Patent Publication Number: US-2010120061-A1

Title: Rapid immunochromatographic detection by amplification of the colloidal gold signal

Description:
The present invention relates in general to the field of diagnostics, namely to a device for the detection of a target in a sample. More precisely, the present invention relates to a rapid immunochromatographic test device especially suitable for ultra-sensitive detection of an antibody and/or antigen in a sample using oligonucleotides and their complementary oligonucleotides and/or antibodies and their specific related antigens. The present invention further refers to a method for the production of the test device, to the uses of the test device for the early detection of disease infection such as HIV in a sample, as well as to a kit comprising the test device. 
     BACKGROUND OF THE INVENTION 
     In recent years the in vitro diagnostics (IVD) industry has made enormous efforts to develop immunochromatographic tests. Such tests have found applications in both clinical and non-clinical fields 1 . A clinical utility of this test format has been shown for more than 150 different analytes, and many of them are target now of commercially available diagnostic products 3 . The wide range of applications for such devices has been reviewed 1,2 . 
     Rapid immunochromatographic test devices, e.g. in the form of a test strip, are made up of a number of components ( FIG. 1   a ). Such a test strip  101  commonly includes a sample pad  102 , a conjugate pad  103 , a membrane  104 , e.g. a nitrocellulose membrane, and an absorbent pad  105 . The membrane  104  is usually attached by means of an adhesive  106  to a supporting backing  107 , e.g. made of plastic. In practice, the user dispense a patient sample (usually urine or whole blood) onto the sample pad  102 . The sample then flows through the sample pad  102  into the conjugate pad  103 , where it mixes with and releases the detector reagent. This mixture then flows across the membrane  104 , where it binds with the test and control reagents located in the capture test zone  108  (sample zone) and negative control zone  109 , respectively. When the mixture binds to the reagent that forms the test line, a positive result is indicated. The colour intensity of the test line is proportional to the concentration of analyte in the sample. Excess sample that flows beyond the test and control zones  108 ,  109  is taken up in the absorbent pad  105 . 
     Rapid immunochromatographic test devices for diagnostic purposes are easy to operate and thus do not only contribute to the comfort of professional users, e.g. medical stuff, but also allow the operation by non-professionals users, e.g. most patients. 
     For example, testing for HIV is an essential component in the diagnosis and treatment of persons infected with the virus, in screening of blood for transfusion, in surveillance and in HIV/AIDS related research. Thus accurate and cost-effective testing is of great importance in combating the spread of HIV. It is imperative that tests for the diagnosis of HIV infection be as accurate as possible, given the serious ethical, legal and social issues that accompany HIV infection. 
     The number of people living with HIV has now risen to reach its highest level ever: close to 40 million people are living with the virus and close to 5 million people were newly infected with HIV in 2004 alone. Worldwide, the AIDS epidemic killed over 3 million people last year alone (Source: UNAIDS). Furthermore, only one in five people needing HIV prevention worldwide have access to basic prevention services and only one in ten people living with HIV has been tested for the virus. 
     The HI virus is most easily transmitted to others during the initial period of acute HIV infection, when the viral load (quantity of HIV RNA in the blood) is especially high and when people are not aware of being contaminated by the virus. Most HIV infections are transmitted at this stage, called primary infection. Earlier detection using ultra sensitive tests avoids missing primary infections, enabling immediate precautionary measures to be taken to help prevent the risk of HIV transmission to a non-infected partner, to an unborn child, or through blood donations or direct blood contact. Earlier detection of HIV infection also ensures the implementation of early antiretroviral therapy (ART) to slow down the progression of HIV infection, thereby improving patient care and quality of life. 
     The diagnosis of HIV infection is usually made on the basis of the detection of HIV antibodies and/or antigen. The diagnosis of an HIV infection can be made indirectly, i.e. through the demonstration of virus-specific antibodies. Besides such indirect diagnosis based on detection of antibodies, a direct diagnosis of HIV infection is also possible: either through the demonstration of infectious virus (using cell culture), viral antigens (p24 antigen ELISA) or viral nucleic acid (i.e. viral genome); the latter is also termed nucleic acid testing (NAT). 
     One important problem of HIV antibody testing is the so-called “diagnostic window”. This is the time period that elapses between the time of acquisition of HIV infection until detectable levels of antibodies are present. The switch from antibody-negative to antibody-positive is called “seroconversion”. 
     The most widely used screening tests are ELISAs as they are the most appropriate for screening large numbers of specimens on a daily basis, e.g. blood donations. The earliest assays used purified HIV lysates (1st generation assays). Improved assays based on recombinant proteins and/or synthetic peptides, which also enabled the production of combined HIV-1/HIV-2 assays, became rapidly available (2nd generation assays). The so-called 3rd generation or antigen-sandwich assays, which use labeled antigens as conjugate, are more sensitive and have reduced the diagnostic window period considerably 4,5 . 
     The window interval between the presence of HIV-1 RNA in plasma and antibody seroconversion varies between 27.4 and 10.2 days depending on the route of infection. HIV infection is detected between 17.4 and 9.4 days earlier by testing for the HIV antigen p24 compared to the above mentioned 3rd generation assays 6 . Testing for the antigen p24 was the first assay available for the diagnosis of HIV infection prior to antibody seroconversion and has been available commercially since 1986 for the detection of HIV antigen in serum, plasma and cerebrospinal fluid (CSF) using enzyme immunoassay (EIA) technology 7-10 . 
     Although the prevalence and incidence of HIV infection in the general population in industrialized countries are relatively low, the residual risk for HIV transmission by blood donation (mostly by viremic but antibody negative donors) is ˜1/493 000 per unit in the USA 11 . 
     Despite the efforts to improve self-exclusion, some donors may not report or not perceive risk behavior for HIV infection 12 . By additional screening for the p24 antigen, the risk of HIV infection may be reduced to 1/676 000. However, the cost-effectiveness of such testing is predicted to be far below that of most medical interventions 13 . In countries with high transmission rates, i.e. Thailand where the HIV incidence is 10-100 times than that in the USA, p24 antigen testing of donors has been shown to be highly cost-effective 14 . 
     Furthermore, anti-retroviral therapy is becoming available more readily throughout the developing world as a result of increases in health budgets as well as drastic price reductions negotiated with pharmaceutical companies. Unfortunately, the cost of serological tests required for the follow up of the treatment remains highly prohibitive for the majority of the patients in resource-limited countries. This situation may not only contribute to render anti-retroviral therapy ineffective but also contribute to the emergence of drug-resistant HIV strains 15 . A single PCR-based determination of the RNA viral load can cost US $100 or more per test, which is equal to the costs for one month of life-saving treatment for an HIV patient receiving anti-retroviral therapy 16 . The development and implementation of reliable low-cost tools to monitor the effectiveness of treatment is therefore urgently desired. 
     In recent years, the development of enhanced ELISA assays that detect both HIV antibody and antigen (4th generation assays) has led to earlier detection of HIV seroconversion by further reducing the diagnostic window period. 4th generation HIV assays allow the combined detection of HIV antigen and antibody (Ag/Ab) in order to reduce the diagnostic window between infection and antibody detection in primary HIV infection. These 4th generation HIV screening assays are known in the art since the late 1990s. These assays are reported to reduce the diagnostic window of HIV infection by an average of 7 days in comparison to the 3rd generation HIV screening assays. Therefore, an earlier diagnosis of HIV infection is possible, by detecting p24 antigen which may be present in samples from individuals with recent HIV infection prior to seroconversion. 
     Several 4th generation HIV screening assays are also commercially available [17]. For example, AxSYM® HIV Ag-Ab (Abbott Laboratories, Abbott Park, USA), Murex HIV Ag/Ab Combination (Abbott/Murex Biotech Ltd., Dartford, UK), Genscreen® Plus HIV Ag-Ab (Bio-Rad Laboratories, Hercules, USA) and Enzymun-Test® HIV Combi (Roche Boehringer Mannheim, Penzberg, Germany). In these commercial assays, the presence of HIV antibodies and p24 antigen is detected at the same time as one combined signal, However, such one combined signal does not allow to discriminate whether the positive signal is based on a detection of antibodies or antigen or both. There further exist for example Vironostika® HIV Uni-Form II Ag/Ab (Organon Teknika, Boxtel, Netherlands) or Enzygnost® HIV Integral (Dade Behring, Mannheim, Germany). 
     Furthermore, there are the commercially available 4th generation assays of the type VIDAS® HIV DUO, such as VIDAS® HIV DUO and VIDAS® HIV DUO ULTRA (bioMérieux, Lyon, France). They utilize solid-phase receptacles, divided in a lower and an upper part, wherein the lower part detects HIV antibodies and the upper part detects HIV p24, i.e. the presence of HIV antibodies and p24 antigen can be detected as two separate signals. However, the majority of the commercially available 4th generation HIV screening assays still utilize coated microtiter plates or blends of microparticles (except for assays of the type VIDAS® HIV DUO which utilize solid-phase receptacles). 
     Recently, a variety of simple, instrument-free initial HIV tests have become available, including agglutination, immunofiltration (flow through tests), immunochromatographic (lateral flow tests) and dipstick tests, which are primarily based on the principle of the 3rd generation assays 18 . Specimen and reagents are often added by means of a dropper to the test device. A positive result is indicated by the appearance of a colored dot or line, or shows an agglutination pattern. Most of these tests can be performed in less than 20 minutes, and are therefore called simple/rapid assays. The results are read visually. Examples for commercially available simple and/or rapid 3rd generation assays are InstantCHEKT™-HIV 1+2 (EY Laboratories Inc.), GENIE II HIV-1/HIV-2 (Bio-Rad), Efoora HIV Rapid (Efoora Inc.). OraQuick HIV-1/2 Rapid HIV-1/2 antibody (OraSure Technologies Inc.), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), Hema•Strip® HIV 1/2 (Chembio Diagnostics), HIV 1/2 STAT-PAK (Chembio Diagnostics), HIV (1+2) Antibody (Colloidal Gold) (KHB Shanghai Kehua Bio-engineering Co. Ltd.), GENEDIA® HIV 1/2 Rapid 3.0 (Green Cross Life Science Corp.), DoubleCheckGold™ HIV 1&amp;2 (Orgenics Ltd.), and Uni-Gold™ HIV1/2 (Trinity Biotech Ltd., Ireland) [18]. In general, these simple/rapid tests are most suitable in testing and counselling centres and laboratories that have limited facilities and process low numbers of specimens daily. 
     Canadian patent application CA 2,431,778 discloses a rapid diagnostic immunoassay that belongs to the 4th generation assays since it allows the combined detection of HIV 1+2 antibodies and the HIV antigen p24. This immunoassay comprises a test strip having an upstream and a downstream end, two test zones and one control zone and a housing having opening and/or transparent materials. One of the two test zones of the test strip contains HIV1+2 antigen for the detection of HIV 1+2 antibodies and the other of the two test zones contains a monoclonal antibody against p24 for the detection of p24 antigen. 
     However, most commercially available 4th generation HIV screening assays reduce but still cannot close the diagnostic window during primary HIV infection. Therefore, HIV screening assays always need to be judged in the context of symptoms and risk factors. Furthermore, the sensitivity of the p24 antigen detection in 4th generation assays needs to be improved 19 . Therefore, there is a need for further improving 4th generation assays in order to increase the sensitivity as well as the specificity. 
     Further, there is not only a need to further improve the 4 th  generation assays, there is the fundamental need to improve the sensitivity as well as the specificity of rapid immunochromatographic test devices which are simple in use. As above in case of HIV outlined the early detection of disease infection is crucial to ensure the implementation of an early therapy and thus to slow down the progression of the infection, thereby improving patient care and quality of life. This applies to the detection of infections such as Hepatitis C,  H. Pylori , Hepatitis B,  Leishmania , Schistosomiasis, Malaria, Tuberculosis, and in particular HIV. 
     Thus there is need in the prior art to provide a rapid immunochromatographic test device suitable for the ultra-sensitive detection of target in a sample. 
     Therefore it is an object of the present invention to overcome the drawbacks of the prior art, especially to provide a simple and rapid test device for the ultra-sensitive antibody and/or antigen detection by signal amplification suitable to be employed for the early detection of disease infections in a sample. 
     SUMMARY OF THE INVENTION 
     In one embodiment the present invention concerns a rapid immunochromatographic test device for the detection of a target in a sample, comprising
         a) a first gold conjugate releasing pad, comprising colloidal gold conjugated with a first antibody or antigen and at least one oligonucleotide, and   b) a second gold conjugate releasing pad, comprising colloidal gold conjugated with at least one oligonucleotide complementary to the at least one oligonucleotide of the first colloidal gold conjugate;   wherein both releasing pads are located at different positions within the test device.       

     In another embodiment the present invention relates to a rapid immunochromatographic test device for the detection of a target in a sample, comprising
         a) a first gold conjugate releasing pad, comprising colloidal gold conjugated with a first antibody or antigen and at least one further antibody or antigen, wherein said further antibody or antigen differs from said first antibody or antigen, and   b) a second gold conjugate releasing pad, comprising colloidal gold conjugated with at least one further antibody or antigen, wherein said further antibody or antigen is specific for the at least one further antibody or antigen of the first colloidal gold conjugate;   wherein both releasing pads are located at different positions within the test device.       

     In a further embodiment the present invention concerns a method for the production of a device according to the present invention comprising the steps of:
         a) preparing a colloidal gold solution;   b) preparing a conjugation buffer;   c) partitioning the conjugation buffer by dividing it into a first and a second flask;   d) adding an antibody according to the present invention to the conjugation buffer in the first flask;   e) adding colloidal gold solution into each flask;   f) adding stabilizing buffer to each flask;   g) concentrating each conjugate;   h) adding a surfactant to the first conjugate and soaking glass fibre sheet conjugate pad into the conjugate;   i) soaking another glass fibre sheet conjugate pad into the second conjugate;   j) printing sample and control lines onto the membrane;   k) laminating cards; and   l) cutting cards into strips.       

     In another embodiment the present invention relates to the use of a device according to the present invention for the detection of a disease in at least one sample. 
     In a further embodiment the present invention refers to a kit for detection of a disease comprising the device according to the present invention and a manual. 
     DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION 
     Before the present invention is described in more detail below, it is to be understood that this invention is not limited to the particular methodology, protocols and reagents described herein as these may vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention which will be limited only by the appended claims. Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art. 
     Throughout this specification and the claims which follow, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” and “comprising”, will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integer or step. 
     Several documents are cited throughout the text of this specification. Each of the documents cited herein (including all patents, patent applications, scientific publications, manufacturer&#39;s specifications, instructions, etc.), whether supra or infra, are hereby incorporated by reference in their entirety. Nothing herein is to be construed as an admission that the invention is not entitled to antedate such disclosure by virtue of prior invention. 
     As outlined above there is a need in the prior art to provide a new test device suitable for the early detection of a disease infection in a sample. There is also a need in the art for devices suitable for simple, rapid and ultra-sensitive detection of an antigen and/or antibody, which devices having a higher sensitivity than devices from the prior art. 
     In a first aspect the present invention provides a rapid immunochromatographic test device for the detection of a target in a sample, comprising
         a) a first gold conjugate releasing pad, comprising colloidal gold conjugated with a first antibody or antigen and at least one oligonucleotide, and   b) a second gold conjugate releasing pad, comprising colloidal gold conjugated with at least one oligonucleotide complementary to the at least one oligonucleotide of the first colloidal gold conjugate;   wherein both releasing pads are located at different positions within the test device.       

     The first colloidal gold conjugated with a first antibody or antigen captures the target in the sample and forms a complex “target-first colloidal conjugate”. Preferably this target in the sample is an antigen and/or antibody. 
     In a preferred embodiment of the device according to the present invention each gold conjugate comprises between 1 and 6 different oligonucleotides. Preferably each gold conjugate comprises between 2 and 4 different oligonucleotides. These oligonucleotides usually have a length of about 15 to 25 nucleotides, preferably of about 20 nucleotides. Further these oligonucleotides have an amino group at the 5′ terminus, preferably conjugated with bovine serum albumin. The bonds formed between the gold and oligonucleotides are the same bonds as those usually formed between gold and antibodies/antigens, and which are known to a person skilled in the art. Preferably such bonds are driven by hydrophobic, hydrophilic and dative binding forces. 
     In another preferred embodiment of the device according to the present invention the rapid immunochromatographic test device for the detection of a target in a sample, comprises
         a) a first gold conjugate releasing pad, comprising colloidal gold  201  conjugated with a first antibody  202  or antigen and four different oligonucleotides ( 203 ,  204 ,  205 ,  206 , and   b) a second gold conjugate releasing pad, comprising colloidal gold  211  conjugated with four different oligonucleotide  203 ′,  204 ′,  205 ′,  206 ′ complementary to the four oligonucleotides  203 ,  204 ,  205 ,  206  of the first colloidal gold conjugate  201 ;   wherein both releasing pads are located at different positions within the test device.       

     In a second aspect the present invention provides a rapid immunochromatographic test device for the detection of a target in a sample, comprising
         a) a first gold conjugate releasing pad, comprising colloidal gold conjugated with a first antibody or antigen and at least one further antibody or antigen, wherein the further antibody or antigen differs from said first antibody or antigen, and   b) a second gold conjugate releasing pad, comprising colloidal gold conjugated with at least one further antibody or antigen, wherein the further antibody or antigen is specific for the at least one further antibody or antigen of the first colloidal gold conjugate;   wherein both releasing pads are located at different positions within the test device.       

     In one embodiment of the device according to the present invention the device comprises a test strip comprising
         a) a sample pad,   b) a conjugate pad comprising the first gold conjugate pad,   c) a conjugate pad comprising the second gold conjugate pad,   d) a membrane comprising a capture test zone and a negative control zone, and   e) an absorbent pad.       

     In a preferred embodiment of the device according to the present invention the capture test zone comprises a second antibody or antigen. The antibody immobilized within the test zone capture the target from a site that differs from that site captured by the first antibody conjugated with the first colloidal gold, why both antibodies differ from each other. 
     In another preferred embodiment the second antibody or antigen is immobilized within the test zone. The complex “target-first colloidal gold conjugate” will be captured by this second antibody or antigen and therefore kept within the test zone to form a sandwich detection. Then, the second gold conjugate releasing pad will release its colloidal gold conjugated with the complementary oligonucleotides. The last mentioned conjugate would bind with the first conjugate from the oligonucleotide(s) side ( FIG. 3 ). This binding could be happened by any of the conjugated oligonucleotides with its complementary oligonucleotide on the other gold conjugate. At the same time, the other oligonucleotides will be able to link with their complementary oligonucleotides beside the probability of capturing the first conjugate that will capture the second conjugate to form more and more branched bonds that propagate the accumulation of colloidal gold particles onto the capturing/sample line. This propagation and accumulation of colloidal gold signal will amplify the signal and highly increase the sensitivity. This enables to detect very low concentrations that are not detectable using the same technique without signal amplification. 
     In one embodiment of the device according to the present invention the membrane is attached by means of an adhesive to a supporting backing. Preferably an acrylic pressure sensitive adhesive as known in the art is used. 
     In another embodiment of the device according to the present invention the first and second gold conjugate pad are laminated between the sample pad and the membrane, wherein the two gold conjugates are separated by a divider. 
     In a preferred embodiment of the device according to the present invention the first  103 . 1  and second gold conjugate pad  103 . 2  are laminated between the sample pad  102  and the membrane  104 , wherein the two gold conjugates are separated by a divider  110  ( FIG. 1   b ). Preferably, the divider is an inert divider, more preferably the divider is a plastic divider 
     In another embodiment, the device according to the present invention the first gold conjugate pad is attached between the sample pad and the membrane while the second gold conjugate pad is within the upper part of the plastic housing to be released after sample application onto the nitrocellulose membrane directly. 
     In one preferred embodiment of the device according to the present invention the supporting backing is a plastic backing. 
     In another preferred embodiment of the device according to the present invention the membrane is nitrocellulose membrane. 
     In one embodiment of the device according to the present invention the first or second antibody is selected from the group comprising mouse anti-HIV p24, mouse anti-HBsAg, anti-hlgG, anti-Lipoarabinomannan, anti- H. Pylori  antigen, anti- Leishmania  antigen, anti-Pneumonia antigen, anti-Malaria antigen, anti-Chlamydia antigen, anti-Toxoplasma antigen, anti-Schistosoma antigen, HIV 1 antibody, and HIV 2 antibody. 
     In a preferred embodiment of the device according to the present the first or second antibody is a monoclonal or polyclonal antibody, preferably a monoclonal antibody. 
     In another embodiment of the device according to the present invention the first antigen is selected from the group comprising conjugate of HIV antigen, conjugate of hepatitis C antigen, HIV 1 antigen, HIV 2 antigen, Lipoarabinomannan,  H. Pylori  antigen, Toxoplasma antigen. 
     In a further embodiment of the device according to the present invention the control zone  109  comprises a non-specific capturing antibody and/or a non-specific antibody capturing protein. 
     In one preferred embodiment of the device according to the present invention the non-specific antibody is selected from the group consisting of anti-mouse IgG, anti-rabbit IgG, anti-goat IgG, anti-donkey IgG, Anti-sheep IgG, anti-HIV p24, anti-Lipoarabinomannan, anti- H. Pylori  antigen, anti- Leishmania  antigen, anti-Pneumonia antigen, anti-Malaria antigen, anti-Chlamydia antigen, anti-Toxoplasma antigen, anti-Schistosoma antigen, HIV 1 antibody, and HIV 2 antibody. 
     In another preferred embodiment of the device according to the present invention the non-specific capturing protein is either Protein A or Protein G. 
     In one embodiment of the device according to the present invention the device comprises at least one test strip according to the present invention. 
     In a preferred embodiment of the device according to the present invention the device comprises a housing comprising at least one test strip according to the present invention. 
     In another preferred embodiment of the device according to the present invention the housing comprises two, three, four, five, six, seven, eight, nine, or ten test strips. Preferably the housing comprises two, three, four, or five test strips, more preferably the housing comprises two or three test strips. 
     In one preferred embodiment of the device according to the present invention each test strip contains at least two antibodies or antigens, or at least one antibody and one antigen, wherein one of these antibodies or antigens is immobilized onto the membrane and the other one is conjugated with the first colloidal gold. In case of two antibodies, they have to be different to capture the target from two different sites. 
     In another aspect the present invention concerns a method for the production of a device according to the present invention, comprising the steps of
         c) preparing a colloidal gold solution;   d) preparing a conjugation buffer;   e) partitioning the conjugation buffer by dividing it into a first and a second flask;   f) adding an antibody according to the present invention to the conjugation buffer in the first flask;   g) adding colloidal gold solution into each flask;   h) adding stabilizing buffer to each flask;   i) concentrating each conjugate;   j) adding a surfactant to the first conjugate and soaking glass fibre sheet conjugate pad into the conjugate;   k) soaking another glass fibre sheet conjugate pad into the second conjugate;   l) printing sample and control lines onto the membrane;   m) laminating cards; and   n) cutting cards into strips.       

     In a preferred embodiment of the method according to the present invention the method further comprises the steps of
         a. preparing and adding oligonucleotides labelled BSA aqueous solution to the first flask;   b. preparing and adding complementary oligonucleotides labelled BSA aqueous solution to the conjugation buffer in the second flask;   wherein the solutions are added before step e) according to the method of the present invention.       

     In another preferred embodiment of the method according to the present invention the method further comprises the steps of
         a) preparing and adding aqueous solution comprising antibodies or antigens, wherein said antibodies are different from the antibody used in step d) according to the method of the present invention to the first flask;   b) preparing and adding aqueous solution comprising antibodies or antigens complementary to the antibodies or antigens used in step a) to the conjugation buffer in the second flask;   wherein the solutions are added before step e) according to the method of the present invention.       

     In another aspect the present invention relates to the use of a device according to the present invention for the detection of a disease in at least one sample. 
     In one preferred embodiment of the use according to the present invention the antibody in one sample (e.g. specimen) and the antigen in another sample (e.g. specimen) is detected. For example, in the case two test strips are used, Lipoarabinomannan-antigen can be detected in urine, while anti-lipoarabinomannan is detected in serum ( FIGS. 4   a  and  b ). 
     In another preferred embodiment of the use according to the present invention the antibody and antigen are detected in the same sample (specimen). For example, HIV antibodies and the HIV p24 antigen are detected in the same serum sample (specimen) using a device of two different strips ( FIGS. 5   a  and  b ). 
     In one embodiment of the use of the device according to the present invention the sample is obtained from a human. 
     In one preferred embodiment of the use of the device according to the present invention the sample is selected from the group comprising of whole blood, serum, plasma, saliva, and urine. 
     In another preferred embodiment of the use of the device according to the present invention the disease detected in said sample is selected from the group consisting of HIV, Hepatitis A, Hepatitis B, Hepatitis C,  H. Pylori, Leishmania , Schistosomiasis, Malaria, Pneumonia, Toxoplasmosis, Tubercolosis and Chlamydial infection. 
     In a further aspect the present invention refers to a kit for detection of a disease comprising the device according to the present invention and a manual. 
     In one preferred embodiment of the kit according to the present invention the kit further comprises an assay buffer. The assay buffer can be any buffer known in the art suitable for the use of whole blood samples. Preferably in the case of whole blood samples Tris buffer is used, more preferably 0.1M Tris buffer having a pH of 7.5 and comprising a preservative. Any preservative known by a person skilled in the art can be used, preferably sodium azide and even more preferably 0.01M sodium azide is used. 
     The following example illustrate the present invention without, however, limiting the same thereto. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         FIG. 1   a : shows top and side views of a typical rapid-flow immunochromatographic test device known in the art in the form of a test strip  101  comprising a sample pad  102 , a conjugate pad  103 , a membrane  104 , an absorbent pad  105 , an adhesive  106 , a supporting backing  107 , a test zone  108 , and a control zone  109 . 
         FIG. 1   b : shows top and side views of a preferred embodiment of a rapid-flow immunochromatographic test device according to the present invention in the form of a test strip  101  comprising a sample pad  102 , a first conjugate pad  103 . 1 , a second conjugate pad  103 . 2 , a membrane  104 , an absorbent pad  105 , an adhesive  106 , a supporting backing  107 , a test zone  108 , a control zone  109 , and the conjugates divider  110 . 
         FIG. 2 : shows the schematically view of a preferred embodiment of the first and second colloidal gold according to the present invention, wherein the first colloidal gold  201  is conjugated with an antibody  202  and four different oligonucleotides  203 ,  204 ,  205 ,  206  and wherein the second colloidal gold  211  is conjugated with four oligonucleotides complementary  203 ′,  204 ′,  205 ′,  206 ′ to the oligonucleotides of the first colloidal gold  201 . 
         FIG. 3 : shows the main principle of a preferred embodiment of the signal amplification according to the present invention. By the sample flow within the rapid immunochromatographic test the target in the sample  220  will be captured by the antibody  202  or antigen of the first colloidal gold  201  to form the complex “target-first colloidal gold”. This complex flows to the test zone  108 , where it will be captured by the other antibody or antigen that is immobilized onto the membrane  104  of the test zone  108  to form a sandwich detection. Then, the second colloidal gold  211  conjugated with the complementary oligonucleotides  203 ′,  204 ′,  205 ′,  206 ′ to the oligonucleotides of the first colloidal gold  203 ,  204 ,  205 ,  206  will be released and will bind to the first conjugate from the oligonucleotide (s) side and enhance the signal. 
         FIG. 4   a : shows an internal view of a preferred embodiment of the test device according to the present invention suitable to detect two different targets within the same sample (specimen) from the same person (patient). In this preferred embodiment the device comprises two test strips  101 . a  and  101 . b , wherein both test strips share the same sample pad  102 , the same humidity indicator  110  and the same absorbent pad  105 . Further each test strip  101 . a  and  101 . b  comprises its own gold conjugate  103 . a  and  103 . b , sample line  108 . a  and  103 . b  and control line  109 . a  and  109 . b.    
         FIG. 4   b : shows an internal view of a preferred embodiment of the test device according to the present invention suitable to detect two different targets within two different samples (specimens) from the same person (patient). In this preferred embodiment the device comprises two test strips  101 . a  and  101 . b , wherein each of these two strips comprises its own sample pad  102 . a  and  102 . b , gold conjugate  103 . a  and  103 . b , sample line  108 . a  and  103 . b , control line  109 . a  and  109 . b , humidity indicator  110 . a  and  110 . b , and absorbent pad  105 . a  and  105 . b.    
         FIG. 5   a : shows an external view of a preferred embodiment of a test device  501  according to the present invention suitable to detect two targets within the same sample (specimen) from the same person (patient). In this preferred embodiment the device  501  comprises a sample application window  502 , two test result windows  503 . a  and  503 . b , two control result windows  504 . a  and  504 . b , humidity indication window  505  and a patient ID area  506 . 
         FIG. 5   b : shows an external view of a preferred embodiment of a test device  501  according to the present invention suitable to detect two targets within two different samples (specimens) from the same person (patient). In this preferred embodiment the device  501  comprises two sample application windows  502 . a  and  502 . b , two test result windows  503 . a  and  503 . b , two control result windows  504 . a  and  504 . b , two humidity indication windows  505 . a  and  505 . b  and a patient ID area  506 . 
     
    
    
     EXAMPLES 
     Example 1 
     Preparation of Oligonucleotide- and Complementary Oligonucleotide Labeled Bovine Serum Albumin 
     5 mg of bovine serum albumin (BSA) was linked to each oligonucleotide and another 5 mg to the complementary oligonucleotide. Every oligonucleotide had a length of about 20 nucleotides having an amino group at the 5′ terminus. The procedure was performed according to the method described by Duncan et al. 1983 20  comprising the following steps: 
     
       
         
         
             
             
         
       
     
     Example 2 
     Preparation of an Preferred Embodiment of a Test Device According to the Present Invention 
     The oligonucleotide and complementary oligonucleotide linked BSA prepared as described in Example 1 are further processed according to a procedure comprising the following steps
         a) prepare oligonucleotide linked BSA solution, according to example 1 (solution 1);   b) prepare complementary oligonucleotide linked BSA solution, according to example 1 (solution 2);   c) prepare 1% aqueous solution of tetrachloroauric acid at room temperature;   d) prepare 4% trisodium citrate aqueous solution at room temperature;   e) prepare 0.05 M Potassium Carbonate aqueous solution at room temperature;   f) prepare 600 ml of phosphate stabilizing buffer of pH 7.4, containing BSA, Tween 20, Sucrose, polyvinylpurrolidone and a preservative, e.g. sodium azide, at room temperature;   g) prepare colloidal gold solution by reduction of 1.7 ml boiling tetrachloroauric acid solution (after dilution into 100 ml) using 1 ml trisodium citrate solution and let it takes the room temperature;   h) dilute the colloidal gold solution as 1:1 using distilled water. Adjust the pH to 7.4 using potassium carbonate solution at room temperature;   i) prepare 200 ml of phosphate conjugation buffer of pH 7.4 at room temperature;   j) partition the 200 ml conjugation buffer by dividing it into two flasks (100 ml of each);   k) add 0.5 mg of aqueous antibody (e.g. anti-hIgG or anti-p24) to the conjugation buffer in the first flask with stirring at room temperature;   l) add 0.5 mg of oligonucleotides labelled BSA aqueous solution (solution 1) to the first flask at room temperature;   m) add 1.0 mg of complementary oligonucleotides labelled BSA aqueous solution (solution 2) to the conjugation buffer in the second flask with stirring at room temperature;   n) add 100 ml colloidal gold solution into each flask with stirring at room temperature;   o) after about 45 minutes; add 200 ml of stabilizing buffer to each flask;   p) after about 20 minutes; concentrate each conjugate by cooled (temperature around 15° C.). high speed centrifugation (10,000 rpm for one hour);   q) discard the supernatant and re-suspend the concentrated conjugates using the stabilising buffer at room temperature;   r) adjust the concentration for each of the two conjugates to O.D. 520 =2.0;   s) add 0.1 ml of Tween 20 to the first conjugate and soak glass fibre sheet conjugate pad into the conjugate, then heat dry at temperature around 50° C.; and   t) soak another glass fiber sheet conjugate pad into the second conjugate, then heat dry at temperature around 50° C.       

     (* In case of antibodies/antigens and their specific antigens/antibodies there is no need for these steps of bovine serum albumin or any other protein labelling. ** Other proteins or peptides could be used other than bovine serum albumin). 
     Additionally, print sample (e.g. anti-HIV p24, 2 nd  clone) and control lines (e.g. anti-mouse IgG) onto nitrocellulose membrane, then heat dry at temperature around 50° C. 
     Finally, laminate cards according to the following procedure: 
     A. In Case of Conjugate Releasing Site Laminated within the Upper Side of the Device Plastic Housing 
     Lamination of cards using the first gold conjugate. Laminate card components onto the backing material with the sequence:
         1. laminate the nitrocellulose membrane nearly in the middle of the card;   2. laminate the absorbent pad in the end of the card (overlaps from the nitrocellulose membrane side);   3. laminate the first conjugate pad in the other side of the nitrocellulose membrane; and   4. laminate the sample pad.
 
B. In Case of Conjugate Releasing Site Laminated onto the Test Strip Itself Separated from the First Conjugate by a Divider
       

     Laminate card components onto the backing material with the sequence (see  FIG. 1   b ):
         1. laminate the nitrocellulose membrane nearly in the middle of the card;   2. laminate the absorbent pad in the end of the card (overlaps from the nitrocellulose membrane side);   3. laminate the first conjugate pad  103 . 1  in the other side of the nitrocellulose membrane  104 ;   4. laminate the plastic divider onto the first conjugate (overlaps from the nitrocellulose membrane side);   5. laminate the second conjugate pad onto the divider (overlaps from the nitrocellulose membrane side);   6. laminate the sample pad onto the other end of the card, the sample pad will overlaps with the two conjugate pads and; and   7. then cut cards into strips.       

     C. Alternatively 
     Lamination of the second gold conjugate could be applied within the plastic housing itself to ensure that the two conjugates will not propagate before release from the releasing pad and so stick within the releasing pad. 
     Example 3 
     HIV p24 Antigen Detection System 
     The first gold conjugate  103 . 1  is a conjugate of mouse anti-HIV p24, 1 st  clone (please note that the numbering of clones are only for explanation and to recognize that always two different clones of monoclonal antibodies were used; these two monoclonal antibodies capture the target antigen from two different sites, why they were called as a pair of monoclonal antibodies by the inventors) and four oligonucleotides, and the second gold conjugate is the conjugate of the four complementary oligonucleotides. The first conjugate releasing pad  103 . 1  is laminated on the test strip between the sample pad  102  and the nitrocellulose membrane  104  while the second  103 . 2  is above the first conjugate pad  103 . 1  separated by a divider  110  to be released directly toward the nitrocellulose membrane  104  without flow through the first conjugate pad  103 . 1  to avoid interact with the first conjugate before reaching the membrane  104  (see  FIG. 1   b ). The second conjugate releasing site  103 . 2  could be laminated within the upper side of the device plastic housing, whereas the plastic housing is the plastic design where the test strip is finally inserted. The sample line, more precisely the capture test zone  108 , is a mouse anti-HIV p24 2 nd  clone immobilized onto the nitrocellulose membrane  104 . The control line  109  is anti-mouse IgG. Sample  108  and control  109  lines turn into purple color in case of HIV p24 antigen availability in the sample; only the control line  109  turns into purple color in case of HIV p24 antigen free sample ( FIG. 1   b ). 
     At the moment there aren&#39;t any commercially available rapid tests sensitive enough for HIV p24 antigen detection in early stages of infection with concentrations less than 10 pg/ml while according to this system it is so simple to detect it. 
     Example 4 
     Hepatitis B Surface Antigen (HBsAg) Detection System 
     The first gold conjugate  201  is mouse anti-HBsAg (clone 1) and four oligonucleotides conjugated with colloidal gold conjugate, and the second gold conjugate  211  is the conjugate of the four complementary oligonucleotides. The first conjugate releasing pad  103 . 1  is laminated on the test strip between the sample pad  102  and the nitrocellulose membrane  104  while the second  103 . 2  is above the first conjugate pad  103 . 1  separated by a divider  110  to be released directly toward the nitrocellulose membrane  104  without flow through the first conjugate pad  103 . 1  to avoid interact with the first conjugate before reaching the membrane, ( FIG. 1   b ). The second conjugate releasing site  103 . 2  also could be laminated within the upper side of the device plastic housing. 
     The sample line  108  is mouse anti-HBsAg (clone 2) immobilized onto the nitrocellulose membrane  104 . The control line  109  is anti-mouse IgG. Sample  108  and control lines  109  turn into purple color in case of HBsAg availability in the sample; only the control line  109  turns into purple color in case of HBsAg free sample, see  FIG. 1   b.    
     The commercially available rapid tests sensitivity for Hepatitis B surface antigen is within the range 500-1000 pg/ml while according to this system it is so simple to detect less than 10 pg/ml. 
     Example 5 
     Human Immunodeficiency Virus (HIV) Antibodies Detection System 
     The first gold conjugate is mouse anti-human Immunoglobulin G (anti-hIgG) and four oligonucleotides conjugated with colloidal gold conjugate, and the second gold conjugate is the conjugate of the four complementary oligonucleotides. The first conjugate releasing pad  103 . 1  is laminated on the test strip between the sample pad  102  and the nitrocellulose membrane  104  while the second  103 . 2  is above the first conjugate pad  103 . 1  separated by a divider  110  to be released directly toward the nitrocellulose membrane  104  without flow through the first conjugate pad  103 . 1  to avoid interact with the first conjugate before reaching the membrane  104  ( FIG. 1   b ). The second conjugate releasing site  103 . 2  could be laminated within the upper side of the device plastic housing. 
     The sample line  108  is a combination of synthetic/recombinant HIV antigen immobilized onto the nitrocellulose membrane  104 . The control line  109  is anti-mouse IgG. Sample  108  and control  109  lines turn into purple color in case of HIV antibodies availability in the sample; only the control line  109  turns into purple color in case of HIV antibodies free sample, ( FIG. 1   b ). 
     According to this system it is so simple to detect very low titers of HIV antibodies in serum. 
     Example 6 
     Human Immunodeficiency Virus (HIV) Antibody/Antigen Detection System (the 4 th  Generation) 
     The system is a test device comprises a housing which comprises two test strips  101  as a combination of Examples 3 and 5, wherein each test strip  101  comprises at least one sample application site  102 , at least one test zone  108  and one control zone  109 . 
     According to this system it is so simple to detect very low titers of HIV antibodies parallel with the detection of very low concentrations of HIV p24 antigen and so early detection of HIV infection. 
     Example 7 
     Human Immunodeficiency Virus (HIV) Antibody Detection in Saliva 
     The system is the same as that in Example 5 with some modifications on the system due to the difference of samples composition and properties. Instead of the cellulose material (as used in urine detection strip) fiber glass material is used as a sample pad to increase the ability of movement of the viscose saliva sample. Due to the higher concentration of IgG in saliva compared to that of urine the concentration of the capture antibody/antigen on the nitrocellulose membrane for urinary detections is increased. In addition, the concentration of sample pad buffer used for the urinary detection is different from used for oral detection, i.e. it is about double of concentration in urinary detection systems. 
     According to this system it is so simple to detect very low titers of HIV antibodies in saliva. 
     Example 8 
     Human Immunodeficiency Virus (HIV) Antibody Detection in Urine 
     The system is the same as that in Example 5 and 7 with some modifications on the system due to the difference of samples composition and properties. According to this system it is so simple to detect very low titers of HIV antibodies in urine. 
     Example 9 
     Hepatitis C Virus (HCV) Antibody Detection in Saliva 
     The system is the same as that in Example 7 except the sample line that contains hepatitis C antigens instead of HIV antigens. According to this system it is so simple to detect very low titers of HCV antibodies in saliva. 
     Example 10 
     Hepatitis C Virus (HCV) Antibody Detection in Urine 
     The system is the same as that in Example 9 except the sample line that contains hepatitis C antigens instead of HIV antigens. According to this system it is so simple to detect very low titers of HCV antibodies in urine. 
     Example 11 
       H. Pylori  Antibody Detection in Urine 
     The system is the same as that in Examples 9 and 10 except the sample line that contains  H. Pylori  antigens instead of HIV or HCV antigens. According to this system it is so simple to detect very low titers of HCV antibodies in urine. 
     The features disclosed in the foregoing description, in the claims and/or in the accompanying drawings may, both separately and in any combination thereof, be material for realizing the invention in diverse forms thereof. 
     REFERENCES 
     
         
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