A dual-aptamer sandwich assay by detection of C-reactive protein in synovial fluid on an integrated microfluidic system for diagnosis of periprosthetic joint infection

Diagnosing periprosthetic joint infection (PJI) in equivocal cases is always challenging. Synovial fluid (SF) C-reactive protein (CRP) levels have been reported as a surrogate to improve the diagnosis accuracy. This study reported a new integrated microfluidic system (IMS) designed to detect SF-CRP at a dynamic range of 1–50 mg/L. The novel, magnetic bead-based, dual-aptamer assay with two CRP-specific aptamers, St1 and St2, enabled rapid and accurate CRP detection. This represents the first attempt to automatically perform the CRP dual-aptamer assay on a microfluidic chip quantifying CRP in SF with optical signals. CRP concentrations in fourteen clinical samples were accurately quantified by using the dual-aptamer assay on the developed IMS in an automatic format, suggesting the assay’s potential as a reliable diagnostic tool for SF-CRP detection and may serve as an armamentarium for PJI diagnosis. Notably, the assay was deemed superior to traditional enzyme-linked immunosorbent assay (ELISA) because it consumes a smaller amount of sample (only 40 μL), requires fewer reagents (only 50 μL of secondary detection aptamer and horseradish peroxidase), and provides quicker results (∼2 hours).