Abstract:
A system for electrochemically detecting AST and ALT includes a first sampler for producing pyruvate from ALT and a second sampler for producing pyruvate from AST. The system further includes an electrochemical test strip for receiving processed samples from the first and second samplers, the processed samples containing pyruvate. The system further includes a meter for reading the electrochemical test strip and indicating an amount of AST and ALT in the sample.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application 62,271,753 filed Dec. 28, 2015, and hereby incorporated by reference to the same extent as though fully disclosed herein. 
     
    
     BACKGROUND 
       [0002]    The AST/ALT ratio is the ratio between the concentrations of the enzymes aspartate transaminase (AST) and alanine transaminase (ALT). Generally, AST and ALT relate to the health of an individual&#39;s liver. These enzymes are found in the blood of individuals. If the AST measurement is lower than the ALT measurement, it is generally suggestive of some sort of liver disease, especially those caused by alcohol. Hepatitis C or other liver diseases may also result in an imbalance in the levels of AST and ALT. It is desirable to have a point-of-care test to test for these analytes. 
       BRIEF SUMMARY 
       [0003]    In one embodiment, a system for electrochemically detecting AST includes a sampler for producing pyruvate from AST; an electrochemical test strip for receiving a processed sample from the sampler, the processed sample containing pyruvate; and a meter for reading the electrochemical test strip and indicating an amount of AST in the sample. In one configuration, the sampler contains L-Alanine+alpha-Ketoglutarate. In another configuration, the electrochemical test strip includes phosphate and ferricyanide. Optionally, the electrochemical test strip further includes pyruvate oxidase. In one alternative, the sampler includes a heating element. In another alternative, the sampler includes a timer. Alternatively, the meter includes a timer. 
         [0004]    In one embodiment, a system for electrochemically detecting ALT includes a sampler for producing pyruvate from ALT; an electrochemical test strip for receiving a processed sample from the sampler, the processed sample containing pyruvate; and a meter for reading the electrochemical test strip and indicating an amount of ALT in the sample. In one configuration, the sampler contains L-Aspartic acid+alpha-Ketoglutarate. In another configuration, the sampler further contains oxaloacetate decarboxylase. Optionally, the electrochemical test strip includes phosphate and ferricyanide. Alternatively, the electrochemical test strip further includes pyruvate oxidase. In one configuration, the sampler includes a heating element. Optionally, the sampler includes a timer. Alternatively, the meter includes a timer. In another configuration, the electrochemical test strip contains a heating element to heat the sample using the meter as a source of energy. 
         [0005]    In one embodiment, a system for electrochemically detecting AST and ALT includes a first sampler for producing pyruvate from AST and a second sampler for producing pyruvate from ALT. The system further includes an electrochemical test strip for receiving processed samples from the first and second samplers, the processed samples containing pyruvate. The system further includes a meter for reading the electrochemical test strip and indicating an amount of AST and ALT in the sample. Optionally, the first sampler contains L-Alanine+alpha-Ketoglutarate. Alternatively, the second sampler contains L-Aspartic acid+alpha-Ketoglutarate. In one configuration, the second sampler further contains oxaloacetate decarboxylase. In one configuration, the electrochemical test strip further contains oxaloacetate decarboxylase. In another configuration, the electrochemical test strip includes phosphate, pyruvate oxidase, and ferricyanide. 
         [0006]    In one embodiment, a system for electrochemically detecting phosphate includes an electrochemical test strip for receiving a sample; the electrochemical test strip includes pyruvate, pyruvate oxidase, and ferricyanide; and a meter for reading the electrochemical test strip and indicating an amount of phosphate in the sample. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0007]      FIG. 1  shows the standard point-of-care colorimetric ALT reaction; 
           [0008]      FIG. 2  shows a proof-of-concept graph was conducted without any optimization of reagents; 
           [0009]      FIGS. 3 a -3 c    show one embodiment of a sample collector (Redwood Sampler) containing reactants for reacting with ALT or AST; 
           [0010]      FIG. 4  shows one embodiment of an electrochemical test strip for receiving a sample from the sampler of  FIGS. 3 a   - 3   c;    
           [0011]      FIG. 5  shows that ALT and AST tests can be combined as a joint test strip and shows one embodiment of such a strip; 
           [0012]      FIG. 6  shows an embodiment with a single sampling port; and 
           [0013]      FIG. 7  shows an embodiment of strip with a receiving port for a sampler. 
       
    
    
     DETAILED DESCRIPTION 
       [0014]    Certain terminology is used herein for convenience only and is not to be taken as a limitation on the embodiments of the systems and methods for electrochemical aspartate transaminase (AST) and alanine transaminase (ALT) detection and quantification. In the drawings, the same reference letters are employed for designating the same elements throughout the several figures. 
         [0015]    Disclosed are embodiments of ALT and AST assays. One of the challenges of colormetric assays has been the temperamental nature of chromogens on membranes. It is necessary to have a highly sensitive chromophore in order to test for ALT or AST. Some challenges with chromophores are fading during the reaction, instability in the compounding process, light sensitivity, insolubility, and limited by pH ranges. One method and system for overcoming these shortcomings is that these assays could be developed using electrochemistry. By going to an electrochemical assay, it eliminates any need for a chromophore. Some advantages include:
   1. By having an amperometric ALT and AST assay, no membranes are necessary. This provides for a cheaper manufacturing process and avoids being at the mercy of membrane manufacturers&#39; ability to produce reliable, consistent product.   2. Calibration of the analyzer is easier with electrochemical testing. Measuring current (nA) is a standardized process, whereas standardizing reflectance is more difficult.   3. Because the ALT and AST assays are measuring enzymes, the time of testing is longer than most assays. This becomes problematic for colorimetric tests because many chromophores display fading over time, particularly in a heated environment. By testing ALT and AST in an electrochemical environment, there is no need for a chromophore.   4. Electrochemical test strips generally are inexpensive to produce due to the automation and small amounts of reagent used.   5. Testing ALT and AST via electrochemistry probably will result in better precision.   6. In many embodiments, the test range of ALT and AST could be larger than a reflectance assay. Reflectance assays are limited by the amount of color that is produced, whereas electrochemical assays are not limited by the current produced.   7. In many embodiments, the sample size will be small: ˜1.2 μL instead of 15 μL.   8. In many embodiments, there may be no need of a transfer pipette to apply blood to a strip since the blood sample is simply wicked into the sampling port.   
 
         [0024]    Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes primarily associated with the liver. AST primarily is found in the liver, heart, and skeletal muscles, while ALT primarily is found in the liver. The release of ALT and AST from liver cells to the blood stream is an indication of hepatic cell damage or death. There are various medical reasons an ALT or AST test would be recommended. In a point-of-care setting, such assays may be used to monitor patients who are taking medications that may cause adverse effects on the liver. 
         [0025]    Embodiments described herein provide a novel reaction pathway to conduct an electrochemical ALT and AST assay. Once pyruvate is produced, the reaction is the same for both the ALT and AST reactions. We have discovered through literature searches and empirically that pyruvate oxidase specifically from  E. Coli  will react directly with a mediator that will be reduced at the electrode. This provides for an electrochemical reaction. 
       Proposed Electrochemical ALT Reaction Pathway: 
       [0026]    
       
                 
         
             
             
         
       
     
       Proposed Electrochemical AST Reaction Pathway: 
       [0027]    
       
                 
         
             
             
         
       
     
         [0028]    Most ALT/AST reaction pathways that use pyruvate oxidase require the use of oxygen and react the peroxide formed with a chromophore. This process takes an additional reaction step than what is proposed. Furthermore, the journal articles and papers on proposed electrochemical ALT/AST assays also make use of the additional peroxide-peroxidase reaction step. We have shown that we can eliminate this peroxide-peroxidase step by using a pyruvate oxidase from  E. Coli  which reacts directly with the mediator. In theory, by eliminating reaction steps, the precision and speed of the assay should improve. 
         [0029]      FIG. 1  shows the standard point-of-care colorimetric ALT reaction. This reaction and the similar AST reaction have significant issues with the sensitivity of membranes and chromophores. 
         [0030]    Proof of concept has been shown for an electrochemical ALT and AST assay by measuring pyruvate amperometrically.  FIG. 2  shows a proof-of-concept graph was conducted without any optimization of reagents. Using phosphate, pyruvate oxidase from  E. Coli , potassium ferricyanide, co-factors, and polymer binder, an electrochemical sensor was made to measure pyruvate. In approximately ten seconds of time, pyruvate was able to be measured amperometrically (see  FIG. 2 ). 
         [0031]    By showing an electrochemical pyruvate reaction, it is only a matter of reacting the ALT and AST with their reactants to produce pyruvate. This may be done in a number of different ways. One embodiment would be to have all components reacted on the electrochemical test strip. Another approach may be to involve a sample shaker like a “Redwood sampler” which contains the reactants that will react with the enzymes (ALT or AST) to produce pyruvate. In this embodiment, there is a timer started when the blood was allowed to mix with the reactants. In some embodiments, when the blood is introduced to the reactants, pushing the parts together on the Redwood sampler would start a timer on the sampler. In other embodiments, this time is tracked on the meter by depressing a button or giving another indication to the meter when the sample is added. After the given amount of time, the strip would be dosed by the sampler contents. In some embodiments, inside the sampler, it is possible to create an exothermic reaction by using calcium oxide, sodium acetate, or any such chemicals to add heat to the reaction. By adding heat, the ALT and AST reaction will occur more quickly. Alternatively, the meter may apply heat or an electrical heating element may be included in the sampler. In another configuration, the electrochemical test strip contains a heating element to heat the sample using the meter as a source of energy. 
         [0032]      FIGS. 3 a -3 c    show one embodiment of a sample collector (Redwood Sampler) containing reactants for reacting with ALT or AST. In  FIG. 3 a   , a capillary tube system for taking a blood sample is shown.  FIG. 3 b    shows the method of obtaining a blood sample using the capillary tube system.  FIG. 3 c    shows the capillary tube system after it has been inserted in a receiver. This receiver carries the chemicals for the reaction described above. Additionally, the receiver may include a heating element as described, as well as a timer (however, these elements may be located in the capillary tube sampler as well). 
         [0033]      FIG. 4  shows one embodiment of an electrochemical test strip for receiving a sample from the sampler of  FIGS. 3 a -3 c   . In this strip  400 , a receiving port  410  is provided for receiving a sample from the sampler. A fill detection electrode  420  may be provided. Additionally, an electrode  430  and counter electrode  440  are provided. 
         [0034]    In addition to having a single electrochemical ALT or AST sensor, in some embodiments, a versatile electrochemical test strip and offer multiple tests on the same strip. The figures below show an embodiment with multiple blood application sites. However, this in some embodiments, the system has a single blood application site. 
         [0035]      FIG. 5  shows that ALT and AST tests can be combined as a joint test. In addition, other tests may be combined with ALT and AST such as glucose and ketones.  FIG. 5  shows one embodiment of the strip design. Shown are four strips  10 . From left to right, the strips  10  have 4, 3, 2, and 1 sample receiving ports  20 . Each sample receiving port may have an electrode  30 , a counter electrode  40 , and a reference electrode  50 . The reference electrode  50  may provide for a fill indication, as it will only pass a voltage when the sample reaches the electrode  50 . The contacts  70 ,  80  are also visible, which interconnect with the electrodes and connect to contacts in the meter when inserted. The strip size does not change depending on the number of assays.  FIG. 5  displays a separate blood sampling port for each assay. Some embodiments may include separate sampling ports, particularly if there could be “cross talk” between reagents.  FIG. 6  shows an embodiment with a single sampling port. In many embodiments, there will be a singular sampling port  210  for the multi-analyte panels. Again, this strip allows for adaptability of design to meet the needs of particular assays. As shown in the left-most strip, a single sample port  210  may provide for five different sets of contacts, providing for the testing of five different analyte tests. Various combinations of analytes may be used in the strips as described herein. In some embodiments, a central application point is available for the sampler. This eases the challenge of dosing a large number of ports. As shown in  FIG. 7 , a possible geometry for such a configuration is shown. Test strip  710  includes a receiving port  720 , similar to receiving port  410  of  FIG. 4 . The receiving port  720  is sized in a complementary fashion to that of a sampler that may include a premix set. The receiving port  720  includes tubes  730  (typically capillary tubes) for extracting a portion of the sample. Also shown are the contact wires  740 , the connect to the electrodes that are typically located in the tubes  730 . The arrangement shown is only one possible arrangement for a receiving port with multiple interconnected capillary channels. A large number of geometries are possible. Additionally, in some embodiments, the receiving port  720  may include a first and second set point. When the sampler is inserted and pushed to the first set point in the receiving port  720 , the sample may be distributed to the tubes  730 . After distribution, the sampler may be further advanced to separate the sampler from the sample contained in the tubes  730 . In such a scenario receiving port may include breakaway tabs at the first set point through which the user may push the sampler, in order to reach the second set point, whereby fluidic communication between the sample in the tubes is lessened. This may decrease cross talk. 
         [0036]    The pyruvate reaction pathway may apply to the detection of other analytes as well. For instance, in one embodiment, this phosphate may react in a similar fashion. The pyruvate reaction where pyruvate oxidase from  E. Coli  reacts with the mediator for an electrochemical ALT and AST assay (see reaction below) can be used for an electrochemical detection scheme. 
         [0000]    
       
                 
         
             
             
         
       
     
         [0037]    Therefore, it is also possible to have an electrochemical phosphate assay. By providing the pyruvate, ferricyanide, and pyruvate oxidase, one can easily develop an electrochemical phosphate assay. A phosphate assay would be an excellent companion assay with a Vitamin D test. It also could be used in a non-medical application in water testing. One challenge is that many pyruvate oxidase enzymes have been lyophilized from a phosphate buffer. A pyruvate oxidase enzyme that is not provided in a phosphate buffer is needed in some embodiments to complete this assay. 
         [0038]    In conclusion, embodiments for an electrochemical ALT, AST, and phosphate sensor are provided herein. An electrochemical point-of-care ALT/AST test does not previously exist. The ALT and AST tests could be beneficial to those taking medications which could possibly impair liver function. It also may be used in small clinics to determine levels of ALT or AST for further medical diagnosis. Furthermore, having an electrochemical phosphate assay could be used as a companion diagnostic to a Vitamin D assay or a stand-alone test. 
         [0039]    While specific embodiments have been described in detail in the foregoing detailed description and illustrated in the accompanying drawings, it will be appreciated by those skilled in the art that various modifications and alternatives to those details could be developed in light of the overall teachings of the disclosure and the broad inventive concepts thereof. It is understood, therefore, that the scope of this disclosure is not limited to the particular examples and implementations disclosed herein but is intended to cover modifications within the spirit and scope thereof as defined by the appended claims and any and all equivalents thereof.