körner, P. R. Schmidlin, T. Thurnheer, F. J. Wegehaupt, W. E. Kaman, A. Stubbs, J. P. Hays, V. Rusu, A. Michie, T. Binsl, D. Stejskal, M. Karpíšek, K. Bao, N. Bostanci, G. N. Belibasakis, K. Mitsakakis
  OralDisk: A Chair-Side Compatible Molecular Platform Using Whole Saliva for Monitoring Oral Health at the Dental Practice
  2021 Biosensors, Band: 11, Nummer: 11, Seite: 423
• P.N. Paqué, C. Herz, D.B. Wiedemeier, K. Mitsakakis, T. Attin, K. Bao, G.N. Belibasakis, J.P. Hays, J.S. Jenzer, W.E Kaman, M. Karpíšek, P. Körner, J.R. Peham, P.R. Schmidlin, T. Thurnheer, F.J. Wegehaupt, N. Bostanci
  Salivary Biomarkers for Dental Caries Detection and Personalized Monitoring
  2021 J. Pers. Med., Band: 11, Nummer: 3, Seite: 235
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  Kurzfassung

  This study investigated the potential of salivary bacterial and protein markers for evaluating the disease status in healthy individuals or patients with gingivitis or caries. Saliva samples from caries- and gingivitis-free individuals (n = 18), patients with gingivitis (n = 17), or patients with deep caries lesions (n = 38) were collected and analyzed for 44 candidate biomarkers (cytokines, chemokines, growth factors, matrix metalloproteinases, a metallopeptidase inhibitor, proteolytic enzymes, and selected oral bacteria). The resulting data were subjected to principal component analysis and used as a training set for random forest (RF) modeling. This computational analysis revealed four biomarkers (IL-4, IL-13, IL-2-RA, and eotaxin/CCL11) to be of high importance for the correct depiction of caries in 37 of 38 patients. The RF model was then used to classify 10 subjects (five caries-/gingivitis-free and five with caries), who were followed over a period of six months. The results were compared to the clinical assessments of dental specialists, revealing a high correlation between the RF prediction and the clinical classification. Due to the superior sensitivity of the RF model, there was a divergence in the prediction of two caries and four caries-/gingivitis-free subjects. These findings suggest IL-4, IL-13, IL-2-RA, and eotaxin/CCL11 as potential salivary biomarkers for identifying noninvasive caries. Furthermore, we suggest a potential association between JAK/STAT signaling and dental caries onset and progression.
• N. Bostanci, K. Mitsakakis, B. Afacan, K. Bao, B. Johannsen, D. Baumgartner, L. Müller, H. Kotolová, G. Emingil, M. Karpíšek
  Validation and verification of predictive salivary biomarkers for oral health
  2021 Scientific Reports, Band: 11, Seite: 6406
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  Kurzfassung

  Oral health is important not only due to the diseases emerging in the oral cavity but also due to the direct relation to systemic health. Thus, early and accurate characterization of the oral health status is of utmost importance. There are several salivary biomarkers as candidates for gingivitis and periodontitis, which are major oral health threats, affecting the gums. These need to be verified and validated for their potential use as differentiators of health, gingivitis and periodontitis status, before they are translated to chair-side for diagnostics and personalized monitoring. We aimed to measure 10 candidates using high sensitivity ELISAs in a well-controlled cohort of 127 individuals from three groups: periodontitis (60), gingivitis (31) and healthy (36). The statistical approaches included univariate statistical tests, receiver operating characteristic curves (ROC) with the corresponding Area Under the Curve (AUC) and Classification and Regression Tree (CART) analysis. The main outcomes were that the combination of multiple biomarker assays, rather than the use of single ones, can offer a predictive accuracy of > 90% for gingivitis versus health groups; and 100% for periodontitis versus health and periodontitis versus gingivitis groups. Furthermore, ratios of biomarkers MMP-8, MMP-9 and TIMP-1 were also proven to be powerful differentiating values compared to the single biomarkers

2020

• G.N. Belibasakis, B. Lund, C. Krüger Weiner, B. Johannsen, D. Baumgartner, D. Manoil, M. Hultin, K. Mitsakakis
  Healthcare Challenges and Future Solutions in Dental Practice: Assessing Oral Antibiotic Resistances by Contemporary Point-of-Care Approaches
  2020 Antibiotics, Band: 9, Seite: 810
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  Kurzfassung

  Antibiotic resistance poses a global threat, which is being acknowledged at several levels, including research, clinical implementation, regulation, as well as by the World Health Organization. In the field of oral health, however, the issue of antibiotic resistances, as well as of accurate diagnosis, is underrepresented. Oral diseases in general were ranked third in terms of expenditures among the EU-28 member states in 2015. Yet, the diagnosis and patient management of oral infections, in particular, still depend primarily on empiric means. On the contrary, on the global scale, the field of medical infections has more readily adopted the integration of molecular-based systems in the diagnostic, patient management, and antibiotic stewardship workflows. In this perspective review, we emphasize the clinical significance of supporting in the future antibiotic resistance screening in dental practice with novel integrated and point-of-care operating tools that can greatly support the rapid, accurate, and efficient administration of oral antibiotics.
  
  
   
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• P.N. Paqué, C. Herz, J.S. Jenzer, D.B. Wiedemeier, T. Attin, N. Bostanci, G.N. Belibasakis, K. Bao, P. Körner, T. Fritz, J. Prinz, P.R. Schmidlin, T. Thurnheer, F.J. Wegehaupt, K. Mitsakakis, J.R. Peham
  Microbial Analysis of Saliva to Identify Oral Diseases Using a Point-of-Care Compatible qPCR Assay
  2020 J Clin Med, Band: 9, Seite: 2945
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  Kurzfassung

  Oral health is maintained by a healthy microbiome, which can be monitored by state-of-the art diagnostics. Therefore, this study evaluated the presence and quantity of ten oral disease-associated taxa (P. gingivalis, T. forsythia, T. denticola, F. nucleatum, C. rectus, P. intermedia, A. actinomycetemcomitans, S. mutans, S. sobrinus, oral associated Lactobacilli) in saliva and their clinical status association in 214 individuals. Upon clinical examination, study subjects were grouped into healthy, caries and periodontitis and their saliva was collected. A highly specific point-of-care compatible dual color qPCR assay was developed and used to study the above-mentioned bacteria of interest in the collected saliva. Assay performance was compared to a commercially available microbial reference test. Eight out of ten taxa that were investigated during this study were strong discriminators between the periodontitis and healthy groups: C. rectus, T. forsythia, P. gingivalis, S. mutans, F. nucleatum, T. denticola, P. intermedia and oral Lactobacilli (p < 0.05). Significant differentiation between the periodontitis and caries group microbiome was only shown for S. mutans (p < 0.05). A clear distinction between oral health and disease was enabled by the analysis of quantitative qPCR data of target taxa levels in saliva.
• B. Johannsen, D. Mark, N. Boillat-Blanco, A. Fresco, D. Baumgartner, R. Zengerle, K. Mitsakakis
  Rapid diagnosis of respiratory tract infections using a point-of-care platform incorporating a clinical decision support algorithm
  2020 Stud. in Health Technol. Inform, Band: 273, Seiten: 234 - 239
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  Kurzfassung

  Respiratory Tract Infections (RTIs) are among the top reasons for visiting a General Practitioner (GP) and the main cause of unnecessary antibiotic prescriptions. Reducing inappropriate use is essential to decrease antibiotic resistance and adverse events. The goal of the Eurostars project “Respiotic” is to develop a new point-of-care (POC) platform based on the centrifugal microfluidic LabDisk that will detect the main responsible viruses and bacteria for community-acquired RTIs, including associated resistances and host biomarkers. The diagnostic platform will use a Polymerase Chain Reaction (PCR) and an immunoassay cartridge on the same instrument and provide the combined analysis within less than 1 h. An electronic clinical algorithm will co-assess the test results and act as a decision support tool for the GPs’ patient management and prescriptions.
• M. Rombach, S. Hin, M. Specht, B. Johannsen, J. Lüddecke, N. Paust, R. Zengerle, L. Roux, T. Sutcliffe, J. Peham, C. Herz, M. Panning, O. Donoso Mantke, K. Mitsakakis
  RespiDisk: a point-of-care platform for fully automated detection of respiratory tract infection pathogens in clinical samples
  2020 Analyst, Band: 145, Seiten: 7040 - 7047
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  Kurzfassung

  We present the RespiDisk enabling the fully automated and multiplex point-of-care (POC) detection of (currently) up to 19 respiratory tract infection (RTI) pathogens from a single sample based on reverse transcriptase polymerase chain reaction (RT-PCR). RespiDisk comprises a RTI-specific implementation of the centrifugal microfluidic LabDisk platform and combines new and existing advanced unit operations for liquid control, thereby automating all assay steps only by a spinning frequency and temperature protocol in combination with the use of a permanent magnet for in situ bead handing. The capabilities of the system were demonstrated with 36 tested quality samples mimicking clinical conditions (clinical and/or cultured material suspended in transport medium or synthetic bronchoalveolar lavage (BAL)) from past external quality assessment (EQA) panels covering 13 of the 19 integrated RTI detection assays. In total, 36 samples × 19 assays/sample resulting in 684 assays were performed with the RespiDisk, and its analytical performance was in full agreement with the routine clinical workflow serving as reference. A strong feature of the platform is its universality since its components allow the simultaneous detection of a broad panel of bacteria and viruses in a single run, thereby enabling the differentiation between antibiotic-treatable diseases. Furthermore, the full integration of all necessary biochemical components enables a reduction of the hands-on time from manual to automated sample-to-answer analysis to about 5 min. The study was performed on an air-heated LabDisk Player instrument with a time-to-result of 200 min.
• S. Hin, D. Baumgartner, M. Specht, J. Lüddecke, E. M. Arjmand, B. Johannsen, L. Schiedel, M. Rombach, N. Paust, F. von Stetten, R. Zengerle, N. Wipf, P. Müller, K. Mavridis, J. Vontas, K. Mitsakakis, * Indicates equally contributing authors
  VectorDisk: A Microfluidic Platform Integrating Diagnostic Markers for Evidence-Based Mosquito Control
  2020 Processes, Band: 8, Nummer: 12, Seite: 1677
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  Kurzfassung

  Effective mosquito monitoring relies on the accurate identification and characterization of the target population. Since this process requires specialist knowledge and equipment that is not widely available, automated field-deployable systems are highly desirable. We present a centrifugal microfluidic cartridge, the VectorDisk, which integrates TaqMan PCR assays in two feasibility studies, aiming to assess multiplexing capability, specificity, and reproducibility in detecting disk-integrated vector-related assays. In the first study, pools of 10 mosquitoes were used as samples. We tested 18 disks with 27 DNA and RNA assays each, using a combination of multiple microfluidic chambers and detection wavelengths (geometric and color multiplexing) to identify mosquito and malaria parasite species as well as insecticide resistance mechanisms. In the second study, purified nucleic acids served as samples to test arboviral and malaria infective mosquito assays. Nine disks were tested with 14 assays each. No false positive results were detected on any of the disks. The coeffcient of variation in reproducibility tests was <10%. The modular nature of the platform, the easy adaptation of the primer/probe panels, the cold chain independence, the rapid (2–3 h) analysis, and the assay multiplexing capacity are key features, rendering the VectorDisk a potential candidate for automated vector analysis.

2019

• B. Johannsen, L. Müller, D. Baumgartner, L. Karkossa, S. M. Früh, N. Bostanci, M. Karpíšek, R. Zengerle, N. Paust, K. Mitsakakis
  Automated Pre-Analytic Processing of Whole Saliva Using Magnet-Beating for Point-of-Care Protein Biomarker Analysis
  2019 Micromachines, Band: 10, Nummer: 12, Seite: 833
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  Kurzfassung

  Saliva offers many advantages for point-of-care (PoC) diagnostic applications due to non-invasive, easy, and cost-effective methods of collection. However, the complex matrix with its non-Newtonian behavior and high viscosity poses handling challenges. Several tedious and long pre-analytic steps, incompatible with PoC use, are required to liquefy and homogenize saliva samples before protein analysis can be performed. We apply magnet-beating to reduce hands-on time and to simplify sample preparation. A magnet in a chamber containing the whole saliva is actuated inside a centrifugal microfluidic cartridge by the interplay of centrifugal and magnetic forces. Rigorous mixing, which homogenizes the saliva sample, is then initiated. Consequently, fewer manual steps are required to introduce the whole saliva into the cartridge. After 4 min of magnet-beating, the processed sample can be used for protein analysis. The viscosity of whole saliva has been reduced from 10.4 to 2.3 mPa s. Immunoassay results after magnet-beating for three salivary periodontal markers (MMP-8, MMP-9, TIMP-1) showed a linear correlation with a slope of 0.99 when compared to results of reference method treated samples. Conclusively, magnet-beating has been shown to be a suitable method for the pre-analytic processing of whole saliva for fully automated PoC protein analysis.
• J.P. Hays, K. Mitsakakis, S. Luz, A. van Belkum, K. Becker, A. van den Brue, S. Harbarth, J. H. Rex, G. Skov Simonsen, G. Werner, V. Di Gregori, G. Lüdke, T. van Staa, J. Moran-Gilad, T. T. Bachmann, on behalf of the JPIAMR AMR-RDT
  The successful uptake and sustainability of rapid infectious disease and antimicrobial resistance point-of-care testing requires a complex ‘mix-and-match’ implementation package
  2019 Eur J Clin Microbiol, Band: 38, Seiten: 1015 - 1022
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  Kurzfassung

  The emergence and spread of antimicrobial resistance is one of the major global issues currently threatening the health and wealth of nations, with effective guidelines and intervention strategies urgently required. Such guidelines and interventions should ideally be targeted at individuals, communities, and nations, requiring international coordination for maximum effect. In this respect, the European Joint Programming Initiative on Antimicrobial Resistance Transnational Working Group ‘Antimicrobial Resistance - Rapid Diagnostic Tests’ (JPIAMR AMR-RDT) is proposing to consider a ‘mix-and-match’ package for the implementation of point-of-care testing (PoCT), which is described in this publication. The working group was established with the remit of identifying barriers and solutions to the development and implementation of rapid infectious disease PoCT for combatting the global spread of antimicrobial resistance. It constitutes a multi-sectoral collaboration between medical, technological, and industrial opinion leaders involved in in vitro diagnostics development, medical microbiology, and clinical infectious diseases. The mix-and-match implementation package is designed to encourage the implementation of rapid infectious disease and antimicrobial resistance PoCT in transnational medical environments for use in the fight against increasing antimicrobial resistance.

2018

• K. Mitsakakis, W.E. Kaman, G. Elshout, M. Specht, J.P. Hays
  Challenges in identifying antibiotic resistance targets for point-of-care diagnostics in general practice
  2018 Future Microbiol, Band: 13, Nummer: 10, Seiten: 1157 - 1164
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  Kurzfassung

  General practitioners stand at the front line of healthcare provision and have a pivotal role in the fight against increasing antibiotic resistance. In this respect, targeted antibiotic prescribing by general practitioners would help reduce the unnecessary use of antibiotics, leading to reduced treatment failures, fewer side-effects for patients and a reduction in the (global) spread of antibiotic resistances. Current ‘gold standard’ antibiotic resistance detection strategies tend to be slow, taking up to 48 h to obtain a result, although the implementation of point-of-care testing by general practitioners could help achieve the goal of targeted antibiotic prescribing practices. However, deciding on which antibiotic resistances to include in a point-of-care diagnostic is not a trivial task, as outlined in this publication.
• S. Hin, M. Loskyll, V. Klein, M. Keller, O. Strohmeier, F. von Stetten, R. Zengerle, K. Mitsakakis
  Membrane-based sample inlet for centrifugal microfluidic cartridges
  2018 Microelectron Eng, Band: 187-188, Seiten: 78 - 83
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  Kurzfassung

  Centrifugal microfluidics enables the rapid execution of complex blood sample analyses in a fully automated manner at the point of care. However, during blood sample addition, the cartridge is at rest and centrifugal forces are not present to allocate the sample in a controlled way. We present a versatile approach for the user-friendly, well-controlled and safe sample addition into a centrifugal microfluidic cartridge for use in serology. It features a commercial (plasma separation) membrane stacked into the inlet chamber of the cartridge. This combination of sample inlet and plasma separation in one structural unit brings the advantage of reducing footprint in highly integrated point-of-care testing. By using a pipette the user may add a blood sample (90 μL) to the membrane holding the liquid by capillary forces. Flowing across the membrane, cells separate from blood plasma. The blood plasma releases into the downstream structure upon centrifugation. The mean plasma recovery rate was 57.3 (± 4.7) % and mean plasma purity 99.5 (± 0.6) % from samples of varying hematocrit (36%–59%). Furthermore, the analyte C-reactive protein (CRP) did not significantly adsorb to the membrane. This was concluded, since CRP immunoassay results with plasma from spiked whole blood, obtained from membrane-based plasma separation and from plasma separation on a standard laboratory centrifuge, did not significantly differ. Thus, the suggested approach is promising for simultaneous application as sample inlet holding the sample by capillary forces and as a plasma separation module for centrifugal microfluidics. Potential future applications may include other sample matrices. The use with further blood transfer devices (capillary, directly from fingertip) seems possible, yet requiring further evaluation.
• S. Hin, N. Paust, M. Keller, M. Rombach, O. Strohmeier, R. Zengerle, K. Mitsakakis
  Temperature change rate actuated bubble mixing for homogeneous rehydration of dry pre-stored reagents in centrifugal microfluidics
  2018 Lab Chip, Band: 18, Seiten: 362 - 370
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  Kurzfassung

  In centrifugal microfluidics, dead volumes in valves downstream of mixing chambers can hardly be avoided. These dead volumes are excluded from mixing processes and hence cause a concentration gradient. Here we present a new bubble mixing concept which avoids such dead volumes. The mixing concept employs heating to create a temperature change rate (TCR) induced overpressure in the air volume downstream of mixing chambers. The main feature is an air vent with a high fluidic resistance, representing a low pass filter with respect to pressure changes. Fast temperature increase causes rapid pressure increase in downstream structures pushing the liquid from downstream channels into the mixing chamber. As air further penetrates into the mixing chamber, bubbles form, ascend due to buoyancy and mix the liquid. Slow temperature/ pressure changes equilibrate through the high fluidic resistance air vent enabling sequential heating/cooling cycles to repeat the mixing process. After mixing, a complete transfer of the reaction volume into the downstream fluidic structure is possible by a rapid cooling step triggering TCR actuated valving. The new mixing concept is applied to rehydrate reagents for loop-mediated isothermal amplification (LAMP). After mixing, the reaction mix is aliquoted into several reaction chambers for geometric multiplexing. As a measure for mixing efficiency, the mean coefficient of variation (C —— V, n = 4 LabDisks) of the time to positivity (tp) of the LAMP reactions (n = 11 replicates per LabDisk) is taken. The C —— V of the tp is reduced from 18.5% (when using standard shake mode mixing) to 3.3% (when applying TCR actuated bubble mixing). The bubble mixer has been implemented in a monolithic fashion without the need for any additional actuation besides rotation and temperature control, which are needed anyhow for the assay workflow.

2017

• Y. Zhao, G. Czilwik, V. Klein, K. Mitsakakis, R. Zengerle, N. Paust
  C-reactive protein and Interleukin 6 microfluidic immunoassays with on-chip pre-stored reagents and centrifugo-pneumatic liquid control
  2017 Lab Chip, Band: 17, Nummer: 9, Seiten: 1666 - 1677
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  Kurzfassung

  We present a fully automated centrifugal microfluidic method for particle based protein immunoassays. Stick-pack technology is employed for pre-storage and release of liquid reagents. Quantitative layout of centrifugo-pneumatic particle handling, including timed valving, switching and pumping is assisted by network simulations. The automation is exclusively controlled by the spinning frequency and does not require any additional means. New centrifugal microfluidic process chains are developed in order to sequentially supply wash buffer based on frequency dependent stick-pack opening and pneumatic pumping to perform two washing steps from one stored wash buffer; pre-store and re-suspend functionalized microparticles on disk; and switch between the path of the waste fluid and the path of the substrate reaction product with 100% efficiency. The automated immunoassay concept comprises on demand ligand binding, two washing steps, substrate reaction, timed separation of the reaction products, and termination of the substrate reaction. We demonstrated separation of particles from three different liquids with particle loss below 4 % and residual liquid remaining within particles below 3 %. The automated immunoassay concept was demonstrated by means of detecting Creactive protein (CRP) in the range of 1 - 81 ng ml-1 and Interleukin 6 (IL-6) in the range of 64 - 13500 pg ml-1. The limit of detection and quantification were 1.0 ng ml-1 and 2.1 ng ml-1 for CRP; 64 pg ml-1 and 205 pg ml-1 for IL-6, respectively.

2016

• W.E. Kaman, G. Elshout, P.J.E. Bindels, K. Mitsakakis, J.P. Hays
  Current problems associated with the microbiological point-of-care testing of respiratory tract infections in primary care
  2016 Future Microbiol, Band: 11, Seiten: 607 - 610
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  Kurzfassung

  Currently, the world is facing a potential ‘antibiotic apocalypse’, whereby clinically relevant bacteria are becoming increasingly resistant to all currently available antibiotics [1]. Several factors are contributing to this global increase in antibiotic resistance, including the unnecessary prescription of antibiotics for nonbacterial (viral and fungal) infections [2]. General practitioners (GPs) sit on the front line of antibiotic prescribing practice, having regular and broad-based contact with members of society that present to their offices with a range of disease states. One of the major reasons for visiting a GP is when a patient is apparently suffering from a respiratory tract infection [3]. The accurate diagnosis of the cause (i.e., the causative pathogen) of this infection can be difficult for the GP to make when only based on clinical symptoms. In the absence of sufficient diagnostic or clinical evidence, the GP may decide to prescribe antibiotics, or alternatively may withhold antibiotic therapy (suspecting a viral infection) when antibiotic therapy is actually required. On the one hand, the ‘overprescribing’ of antibiotics for nonbacterial infections may not only lead to the acquisition of antibiotic resistance in the resident flora of the patient, but also result in unnecessary healthcare costs for the patient and society [4]. It will also expose the patients to unwanted side effects from the antibiotic [5]. On the other hand, not prescribing antibiotics in case of a bacterial pneumonia, may result in extra morbidity for the patient and subsequent healthcare costs [6]. Access to point-of-care (POC) tests may reduce the prescription of antibiotics in primary care [7], although current POC testing performed by GPs for diagnosing respiratory tract infections tends to rely on the use of nonspecific biomarkers, such as CRP [8]. These biomarkers only provide information on the likelihood of a complicated (lower) respiratory tract infection being present. They do not identify pathogens or any antibiotic resistance that may be associated with a pathogen. For this reason, more advanced POC testing devices are currently being developed for specific use in the primary care environment. Such devices could potentially accurately diagnose the causative pathogen associated with a respiratory tract infection and any accompanying antibiotic resistance genes (if present), thereby potentially helping the GP to personalize their antibiotic prescribing practices to the needs of each patient. Unfortunately, however, many hurdles currently exist to the successful implementation of infectious disease POC diagnostics into primary care, the most important of which are described below.

2012

• Mitsakakis K, Sekula-Neuner S, Lenhert S, Fuchs H, Gizeli E
  Convergence of Dip-pen nanolithography and acoustic biosensors towards a rapid-analysis multi-sample microsystem
  2012 Analyst, Band: 137, Seiten: 3076 - 3082
• S.K. Vashist, A. G. Venkatesh, K. Mitsakakis, G. Czilwik, G. Roth, F. von Stetten, R. Zengerle
  Nanotechnology-Based Biosensors and Diagnostics: Technology Push versus Industrial/Healthcare Requirements
  2012 BioNanoSci., Band: 2, Seiten: 115 - 126
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  Kurzfassung

  There have been considerable advances in the field of nanotechnology-based biosensors and diagnostics (NBBD) during the last two decades. These include the production of nanomaterials (NMs), employing them for new biosensing and diagnostic applications, their extensive characterization for in vitro and in vivo applications, and toxicity analysis. All these developments have led to tremendous technology push and successful demonstrations of several promising NBBD. However, there has been a significant lag in their commercialization, especially due to the lack of international regulatory guidelines for evaluating the safety of NMs and the growing public concerns about their toxicity. Despite these numerous advances and the recent regulatory approval of several NMs, it still remains to be seen if NBBD are superior to conventional ones (not based on NMs), reliable, reproducible, cost effective, and robust enough to meet the requirements of industries and healthcare. This manuscript provides a critical review of NBBD, the technology push, and the industrial/healthcare requirements.

2011

• Mitsakakis K, Gizeli E
  Detection of multiple cardiac markers with an integrated acoustic platform for cardiovascular risk assessment
  2011 Anal Chim Acta, Band: 699, Seiten: 1 - 5
• Mitsakakis K, Gizeli E
  Multi-sample acoustic biosensing microsystem for protein interaction analysis
  2011 Biosens Bioelectron, Band: 26, Seiten: 4579 - 4584

Reviews/Übersichtsartikel in wissenschaftlichen Fachzeitschriften

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2019

• A. van Belkum, T. T. Bachmann, G. Lüdke, J. G. Lisby, G. Kahlmeter, A. Mohess, K. Becker, J. P. Hays, N. Woodford, K. Mitsakakis, J. Moran- Gilad, J. Vila, H. Peter, J. H. Rex, W. M. Dunne Jr., and the JPIAMR AMR-RDT Working Group
  Developmental roadmap for antimicrobial susceptibility testing systems
  2019 Nat Rev Microbiol, Band: 17, Seiten: 51 - 62
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  Kurzfassung

  Antimicrobial susceptibility testing (AST) technologies help to accelerate the initiation of targeted antimicrobial therapy for patients with infections and could potentially extend the lifespan of current narrow-spectrum antimicrobials. Although conceptually new and rapid AST technologies have been described, including new phenotyping methods, digital imaging and genomic approaches, there is no single major, or broadly accepted, technological breakthrough that leads the field of rapid AST platform development. This might be owing to several barriers that prevent the timely development and implementation of novel and rapid AST platforms in health-care settings. In this Consensus Statement, we explore such barriers, which include the utility of new methods, the complex process of validating new technology against reference methods beyond the proof-of-concept phase, the legal and regulatory landscapes, costs, the uptake of new tools, reagent stability, optimization of target product profiles, difficulties conducting clinical trials and issues relating to quality and quality control, and present possible solutions.

2018

• K. Mitsakakis, S. Hin, P. Müller, N. Wipf, E. Thomsen, M. Coleman, R. Zengerle, J. Vontas, K. Mavridis
  Converging Human and Malaria Vector Diagnostics with Data Management towards an Integrated Holistic One Health Approach
  2018 International Journal of Environmental Research and Public Health, Band: 15, Nummer: 2, Seite: E259
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  Kurzfassung

  Monitoring malaria prevalence in humans, as well as vector populations, for the presence of Plasmodium, is an integral component of effective malaria control, and eventually, elimination. In the field of human diagnostics, a major challenge is the ability to define, precisely, the causative agent of fever, thereby differentiating among several candidate (also non-malaria) febrile diseases. This requires genetic-based pathogen identification and multiplexed analysis, which, in combination, are hardly provided by the current gold standard diagnostic tools. In the field of vectors, an essential component of control programs is the detection of Plasmodium species within its mosquito vectors, particularly in the salivary glands, where the infective sporozoites reside. In addition, the identification of species composition and insecticide resistance alleles within vector populations is a primary task in routine monitoring activities, aiming to support control efforts. In this context, the use of converging diagnostics is highly desirable for providing comprehensive information, including differential fever diagnosis in humans, and mosquito species composition, infection status, and resistance to insecticides of vectors. Nevertheless, the two fields of human diagnostics and vector control are rarely combined, both at the diagnostic and at the data management end, resulting in fragmented data and mis- or non-communication between various stakeholders. To this direction, molecular technologies, their integration in automated platforms, and the co-assessment of data from multiple diagnostic sources through information and communication technologies are possible pathways towards a unified human vector approach.
• K. Mitsakakis / V. D’Acremont, S. Hin, F. von Stetten, R. Zengerle
  Diagnostic tools for tackling febrile illness and enhancing patient management
  2018 Microelectron Eng, Band: 201, Seiten: 26 - 59
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  Kurzfassung

  Most patients with acute infectious diseases develop fever, which is frequently a reason to visit health facilities in resource-limited settings. The symptomatic overlap between febrile diseases impedes their diagnosis on clinical grounds. Therefore, the World Health Organization promotes an integrated management of febrile illness. Along this line, we present an overview of endemic and epidemic etiologies of fever and state-of-the-art diagnostic tools used in the field. It becomes evident that there is an urgent need for the development of novel technologies to fulfill end-users’ requirements. This need can be met with Point-of-Care and near-patient diagnostic platforms, as well as e-Health clinical algorithms, which co-assess test results with key clinical elements and biosensors, assisting clinicians in patient triage and management, thus enhancing disease surveillance and outbreak alerts. This review gives an overview of diagnostic technologies featuring a platform based approach: (i) assay (nucleic acid amplification technologies are examined); (ii) cartridge (microfluidic technologies are presented); (iii) instrument (various detection technologies are discussed); and at the end proposes a way that such technologies can be interfaced with electronic clinical decision-making algorithms towards a broad and complete diagnostic ecosystem.

Vorträge

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2019

• K. Mitsakakis
  Converging Human, Animal, and Vector Diagnostics, together with Digital Technologies, towards a Holistic One Health Approach
  2019 Molecular Diagnostics Europe, Lissabon/Portugal, 06. - 09.05.2019

Konferenzbeiträge

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2023

• B. Johannsen, D. Baumgartner, M. Karpíšek, D. Stejskal, N. Paust, R. Zengerle, K. Mitsakakis
  Integration of a bead-based immunoassay on a commercial PCR-performing POC device
  2023 Eurosensors 2023, Lecce, Italy, 10. - 13.09.2023

2021

• B. Johannsen, D. Baumgartner, L. Karkossa, L. Müller, N. Paust, M. Karpíšek, N. Bostanci, R. Zengerle, K. Mitsakakis
  Detection of systemic and oral inflammation biomarkers through biochemical and microfluidic integration
  2021 MicroTAS 2021, Palm Springs/USA, 10.-14.10.2021, online
• D. Baumgartner, B. Johannsen, N. Paust, F. von Stetten, R. Zengerle, K. Mavridis, J. Vontas, K. Mitsakakis
  Microfluidic-based molecular analysis of plant psts for insecticide resistance management (Superpests-Disk)
  2021
• D. Baumgartner, B. Johannsen, N. Paust, F. von Stetten, R. Zengerle, K. Mavridis, J. Vontas, K. Mitsakakis
  SuperPests LabDisk: a microfluidic-based molecular diagnostic platform for detection of biotypes, resistance mutations and plant pathogens P3.021
  2021 Biosensors, Haeundae-gu, South Korea (online), 26. – 29.07.2021

2020

• A. Brunauer, B. Breiner, S. Hennig, D. Kainz, R. Verboket, B. Johannsen, D. Baumgartner, K. Mitsakakis, L. Gutzweiler, Z. Shu, P. Koltay, T. Hutzenlaub, N. Paust, R. Zengerle, F. von Stetten, S. M. Früh
  Actuation principles for bioanalytical platforms to combat infectious diseases
  2020 Virtual EMBL Conference: Microfluidics: Designing the Next Wave of Biological Inquiry 2020, 13.-15.07.2020
• M. Rombach, S. Hin, M. Specht, B. Johannsen, J. Lüddecke, N. Paust, R. Zengerle, K. Mitsakakis
  RespiDisk: A Point-of-Care platform for fully automated detection of respiratory tract infection pathogens in clinical samples
  2020 MicroTAS 2020, 04.-09.10.2020, virtual

2019

• B. Johannsen, L. Müller, D. Baumgartner, L. Karkossa, S. M. Früh, N. Bostanci, M. Karpíšek, R. Zengerle, N. Paust, K. Mitsakakis
  Automated pre-analytic processing of whole saliva on a centrifugal microfluidic platform for protein biomarker analysis
  2019 MicroTAS, 27. – 31. October 2019, Basel/Switzerland
• S. Hin, N. Paust, M. Rombach, J. Lueddecke, M. Specht, R. Zengerle, K. Mitsakakis
  Minimizing ethanol carry-over in centrifugal microfluidic nucleic acid extraction by advanced bead handling and management of diffusive mass transfer
  2019 Transducers 2019 - EUROSENSORS XXXIII, 23.-27. Juni 2019 - Berlin, Germany
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  Kurzfassung

  We present three concepts for centrifugal microfluidics reducing ethanol carry-over in magnetic bead-based nucleic acid (NA) extraction. Ethanol carry-over is critical regarding inhibition of downstream NA amplification. We identified two possible carry-over pathways: Liquid co-transport within bead-clusters and vapor diffusion. For the first time, we integrated magnetic bead handling in centrifugal microfluidics at continuous rotation aiming to avoid liquid co-transport within bead-clusters. Consequently, no significant contribution to ethanol carry-over could be assigned anymore to liquid cotransport. Major carry-over was attributed to diffusive transport of ethanol vapor. Countermeasures reduced this from 9.7 % (v/v) to 0.4 % (v/v), below the critical level for inhibition of downstream amplification reactions.
• B. Johannsen, L. Karkossa, D. Baumgartner, L. Müller, R. Zengerle, K. Mitsakakis
  Storage of protein coated beads on point-of-care microfluidic cartridges for immunoassay applications
  2019 MNE 2019, 23-26.09.2019, Rhodes/Greece

2018

• N. Wipf, K. Mavridis, S. Hin, K. Mitsakakis, M. Specht, S. Medves, B. Carman, P. Müller, J. Vontas
  Development of multiplex TaqMan assays for the LabDisk – an automated diagnostic platform for malaria vectors
  2018 7th MIM Pan African Malaria Conference - Dakar, 18.04.2018
• S. Hin, B. Lopez-Jimena, M.A. Bakheit, V. Klein, S. Stack, C. Fall, A.A. Sall, K. Enan, S. Frischmann, L. Gillies, M. Weidmann, S. Goethel, V. Rusu, O. Strohmeier, N. Paust, R. Zengerle, K. Mitsakakis
  Differential diagnosis of fever in West- and East-Africa
  2018 WHO Geneva Health Forum, 10. – 12.04.2018, Genf / Schweiz

2017

• Y. Zhao, V. Klein, K. Mitsakakis, G. Czilwik, R. Zengerle, N. Paust
  Automated particle based C-reactive protein immunoassay with on-disk pre-stored reagents and centrifugo-pneumatic liquid control
  2017 MST Kongress, München, 23. - 25.10.2017
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  Kurzfassung

  Rapid and highly sensitive immunoassays can be achieved using microparticles due to the large surface to volume ratio. Such assays automated in centrifugal microfluidics show great potential for point-of-care application. We present a fully automated centrifugal microfluidic concept for implementing particle based immunoassay. With all reagents pre-stored on a LabDisk, the automation is controlled exclusively by the spinning frequency and does not require any additional means.
• S. Hin, B. Lopez-Jimena, M. Bakheit, V. Klein, S. Stack, C. Fall, A. Sall, K. Enan, S. Frischmann, L. Gillies, M. Weidmann, S. Goethel, V. Rusu, O. Strohmeier, N. Paust, R. Zengerle, K. Mitsakakis
  The FeverDisk: Multiplex detection of fever-causing pathogens for rapid diagnosis of tropical diseases
  2017 MicroTAS 2017, Savannah /USA, 22.-26.10.2017
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  Kurzfassung

  We report the successful implementation of twelve assays for detecting a diverse panel of fever-causing pathogens based on a centrifugal microfluidic LabDisk platform (FeverDisk). The target panel was selected to diagnose tropical regions’ most prevalent endemic and epidemic fever-causing diseases. The FeverDisk was used by local scientific staff in two clinical settings (Dakar, Senegal & Khartoum, Sudan). It was able to detect single and double infections from real patient samples in less than 2 h without any user intervention. The FeverDisk may provide an important solution for differential diagnosis in cases of fever of unknown origin thus improving accurate diagnostics and reducing the burden of pathogen drug resistance.
• S. Hin, M. Loskyll, V. Klein, M. Keller, O. Strohmeier, F. von Stetten, R.Zengerle, K. Mitsakakis
  User-friendly membrane-based sample inlet for the centrifugal microfluidic LabDisk platform
  2017 MNE 2017, Braga / Portugal, 18. - 22.09.2017
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  Kurzfassung

  We present a sample inlet for whole blood consisting of a plasma separation membrane placed into the inlet chamber of a centrifugal-microfluidic LabDisk to take up the sample via capillary forces. This approach offers advantages regarding several aspects: • Compatibility with a vast range of blood transfer device • Safe, well-controlled and easy application of blood sample without the danger of spilling • Combination of sample inlet with state-of-the art plasma separation leading to reduced footprint of the cartridge

2016

• S. Hin, N. Paust, M. Keller, O. Strohmeier, R. Zengerle, K. Mitsakakis
  A novel approach for dead-volume-free rehydration and mixing of dry pre-stored reagents in non-terminal chambers on centrifugal microfluidic platforms
  2016 20th International Conference on Miniaturized Systems for Chemistry and Life Sciences, µTAS 2016, Dublin / Irland, 09. – 13.10.2016
• J. Vontas, K. Mitsakakis, R. Zengerle, D. Yewhalaw, C. H. Sikaala, J. Etang, M. Fallani, B. Carman, P. Müller, M. Chouaïbou, M. Coleman
  Automated innovative diagnostic, data management and communication tool, for improving malaria vector control in endemic settings
  2016 pHealth 2016, 13th International Conference on Wearable, Micro & Nano Technologies for Personalized Health, 29-31 May, Heraklion, Crete, Greece Studies in Health Technology and Informatics, Band: 224, Seiten: 54 - 60
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  Kurzfassung

  Malaria is a life-threatening disease that caused more than 400,000 deaths in sub-Saharan Africa in 2015. Mass prevention of the disease is best achieved by vector control which heavily relies on the use of insecticides. Monitoring mosquito vector populations is an integral component of control programs and a prerequisite for effective interventions. Several individual methods are used for this task; however, there are obstacles to their uptake, as well as challenges in organizing, interpreting and communicating vector population data. The Horizon 2020 project “DMC-MALVEC” consortium will develop a fully integrated and automated multiplex vector-diagnostic platform (LabDisk) for characterizing mosquito populations in terms of species composition, Plasmodium infections and biochemical insecticide resistance markers. The LabDisk will be interfaced with a Disease Data Management System (DDMS), a custom made data management software which will collate and manage data from routine entomological monitoring activities providing information in a timely fashion based on user needs and in a standardized way. The ResistanceSim, a serious game, a modern ICT platform that uses interactive ways of communicating guidelines and exemplifying good practices of optimal use of interventions in the health sector will also be a key element. The use of the tool will teach operational end users the value of quality data (relevant, timely and accurate) to make informed decisions. The integrated system (LabDisk, DDMS & ResistanceSim) will be evaluated in four malaria endemic countries, representative of the vector control challenges in sub-Saharan Africa, (Cameroon, Ivory Coast, Ethiopia and Zambia), highly representative of malaria settings with different levels of endemicity and vector control challenges, to support informed decision-making in vector control and disease management.
• K. Mitsakakis, F. Stumpf, O. Strohmeier, V. Klein, D. Mark, F. von Stetten, J. R. Peham, C. Herz, P.N. Tawakoli, F. Wegehaupt, T. Attin, N. Bostanci, K. Bao, G.N. Belibasakis, J.P. Hays, G. Elshout, R.C. Huisman, S. Klein, A.P. Stubbs, L. Doms, A. Wolf, V. Rusu, S. Goethel, T. Binsl, A. Michie, J. Jancovicova, V. Kolar, M. Kostka, J. Smutny, M. Karpisek, C. Estephan, C. Cocaud, R. Zengerle
  Chair/bedside diagnosis of oral and respiratory tract infections, and identification of antibiotic resistances for personalised monitoring and treatment
  2016 pHealth 2016, 13th International Conference on Wearable, Micro & Nano Technologies for Personalized Health, 29-31 May, FORTH, Heraklion, Crete, Greece Studies in Health Technology and Informatics, Band: 224, Seiten: 61 - 66
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  Kurzfassung

  Global healthcare systems are struggling with the enormous burden associated with infectious diseases, as well as the incessant rise of antimicrobial resistance. In order to adequately address these issues, there is an urgent need for rapid and accurate infectious disease diagnostics. The H2020 project DIAGORAS aims at diagnosing oral and respiratory tract infections using a fully integrated, automated and user-friendly platform for physicians’ offices, schools, elderly care units, community settings, etc. Oral diseases (periodontitis, dental caries) will be detected via multiplexed, quantitative analysis of salivary markers (bacterial DNA and host response proteins) for early prevention and personalised monitoring. Respiratory Tract Infections will be diagnosed by means of DNA/RNA differentiation so as to identify their bacterial or viral nature. Together with antibiotic resistance screening on the same platform, a more efficient treatment management is expected at the point-of-care. At the heart of DIAGORAS lies a centrifugal microfluidic platform (LabDisk and associated processing device) integrating all components and assays for a fully automated analysis. The project involves an interface with a clinical algorithm for the comprehensive presentation of results to end-users, thereby increasing the platform’s clinical utility. DIAGORAS’ performance will be validated at clinical settings and compared with gold standards.
• S. Hin, M. Loskyll, V. Klein, O. Strohmeier, F. von Stetten, R. Zengerle, K. Mitsakakis
  Membrane-based sample inlet for pathogen-containing whole blood on a centrifugal microfluidic platform (LabDisk)
  2016 Biosensors 2016, Goeteborg, 25. - 27.05.2016
• T. van Oordt, O. Strohmeier, K. Mitsakakis, S. Hin, R. Zengerle, F. von Stetten
  Point-of-Need Detection of Biological Threats
  2016 15th MEDICAL BIODEFENSE CONFERENCE, Munich, 26 - 29 April 2016 , Band: JP20, Seite: 58
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  Kurzfassung

  The state-of-the-art for detection of biological threats often requires complex stationary devices and experts, thus, limiting the capability for a fast and efficient response. A novel portable platform , designated "LabDisk" has been developed . The versatile analytical platform allows automated and easy-to-use detection of biological threats at the point-ofneed. lt consists of a centrifugal device and disposable disks for the detection of various toxins and pathogens.

2015

• D. Baumann, S. Hin, F. Stumpf, V. Klein, K. Mitsakakis, D. Kosse, F. von Stetten, R. Zengerle, D. Mark
  Fully automated stick-packaging for precise liquid reagent pre-storage and release in lab-on-a-chip disposables
  2015 19th International Conference on Miniaturized Systems for Chemistry and Life Sciences October 25-29, 2015, Gyeongju, KOREA

2014

• K. Mitsakakis, S. Hin, V. Klein, O. Strohmeier, D. Mark, F. von Stetten, R. Zengerle
  Disc-shaped Point-of-Care platform for infectious disease diagnosis
  2014 NN14 Nanotexnology, 08.-11.07.2014, Thessaloniki, Greece
• K. Mitsakakis, S. Hin, V. Klein, O. Strohmeier, D. Mark, F. von Stetten, R. Zengerle
  Multi-pathogen identification on a centrifugal microfluidic platform
  2014 CLINAM - European Foundation for Clinical Nanomedicine, 23. - 25. 06.2014, Basel/CH
• S. Hin, K. Mitsakakis, V. Klein, O. Strohmeier, M. Keller, D. Kosse, R. Zengerle, F. von Stetten, D. Mark
  The Lab-on-a-Chip Design & Foundry Service
  2014 2nd MFHS Conference 2014, Freiburg, 08 - 10.Okt. 2014 , Seiten: 195 - 198
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  Kurzfassung

  The Lab-on-a-Chip Design & Foundry Service offers the rapid development of point-of-care systems, which automate diagnostic assays delivered by the customer. The automation is done on a centrifugal microfluidic lab-on-a-chip platform, the LabDisk. The customer profits from the utilization of unit operations in the development process. Those unit operations apply standard rules for the design and production of the cartridges. Unit operations are combined to form process chains for the translation of a manual laboratory protocol into a fully automated analysis. Thus, risk, time, and costs are reduced during the development process, because a wellestablished production technology is used and existing developments can be re-used. To describe that development process, in this paper the example of a unit operation for liquid reagent release is implemented into a LabDisk for the EU-FP7 project DiscoGnosis. The liquid release is needed in a fluidic structure for nucleic acid extraction from pathogens out of a whole blood sample (50 μl). To implement this unit operation, five different buffer solutions are filled into stickpacks. For each buffer, a research-scale batch of 100 stickpacks is produced. It is demonstrated for all buffers that 4 out of 4 stickpacks release their content in the planned time in the protocol. The time effort for this first design iteration was two weeks, including specification phase, CAD, fabrication, and fluidic validation.

2013

• Mitsakakis K, Hin S, Stetten F, Zengerle R
  Disc-shaped Point-of-Care Platform for Infectious Disease Diagnosis
  2013 The 7th Annual Concertation and Consultation Workshop on Micro-Nano-Bio Convergence Systems (MNBS 2013), Cork, Ireland, 24-25 September 2013
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  Kurzfassung

  Malaria and infectious diseases of similar clinical symptoms are one of the primary causes of death in endemic areas of the world where numbers denote the extent of the problem (from WHO, 2010): 174 million malaria cases, 80 % of which in Africa, leading to 600 000 deaths. Patients often suffer from different disease than malaria but exhibit similar clinical symptoms, resulting in wrong diagnosis and subsequent maltreatment. The current “gold standard” diagnostic methods are microscopy smear tests, applicable only to malaria, and Rapid Diagnostic Tests (RDTs), available for other infectious diseases too. The latter are often preferred due to their low cost-per-test. On the other hand, each test detects only one disease; therefore, if the patient is found negative to malaria, more than one (disease-specific) RDTs need to be employed, which significantly increases the cost-per-patient. DiscoGnosis aims at developing a fully-automated diagnostic platform for point-of-care use, keeping the cost-per-patient close to RDTs’ level. The platform is based on a disc-shaped microfluidic cartridge (LabDisk), wherein the fluids are transported by centrifugal forces using a dedicated LabDisk reader, the latter performing the detection too.
• Mitsakakis K, Hin S, Stetten F, Zengerle R
  Disc-shaped Point-of-Care Platform for Infectious Disease Diagnosis
  2013 European Summit on Clinical Nanomedicine (CLINAM), Basel, Switzerland, 23. – 26.06.2013
• Mitsakakis K, Stetten F, Zengerle R
  Disc-shaped Point-of-Care Platform for Infectious Disease Diagnosis
  2013 10th International Conference on Nanosciences & Nanotechnologies (NN13), Thessaloniki, Greece, 09-12 July 2013
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  Kurzfassung

  Abstract: Infectious diseases are a huge threat, not only in developing countries, but globally. An estimated 220 million people get infected by malaria every year; 650.000 cases lead to death, 20% of which are within small children. The clinical symptom is mostly acute fever, but a reliable diagnosis is very difficult because in malaria-endemic areas there are several other diseases with the same symptom (Salmonella typhi/paratyphi bacteria or dengue and chikungunya viruses, all of which, like malaria, are transmitted by mosquitos). Within this context, DiscoGnosis aims to develop a platform for the detection of malaria and similar pathogenic diseases in a rapid, multiplexed, highly specific way at the point-of-need. Using centrifugal forces, a disc-shaped chip will handle the injected blood sample and distribute it among integrated microfluidic chambers for processing till the final detection step. Main technical objectives are: (i) Fully automated and integrated analysis from blood (“sample-to-answer”) where several unit operations are integrated on the disc for self-handling of fluid. All necessary (bio)chemical components will be pre-stored on the disc. (ii) Multiplexed detection, by means of quantum dots and magnetic beads acting as pathogen-specific identification codes in an array configuration on disc. (iii) Both nucleic acid and protein based analysis so as to achieve maximum reliability and cross-checked results and to monitor a broader diagnostic window of the diseases. (iv) Scalable fabrication technology based on the microthermoforming of polymer foils, in order to have a low-cost and high-throughput production of diagnostic kits. Clinical trials will be done in Africa for system validation. Acknowledgement: DiscoGnosis is supported by the European Commission through the objective FP7 ICT-2011.3.2 and under Grant Agreement No. 318408.
• K. Mitsakakis, S. Hin, O. Strohmeier, D. Mark, F. von Stetten, R. Zengerle
  Fully-automated point-of-care detection of malaria and other infectious diseases with a disc-shaped diagnostic platform
  2013 Second WHO Global Forum on Medical Devices Duration, Geneva, Switzerland, 22-24 November 2013
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  Kurzfassung

  Malaria is one of the highest mortality rate infectious diseases globally, mainly prevalent in sub-saharan Africa. Other diseases like dengue, pneumonia, typhoid fever are also present in the same areas, and, although they emerge from different pathogenic agents, they exhibit the same clinical symptom (acute fever). This makes reliable diagnosis extremely challenging especially due to the low resource nature of the endemic regions. Under these circumstances, existing diagnostic methods are often not efficient enough and unable to provide a generic solution: (i) blood smear microscopy is only malaria-specific; (ii) lateral flow Rapid Diagnostic Tests (RDTs) are cheap but single-target specific; (iii) existing molecular methods (e.g., PCR, ELISA) and/or pathogen cultivation require expensive equipment, well-trained users and long time-to-result. The presently suggested technology aims to provide a true point-of-care diagnostic platform, by addressing key application-oriented needs: (i) Portability and autonomous use, based on a disc-shaped plastic disposable cartridge (LabDisk) capable of handling liquid sample (blood) via centrifugal forces operated by a CD-player-like device (LabDisk Player). (ii) Full automation from sample collection to result, via a simple blood transfer device (patient-to-system interface) and on-disc integration of all biochemical components needed for the blood-based pathogen identification (e.g., molecular probes, buffers, etc). (iii) Rapid analysis, by using time-saving analytical protocols based on immunoassays and isothermal nucleic acid amplification (LAMP, instead of PCR). (iv) Multiplexity, by combining a broad diagnostic panel on the same disc (parasites, viruses, bacteria). The panel is flexible and can be tailored to the geographic-specific diseases. (v) Low-cost fabrication technology based on microthermoforming of thin polymer foils, adaptable from pharmaceutical and food package production. This work is part of the EU FP7 project DiscoGnosis, financed by the European Commission which is acknowledged, as well as all the consortium members for their contribution.