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Asthma is a chronic disease affecting over 300 million people worldwide. Airway inflammation is a central feature of asthma. Quantitative sputum cytometry is the most validated method to assess this and to adjust anti-inflammatory therapy, yet it is underutilized due to rigorous processing that requires expensive specialized technicians. To address these limitations, this thesis focuses on the development of several point of need biosensors that rapidly quantify respiratory biomarkers as alternatives to traditional laboratory tests. The project began by developing a paper based sensor for detection of myeloperoxidase (MPO), a neutrophil biomarker. A test was developed using commercially available antibodies, showing direct correlation between the test line colour intensity and total neutrophils. This work was expanded to include a second protein target, eosinophil peroxidase (EPX), for identification of eosinophils. Although the test performed well using neat samples, it failed to identify EPX in clinical sputum samples. Analyzing pre-treatment methods identified that a quick immunoprecipitation technique using protein A/G beads followed by syringe filtration allowed for the device to successfully quantify EPX, eliminating the need for a centrifuge. However, the limited supply of commercial anti-EPX antibodies combined with the need for sample pre-treatment prompted investigation into alternative detection avenues. Nucleic acid aptamers were explored, with aptamer selection for EPX producing several aptamer candidates. Binding affinity and specificity tests were performed, with the T1-5 aptamer emerging. T1-5 was capable of selectively binding EPX over MPO with high affinity. This aptamer was integrated into a simple pull-down assay, capable of detecting EPX with an order of magnitude lower limit of detection than the antibody test. Overall this work has developed multiple sensors with the potential to overcome the limitations of accessibility to sputum cytometry, rapidly identify the presence and type of airway inflammation, and deliver personalized treatment strategies that not only reduce the global healthcare burden, but also greatly improve a patient’s quality of life. / Thesis / Doctor of Philosophy (PhD)

<p dir="ltr">The emergence of infectious diseases like HIV, influenza, and COVID-19 highlights the urgent need for highly scalable testing methods that can be deployed outside traditional laboratory settings. Despite decades of research in point-of-care (POC) diagnostics, the main challenge remains the limited performance of assays, especially in terms of sensitivity. Furthermore, most POC assays originating from academic research struggle to transition beyond the laboratory due to manufacturability issues. This dissertation aims to enhance the effectiveness of viral molecular detection platforms for POC diagnostics by improving analytical and clinical sensitivity and facilitating the practical adaptation of academic-developed POC devices for use outside laboratory settings.</p><p dir="ltr">Each aim addresses a separate aspect of device development. The first aim addresses the need for clinical accuracy during test interpretation, especially in POC or at-home diagnostic tests, by developing an internal amplification control (IAC). Here, I develop a one-pot duplex reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) assay for detecting SARS-CoV- 2 along that incorporates a housekeeping gene as an IAC to ensure the quality of collected samples and the validity of assay reagents. The valid results can be easily visualized in triple-line lateral flow immunoassay (LFIA). The second aim makes progress towards overcoming the limited analytical sensitivity of existing rapid diagnostic tests for acute HIV infection screening. Here, I introduce a novel antibody-initiated LAMP assay targeting the HIV p24 capsid protein that combines LAMP sensitivity with the specificity of HIV p24 and its antibody. There are 3000 p24 capsid proteins present in the virion compared to only 2 viral RNA copies. In the assay, two DNA- conjugated antibody probes will each bind to p24 and their proximity will allow the DNA overlaps to generate a complete DNA target that acts as a trigger for the LAMP reaction. An LFIA is integrated into this design to enable simple result visualization. The third aim improves manufacturability and assembly of our existing nucleic acid detection platform by simplifying the platform components while maintaining the user-friendly sample-to-answer concept. Here, I validate material compatibility testing, assess chamber fabrication methods amenable to large-scale manufacturing, evaluate alternative heating units, and examine fluid flow control mechanisms of the redesigned wax valve. These combined aims demonstrate promising outcomes for practical implementation of molecular diagnostics to the POC.</p>

Yes / Rapid point of care tests for bacterial infection diagnosis are of great importance to reduce the misuse of antibiotics and burden of antimicrobial resistance. Here, we have successfully combined a new class of non-biological binder molecules with electrochemical impedance spectroscopy (EIS)-based sensor detection for direct, label-free detection of Gram-positive bacteria making use of the specific coil-to-globule conformation change of the vancomycin-modified highly branched polymers immobilized on the surface of gold screen-printed electrodes upon binding to Gram-positive bacteria. Staphylococcus carnosus was detected after just 20 min incubation of the sample solution with the polymer-functionalized electrodes. The polymer conformation change was quantified with two simple 1 min EIS tests before and after incubation with the sample. Tests revealed a concentration dependent signal change within an OD600 range of Staphylococcus carnosus from 0.002 to 0.1 and a clear discrimination between Gram-positive Staphylococcus carnosus and Gram-negative Escherichia coli bacteria. This exhibits a clear advancement in terms of simplified test complexity compared to existing bacteria detection tests. In addition, the polymer-functionalized electrodes showed good storage and operational stability.

Fin avril 2009, un nouveau virus grippal A/H1N1 d'origine porcine émerge dans le monde causant la première pandémie grippale du XXIème siècle. Les différents travaux présentés dans cette thèse retracent la gestion de cette situation au laboratoire de virologie des hôpitaux publics de Marseille. D'avril 2009 à avril 2010, nous avons analysé plus de 13 000 prélèvements issus de cas suspects. Nous avons dû adapter continuellement les moyens mis en œuvre pour effectuer le diagnostic et la mise en place d'une stratégie 'Point of Care' s'est avérée très utile. Nos résultats montrent que l'usage des tests rapides en complément de la RT-PCR en temps réel permet de réduire significativement le délai de rendu des résultats pour les patients infectés. Les données épidémiologiques sur les nombreux cas suspects dépistés ont également permis d'obtenir en temps réel des informations précieuses sur l'épidémiologie de cette pandémie comme l'estimation de l'incidence par classe d'âge, la proportion de patients hospitalisés et la mortalité. Enfin, nous avons réalisé une étude de séroprévalence qui montre qu'environ 12% de la population française a été infectée par ce nouveau virus en 2009-2010 et que les taux d'attaque les plus élevés ont été observés chez les enfants et les jeunes adultes. / In late April 2009, a new swine-origin A/H1N1 Influenza virus emerged and spread rapidly worldwide causing the first influenza pandemic of the 21st century. This work describes how we coped with this emergency situation in the virology laboratory of Marseille public hospitals. From April 2009 to April 2010, we analyzed more than 13,000 samples from suspected cases. We needed to adapt continuously the organization to maintain diagnostic capacity and the implementation of a point of care strategy revealed very useful to achieve this goal. Our results support the use of rapid Influenza detection tests in combination with real-time RT-PCR because it reduces significantly the delay from sample to result for positive cases, thus giving the opportunity to improve patient management. Epidemiological data from all suspected cases tested allowed us to obtain timely precious information about the epidemiology of this pandemic as the estimation of (i) the incidence by age group, (ii) the rate of hospitalization and (iii) the mortality rate among tested patients. Finally, we set up a serological study and showed that around 12% of the French population had been infected by this new virus in 2009-2010 with higher attack rates observed in children and young adults.

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