Multiplex lateral flow assay for differentiating bacterial infections from viral infections

Abstract

To provide improved lateral flow assays for detecting the presence and concentration of a plurality of analytes of interest in a sample, when a first analyte is present in the sample at a high concentration and a second, different analyte is present in the sample at a low concentration, including but not limited to a concentration that is one-millionth the high concentration.SOLUTION: Lateral flow assay devices, systems and methods described herein measure concentrations of a plurality of analytes of interest in a sample, and can determine precise concentrations of the plurality of analytes of interest, where one or more analytes of interest are present in the sample at high concentrations and where one or more analytes of interest are present at low concentrations. The precise concentration of each of the analytes can be determined when a single sample is applied to a single lateral flow assay in a single application, including the case a first analyte of interest is present in the single sample at one-millionth the concentration of a second analyte of interest in the single sample.SELECTED DRAWING: Figure 1A

Description

[Technical field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Provisional Application No. 62 / 622,877, filed Jan. 27, 2018, which is incorporated by reference in its entirety.

[0002] The present disclosure relates generally to lateral flow assay devices, test systems, and methods. More particularly, the present disclosure relates to a lateral flow assay device for determining the presence and concentration of multiple analytes in a sample, including when one or more analytes of interest are present at high concentrations and one or more analytes of interest are present at low concentrations. The exact concentration of each of the multiple analytes can be determined when a single sample is applied to a single lateral flow assay in a single application, including when a first analyte of interest is present in the single sample at a concentration one million times lower than a second analyte of interest in the single sample. [Background technology]

[0003] Immunoassay systems including lateral flow assays described herein provide reliable, inexpensive, portable, rapid, and simple diagnostic tests. Lateral flow assays can rapidly and accurately detect and potentially quantify the presence or absence of an analyte of interest in a sample. Advantageously, lateral flow assays are minimally invasive and can be used as point-of-care testing systems. Lateral flow assays have been developed to detect a wide variety of medical or environmental analytes. In a sandwich format lateral flow assay, a labeled antibody against the analyte of interest is applied on a test strip in or near the sample receiving zone. The labeled antibody may include, for example, a detection molecule or "label" attached to the antibody. When a sample is applied to the test strip, the analyte present in the sample is bound by the labeled antibody, which flows along the test strip to the capture zone, where the immobilized antibody against the analyte binds to the labeled antibody-analyte complex. The antibody immobilized on the capture line may be different from the labeled antibody applied in or near the sample receiving zone. The captured complex is detected to determine the presence of the analyte. In the absence of analyte, the labeled antibody flows along the test strip but passes through the capture zone. The lack of signal in the capture zone indicates the absence of analyte. Although multiplex assays can be developed to detect more than one analyte of interest present in a single sample applied to a lateral flow assay, such assays have many drawbacks, including cross-reactivity between antibodies and analytes of interest, the inability to use one optical reader to detect multiple analytes of interest applied to a single test strip during a single test event, and the inability to detect analytes of interest present in a single sample at significantly different concentrations. Typically, a sample with a high concentration of analyte must first be diluted to test for the presence or concentration of the high concentration analyte. Such dilution further reduces the concentration of any analyte of interest present in the sample at low concentrations, rendering the low concentration analyte undetectable.To date, multiplex lateral flow assays are not suitable for determining the amount and presence of multiple analytes in a sample where one or more analytes are present at high concentrations and one or more analytes are present at low concentrations. Summary of the Invention

[0004] Accordingly, one aspect of the present disclosure is to provide an improved lateral flow assay for detecting the presence and concentrations of multiple analytes of interest in a sample, where a first analyte is present in the sample at a high concentration and a second, distinct analyte is present in the sample at a low concentration, including but not limited to, at a concentration that is one millionth of the high concentration.

[0005] In one embodiment of the present disclosure, a method is provided for detecting a first analyte of interest and a second analyte of interest present in a sample at different concentrations. The method includes providing a lateral flow assay including a first complex coupled to a flow path of the lateral flow assay, the first complex including a label, an antibody or fragment thereof that specifically binds to the first analyte, and the first analyte. The lateral flow assay also includes a labeled second antibody or fragment thereof coupled to the flow path and configured to specifically bind to the second analyte. The lateral flow assay further includes a first capture zone downstream of the first complex, the first capture zone including a first immobilized capture agent specific to the first analyte. The lateral flow assay also includes a second capture zone downstream of the labeled second antibody or fragment thereof, including a second immobilized capture agent specific to the second analyte. The method also includes applying a sample to the first complex and a labeled second antibody or fragment thereof, and binding a second analyte to the labeled second antibody or fragment thereof to form a second complex. The method further includes flowing the fluid sample and the first complex through a first capture zone, where the first analyte and the first complex in the fluid sample compete to bind to the first immobilized capture agent in the first capture zone, and further includes flowing the second complex in the flow path through a second capture zone, where the second complex binds to the second immobilized capture agent in the second capture zone. The method also includes detecting a first signal from the first complex bound to the first immobilized capture agent in the first capture zone and a second signal from the second complex bound to the second immobilized capture agent in the second capture zone.

[0006] In another embodiment of the present disclosure, a lateral flow assay is provided that is configured to detect a first analyte of interest and a second analyte of interest present in a fluid sample at different concentrations, the lateral flow assay comprising: a first complex coupled to a flow path of the lateral flow assay, the first complex comprising a label, an antibody or fragment thereof that specifically binds to the first analyte, and the first analyte; a labeled second antibody or fragment thereof coupled to the flow path and configured to specifically bind to the second analyte; a first capture zone downstream of the first complex, the first capture zone comprising a first immobilized capture agent specific for the first analyte; and a second capture zone downstream of the labeled second antibody or fragment thereof, the second capture zone comprising a second immobilized capture agent specific for the second analyte.

[0007] In yet another embodiment of the present disclosure, an assay test strip is provided. The assay test strip includes a flow path configured to receive a fluid sample, a sample receiving zone coupled to the flow path, and a detection zone coupled to the flow path downstream of the sample receiving zone. The detection zone includes a first capture zone, a second capture zone, and a third capture zone. The first capture zone includes a first immobilized capture agent specific to a first analyte of interest, the second capture zone includes a second immobilized capture agent specific to a second analyte of interest, and the third capture zone includes a third immobilized capture agent specific to a third analyte of interest. The assay test strip also includes a first complex coupled to the flow path in a first phase and configured to flow through the flow path to the detection zone in the presence of the fluid sample in a second phase. The first complex includes a label, a first antibody or fragment thereof that specifically binds to the first analyte of interest, and the first analyte of interest. The assay test strip further comprises a labeled second antibody or fragment thereof that specifically binds to a second analyte of interest, the labeled second antibody or fragment thereof being configured to be bound to the flow path in a first phase and to flow through the flow path to the detection zone in the presence of a fluid sample in a second phase. The assay test strip also comprises a labeled third antibody or fragment thereof that specifically binds to a third analyte of interest, the third antibody or fragment thereof being configured to be bound to the flow path in a first phase and to flow through the flow path to the detection zone in the presence of a fluid sample in a second phase.

[0008] In yet another embodiment of the present disclosure, a diagnostic test system is provided that includes an assay test strip as described above, a reader including a light source and a detector, and a data analyzer.

[0009] In another embodiment of the present disclosure, a method for determining the presence or concentration of each of a plurality of analytes of interest in a fluid sample is provided. The method includes applying the fluid sample to the assay test strip described above, where the first complex, the labeled second antibody or fragment thereof, and the labeled third antibody or fragment thereof are each bound to the flow path in a first phase. The method also includes the steps of: binding the second analyte to the labeled second antibody or fragment thereof if the second analyte is present in the fluid sample, thereby forming a second complex; binding the third analyte to the labeled third antibody or fragment thereof if the third analyte is present in the fluid sample, thereby forming a third complex; separating the first complex, the second complex if formed, and the third complex if formed from the flow path; flowing the fluid sample to the detection zone in a second phase; and binding the first complex to the first immobilized capture agent in the first capture zone and forming a first complex. the binding of the second complex, if formed, to a second immobilized capture agent in the second capture zone, and the binding of the third complex, if formed, to a third immobilized capture agent in the third capture zone; detecting a first signal from the first complex bound to the first immobilized capture agent in the first capture zone; if a second complex is formed, detecting a second signal from the second complex bound to the second immobilized capture agent in the second capture zone; and if a third complex is formed, detecting a third signal from the third complex bound to the third immobilized capture agent in the third capture zone. [Brief description of the drawings]

[0010] [Figure 1A] 1 illustrates an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample includes a first analyte of interest, a second analyte of interest, and a third analyte of interest. [Figure 1B] 1 illustrates an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample includes a first analyte of interest, a second analyte of interest, and a third analyte of interest. [Figure 2A] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample does not contain the analyte of interest. [Figure 2B] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample does not contain the analyte of interest. [Figure 3A] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a first analyte of interest but not a second or third analyte of interest. [Figure 3B] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a first analyte of interest but not a second or third analyte of interest. [Figure 4A] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a second analyte of interest but not the first or third analytes of interest. [Figure 4B] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a second analyte of interest but not the first or third analytes of interest. [Figure 5A] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a third analyte of interest but does not contain the first or second analytes of interest. [Figure 5B] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a third analyte of interest but does not contain the first or second analytes of interest. [Figure 6A] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a first and a third analyte of interest, but not a second analyte of interest. [Figure 6B] 1 shows an exemplary lateral flow assay according to the present disclosure before and after a fluid sample is applied at a sample receiving zone, where the fluid sample contains a first and a third analyte of interest, but not a second analyte of interest. [Figure 7A] An exemplary dose-response curve for an exemplary lateral flow assay as shown in Figures 3A and 3B is shown where the fluid sample contains only C-reactive protein (CRP) at a concentration of up to 150 μg / mL, and the fluid sample does not contain any additional analytes such as TNF-related apoptosis-inducing ligand (TRAIL) or interferon-gamma-inducible protein 10 (IP-10). [Figure 7B] An exemplary dose-response curve for an exemplary lateral flow assay such as that shown in Figures 4A and 4B is shown where the fluid sample contains only IP-10 at a concentration of up to 1000 pg / mL, and where the fluid sample does not contain any additional analytes of interest such as TRAIL or CRP. [Figure 7C] An exemplary dose-response curve for an exemplary lateral flow assay such as that shown in Figures 5A and 5B is shown where the fluid sample contains only TRAIL at concentrations up to 500 pg / mL, and where the fluid sample does not contain any additional analytes of interest such as IP-10 or CRP. [Figure 8] 1 shows an exemplary lateral flow assay device according to the present disclosure, including a sample receiving zone and a detection zone, which may include an indication of the presence and / or concentration of multiple analytes, such as, but not limited to, CRP, IP-10, and TRAIL, in a fluid sample, including when one or more analytes of interest are present at high concentrations and when one or more analytes of interest are present at low concentrations. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] The devices, systems, and methods described herein accurately determine the amount or presence of multiple analytes of interest in a sample. The lateral flow devices, test systems, and methods of the present disclosure accurately determine the presence or amount of multiple analytes of interest in situations where one or more analytes of interest are present in the sample at elevated or high concentrations, and one or more analytes of interest are present in the sample at low concentrations. Advantageously, the lateral flow devices, test systems, and methods described herein determine the presence or amount of analytes of interest present in a single sample at significantly different concentrations after applying a single sample to a single lateral flow assay, such as a single test strip, in a single test event. Thus, the lateral flow assays described herein can simultaneously detect multiple analytes in a single sample, even when the analytes are present in significantly different concentration ranges.

[0012] The lateral flow assays described herein can use a combination of binding assays on a single test strip, including a combination of assays that detect one or more analytes present at high concentration and assays that detect one or more analytes present at low concentration. A single test strip of the lateral flow assays described herein can include a detection zone with a separate capture zone specific to each analyte of interest. For example, a sample can include three analytes of interest, namely a first analyte of interest, a second analyte of interest, and a third analyte of interest. Thus, the detection zone of the lateral flow assay will include three capture zones, namely a first capture zone specific to the first analyte of interest, a second capture zone specific to the second analyte of interest, and a third capture zone specific to the third analyte of interest.

[0013] In this non-limiting example, the first analyte of interest may be present in the sample at a high concentration, for example, but not limited to, in the range of 1-999 μg / ml. The lateral flow assays described herein may generate a maximum intensity signal in the first capture zone when the concentration of the first analyte of interest in the sample is zero. Increasing the concentration of the first analyte of interest may decrease the signal from a maximum intensity signal to a decreasing intensity signal, which may be correlated to the concentration of the first analyte of interest. In this example, the second and third analytes of interest may be present in the sample at a low concentration, for example, but not limited to, in the range of 1-999 pg / ml. The lateral flow assays described herein may generate signal intensities in the second and third capture zones, with the signal intensities increasing in correlation with increasing concentrations of the second and third analytes of interest, respectively. Thus, the lateral flow assays according to the present disclosure may detect high and low concentrations of analytes using a single assay, such as a single test strip.

[0014] The lateral flow assays according to the present disclosure can measure the presence and concentration of multiple analytes of interest present at significantly different concentrations in a single undiluted sample applied to a single lateral flow assay in a single test event. The ability to measure the presence and concentration of multiple analytes of interest at vastly different concentrations (including six orders of magnitude or even a million-fold difference in concentration) without diluting the sample provides a significant advantage. For example, the lateral flow assay embodiments described herein can measure analytes present in whole blood, venous blood, capillary blood, serum, and plasma samples that have not been diluted or pretreated prior to application to a lateral flow assay, such as a single lateral flow assay test strip.

[0015] Advantageously, embodiments of lateral flow assays allow for the simultaneous detection of low concentration analytes present in the same sample as high concentration analytes, even when the high concentration analyte has a large dynamic range (including, but not limited to, CRP, which may be present in the sample over a large dynamic range). Furthermore, the ability to simultaneously and accurately detect the concentrations of multiple analytes of interest present in a single sample at widely differing concentrations (on the order of parts per million) has great diagnostic advantages. In one non-limiting example of a lateral flow assay of the present disclosure, measurements of optical signals from a single test strip can be correlated with the presence or absence of a viral infection, bacterial infection, or infection in a patient.

[0016] Signals generated by assays according to the present disclosure are described herein in the context of optical signals generated by reflective labels (e.g., gold nanoparticle labels). Although embodiments of the present disclosure are described herein by reference to "optical" signals, it will be understood that the assays described herein can use any suitable material for labeling to generate a detectable signal, including, but not limited to, fluorescent latex bead labels that generate fluorescent signals, and magnetic nanoparticle labels that generate signals indicative of changes in a magnetic field associated with the assay.

[0017] According to the present disclosure, a lateral flow assay device includes a labeled antibody designed to detect a high concentration of an analyte in a sample, together with a labeled antibody designed to detect a low concentration of an analyte in the same sample. For example, the sample may include a high concentration of a first analyte of interest, a low concentration of a second analyte of interest, and a low concentration of a third analyte of interest. To detect a high concentration of the first analyte of interest, a first complex is first bound on the surface of the lateral flow assay test strip in a receiving or labeling zone, for example, on a conjugate pad. The first complex includes a label, a first antibody that specifically binds to the first analyte of interest, and the first analyte of interest. When the fluid sample is applied to the test strip, the first complex becomes unbound from the labeling zone and migrates with the fluid sample to a detection zone of the test strip that may include the first analyte of interest. The detection zone includes a capture zone specific for each analyte of interest, and thus includes a first capture zone for capturing the first analyte of interest, a second capture zone for capturing the second analyte of interest, and a third capture zone for detecting the third analyte of interest. The first complex and the first analyte of interest in the sample (if present) bind to the first capture agent in the first capture zone. The first capture agent only binds to the first complex when the first analyte of interest is not present in the sample, otherwise it competes with the first complex. Thus, a first signal having a maximum intensity is generated in the first capture zone when the first analyte of interest is not present in the sample. When the first analyte of interest is present in the sample at a low concentration, the first complex competes with a relatively small amount of the first analyte to bind to the first capture agent, resulting in a first signal that is the same or substantially equivalent (within a limited range of variance) to the first signal having a maximum intensity. When the first analyte of interest is present in the sample at a high concentration, the first complex competes with a relatively large amount of the first analyte to bind to the first capture agent, resulting in a first signal that is smaller than the first signal having a maximum intensity.

[0018] To detect a second analyte of interest (present in the sample at low concentration in this non-limiting example), a labeled second antibody that specifically binds to the second analyte of interest is first bound to the surface of the lateral flow assay test strip in the receiving or labeling zone, for example, on a conjugate pad. When a fluid sample is applied to the test strip, the labeled second antibody is released from the labeling zone and binds to the second analyte of interest to form a second complex. The second complex migrates with the fluid sample to the detection zone of the test strip. In the second capture zone, the second complex binds to a second capture agent specific to the second analyte of interest. As a result, a second signal is generated in the second capture zone when the second analyte of interest is present in the sample. If the second analyte of interest is not present in the sample (or is present at a level below detectable), the second complex is not formed (or less than a detectable amount of the second complex is formed), and therefore the second complex is not captured in the second capture zone (or a detectable amount of the second complex is not captured in the second capture zone). In this situation, the labeled second antibody migrates with the fluid sample to the detection zone of the test strip, but does not bind to the second capture agent in the second capture zone. As a result, no second signal is detected in the second capture zone. The signal intensity of the second signal correlates with the concentration of the second analyte of interest, and an increased signal intensity correlates with an increased concentration of the second analyte of interest in the sample.

[0019] Similarly, to detect a third analyte of interest (present in the sample at low concentration in this non-limiting example), a labeled third antibody that specifically binds to the third analyte of interest is first bound to the surface of the lateral flow assay test strip, for example, on a conjugate pad, in the receiving or labeling zone. When a fluid sample is applied to the test strip, the labeled third antibody is released from the labeling zone and binds to the third analyte of interest to form a third complex. The third complex migrates with the fluid sample to the detection zone of the test strip. The third complex binds to a third capture agent specific to the third analyte of interest in the third capture zone. As a result, a third signal is generated in the third capture zone if the third analyte of interest is present in the sample. If the third analyte of interest is not present in the sample (or is present below detectable levels), the third complex is not formed (or a detectable amount of the third complex is not formed), and therefore the third complex is not captured in the third capture zone (or a detectable amount of the third complex is not captured in the third capture zone). In this situation, the labeled third antibody migrates with the fluid sample to the detection zone of the test strip, but does not bind to the third capture agent in the third capture zone. As a result, no third signal is detected in the third capture zone. The signal intensity of the third signal correlates with the concentration of the third analyte of interest, and an increased signal intensity correlates with an increased concentration of the third analyte of interest in the sample.

[0020] The above description is intended to illustrate a situation where a fluid sample may include a first analyte of interest present at a high concentration, a second analyte of interest present at a low concentration, and a third analyte of interest present at a low concentration. Those skilled in the art will recognize that the examples are intended to be illustrative and that various modifications and variations may be employed in the lateral flow assays described herein. For example, a fluid sample may include only two analytes of interest, where the first analyte is present at a high concentration and the second analyte is present at a low concentration. Alternatively, a fluid sample may include three analytes of interest, where the first analyte of interest is present at a high concentration, the second analyte of interest is present at a high concentration, and the third analyte of interest is present at a low concentration. Furthermore, a fluid sample may include more than three (e.g., 4, 5, 6, 7, 8, 9, or 10) analytes of interest with various replicates for multiple analytes present at high concentration and multiple analytes present at low concentration. In each of the various iterations, the lateral flow assay is designed as described above to detect the amount and presence of both high concentration analytes and the amount and presence of low concentration analytes simultaneously and on a single lateral flow assay device.

[0021] Those skilled in the art will also recognize that high and low concentrations are relative terms, and the following non-limiting embodiments are intended to illustrate, rather than limit, the present disclosure. In some non-limiting implementations described below, a first "low concentration" analyte is present in a sample at a concentration one million times lower than a second, different "high concentration" analyte present in the same sample. Lateral flow assays according to the present disclosure can measure the presence and concentration of analytes present at different orders of magnitude, including, but not limited to, a first analyte at a concentration one, two, three, four, five, six, seven, eight, nine, and ten orders of magnitude higher than the concentration of the second, different analyte.

[0022] Without being bound to any particular theory, the operation of a first complex (including a label, a first antibody that specifically binds to a first analyte of interest, and a first analyte of interest) together with a second labeled antibody that specifically binds to a second analyte of interest, both bound to the label zone of a single lateral flow assay, for simultaneous detection and quantification of high and low concentration analytes of interest is described herein. Without being bound to any particular theory, the first complex is used to mask the portion of a conventional sandwich-type lateral flow assay dose-response curve where the signal is increasing (low concentration of the first analyte), thereby generating a first dose-response curve in the first capture zone that starts with a maximum intensity signal at zero concentration of the first analyte of interest and then remains relatively constant (low concentration of the first analyte) or decreases (high concentration of the first analyte). The second (or additional) labeled antibody that specifically binds to the second analyte of interest generates a second dose-response curve in the second capture zone that generates an increasing signal intensity with increasing concentration of the second analyte. The lateral flow assays of the present disclosure address the drawbacks associated with measuring multiple analytes of interest in a sample, particularly when one or more analytes of interest are present at high concentrations and one or more analytes of interest are present at low concentrations.

[0023] In some situations, for example, a fluid sample may contain multiple analytes of interest, with one or more analytes of interest present at high concentrations and one or more analytes of interest present at low concentrations. In particular, one or more analytes of interest may be present in the sample in amounts millions of times greater than the amount of one or more analytes of interest present at low concentrations. Previously, to address this issue, two or more separate tests were required to detect analytes present in a fluid sample at significantly different concentrations. For example, to detect high concentrations of analytes, the sample may be diluted to reduce the high concentrations of analytes in the sample to testable concentrations. Dilution of the sample requires an additional physical step of diluting the sample. In addition, dilution also requires an additional step of calculating the amount of analyte, which may result in more complex algorithms and affect the accuracy of the measured amount of analyte in the sample. Furthermore, dilution of the sample eliminates the ability to detect analytes present at low concentrations, as the dilution of the sample reduces the concentration of the analyte below the detectable range. Thus, a single sample having both high and low concentrations of analytes can be diluted to determine the concentration of a high analyte, but this same sample is not suitable for determining the concentration of a low analyte in a conventional multiplex assay.

[0024] To detect low concentration analytes, sandwich-type lateral flow assays can be used.Traditional sandwich-type lateral flow assays are not suitable, and in some cases are not possible, for accurately measuring the amount of high concentration analytes.Therefore, to detect both high and low concentration analytes present in a single sample, it has previously been necessary to apply the sample to multiple detection assays, each of which is specifically designed to detect the presence of a specific target analyte within a specific dynamic range of the target analyte.

[0025] In contrast, the lateral flow assays described herein are capable of determining the presence and / or amount of multiple analytes in a fluid sample in a single test (e.g., a single application of the fluid sample to a single lateral flow assay test strip), where one or more of the analytes of interest are present in high concentrations in the fluid sample and one or more of the analytes of interest are present in low concentrations in the fluid sample.

[0026] The lateral flow assays described herein include further advantageous features. For example, the signals generated when the first analyte is at high concentration are easily detectable (e.g., they have intensities within the range of optical signals that conventional readers typically distinguish, and are well spaced), do not overlap on a dose-response curve with signals generated when the first analyte is at zero or low concentrations, and can be used to calculate highly accurate concentration readings at high and even very high concentrations. In some advantageous embodiments, the intensity level of the signal generated when the first analyte is present at high concentrations does not overlap with the intensity level of the signal generated when the first analyte is present at low concentrations.

[0027] The lateral flow assay embodiments described herein are particularly advantageous in diagnostic testing of multiple analytes of interest, where the relative concentrations of the multiple analytes of interest are indicative of a disease state: when one analyte of interest is present at a concentration above the normal or healthy state, while the other analytes of interest are unchanged compared to the normal or healthy state, a diagnosis of a particular disease state can be determined with confidence.

[0028] Examples of analytes that can be detected and measured by the disclosed lateral flow assay devices, test systems, and methods include, but are not limited to, the following proteins: TRAIL, CRP, IP-10, PCT, and MX1. Embodiments of the present disclosure can measure either the soluble and / or membrane forms of TRAIL protein. In one embodiment, only the soluble form of TRAIL is measured.

[0029] Various aspects of the device, test system, and method are described in more detail below with reference to the accompanying drawings. However, the present disclosure can be embodied in many different forms. Based on the teachings herein, a person skilled in the art should understand that the scope of the present disclosure is intended to encompass any aspect of the device, test system, and method disclosed herein, regardless of whether it is implemented independently or in combination with any other aspect of the present disclosure. For example, the device may be implemented or the method may be implemented using any number of the aspects described herein.

[0030] Although specific aspects are described herein, many variations and permutations of these aspects are within the scope of the disclosure. Although some benefits and advantages are described, the scope of the disclosure is not intended to be limited to specific benefits, applications, or purposes. Rather, the aspects of the disclosure are intended to be broadly applicable to different detection techniques and device configurations, some of which are shown as examples in the figures and the following description. The detailed description and drawings are merely illustrative rather than limiting of the disclosure, the scope of the disclosure being defined by the appended claims and their equivalents.

[0031] A lateral flow device as described herein is an analytical device used in lateral flow chromatography. A lateral flow assay is an assay that can be performed on a lateral flow device as described herein. A lateral flow device may be implemented on a test strip, although other forms may be suitable. In a test strip format, a test fluid sample suspected of containing an analyte flows through the strip (e.g., by capillary action). The strip may be made from bibulous materials such as paper, nitrocellulose, and cellulose. The fluid sample is received in a sample reservoir. The fluid sample is allowed to flow along the strip to a capture zone where the analyte (if present) interacts with a capture agent to indicate the presence, absence, and / or amount of the analyte. The capture agent may include an antibody immobilized in the capture zone.

[0032] Lateral flow assays can be performed in a sandwich format. Although the sandwiches and assays described herein are described in the context of a reflectance label (such as a gold nanoparticle label) that generates an optical signal, it will be understood that the assay can include a latex bead label configured to generate a fluorescent signal, a magnetic nanoparticle label configured to generate a magnetic signal, or any other label configured to generate a detectable signal. A sandwich-type lateral flow assay includes a labeled antibody attached to a sample reservoir on a solid substrate. After the sample is applied to the sample reservoir, the labeled antibody dissolves in the sample, and then the antibody recognizes and binds to a first epitope on an analyte in the sample to form a label-antibody-analyte complex. This complex flows along the liquid surface from the sample reservoir through the solid substrate to a capture zone (sometimes called a "test line") where an immobilized antibody (sometimes called a "capture agent") is located. If the analyte is multimeric or contains multiple identical epitopes on the same monomer, the labeled antibody attached to the sample reservoir can be the same as the antibody immobilized in the capture zone. The immobilized antibody recognizes and binds to an epitope on the analyte, thereby capturing the label-antibody-analyte complex at the capture zone. The presence of the labeled antibody in the capture zone provides a detectable light signal in the capture zone. In one non-limiting example, gold nanoparticles are used to label the antibody because they are relatively inexpensive, stable, and provide an easily observable color indication based on the surface plasmon resonance properties of gold nanoparticles. In some cases, this signal provides qualitative information, such as whether the analyte is present in the sample. In some cases, this signal provides quantitative information, such as a measurement of the amount of analyte in the sample.

[0033] Lateral flow assays can provide qualitative information, such as information regarding the presence or absence of an analyte of interest in a sample. For example, detection of any measurable optical signal in the capture zone can indicate that the analyte of interest is present in the sample (in some unknown amount). The absence of a measurable optical signal in the capture zone can indicate that the analyte of interest is not present in the sample or is below the detection limit. For example, if the sample does not contain the analyte of interest, the sample still solubilizes the labeling agent, and the labeling agent still flows to the capture zone. However, the labeling agent does not bind to the capture agent in the capture zone. Instead, it flows through the capture zone, through the control line (if present), and possibly to the optional absorption zone. Some labeling agents bind to control agents deposited on the control line and emit detectable optical signals. In these circumstances, the absence of a measurable optical signal emitted from the capture zone indicates that the analyte of interest is not present in the sample, and the presence of a measurable optical signal emitted from the control line indicates that the sample has migrated from the sample receiving zone through the capture zone to the capture line as intended during normal operation of the lateral flow assay.

[0034] Some lateral flow devices can provide quantitative information, such as a measurement of the amount of an analyte of interest in a sample. In particular, lateral flow assays can provide reliable quantification of an analyte when the analyte is present at low concentrations. The quantitative measurement obtained from a lateral flow device can be the concentration of the analyte present in a given volume of sample, obtained using a dose-response curve that correlates the intensity of the signal detected in the capture zone with the concentration of the analyte in the sample. Examples of signals include optical signals, fluorescent signals, and magnetic signals. In a sandwich-type lateral flow assay, if the sample does not contain the analyte of interest, the concentration of the analyte in the sample is zero, and the analyte does not bind to the labeling agent to form a label-antibody-analyte complex. In this situation, there is no complex that flows into the capture zone and binds to the capture antibody. Therefore, no detectable optical signal is observed in the capture zone, and the magnitude of the signal is zero.

[0035] As the analyte concentration in the sample increases, a signal is detected. This occurs because as the analyte concentration increases, the formation of the label-antibody-analyte complex increases. The capture agent immobilized in the capture zone binds to the increasing complex that flows into the capture zone, resulting in an increase in the signal detected at the capture zone. Such an assay provides reliable quantification of the analyte when it is present at low concentrations.

[0036] However, the above-mentioned assays suitable for quantifying a target analyte present at low concentrations are not suitable for quantifying a target analyte present at high concentrations. In such cases, the concentration of the analyte may exceed the amount of labeling agent available to bind to the analyte, resulting in an excess of analyte. In such a situation, the excess analyte that is not bound to the labeling agent competes with the label-antibody-analyte complex to bind to the capture agent in the capture zone. The capture agent in the capture zone binds to the unlabeled analyte (in other words, the analyte that is not bound to the labeling agent) and the label-antibody-analyte complex. However, the unlabeled analyte that binds to the capture agent does not emit a detectable signal. As the concentration of the analyte in the sample increases, the amount of unlabeled analyte that binds to the capture agent (instead of the labeled antibody-analyte complex that emits a detectable signal) increases. As more unlabeled analyte binds to the capture agent instead of the labeled antibody-analyte complex, the signal detected in the capture zone decreases.

[0037] This phenomenon, where the detected signal initially increases at low concentrations and decreases at high concentrations, is called the "hook effect." As the concentration of analyte increases, more analyte binds to the labeling agent, resulting in an increase in signal intensity. At saturation concentrations, the labeling agent is saturated with analyte from the sample (e.g., the available amount of labeling agent is all or nearly all bound to analyte from the sample) and the detected signal reaches a maximum signal intensity. As the concentration of analyte in the sample continues to increase beyond the maximum signal intensity, the detected signal decreases because excess analyte beyond the labeled reagent saturation point competes with the labeling agent-analyte to bind to the capture agent.

[0038] The hook effect, also known as the "prozone effect," adversely affects lateral flow assays, especially in situations where the analyte of interest is present in high concentrations in the sample. The hook effect can lead to inaccurate test results. For example, the hook effect can result in false negative or inaccurately low results. Specifically, inaccurate results occur when a sample contains high levels of analyte that exceed the concentration of the labeling agent attached to the test strip. In this scenario, when the sample is placed on the test strip, the labeling agent is saturated and all of the analyte is not labeled. The unlabeled analyte flows through the assay, binds in the capture zone, and competes with the labeled complex, thereby reducing the detectable signal. Thus, a single detection signal corresponds to both low and high concentrations, and the device (or the device operator) cannot distinguish whether the optical signal corresponds to a low or high concentration. If the level of analyte is large enough, the analyte will completely compete with the labeled complex and no signal will be observed in the capture zone, resulting in a false negative test result.

[0039] Example of a lateral flow device that accurately quantifies multiple analytes present in a single sample at both high and low concentrations The lateral flow assays, test systems, and methods described herein address these and other shortcomings of multiplex sandwich-type lateral flow assays. Figures 1A-6B show an exemplary lateral flow assay capable of accurately measuring the amount of multiple analytes of interest, where one or more analytes of interest are present at high concentrations and one or more analytes of interest are present at low concentrations in a single sample. Figures 7A-7C provide exemplary dose-response curves that graphically illustrate the optical signals measured from the lateral flow assays described herein, and in particular provide the relationship between the magnitude of the optical signal detected at the capture zone (measured along the y-axis) and the concentration of the analyte in the sample applied to the assay (measured along the x-axis). Although the assays according to the present disclosure are described in the context of reflective labels that generate an optical signal, it will be understood that the assays according to the present disclosure may include labels of any suitable material configured to generate a fluorescent signal, a magnetic signal, or any other detectable signal.

[0040] The lateral flow assay devices, systems, and methods described herein can detect the presence and determine the concentration of multiple analytes in a sample, where one or more analytes are present at high concentrations and one or more analytes are present at low concentrations. In some embodiments, a first analyte of interest in a sample that is present at high concentrations may be present in an amount that is 10, 9, 8, 7, 6, 5, 4, 3, 2, 1, 500,000, 100, 500, 100, or 10 times greater than the amount of a second, different analyte of interest that is also present in the sample but at low, very low, or extremely low concentrations. In some cases, the second analyte of interest is present in a minute amount in a given volume of fluid sample compared to the first analyte of interest. For example, a high concentration analyte may be present in an amount of 10 to 100 μg / mL (10 million to 100 million pg / mL), while a low concentration analyte may be present in an amount of 10 to 100 pg / mL.

[0041] An exemplary lateral flow assay 101 shown in Figures 1A-6B includes a test strip having a sample receiving zone 110, a labeling zone 120, and a detection zone 130, the detection zone including a first capture zone 135, a second capture zone 133, and a third capture zone 131. Figures 1A and 1B show the lateral flow device 101 before and after a fluid sample 111 is applied to a sample reservoir 110, the fluid sample including a first analyte of interest 112, a second analyte of interest 113, and a third analyte of interest 114. In the illustrated example, the labeling zone 120 is downstream of the sample receiving zone 110 along the direction of sample flow within the test strip. In some cases, the sample receiving zone 110 is located within the labeling zone 120 and / or is coextensive with the labeling zone 135. A first capture agent 136 is immobilized within the first capture zone, a second capture agent 134 is immobilized within the second capture zone 133, and a third capture agent 132 is immobilized within the third capture zone 131.

[0042] In an embodiment of the present disclosure, a first complex 121 is bound on the label zone 120. The first complex 121 includes a label 124, a first antibody that specifically binds to a first analyte of interest 112, and the analyte of interest 112. A second labeled antibody 123 is bound on the label zone 120. The second labeled antibody 123 includes a label 124 and a second antibody that specifically binds to a second analyte of interest 113. A third labeled antibody 122 is bound on the label zone 123. The third labeled antibody 122 includes a label 124 and a third antibody that specifically binds to a third analyte of interest 114. As shown in FIGS. 1A-6B, the label 124 is the same for each of the first complex 121, the second labeled antibody 123, and the third labeled antibody 122. It is understood that the label 124 may be the same for each of the first complex 112, the second labeled antibody 123, and the third labeled antibody 122. Alternatively, the label may be different for each of the first complex 121, the second labeled antibody 123, and the third labeled antibody 122. Thus, the label may provide the same or different optical signals for each of the multiple analytes of interest. The label may be a reflectance label that generates an optical signal, a latex bead label configured to generate a fluorescent signal, a magnetic nanoparticle label configured to generate a magnetic signal, or any other label configured to generate a detectable signal.

[0043] For example, the label can be any substance, compound, or particle that can be detected by visual, fluorescent, radiological, or instrumental means. The label can be, for example, a pigment manufactured as a dye or ink, such as Brilliant Blue, 3132 Fast Red 2R, and 4230 Malachite Blue Lake. The label can be, for example, a particulate label, such as blue latex beads, gold nanoparticles, colored latex beads, magnetic particles, carbon nanoparticles, selenium nanoparticles, silver nanoparticles, quantum dots, upconversion fluorophores, organic fluorophores, textile dyes, enzymes, or liposomes.

[0044] In some cases, the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 are formed and applied to the test strip prior to use of the test strip by an operator. For example, the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 may be bound to the label zone 120 during manufacture of the test strip. In another example, the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 are bound to the label zone 120 after manufacture but prior to application of the fluid sample 111 to the test strip. The first complex 121, the second labeled antibody 123, and the third labeled antibody 122 may be bound to the test strip in a number of ways, which are discussed in more detail below.

[0045] Thus, in embodiments of the lateral flow device of the present disclosure, the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 are formed and bound on the test strip before any fluid sample 111 is applied to the lateral flow device 101. In one non-limiting embodiment, the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 are formed and bound on the conjugate pad of the test strip before any fluid sample 111 is applied to the lateral flow device 101. Furthermore, in embodiments of the lateral flow device of the present disclosure, the analyte in the first complex 121 is not an analyte from the fluid sample 111.

[0046] To perform a test using the test strip 101, a sample 111 having a first analyte of interest 112, a second analyte of interest 113, and a third analyte of interest 114 is deposited on the sample receiving zone 110, as shown in Figures 1A and 1B. In the illustrated embodiment, where the labeling zone 120 is downstream of the sample receiving zone 110, the first analyte of interest 112, the second analyte of interest 113, and the third analyte of interest 114 in the sample 111 flow into the labeling zone 120 and contact the bound first complex 121, the second labeled antibody 123, and the third labeled antibody 122. The sample 111 solubilizes the first complex 121, the second labeled antibody 123, and the third labeled antibody 122. In one non-limiting example, the sample 111 dissolves the first complex 121, the second labeled antibody 123, and the third labeled antibody 122. The bonds that held the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 to the surface of the test strip in the label zone 120 are released and the first complex 121, the second labeled antibody 123, and the third labeled antibody 122 are no longer bound to the surface of the test strip. The second labeled antibody 123 binds to a second analyte of interest 113 in the sample forming a second complex, and the third labeled antibody 122 binds to a third analyte of interest 114 in the sample forming a third complex.

[0047] The first complex 121, the second complex, and the third complex, along with the first analyte 112 (unbound) in the sample 111, migrate along the fluid surface to the detection zone 130. A first capture agent 136 in the first capture zone 135 binds the first complex 121 and the first analyte 112 from the sample 111. A second capture agent 134 in the second capture zone 133 binds the second complex, and a third capture agent 132 in the third capture zone 131 binds the third complex.

[0048] In an embodiment of the present disclosure, depending on the amount of the first analyte 112 in the sample 111, the first complex 121 and the first analyte 112 compete with each other for binding to the first capture agent 136 in the first capture zone 135. A first detectable signal is detected in the first capture zone 135, where the first detectable signal decreases from a maximum intensity signal in the presence of the first analyte of interest 112 in the sample, because the first analyte of interest 112 competes with the first complex 121 for binding to the first capture agent 136 in the first capture zone. Conversely, a second detectable signal is detected in the second capture zone 133, where the intensity increases with increasing concentration of the second analyte of interest 113 in the sample, because the second analyte of interest 113 forms a second complex that emits a detectable signal in the second capture zone 133. Similarly, a third detectable signal is detected at the third capture zone 131, and the intensity of the third detectable signal increases with increasing concentration of the third target analyte 114 in the sample, as the third target analyte 114 forms a third complex that emits a detectable signal at the third capture zone 131.

[0049] Thus, a lateral flow device according to the present disclosure includes a first complex comprising a label, a first antibody that specifically binds to a first analyte of interest, and a first analyte of interest, a second labeled antibody that specifically binds to a second analyte of interest, and a third labeled antibody that specifically binds to a third analyte of interest, each of which binds to a label zone of the lateral flow device in a first phase (e.g., before a fluid sample is applied to the lateral flow device) and then migrates through the test strip in a later second phase (e.g., when a fluid sample is applied to the sample receiving zone). The first complex can bind to a first capture agent in the first capture zone, the second complex can bind to a second capture agent in the second capture zone, and the third complex can bind to a third capture agent in the third capture zone in a third phase (e.g., after the fluid sample flows to the detection zone). Thus, the first complex, second labeled antibody, and third labeled antibody described herein may be initially disposed in a first region of the lateral flow device (such as a labeling zone) and then (upon contact with a fluid) migrate with the fluid to other regions of the lateral flow device downstream from the first region, and then bind to a capture agent in the capture zone.

[0050] As described above, the fluid sample 111 solubilizes the first complex 121, the second labeled antibody 123, and the third labeled antibody 122. In one embodiment, the first analyte of interest 112 in the sample 111 does not interact or does not substantially interact with the first complex 121 during this process. Without being bound to a particular theory, in this embodiment of the lateral flow device described herein, the first analyte of interest 112 does not conjugate, bind, or associate with the first complex 121 as the sample 111 flows through the label zone 120. In another embodiment of the lateral flow device described herein, the first analyte of interest 112 in the sample 111 interacts with the first complex 121 as the fluid sample 111 solubilizes the first complex 121. In one non-limiting example, without being bound to a particular theory, at least a portion of the first analyte of interest 112 in the sample 111 exchanges with the first analyte present in the first complex 121. Without being bound to a particular theory, in this embodiment, the first capture agent 136 in the first capture zone 135 may bind to at least a portion of the first complex 121, where the analyte in the first complex 121 is the first analyte of interest 112 that was introduced to the device 101 via the sample 111.

[0051] As shown in Figures 2A and 2B, when the first analyte of interest 112, the second analyte of interest 113, and the third analyte of interest 114 are not present in the fluid sample 111 (or are present below detectable levels), the first complex 121 saturates the first capture agent 136 in the first capture zone 135 (e.g., all molecules of the first capture agent 136 in the first capture zone 135 bind to one first complex 121 shed from the label zone 120). Since no second complex is formed in the absence of the second analyte of interest 113, the second capture agent 134 in the second capture zone 133 does not bind to any second complex. In a situation where the second analyte of interest 113 is present below detectable levels, no detectable amount of the second complex is formed. In the absence of the third analyte of interest 114, no third complex is formed, so the third capture agent 132 in the third capture zone 131 does not bind to any third complex. In a situation where the third analyte of interest 114 is present below detectable levels, no detectable amount of the third complex is formed. The first complex 121 captured in the first capture zone 135 emits a first detectable light signal, which is the maximum intensity signal obtainable from the first capture zone 135 of the lateral flow device 101. In a scenario where the first analyte of interest 112 is not present in the sample 111 (or is below detectable levels), the first light signal detected in the first capture zone 135 is the maximum intensity signal in the first capture zone. This is because all the first capture agents 136 available in the first capture zone 135 are bound to the first complex 121. If the second analyte of interest 113 is not present (or is at or below detectable levels), then the second complex is not formed (or a detectable amount of the second complex is not formed), and therefore the second capture agent 134 does not capture any second complex (or a detectable amount of the second complex), and no detectable second signal is observed. Similarly, if the third analyte of interest 114 is not present (or is at or below detectable levels), then the third capture agent 132 does not capture any third complex (or a detectable amount of the third complex), and therefore no detectable third signal is observed.

[0052] 3A-3B show an example of a lateral flow assay in which only a first analyte of interest 112 is present in a fluid sample 111, while a second analyte of interest 113 and a third analyte of interest 114 are absent or present at below detectable levels in the fluid sample 111. In this example, the first analyte of interest 112 competes with a first complex 121 for binding to a first capture agent 136 at a first capture zone 135. As a result, as the concentration of the first analyte of interest 112 increases in the sample 111, an increasing amount of the first analyte of interest 112 binds to the first capture agent 136 at the first capture zone 135. Because the first target analyte 112 does not emit a detectable signal, and because a small amount of the first complex 121 binds to the first capture agent 136 in the first capture zone 135 in the presence of the first complex 121, the first detectable signal is reduced compared to the maximum signal intensity observed when the first target analyte 112 is not present in the sample 111.

[0053] An exemplary dose-response curve representing the exemplary lateral flow assay of Figures 3A and 3B is shown in Figure 7A. In Figure 7A, the signal intensity for the first analyte of interest detected in the first capture zone (here, the signal intensity measured from the first capture zone configured to bind CRP is plotted as a square) decreases as the concentration of the first analyte of interest in the sample increases. In contrast, the second signal for the second analyte of interest (here, the signal intensity measured from the second capture zone configured to bind IP-10 is plotted as a triangle) and the third signal for the third analyte of interest (here, the signal intensity measured from the third capture zone configured to bind TRAIL is plotted as a circle) do not increase due to the absence (or below detectable levels) of the second and third analytes of interest in the sample.

[0054] 4A-B show an exemplary lateral flow assay in which only the second analyte of interest 113 is present in the fluid sample 111, while the first analyte of interest 112 and the third analyte of interest 114 are absent or present at below detectable levels in the fluid sample 111. In this example, the second analyte of interest 113 binds to a second labeled antibody 123 that specifically binds to the second analyte of interest 113, forming a second complex. The second complex flows with the fluid sample 111 to the detection zone 130, where the second complex is bound by a second capture agent 134 in a second capture zone 133. A second detectable signal is emitted from the bound second complex in the second capture zone 133, indicating the presence of the second analyte of interest 113 in the fluid sample 111. As the concentration of the second analyte of interest 113 increases in the sample 111, the intensity of the second detectable signal emitted from the second complex bound in the second capture zone 133 increases.

[0055] An exemplary dose-response curve representing the exemplary lateral flow assay of Figures 4A and 4B is shown in Figure 7B. In Figure 7B, the signal intensity of the second analyte of interest (here, the signal intensity measured from the second capture zone configured to bind IP-10 is plotted as triangles) increases with increasing concentration of the second analyte of interest in the sample. The signal intensity of the first analyte of interest (here, the signal intensity measured from the first capture zone configured to bind CRP is plotted as squares) remains at or substantially at a maximum value (about 70 AU (arbitrary signal intensity units) in this example) for all concentrations of the second analyte of interest, indicating that the first analyte of interest is not present (or is below detectable levels) in the sample. The signal intensity of the third analyte of interest (here, the signal intensity measured from the third capture zone configured to bind TRAIL is plotted as circles) does not increase, indicating that the third analyte of interest is not present (or is below detectable levels) in the sample.

[0056] 5A-5B show an exemplary lateral flow assay in which only a third analyte of interest 114 is present in the fluid sample 111, while a second analyte of interest 113 and a first analyte of interest 112 are absent or present at below detectable levels in the fluid sample 111. In this example, the third analyte of interest 114 binds to a third labeled antibody 122 that specifically binds to the third analyte of interest 114, forming a third complex. The third complex flows with the fluid sample 111 to a detection zone 130, where the third complex is bound by a third capture agent 132 in a third capture zone 131. A third detectable signal is emitted from the bound third complex in the third capture zone 131, indicating the presence of the third analyte of interest 114 in the fluid sample 111. As the concentration of the third analyte of interest 114 increases in the sample 111, the intensity of the third detectable signal emitted from the bound third complex in the third capture zone 131 increases.

[0057] An exemplary dose-response curve representing the exemplary lateral flow assay of Figures 5A and 5B is shown in Figure 7C. In Figure 7C, the signal intensity of the third analyte of interest (here, the signal intensity measured from the third capture zone configured to bind TRAIL plotted as circles) increases with increasing concentrations of the third analyte of interest in the sample. The signal intensity of the first analyte of interest (here, the signal intensity measured from the first capture zone configured to bind CRP plotted as squares) remains at or substantially at a maximum value (in this example, about 70 AU for all concentrations of the third analyte of interest), indicating that the first analyte of interest is not present (or is below detectable levels) in the sample. The signal intensity of the second analyte of interest (here, the signal intensity measured from the second capture zone configured to bind IP-10 plotted as triangles) does not increase, indicating that the second analyte of interest is not present (or is below detectable levels) in the sample.

[0058] 6A-6B show an exemplary lateral flow assay in which only a first analyte of interest 112 and a second analyte of interest 113 are present in a fluid sample 111, but a third analyte of interest 114 is absent or present at below detectable levels in the fluid sample 111. This exemplary lateral flow assay is a combination of FIGS. 3A-3B and 4A-4B, illustrating an iteration in which more than one analyte of interest may be present, but not all of the analytes of interest are present (not necessarily at detectable levels). In this example, a first analyte of interest 112 in the sample competes with a first complex 121 for binding to a first capture agent 136 in a first capture zone 135 in the manner described above with reference to FIGS. 3A-3B. The first detectable signal detected at the first capture zone 135 decreases from a maximum signal intensity as the concentration of the first analyte of interest 112 increases, indicating the presence and amount of the first analyte of interest 112 in the fluid sample 111. At or near the same time, the second analyte of interest 113 binds to the second labeled antibody 123 in the label zone and forms a second complex. The second complex flows to the detection zone and binds to the second capture agent 134 at the second capture zone 133. The second detectable signal increases as the concentration of the second analyte of interest 113 increases, indicating the presence and amount of the second analyte of interest 113 in the fluid sample 111.

[0059] 1A-6B show the first capture zone 135, the second capture zone 133, and the third capture zone 131 arranged perpendicular to the longitudinal axis of the test strip, with the first capture zone 135 furthest from the sample receiving zone 110 and the third capture zone 131 closest to the sample receiving zone 110. In this non-limiting example, the first complex 121 will flow through the third capture zone 131 and the second capture zone 133 before reaching the first capture zone 135 and binding to the first capture agent 136 immobilized in the first capture zone 135. These figures are illustrative and various iterations, variations, and modifications can be realized. The relative positions of the first capture zone 135, the second capture zone 133, and the third capture zone 131 may be different from that depicted in FIG. 1A-6B such that the fluid sample 111 flows through the capture zones in a different order than depicted. For example, the first capture zone, second capture zone, and third capture zone may be arranged perpendicular to the longitudinal axis of the test strip in various orders (e.g., 3, 2, 1; 3, 1, 2; 1, 2, 3; 1, 3, 2; 2, 1, 3; or 2, 3, 1). Additionally, the capture zones may be arranged parallel to, rather than perpendicular to, the longitudinal axis of the test strip such that each capture zone is equidistant from the sample receiving zone.

[0060] There are many ways to determine the maximum intensity signal of the first capture zone 135 of the lateral flow device 101. In one non-limiting example, the maximum intensity signal obtained from a particular first capture zone 135 of the lateral flow device 101 can be empirically determined and stored in a look-up table. In some cases, the maximum intensity signal is determined empirically by testing a lateral flow device 101 of known characteristics and construction, for example, by averaging the maximum intensity signals obtained when a sample with zero or near-zero concentration of the first analyte of interest is applied to a lateral flow device 101 of known specifications and construction. In another non-limiting example, the maximum intensity signal obtained from a particular first capture zone 135 of the lateral flow device 101 can be determined using theoretical calculations given the known specifications and construction of the lateral flow device 101 (e.g., the amount and particular characteristics of the first complex 121 bound on the label zone 120).

[0061] Further, although reference is made herein to a "maximum intensity signal," it will be understood that a signal that is within a certain range of the expected maximum intensity can be considered substantially equivalent to the "maximum intensity signal." Further, it will be understood that a "maximum intensity signal" can refer to a maximum intensity light signal, a maximum intensity fluorescent signal, a maximum intensity magnetic signal, or any other type of signal that occurs at a maximum intensity. As one non-limiting example, a detection signal in the first capture zone 135 that is within 1% of the expected maximum intensity signal is considered substantially equivalent to the expected maximum intensity signal in the first capture zone 135. If the maximum intensity signal is at or about 70 AU, a detection signal in the range of about 75.3 AU to about 70.7 AU would be considered substantially equivalent to a maximum intensity signal of 70 AU. As another example, in the non-limiting embodiment described with reference to Figures 7A-7C, a detection signal in the first capture zone 135 that is within 10% of the expected maximum intensity signal is considered substantially equivalent to the expected maximum intensity signal in the first capture zone 135. Thus, in the examples illustrated in Figures 7A-7C, where the maximum intensity signal is at or about 70AU, a detection signal within the range of about 63AU to about 77AU is considered to be substantially equivalent to a maximum intensity signal of 70AU. These examples are provided for illustrative purposes only, and other variations may be acceptable. For example, in a lateral flow assay device according to the present disclosure, a detection signal in the first capture zone 135 within any suitable range of variation from the expected maximum intensity signal (e.g., 1.1%, 1.2%, 1.3%, 1.4%, 1.5%, 2.0%, 2.5%, 3%, 3.5%, 4%, 4.5%, 5%, 5.5%, 6%, 6.5%, 7%, 7.5%, 8%, 8.5%, 9%, 9.5%, 10%, 11%, 12%, 13%, 14%, 15%) can be considered to be substantially equivalent to the expected maximum intensity signal in the first capture zone 135.

[0062] 7A, the decrease in the first signal at the first capture zone 135 as the concentration of the first analyte of interest increases is advantageously gradual in embodiments of lateral flow devices according to the present disclosure. As a result of this gradual decrease in the detected first signal, embodiments of lateral flow devices described herein advantageously allow the detector to accurately measure the first signal with high resolution and the data analyzer to determine the concentration of the first analyte of interest with high accuracy when the concentration is high.

[0063] Furthermore, the dose-response curve for the analyte of interest present at high concentrations in the lateral flow device according to the present disclosure advantageously starts with a maximum intensity signal and decreases from this maximum intensity signal. This advantageously means that in the dose-response curve for the first analyte present at high concentrations, the signal in the portion of the dose-response curve where the signal is decreasing does not have the same magnitude as the maximum intensity signal. Furthermore, since the first signal at low concentrations of the first analyte in the sample is the same or substantially the same as the maximum intensity signal (e.g., they are considered to be substantially equivalent to the maximum intensity signal as described above), there is a plateau of the first optical signal at a relatively constant value ("maximum intensity signal") for zero to low concentrations of the first analyte (described in detail below with reference to non-limiting examples). This advantageously means that in the portion of the first dose-response curve where the first signal is decreasing, there is no signal with approximately the same magnitude as the maximum intensity signal. Thus, embodiments of the lateral flow devices described herein avoid false negatives and inaccurately low readings for analytes present at high concentrations, and allow for detection of both high and low concentration analytes present in a single sample without diluting or otherwise pre-treating the sample prior to application to a single lateral flow assay.

[0064] Advantageously, in the embodiments of the lateral flow device described herein, the first complex 121 can be pre-formulated to contain a known amount of the first analyte of interest prior to deposition onto the conjugate pad. In some embodiments, a known concentration of the first analyte of interest is incubated with an antibody or antibody fragment and a labeling molecule in a reaction vessel separate from the test strip. During incubation, the first analyte of interest is conjugated, bound, or attached to the antibody and labeling molecule to form the first complex 121 as described above. After incubation, the first complex 121 is added directly to a solution at a precise known concentration or isolated to remove excess free first analyte of interest prior to being sprayed onto the conjugate pad. The solution containing the first complex 121 is applied to the test strip, such as the labeling zone 120 described above. During deposition, the first complex 121 is bound onto the surface of the test strip. In one non-limiting example, the first complex 121 is bound onto the conjugate pad of the test strip. Advantageously, the first complex 121 can remain physically bound to the surface of the test strip and chemically stable until the operator applies a fluid sample to the test strip, after which the first complex 121 unbinds from the test strip and flows with the fluid sample as described above.

[0065] Similarly, the second labeled antibody 123 and the third labeled antibody 122 can be formulated separately. For example, a second antibody that specifically binds to a second analyte of interest can be incubated with a labeled molecule to form the second labeled antibody 123. The second labeled antibody 123 can be attached onto the test strip in a manner similar to the attachment of the first complex 121, or in any other suitable manner. The second labeled antibody 123 can remain physically bound to the surface of the test strip and chemically stable until an operator applies a fluid sample to the test strip, after which the second labeled antibody 123 unbinds from the test strip, binds to any second analyte present in the fluid sample, and flows with the fluid sample as described above. Similar methods can be used for the third labeled antibody, or any additional labeled antibodies or complexes for detection of additional analytes of interest.

[0066] In some embodiments, the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 are each deposited in an amount ranging from about 0.1-20 μL per test strip. In some embodiments, the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 are each deposited in the label zone in an amount of 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 μL per test strip. In one non-limiting example, the first conjugate 121 is deposited in an amount of about 3 μL / cm, the second labeled antibody 123 is deposited in an amount of about 7 μL / cm, and the third labeled antibody 122 is deposited in an amount of about 7 μL / cm.

[0067] The solution containing the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 can be applied to the test strip in many different ways. In one example, the solution is applied to the label zone 120 by spraying the solution using air jet technology. In another example, the solution is applied by injecting the solution, spraying the solution, formulating the solution as a powder or gel that is applied or rubbed onto the test strip, or any other suitable method for applying the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122. In some embodiments, after application, the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 are dried on the surface of the test strip after application by heating or blowing air on the conjugate pad. Other mechanisms for drying the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 on the surface of the test strip are suitable. For example, vacuum or freeze drying may be used to dry the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 on the conjugate pad.

[0068] In some cases, the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 are not added to a solution prior to deposition, but instead are applied directly to the test strip. The first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 may be applied directly using any suitable method, including, but not limited to, applying a compressive or vacuum pressure to the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 on the surface of the test strip, and / or applying the first conjugate 121, the second labeled antibody 123, and the third labeled antibody 122 in the form of lyophilized particles to the surface of the test strip.

[0069] The lateral flow assay embodiments described herein do not need to include a control line or zone configured to verify that the sample applied to the sample receiving zone 110 has flowed to the detection zone 130 as intended. Under normal operating circumstances, if the sample has flowed to the first capture zone 135, some detectable signal will always be emitted from the first capture zone 135. Advantageously, the first capture zone 135 is positioned downstream of both the third capture zone 131 and the second capture zone 133 to provide a visual indication that the sample 111 has flowed through all three capture zones as intended, such that the first capture zone 135 effectively functions as a control line or zone. Under normal operating circumstances, if the sample has flowed to the first capture zone 135, some detectable signal will always be emitted from the first capture zone 135, even if the first analyte of interest is present in the sample at a very low concentration. This is because the lateral flow device of the present disclosure generates a first dose-response curve that remains at or near a maximum intensity signal for zero or low concentrations of the first analyte of interest. Even in the presence of physiologically possible high concentrations of the first analyte 112 in the sample, the signal on the first capture zone 135 may be significantly reduced but not completely eliminated due to careful design of the lateral flow assay. Thus, the absence of a detectable signal in the first capture zone 135 after the sample is applied to the sample receiving zone 110 can be used as an indication that the lateral flow assay did not work as intended (e.g., the sample did not flow to the first capture zone 135 as intended, or, as another example, the immobilized first capture agent 136 in the first capture zone 135 is defective or broken). Thus, a further advantage of embodiments of the lateral flow device according to the present disclosure is the ability of the first capture zone 135 to function as a control line, thereby allowing a separate control line to be omitted entirely from the test strip.However, it will be understood that control lines may be included in the embodiments of the lateral flow devices described herein for a variety of purposes, including, but not limited to, observation lines for normalizing noise or for detecting interference from analytes in serum.

[0070] In some cases, the lateral flow device includes one or more control zones. The control zone may be within the detection zone or may be separate from the detection zone. In some embodiments, the control zone may be a positive control zone and may include a small molecule conjugated to a protein such as bovine serum albumin (BSA). A positive control labeled antibody that specifically binds to a small molecule may be deposited on the conjugate pad. When the positive control labeled antibody is rehydrated with a fluid sample, the antibody flows toward the positive control zone and binds to the small molecule to form a semi-sandwich. The positive control signal generated in the positive control zone is independent of the presence and concentration of multiple analytes present in the fluid sample, and therefore maintains a relatively constant intensity. However, due to the variability in the amount of positive control labeled antibody deposited on the conjugate pad by the non-uniform pad material, the intensity of the positive control signal generated in the positive control zone and the intensity of the signal generated in each capture zone may vary slightly from device to device, even when tested with the same sample. The change in intensity of the signal in the positive control zone and capture zone from device to device is the same. The positive control zone can therefore be used as a reference line to better gauge the relative signal strength generated in the capture zone and therefore the positive control zone can provide a more accurate analyte concentration.

[0071] Lateral flow assays may further include a negative control zone. The negative control zone may include a negative control antibody from the same species as the antibody used in the capture zone. Some components from some blood samples may interfere with immunoassays. If such an interfering substance is present in one sample, it will not only interfere with the signal intensity in the capture zone, but also with the signal intensity in the negative control zone. The reader and data analyzer embodiments disclosed herein can process the signal measurements obtained from the negative control zone to correct any calculations or notify the operator of invalid results.

[0072] The following non-limiting examples illustrate features of the lateral flow devices, test systems, and methods described herein and are not intended to limit the scope of the disclosure in any way.

[0073] Example 1 Preparation of a lateral flow assay for the quantification of proteins at both high and low concentrations The following example describes the preparation of a lateral flow assay to quantify multiple analytes of interest as described herein. In this non-limiting example, the analytes of interest are proteins in a single sample: C-reactive protein (CRP), interferon-gamma-inducible protein 10 (IP-10), and TNF-related apoptosis-inducing ligand (TRAIL). In this non-limiting example, CRP is present at elevated or high concentrations in the serum sample, while IP-10 or TRAIL is present at low concentrations in the serum sample.

[0074] CRP is a protein found in blood plasma. CRP levels are elevated in response to inflammation and infection. CRP is a marker of inflammation and infection and can be used to diagnose inflammation and infection. Elevated CRP levels in a subject's serum can correlate with inflammation and / or bacterial infection in the subject. Normal values ​​for CRP in healthy human subjects range from about 1 μg / mL to about 10 μg / mL. Mild inflammation and bacterial infections have CRP concentrations of 10-40 μg / mL, active inflammation and bacterial infections have CRP concentrations of 40-200 μg / mL, and severe bacterial infections and burns have CRP concentrations greater than 200 μg / mL. Measuring and charting CRP levels is useful for determining disease progression and treatment outcomes.

[0075] CRP exists in plasma over a wide dynamic range, for example, from low concentrations of about 1 μg / mL to about 10 μg / mL to very high concentrations of over 200 μg / mL. Although CRP can be measured with high sensitivity in some cases, such measurements typically have low specificity (e.g., CRP measurements are very sensitive to minute changes in concentration, but a single concentration measurement may correlate with multiple disease states or may not correlate with any disease state at all (inflammation or other non-disease conditions)). The embodiments of the lateral flow devices, test systems, and methods described herein advantageously allow for measuring concentrations of analytes of interest present at low concentrations in the same single sample while measuring CRP with high sensitivity, thereby increasing the specificity of the multiplex assay as a whole. Thus, embodiments of the present disclosure highly accurately measure concentrations of CRP over its large dynamic range, along with concentrations of additional analytes of interest present at concentrations one millionth the concentration of CRP, using a single sample applied to a single lateral flow assay in a single test event, including situations where the single sample is not diluted or pretreated before being applied to the single assay. For example, the single sample can be an undiluted whole blood sample; an undiluted venous blood sample; an undiluted capillary blood sample; an undiluted serum sample; an undiluted plasma sample.

[0076] IP-10 is a protein that is highly elevated in plasma during viral infection and only moderately elevated in plasma during bacterial infection. The normal concentration of IP-10 in healthy human subjects may be around 100-300 pg / mL, while the concentration of IP-10 during bacterial infection may be around 300-500 pg / mL. The concentration of IP-10 during viral infection is around 500-1000 pg / mL.

[0077] TRAIL is a protein that is elevated in plasma during viral infection, whereas during bacterial infection, TRAIL levels can be suppressed. Normal levels of TRAIL in healthy human subjects range from approximately 20-100 pg / mL. Concentrations of TRAIL during viral infection range from 20-500 pg / mL.

[0078] Assays for measuring the concentration or presence of CRP, IP-10 and TRAIL require the detection of low concentrations of analytes and the simultaneous detection of high concentrations of analytes. In fact, CRP concentrations can be a million times higher than IP-10 and / or TRAIL concentrations. Detection of mildly elevated CRP, elevated IP-10, and TRAIL can indicate viral infection. Detection of elevated levels of CRP and IP-10 and no detection of TRAIL can indicate bacterial infection. Detection of elevated levels of CRP alone, without detection of IP-10 and TRAIL, can indicate inflammation. Detection of no detection of CRP, IP-10, or TRAIL (or detection of CRP within the healthy subject range of about 1 μg / mL to about 10 μg / mL) can be a negative result for infection, indicating that the subject is unlikely to be suffering from a viral or bacterial infection.

[0079] An assay prepared according to this non-limiting example can be used to determine the presence and concentration of CRP, IP-10, and TRAIL (analytes of interest) in whole blood or a fraction of a whole blood sample, even when the concentration of CRP is high and the concentrations of IP-10 or TRAIL are low. The assay comprises a label, a first antibody or fragment thereof that specifically binds to CRP, and a complex comprising CRP. The assay further comprises a labeled second antibody or fragment thereof that specifically binds to IP-10, and a labeled third antibody or fragment thereof that specifically binds to TRAIL.

[0080] To prepare the assay, anti-CRP antibody was incubated with gold nanoparticles to form a labeled anti-CRP antibody. This labeled antibody was then incubated with CRP to form a complex of the labeled antibody bound to CRP. The solution containing this complex was sprayed with an air jet, and the complex was deposited on the conjugate pad (labeled zone) in a volume of 1.8 μL per test strip.

[0081] Anti-IP-10 antibody was incubated with gold nanoparticles to form a labeled anti-IP-10 antibody. The labeled anti-IP-10 antibody was attached to the conjugate pad (labeling zone) in an amount of 7 μL / test strip by spraying a solution containing the labeled anti-IP-10 antibody with an air jet. Anti-TRAIL antibody was incubated with gold nanoparticles to form a labeled anti-TRAIL antibody. The labeled anti-TRAIL antibody was attached to the conjugate pad (labeling zone) in an amount of 7 μL / test strip by spraying a solution containing the labeled anti-TRAIL antibody with an air jet. The conjugate pad was heated to dry the conjugate and each of the labeled anti-IP-10 antibody and the labeled anti-TRAIL antibody on the conjugate pad.

[0082] The amount of antibody-label-CRP conjugate deposited on the conjugate pad was carefully considered to ensure the amount of conjugate necessary to provide an optimal range of optical signals at the capture zone that would allow the test system to quantify elevated levels of CRP. Depositing an excessive amount of conjugate on the conjugate pad would shift the dose-response curve, resulting in excessively high quantifiable CRP concentrations (potentially generating an optical signal for very high concentrations of CRP (if present), but not for mild to high concentrations). Not depositing enough conjugate on the conjugate pad would shift the dose-response curve in the other direction, resulting in a signal that would not allow very high CRP concentrations to be quantified, but would allow quantification of relatively low CRP concentrations.

[0083] In this example, the optimal amount of antibody-labeled-CRP complex added to the conjugate pad resulted in 50ng of CRP being attached to the conjugate pad, which corresponds to a signal of 70.06AU. At this amount, the ratio of unlabeled CRP in the sample to the antibody-labeled-CRP complex when competing for binding to the capture agent in the capture zone produces a strong light signal over the optimal range of unlabeled CRP concentrations, thereby allowing for adequate resolution of the signal and accurate quantification of elevated CRP concentrations in the sample. In addition, the amount of labeled anti-IP-10 antibody and labeled anti-TRAIL antibody attached on the conjugate pad was about 260ng per test strip.

[0084] Additionally, an assay was prepared having detection zones, including a capture zone for each analyte of interest, such that the detection zones include a first capture zone including a first immobilized capture agent that specifically binds CRP, a second capture zone including a second immobilized capture agent that specifically binds IP-10, and a third capture zone including a third immobilized capture agent that specifically binds TRAIL.

[0085] In this example, an anti-CRP antibody was deposited in the first capture zone in an amount of 2.4 mg / mL at 0.75 μL / cm, an anti-IP-10 antibody was deposited in the second capture zone in an amount of 2.4 mg / mL at 0.75 μL / cm, and an anti-TRAIL antibody was deposited in the third capture zone in an amount of 3 mg / mL at 0.75 μL / cm.

[0086] In this example, the detection zone also includes a positive control capture zone and a negative control capture zone. The positive control capture zone is provided to ensure that the assay is functioning properly. In this example, the positive control capture zone includes immobilized bovine serum albumin derivatized with biotin (BSA-biotin). The immobilized BSA-biotin captures the labeled anti-biotin antibody present on the test strip that is rehydrated with the fluid sample and flows into the positive control capture zone, indicating that the assay is functioning properly. The labeled anti-biotin antibody is captured at the positive control line, and the positive control signal indicates that the assay is functioning properly. The positive control signal may also be used as a reference line to determine the relative signal intensities of the first capture zone, the second capture zone, and the third capture zone to increase the accuracy of the concentration of the analyte of interest.

[0087] The negative control capture zone contains immobilized antibodies against interfering components that may be present in the fluid sample. Such interfering components may interfere with the first, second, or third capture zones, thereby causing erroneous signal intensities. The interfering components also bind to the negative control capture zone. The reader and data analyzer embodiments disclosed herein can process the signal measurements obtained from the negative control zone to correct the signals measured in the first, second, and third capture zones, or to alert the operator that the test was invalid.

[0088] Example 2 Quantitation of CRP, IP-10, or TRAIL using a single multiplex lateral flow assay Because the concentration of CRP varies greatly compared to IP-10 and TRAIL, sandwich-type lateral flow assays are generally inappropriate for quantifying CRP when it is present at high concentrations, and simultaneously quantifying the concentrations of IP-10 and TRAIL when they are present (at low or high concentrations). At any concentration in a typical volume of sample, IP-10 and TRAIL are present on the order of 1-999 pg / mL, in contrast to CRP, which is present on the order of 1-999 μg / mL when present in the same typical volume of sample. Measuring elevated concentrations of CRP previously required serial dilution of the sample, which was an inefficient and cumbersome process and reduced the already low concentrations of IP-10 and TRAIL to undetectable concentrations. However, using the lateral flow devices, test systems, and methods described herein, high concentrations of CRP and significantly lower concentrations of IP-10 and TRAIL (e.g., one millionth the concentration of CRP) can be accurately, reliably, and rapidly quantified.

[0089] The lateral flow assay prepared in Example 1 was contacted with samples containing various concentrations of CRP, IP-10, or TRAIL as listed in Table 1 below. Fluid samples were prepared by spiking the amounts of CRP, IP-10, or TRAIL shown in Table 1 into 45 μL of human serum. The samples were received in the lateral flow assay and chased after 30 seconds with 45 μL of HEPES buffer. After 10 minutes, the optical signal was measured. Figures 7A-7C show the dose-response curves obtained for the lateral flow assay. Figure 7A shows the dose-response curve for increasing concentrations of CRP in the absence of IP-10 or TRAIL. In Figure 7A, the signal intensity of the dose-response curve for CRP (plotted with squares) decreases with increasing CRP concentration, consistent with competition between unlabeled CRP present in the sample and the antibody-labeled-CRP complex. In Figure 7A, the signal intensities of the dose-response curves for IP-10 (plotted with triangles) and TRAIL (plotted with circles) remain at or near 0, indicating the absence of IP-10 and TRAIL in the samples (IP-10 and TRAIL are below detectable levels).

[0090] FIG. 7B shows dose-response curves for increasing concentrations of IP-10 in the absence of CRP or TRAIL. In FIG. 7B, the signal intensity of the dose-response curve for IP-10 (triangles) increases with increasing concentrations of IP-10. In FIG. 7B, the signal intensity of the dose-response curve for TRAIL (circles) remains at or near 0, indicating the absence of TRAIL in the sample (or the presence of TRAIL at levels below detectable levels). Additionally, the signal intensity for the dose-response curve for CRP (squares) remains at the signal maximum (near 70 AU), indicating the absence of CRP in the sample (or the presence of CRP at levels below detectable levels).

[0091] FIG. 7C shows dose-response curves for increasing concentrations of TRAIL in the absence of CRP or IP-10. In FIG. 7C, the signal intensity (circles) of the TRAIL dose-response curve increases as the concentration of TRAIL increases. In FIG. 7C, the signal intensity (triangles) of the IP-10 dose-response curve remains at or near zero, indicating the absence of IP-10 (or the presence of IP-10 below detectable levels) in the sample. Furthermore, the signal intensity (squares) of the dose-response curve for CRP remains at the signal maximum (near 70 AU), indicating the absence of CRP (or the presence of CRP below detectable levels) in the sample. Table 1: Lateral flow assays for CRP, IP-10 and TRAIL. TIFF2024057619000002.tif169166

[0092] Example 3 Simultaneous quantification of CRP, IP-10, and TRAIL using a single multiplex lateral flow assay Example 2 illustrates a single multiplex lateral flow assay for simultaneously detecting CRP, IP-10, or TRAIL in a serum sample. This example further illustrates a single lateral flow assay for detecting the presence of any one or more combinations of CRP, IP-10, and TRAIL in a serum sample.

[0093] The lateral flow assay prepared in Example 1 was contacted with a sample containing a combination of CRP, IP-10, and TRAIL, as described in Table 2 below. The fluid sample was prepared by adding either CRP in an amount of 40 μg / mL, IP-10 in an amount of 500 pg / mL, or TRAIL in an amount of 250 pg / mL, or a combination thereof, as shown in Table 2, to 45 μL of human serum replacement. The sample was received by the lateral flow assay and chased with 45 μL of HEPES buffer after 30 seconds. After 10 minutes, the optical signal was observed. FIG. 8 shows the lateral flow assay device for each condition in Table 2. FIG. 8 shows six lateral flow assay devices under the following conditions (from left to right): presence of CRP, IP-10, and TRAIL, respectively (see also FIG. 1A and FIG. 1B); absence of CRP, IP-10, and TRAIL (see also FIG. 2A and FIG. 2B); presence of CRP alone (see also FIG. 3A and FIG. 3B); presence of IP-10 alone (see also FIG. 4A and FIG. 4B); presence of TRAIL alone (see also FIG. 5A and FIG. 5B); presence of both CRP and IP-10 (see also FIG. 6A and FIG. 6B). In FIG. 8, lateral flow assays in which CRP is not present in the sample result in maximum signal intensity at the CRP capture zone, while lateral flow assays in which CRP was present in the sample result in reduced signal intensity at the CRP capture zone. Conversely, the presence of IP-10 or TRAIL increases the signal intensity at the IP-10 capture zone or the TRAIL capture zone, respectively. A sample having a combination of CRP, IP-10, and TRAIL indicates the presence of each analyte and can be used to measure inflammation, viral infection, or bacterial infection. Table 2: Lateral flow assays for testing combinations of CRP, IP-10, and TRAIL. TIFF2024057619000003.tif71164

[0094] Examples 2 and 3 show the effectiveness of the exemplary lateral flow assays described herein for determining the concentrations of multiple analytes of interest when one or more analytes of interest are present at high concentrations and one or more analytes of interest are present at low concentrations, even when the one or more analytes of interest present at high concentrations are present at millions of times the amount of the analytes of interest at low concentrations. Although Examples 2 and 3 use two sandwich-type lateral flow assays for measuring two analytes at low concentrations in combination with a sandwich-type assay configured to detect an analyte at high concentrations on a single test strip, it will be understood that the present disclosure is applicable to other configurations. As another non-limiting example, the lateral flow assays described herein can use one sandwich-type lateral flow assay for measuring one analyte at low concentrations in combination with two sandwich-type assays configured to detect two analytes at high concentrations on a single test strip.

[0095] Advantageously, the lateral flow assay according to the present disclosure allows accurate measurement of concentrations of CRP at concentrations above 10 μg / mL, while simultaneously allowing accurate measurement of concentrations of IP-10 and TRAIL at concentrations between 30 and 1000 pg / mL. This is particularly advantageous for accurately diagnosing disease and non-disease conditions in which one or more of CRP, IP-10, and TRAIL may be present, such as inflammatory conditions, viral infection conditions, or bacterial infection conditions. The lateral flow assay according to the present disclosure can distinguish between inflammation, viral infection, or bacterial infection by determining the respective concentrations of CRP, IP-10, and TRAIL in a single assay. CRP, IP-10, and TRAIL may be present in a single sample applied to a single assay in a single test event.

[0096] Furthermore, the lateral flow device described herein quantifies elevated concentrations of multiple analytes in a sample in one single assay without the need to dilute the sample. Assays for quantifying high concentrations of analytes often dilute the sample to reduce the total amount of analyte on the assay. Dilution requires additional physical steps as well as additional calculations. In addition, dilution may be useful for high concentrations of analytes, but low concentrations of analytes are harmed by dilution as it reduces the ability to detect low concentrations of analytes. Thus, dilution is not suitable for a single assay to detect both low and high concentrations of analytes. The lateral flow assay of the present disclosure can determine minute differences in the concentrations of multiple analytes based on the signal obtained at the detection zone after one test.

[0097] Methods of diagnosing conditions using lateral flow assays according to the present disclosure Some embodiments provided herein relate to a method of using a lateral flow assay to diagnose a medical condition. In some aspects, the method includes providing a lateral flow assay as described herein. In some aspects, the method includes receiving a sample in a sample reservoir of the lateral flow assay.

[0098] In some embodiments, the sample is obtained from a source, including the environment or a biological source. In some embodiments, the sample is suspected of having one or more analytes of interest. In some embodiments, the sample is not suspected of having the analytes of interest. In some embodiments, the sample is obtained and analyzed for verification of the absence or presence of multiple analytes. In some aspects, the sample is obtained and analyzed for the amount of multiple analytes in the sample. In some embodiments, the amount of any one of the one or more analytes present in the sample is less than the normal value present in a healthy subject, is the normal value present in a healthy subject, or is greater than the normal value present in a normal subject.

[0099] In some embodiments, receiving a sample in a sample reservoir of a lateral flow assay includes contacting the sample with the lateral flow assay. The sample may be contacted with the lateral flow assay by introducing the sample into the sample reservoir by external application, such as with a dropper or other applicator. In some embodiments, the sample reservoir may be directly immersed in the sample, such as when a test strip is immersed in a container that holds the sample. In some embodiments, the sample may be poured, dripped, sprayed, placed, or otherwise contacted into the sample reservoir.

[0100] The complex in the disclosed embodiment includes an antibody that specifically binds to the analyte of interest, a label, and the analyte of interest, and may be deposited on a conjugate pad (or label zone) in the sample reservoir or downstream. The device may include a first complex having a first analyte of interest, a label, and an antibody that specifically binds to the first analyte of interest. This complex is used to determine the presence and / or amount of an analyte that may be present in high concentrations in the sample. Thus, additional complexes may be included in the device if the operator is interested in determining the presence and / or amount of two or more analytes of interest that are present in high concentrations.

[0101] Additionally, the device may include a labeled antibody that specifically binds to the analyte of interest and a label, but not the antibody of interest. The device may further include a second labeled antibody that specifically binds to a second analyte of interest and a label, and the device may also include a third labeled antibody that specifically binds to a third analyte of interest and a label. The labeled antibody is used to determine the presence and / or amount of an analyte that may be present in a sample at low concentrations. Thus, if the operator is interested in determining the presence and / or amount of more second and third analytes of interest, additional labeled antibodies may be included in the device. The labeled antibodies may be attached on a conjugate pad (or label zone) inside or downstream of the sample reservoir.

[0102] The first complex, the second labeled antibody, and the third labeled antibody may be bound on the conjugate pad by physical or chemical bonds. The sample solubilizes the first complex, the second labeled antibody, and the third labeled antibody after the sample is added to the sample reservoir, releasing the bonds that held the first complex, the second labeled antibody, and the third labeled antibody to the conjugate pad. The second labeled antibody binds to the second analyte of interest to form a second complex if the second analyte of interest is present in the sample. The third labeled antibody binds to the third analyte of interest to form a third complex if the third analyte of interest is present in the sample. The sample with or without the first analyte of interest, the first complex, the second complex (if the second analyte of interest is present in the sample), and the third complex (if the third analyte of interest is present in the sample) flow along the fluid front through the lateral flow assay to the detection zone. The detection zone may include a capture zone for capturing each complex. For example, the detection zone may include a first capture zone for capturing the first complex, a second capture zone for capturing the second complex, and a third capture zone for capturing the third complex. The first capture agent immobilized in the first capture zone binds to the first analyte (if present) and the first complex. When the first complex binds to the first capture agent in the first capture zone, a first signal from the label is detected. The first signal may include an optical signal as described herein. When a low concentration of the first analyte is present in the sample (e.g., below a healthy level), a maximum intensity signal in the first capture zone is detected. At a high concentration of the first analyte (e.g., above a healthy value), the intensity of the first signal decreases in proportion to the amount of the first analyte in the sample. The first signal is compared to a value on a dose-response curve for the first analyte of interest, and the concentration of the first analyte in the sample is determined.

[0103] The second capture agent immobilized in the second capture zone binds to the second complex. When the second complex binds to the second capture agent in the second capture zone, a second signal from the label is detected. The second signal can include an optical signal as described herein and can be at the same wavelength as the first signal or at a different wavelength than the first signal. As the concentration of the second analyte increases, the formation of the second complex increases, resulting in an increase in the amount of the second complex captured by the second capture agent in the second capture zone, resulting in an increase in the second signal intensity.

[0104] The third capture agent immobilized in the third capture zone binds to the third complex. When the third complex binds to the third capture agent in the third capture zone, a third signal from the label is detected. The third signal can include an optical signal as described herein and can be at the same wavelength as the first signal or the second signal, or at a different wavelength than the first signal or the second signal. An increase in the concentration of the third analyte increases the formation of the third complex, which results in an increase in the amount of the third complex captured by the third capture agent in the third capture zone, which results in an increase in the third signal intensity.

[0105] In some embodiments, the first analyte is present at an elevated concentration. An elevated concentration of the first analyte can refer to a concentration of the first analyte that is greater than a healthy level. Thus, an elevated concentration of the first analyte can include a concentration of the first analyte that is 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 125%, 150%, 200% or more greater than a healthy level. In some embodiments, the first analyte of interest comprises C-reactive protein (CRP), which is present in the serum of healthy individuals in an amount of about 1 to about 10 μg / mL. Thus, elevated CRP concentrations in a sample include amounts of greater than or equal to 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 μg / mL.

[0106] In some embodiments, the second analyte is present at an elevated concentration. An elevated concentration of the second analyte can refer to a concentration of the second analyte that is greater than a healthy level. Thus, an elevated concentration of the second analyte can include a concentration of the second analyte that is 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 125%, 150%, 200% or more greater than a healthy level. In some embodiments, the second analyte of interest comprises interferon gamma-inducible protein 10 (IP-10), which is present in the serum of healthy individuals in an amount of about 100 to about 300 pg / mL. Thus, high concentrations of IP-10 in a sample include amounts of greater than or equal to 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490 or 500 pg / mL.

[0107] In some embodiments, the third analyte is present at an elevated concentration. An elevated concentration of the third analyte can refer to a concentration of the third analyte that is greater than a healthy level. Thus, an elevated concentration of the third analyte can include a concentration of the third analyte that is 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 125%, 150%, 200% or more greater than a healthy level. In some embodiments, the third analyte of interest comprises TNF-related apoptosis-inducing ligand (TRAIL), which is present in the serum of healthy individuals in an amount of about 1 to about 15 pg / mL. Thus, high concentrations of TRAIL in a sample include amounts of 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 pg / mL or greater.

[0108] In some embodiments, when the first analyte, the second analyte, the third analyte, or a combination thereof is determined to be present in the sample at high concentration, the subject is diagnosed with a certain disease.For example, an elevated CRP concentration, but no elevated IP-10 or TRAIL, can indicate inflammation. An elevated IP-10 and CRP concentration, but no elevated TRAIL, can indicate bacterial infection. An elevated concentration of all of CRP, IP-10, and TRAIL can indicate viral infection. In some embodiments, a diagnosis of inflammation is made when the concentration of CRP is greater than or equal to 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 μg / mL, but the concentrations of both IP-10 and TRAIL are determined to be within the healthy range. In some embodiments, a diagnosis of bacterial infection is made when the concentration of CRP is greater than or equal to 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 μg / mL and the concentration of IP-10 is greater than or equal to 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, or 500 pg / mL, but the concentration of TRAIL is determined to be within the healthy range. In some embodiments, a diagnosis of viral infection is made when CRP levels are present at low levels and both IP-10 and TRAIL levels are elevated.In a non-limiting example, a diagnosis of viral infection is determined by a CRP concentration that is not elevated (e.g., between about 1 μg / mL and about 10 μg / mL), an IP-10 concentration of 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, or 500 pg / mL or greater, and a TRAIL concentration of 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, or 300 pg / mL or greater. , 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, or 500 pg / mL or higher.

[0109] Diagnosis of conditions including inflammation, bacterial infection, or viral infection can be made from a single application of a single sample on a single lateral flow assay device described herein, even when the concentration of one analyte of interest (e.g., CRP) is present in a significantly greater amount than other analytes of interest (e.g., IP-10 or TRAIL). Thus, a single device can accurately determine the presence and / or concentration of an analyte of interest that is present in an amount that is 10, 9, 8, 7, 6, 5, 4, 3, 2, 1, 500,000, 100, 500, 100, or 10 times greater than an analyte present in a lower concentration.

[0110] The above-described embodiments of the lateral flow device, test system, and method according to the present disclosure detect the presence and / or concentration of CRP, TRAIL, and IP-10 in a single sample applied to a single lateral flow assay (e.g., a single lateral flow assay test strip) in a single application. It will be understood that the present disclosure is not limited to these embodiments. For example, in another non-limiting example, the lateral flow device, test system, and method according to the present disclosure can detect the presence and / or concentration of CRP, TRAIL, and Mx1 in a single sample applied to a single lateral flow assay (e.g., a single lateral flow assay test strip) in a single application. In a further non-limiting example, the lateral flow device, test system, and method according to the present disclosure can detect the presence and / or concentration of CRP, PCT, and IP-10 in a single sample applied to a single lateral flow assay (e.g., a single lateral flow assay test strip) in a single application. In yet another non-limiting example, the lateral flow devices, test systems, and methods of the present disclosure can detect the presence and / or concentration of CRP, PCT, and Mx1 in a single sample applied to a single lateral flow assay (e.g., a single lateral flow assay test strip) in a single application. In yet another non-limiting example, the lateral flow devices, test systems, and methods of the present disclosure can detect the presence and / or concentration of CRP, TRAIL, IP-10, Mx1, and PCT (or any combination thereof) in a single sample applied to a single lateral flow assay (e.g., a single lateral flow assay test strip) in a single application. In yet another non-limiting example, the lateral flow devices, test systems, and methods of the present disclosure can detect the presence and / or concentration of any of CRP and / or TRAIL, IP-10, Mx1, and PCT in a single sample applied to a single lateral flow assay (e.g., a single lateral flow assay test strip) in a single application. It will be understood that the specific analytes listed in these non-limiting examples are illustrative rather than limiting of the present disclosure.Additionally, any analyte of interest can be detected and measured using the lateral flow devices, test systems, and methods described herein.

[0111] Additional embodiments of multiplexed lateral flow assays according to the present disclosure capable of detecting the presence and concentration of high concentration analytes The lateral flow devices, test systems, and methods of the present disclosure accurately determine the presence or amount of multiple analytes of interest in situations where one or more analytes of interest are present in high or high concentrations in the sample and one or more analytes of interest are present in low concentrations in the sample. Advantageously, the lateral flow devices, test systems, and methods described herein determine the presence or amount of analytes of interest present in a single sample at significantly different concentrations after applying the single sample to a single lateral flow assay, such as a single test strip, in a single test event. Thus, the lateral flow assays described herein can simultaneously detect multiple analytes in a single sample, even when the analytes are present in significantly different concentration ranges. Exemplary lateral flow devices, test systems, and methods for determining the presence or amount of one or more analytes of interest present in a sample at high concentrations are described above with reference to the non-limiting embodiments shown in Figures 1A-6B. Further exemplary embodiments are described in International Application No. PCT / US2018 / 039347, filed June 25, 2018, which is incorporated herein by reference in its entirety.

[0112] The multiplexed lateral flow devices, test systems, and methods of the present disclosure can use additional techniques to determine the presence or amount of one or more analytes of interest that are present in high concentrations in a sample. For example, additional lateral flow devices, test systems, and methods described in International Application No. PCT / US2018 / 063586, filed December 3, 2018, and incorporated herein by reference in its entirety, can be implemented in the multiplexed lateral flow devices, test systems, and methods of the present disclosure to determine the presence or amount of one or more analytes of interest that are present in high concentrations in a sample.

[0113] An embodiment described in International Application No. PCT / US2018 / 063586 relates to an assay test strip including a flow path configured to receive a fluid sample, a sample receiving zone coupled to the flow path, a capture zone, a labeled antibody or fragment thereof, and oversized particles in the flow path upstream of the capture zone. The capture zone is coupled to the flow path downstream of the sample receiving zone and includes an immobilized capture agent specific for an analyte of interest (e.g., but not limited to, CRP). The labeled antibody or fragment thereof is coupled to the flow path upstream of the capture zone specific for the analyte of interest. The oversized particles are bound to the antibody or fragment thereof specific for the analyte of interest to form antibody-bound oversized particles of a size and dimensions that reside upstream of the capture zone when the fluid sample is received on the assay test strip. The flow path in this example is configured to receive a fluid sample including an analyte of interest (e.g., but not limited to, CRP). The labeled antibody or fragment thereof and the antibody-bound oversized particles compete to specifically bind to the analyte of interest. The labeled antibody or fragment thereof is configured to flow with the bound analyte of interest in the flow path to the capture zone when a fluid sample is received on the assay test strip, where the labeled antibody bound to the analyte of interest is captured and produces a detectable signal.

[0114] In some cases, the flow path is configured to receive a fluid sample with or without an analyte of interest (such as, but not limited to, CRP). The antibody-bound oversized particles specifically bind to a known amount of the analyte of interest, thereby retaining the known amount of the analyte of interest upstream of the capture zone.

[0115] The assay test strip in this example includes a control zone downstream of the capture zone. The control zone includes an antibody that specifically binds to the labeled antibody or fragment thereof that does not bind to the analyte of interest and flows through the capture zone. If the fluid sample does not include the analyte of interest, the labeled antibody or fragment thereof flows into the control zone and emits an optical signal only in the control zone, indicating the absence of the analyte of interest in the fluid sample. The immobilized capture agent includes an antibody or fragment thereof specific for the analyte of interest. In some embodiments, the antibody-bound oversized particles are bound on the surface of the test strip. In some embodiments, the oversized particles include gold particles, latex beads, magnetic beads, or silicon beads. In some embodiments, the oversized particles have a diameter of about 1 μm to about 15 μm. In some embodiments, the fluid sample is selected from the group consisting of whole blood, venous blood, capillary blood, plasma, serum, urine, sweat, or saliva samples. In some embodiments, the analyte of interest includes C-reactive protein (CRP), and the antibody or fragment thereof bound to the oversized particles includes an anti-CRP antibody or fragment thereof bound to the CRP.

[0116] The above-described embodiments for measuring the presence and concentration of a high concentration of an analyte of interest, such as, but not limited to, CRP, can be included in a single multiplex lateral flow assay test strip according to the present disclosure to detect multiple analytes of interest present in a sample at significantly different concentrations. For example, embodiments of the lateral flow device, test system, and method according to the present disclosure can be employed on a single test strip in combination with two sandwich-type lateral flow assays for measuring low concentrations of two analytes of interest in a single sample (such as, for example, the second analyte of interest 113 and the third analyte of interest 114 described above with reference to Figures 4A-4B, Figures 5A-5B, and Examples 2 and 3) in a single sample, in combination with a sandwich-type assay described in International Application No. PCT / US2018 / 063586 configured to detect high concentrations of an analyte of interest (such as, but not limited to, CRP) in the same single sample applied to a single test strip in a single test event.

[0117] Examples of test systems including lateral flow assays according to the present disclosure The lateral flow assay test system described herein can include a lateral flow assay test device (e.g., a test strip), a housing including a port configured to receive all or a portion of the test device, a reader including a light source and a photodetector, a data analyzer, or combinations thereof. The housing can be constructed of any one of a variety of materials including plastic, metal, or composite materials. The housing forms a protective enclosure for the components of the diagnostic test system. The housing also defines a receptacle that mechanically registers the test strip with the reader. The receptacle may be designed to receive any of a wide variety of different types of test strips. In some embodiments, the housing is a portable device that allows the ability to perform lateral flow assays in a variety of environments including on a bench, in the field, at home, or in a domestic, commercial, or environmental facility.

[0118] The reader can include one or more optoelectronic components capable of optically inspecting the exposed area of ​​the detection zone of the test strip and detecting multiple capture zones within the detection zone. In some embodiments, the reader includes at least one light source and at least one photodetector. In some embodiments, the light source can include a semiconductor light emitting diode and the photodetector can include a semiconductor photodiode. Depending on the nature of the label used by the test strip, the light source can be designed to emit light within a particular wavelength range or light having a particular polarization. For example, if the label is a fluorescent label such as a quantum dot, the light source is designed to illuminate the exposed area of ​​the capture zone of the test strip with light in a wavelength range that induces fluorescent emission from the label. Similarly, the photodetector can be designed to selectively capture light from the exposed area of ​​the capture zone. For example, if the label is a fluorescent label, the photodetector is designed to selectively capture light within the wavelength range of the fluorescence emitted by the label, or light of a particular polarization. On the other hand, if the label is a reflective label, the photodetector is designed to selectively capture light within the wavelength range of the light emitted by the light source. For these purposes, the photodetector can include one or more optical filters that define the wavelength range or polarization axis of the captured light. The signal from the label can be analyzed by visual observation or using a spectrophotometer to detect color from a chromogenic substrate, e.g., a radiation counter to detect radiation, such as a gamma counter to detect 125I, or a fluorometer to detect fluorescence in the presence of light of a particular wavelength. When an enzyme-linked assay is used, a spectrophotometer can be used to perform a quantitative analysis of the amount of the analyte of interest. The lateral flow assays described herein can be automated or performed robotically, if desired, and signals from multiple samples can be detected simultaneously. Furthermore, multiple signals can be detected for multiple analytes of interest, including when the labels of each analyte of interest are the same or different.

[0119] The data analyzer processes the signal measurements obtained by the reader. In general, the data analyzer can be implemented in any computing or processing environment, including digital electronic circuitry or computer hardware, firmware, or software. In some embodiments, the data analyzer includes a processor (e.g., a microcontroller, microprocessor, or ASIC) and an analog-to-digital converter. The data analyzer can be incorporated within the housing of the diagnostic test system. In other embodiments, the data analyzer is located in a separate device, such as a computer, that can communicate with the diagnostic test system via a wired or wireless connection. The data analyzer may also include circuitry for transferring results to an external source via a wireless connection for data analysis or to review the results.

[0120] Generally, the result indicator can include any one of a variety of different mechanisms for indicating one or more results of an assay test. In some embodiments, the result indicator includes one or more lights (e.g., light emitting diodes) that are activated, for example, to indicate completion of an assay test. In other embodiments, the result indicator includes an alphanumeric display (e.g., a two or three character light emitting diode array) for presenting the assay test results.

[0121] The test systems described herein may include a power supply that provides power to the operating components of the diagnostic test system, including the reader, data analyzer, and result display. The power supply may be implemented, for example, by a replaceable or rechargeable battery. In other embodiments, the diagnostic test system may be powered by an external host device (e.g., a computer connected via a USB cable).

[0122] Exemplary Lateral Flow Device Features The lateral flow devices described herein can include a sample reservoir (also referred to as a sample receiving zone) where a fluid sample is introduced to a test strip, such as but not limited to an immunochromatographic test strip, present in the lateral flow device. In one example, the sample can be introduced to the sample reservoir by external application, such as with a dropper or other applicator. The sample can be poured or expressed onto the sample reservoir. In another example, the sample reservoir can be directly immersed in the sample, such as when a test strip is immersed in a container that holds the sample.

[0123] The lateral flow device described herein may include a solid support or substrate. Suitable solid supports include, but are not limited to, nitrocellulose, walls of wells in reaction trays, multi-well plates, test tubes, polystyrene beads, magnetic beads, membranes, and microparticles (such as latex particles). Any suitable porous material with sufficient porosity to allow access by the labeling agent and suitable surface affinity for immobilizing the capture agent can be used in the lateral flow device described herein. For example, the porous structure of nitrocellulose has excellent absorption and adsorption properties for a wide variety of reagents, such as capture agents. Nylon has similar properties and is suitable. Microporous structures are useful as well as materials with a gel structure in the hydrated state.

[0124] Further examples of useful solid supports include: natural polymeric carbohydrates and their synthetically modified, cross-linked or substituted derivatives such as agar, agarose, cross-linked alginic acid, substituted and cross-linked guar gum, cellulose esters, especially with nitrates and carboxylic acids, mixed cellulose esters, and cellulose ethers; nitrogen-containing natural polymers such as proteins and derivatives, including cross-linked or modified gelatin; natural hydrocarbon polymers such as latex and rubber; vinyl polymers including polyethylene, polypropylene, polystyrene, polyvinyl chloride, polyvinyl acetate and their partially hydrolyzed derivatives, polyacrylamides, polymethacrylates, copolymers and terpolymers of the above polycondensates, e.g., polyesters and polyamides. synthetic polymers which can be prepared in suitable porous structures, such as coalescers, as well as other polymers such as polyurethanes or polyepoxides; porous inorganic materials such as barium sulfate, calcium sulfate, calcium carbonate, alkali and alkaline earth metal silicates, sulfates or carbonates of alkaline earth metals and magnesium, including aluminum and magnesium; oxides or hydrates of aluminum or silicon, such as clays, alumina, talc, kaolin, zeolites, silica gel, glass, etc. (These materials can be used as filters together with the above polymeric materials); mixtures or copolymers of the aforementioned types, for example graft copolymers obtained by the initial polymerization of a synthetic polymer onto an existing natural polymer.

[0125] The lateral flow device described herein may include a porous solid support, such as nitrocellulose, in the form of a sheet or strip. The thickness of such a sheet or strip may vary over a wide range, for example, from about 0.01 mm to 0.5 mm, from about 0.02 mm to 0.45 mm, from about 0.05 mm to 0.3 mm, from about 0.075 mm to 0.25 mm, from about 0.1 mm to 0.2 mm, or from about 0.11 mm to 0.15 mm. The size of the holes in such a sheet or strip may also vary over a wide range, for example, from about 0.025 to 15 microns, more specifically, from about 0.1 to 3 microns. However, the pore size is not intended to be a limiting factor in the selection of the solid support. Where applicable, the flow rate of the solid support can also be varied over a wide range, for example, about 12.5 to 90 sec / cm (50 to 300 sec / 4 cm), about 22.5 to 62.5 sec / cm (90 to 250 sec / 4 cm), about 25 to 62.5 sec / cm (100 to 250 sec / 4 cm), about 37.5 to 62.5 sec / cm (150 to 250 sec / 4 cm), or about 50 to 62.5 sec / cm (200 to 250 sec / 4 cm). In certain embodiments of the devices described herein, the flow rate is about 35 sec / cm (140 sec / 4 cm). In other certain embodiments of the devices described herein, the flow rate is about 37.5 sec / cm (150 sec / 4 cm).

[0126] The surface of the solid support can be activated by a chemical process that causes the covalent attachment of an agent (e.g., a capture reagent) to the support. As described below, the solid support can include a conjugate pad. Many other suitable methods can be used to immobilize an agent (e.g., a capture reagent) to a solid support, including, but not limited to, ionic interactions, hydrophobic interactions, covalent interactions, and the like.

[0127] Unless physically limited, a solid support can be used in any suitable form, such as a film, sheet, strip, or plate, or can be coated on or adhered or laminated to a suitable inert carrier, such as paper, glass, plastic film, or fabric.

[0128] The lateral flow devices described herein can include a conjugate pad, such as a membrane or other type of material that contains the capture reagent. The conjugate pad can be cellulose acetate, cellulose nitrate, polyamide, polycarbonate, glass fiber, membrane, polyethersulfone, regenerated cellulose (RC), polytetra-fluorethylene (PTFE), polyester (e.g., polyethylene terephthalate), polycarbonate (e.g., 4,4-hydroxydiphenyl-2,2'-propane), aluminum oxide, mixed cellulose esters (e.g., a mixture of cellulose acetate and cellulose nitrate), nylon (e.g., polyamide, hexamethylenediamine, and nylon 66), polypropylene, PVDF, high density polyethylene (HDPE) + nucleating agent "aluminum dibenzoate" (DBS) (e.g., 80 u 0.024 HDPE DBS (Posex)), and HDPE.

[0129] The lateral flow devices described herein are highly sensitive to multiple analytes of interest present in a sample at widely differing concentrations, such as high (10s to 100s of μg / mL) and low (1s to 10s of pg / mL) concentrations. "Sensitivity" refers to the proportion of actual positives (e.g., the proportion of infected, latent, or symptomatic subjects correctly identified as having a condition) that are correctly identified as having the disease. Sensitivity can be calculated as the number of true positives divided by the number of true positives plus the number of false negatives.

[0130] The lateral flow devices described herein are capable of accurately measuring multiple analytes of interest in many different types of samples. Samples can include samples or cultures obtained from any source, as well as biological and environmental samples. Biological samples can be obtained from animals (including humans) and include fluids, solids, tissues, and gases. Biological samples include urine, saliva, and blood products such as plasma and serum. However, such examples should not be construed as limiting the types of samples applicable to the present disclosure.

[0131] In some embodiments, the sample is an environmental sample for detecting multiple analytes in the environment. In some embodiments, the sample is a biological sample from a subject. In some embodiments, the biological sample can include peripheral blood, serum, plasma, ascites, urine, cerebrospinal fluid (CSF), sputum, saliva, bone marrow, synovial fluid, aqueous humor, amniotic fluid, earwax, breast milk, bronchoalveolar lavage fluid, semen (including prostatic fluid), cowper's fluid or pre-ejaculatory fluid, female ejaculate, sweat, fecal material, hair, tears, cyst fluid, pleural and peritoneal fluid, pericardial fluid, lymph, chyme, bile, interstitial fluid, menses, pus, sebum, vomitus, vomit, vaginal secretions, mucosal secretions, stool, pancreatic juice, sinus lavage, bronchopulmonary aspirate, or other lavage fluid.

[0132] As used herein, "analyte" generally refers to a substance to be detected. For example, analytes can include antigenic substances, haptens, antibodies, and combinations thereof. Analytes include, but are not limited to, toxins, organic compounds, proteins, peptides, microorganisms, amino acids, nucleic acids, hormones, steroids, vitamins, drugs (both therapeutically and illicitly administered), drug intermediates or by-products, bacteria, virus particles, and metabolites or antibodies of the above substances.Some specific examples of analytes include: ferritin; creatinine kinase MB (CK-MB); human chorionic gonadotropin (hCG); digoxin; phenytoin; phenobarbitol; carbamazepine; vancomycin; gentamicin; theophylline; valproic acid; quinidine; luteinizing hormone (LH); follicle-stimulating hormone (FSH); estradiol, progesterone; C-reactive protein (CRP); lipocalin; IgE antibodies; cytokines; TNF-related apoptosis-inducing ligand (TRAIL); vitamin B2 microglobulin; interferon-gamma-inducible protein 10 (IP-10); interferon-inducible GTP-binding protein (myxovirus (influenza virus) resistance 1, MX 1, MxA, IFI-78). K, IFI78, MX, also known as GTPase 1, such as MX-dynamin; procalcitonin (PCT); glycated hemoglobin (glycohemoglobin); cortisol; digitoxin; N-acetylprocainamide (NAPA); procainamide; antibodies against rubella, such as rubella IgG and rubella IgM; antibodies against toxoplasmosis, such as toxoplasmosis IgG (Toxo-IgG) and toxoplasmosis IgM (Toxo-IgM); testosterone; salivary gland. thyrates; acetaminophen; hepatitis B surface antigen (HBsAg); antibodies to hepatitis B core antigen, such as anti-hepatitis B core antigen IgG and IgM (anti-HBC); human immunodeficiency viruses 1 and 2 (HIV1 and 2); human T-cell leukemia virus types 1 and 2 (HTLV); hepatitis B e antigen (HBeAg); hepatitis B e antigen antibody (anti-HBe); influenza virus; thyroid stimulating hormone (TSH); thyroxine (T4); total triiodothyronine (Total T3); free triiodothyronine (Free T3); carcinoembryonic antigen (CEA); lipoproteins, cholesterol, triglycerides; and alpha-fetoprotein (AFP).Drugs of abuse and controlled substances include, but are not limited to, amphetamines; methamphetamines; barbiturates, such as amobarbital, secobarbital, pentobarbital, phenobarbital, barbital; benzodiazepines, such as librium and valium; cannabinoids, such as cannabis and marijuana; cocaine; fentanyl; LSD; methaqualone; opiates, such as heroin, morphine, codeine, hydromorphone, hydrocodone, methadone, oxycodone, oxymorphone, and opium; phencyclidine; and propoxyphene. Additional analytes can be included for purposes of biological or environmental substances of interest.

[0133] The present disclosure relates to lateral flow assay devices, test systems, and methods for determining the presence and concentration of multiple analytes in a sample, including when one or more analytes of interest are present at high concentrations and one or more analytes of interest are present at low concentrations. As mentioned above, as used herein, "analyte" generally refers to a substance to be detected, such as a protein. Examples of proteins that can be detected by the lateral flow assay devices, test systems, and methods described herein include, but are not limited to, the following:

[0134] TRAIL: TNF-related apoptosis-inducing ligand (also known as Apo2L, Apo-2 ligand, CD253); representative RefSeq DNA sequences are NC_000003.12; NC_018914.2; and NT_005612.17, and representative RefSeq Protein sequence accession numbers are NP_001177871.1; NP_001177872.1; and NP_003801.1. TRAIL proteins belong to the tumor necrosis factor (TNF) ligand family.

[0135] CRP: C-reactive protein; representative RefSeq DNA sequences are NC_000001.11; NT_004487.20; and NC_018912.2, and the accession number of a representative RefSeq Protein sequence is NP_000558.2.

[0136] IP-10: chemokine (CXC motif) ligand 10; representative RefSeq DNA sequences are NC_000004.12; NC_018915.2; and NT_016354.20, and the RefSeq Protein sequence is NP_1556.2.

[0137] PCT: Procalcitonin is the peptide precursor of the hormone calcitonin. The representative RefSeq amino acid sequence for this protein is NP_000558.2. Representative RefSeq DNA sequences include NC_000001.11, NT_004487.20, and NC_018912.2.

[0138] MX1: Interferon-induced GTP-binding protein Mx1 (also known as interferon-induced protein p78, interferon-regulated resistant GTP-binding protein MxA). Representative RefSeq amino acid sequences for this protein are NP_001138397.1; NM_001144925.2; NP_001171517.1; and NM_001178046.2.

[0139] The lateral flow assay devices, test systems and methods according to the present disclosure can measure either the soluble and / or membrane forms of TRAIL protein, hi one embodiment, only the soluble form of TRAIL is measured.

[0140] The lateral flow devices described herein may include a label. The label may take many different forms, including a molecule or composition that is bound or capable of binding to an analyte, an analyte analog, a detection reagent, or a binding partner that is detectable by spectroscopic, photochemical, biochemical, immunochemical, electrical, optical, or chemical means. Examples of labels include enzymes, colloidal gold particles (also called gold nanoparticles), colored latex particles, radioisotopes, cofactors, ligands, chemiluminescent or fluorescent agents, protein-adsorbed silver particles, protein-adsorbed iron particles, protein-adsorbed copper particles, protein-adsorbed selenium particles, protein-adsorbed sulfur particles, protein-adsorbed tellurium particles, protein-adsorbed carbon particles, and protein-bound dye capsules. The binding of a compound (e.g., a detection reagent) to the label may be by covalent bonds, adsorption processes, hydrophobic and / or electrostatic bonds, such as in chelators, or a combination of these bonds and interactions, and / or may include a binding group.

[0141] The term "specific binding partner (or binding partner)" refers to a member of a pair of molecules that interact by specific non-covalent interactions that depend on the three-dimensional structures of the molecules involved. Typical pairs of specific binding partners include antigen / antibody, hapten / antibody, hormone / receptor, nucleic acid strand / complementary nucleic acid strand, substrate / enzyme, inhibitor / enzyme, carbohydrate / lectin, biotin / (strept)avidin, receptor / ligand, and viral / cellular receptor, or various combinations thereof.

[0142] As used herein, the term "immunoglobulin" or "antibody" refers to a protein that binds to a specific antigen. Immunoglobulins include polyclonal, monoclonal, chimeric and humanized antibodies, Fab fragments, F(ab')2 fragments, including but not limited to the following classes of immunoglobulins: IgG, IgA, IgM, IgD, IbE, and secretory immunoglobulin (sIg). Immunoglobulins generally consist of two identical heavy chains and two light chains. However, the terms "antibody" and "immunoglobulin" also encompass single-chain and double-chain antibodies. For simplicity, the term "labeled antibody" or "capture antibody" is used throughout this specification, although the term "antibody" as used herein refers to an entire antibody or any fragment thereof. Thus, when referring to a labeled antibody that specifically binds to an analyte of interest, it is intended that the term refers to a labeled antibody or a fragment thereof that specifically binds to an analyte of interest. Similarly, when referring to a capture antibody, the term refers to a capture antibody or a fragment thereof that specifically binds to an analyte of interest.

[0143] The antibodies in the lateral flow devices, test systems, and methods of the present disclosure can include polyclonal antibodies. Polyclonal antibodies for measuring any of the analytes of interest disclosed herein include, but are not limited to, antibodies produced from serum by active immunization with one or more of the following: rabbit, goat, sheep, chicken, duck, guinea pig, mouse, donkey, camel, rat, and horse. The antibodies in the lateral flow devices, test systems, and methods of the present disclosure can include monoclonal antibodies.

[0144] Antibodies for measuring TRAIL include monoclonal and polyclonal antibodies for measuring TRAIL. In some embodiments, the TRAIL antibody binds to soluble TRAIL and / or the extracellular domain of TRAIL, e.g., amino acids 90-281. Examples of monoclonal antibodies for measuring TRAIL include, but are not limited to, the following: mouse, monoclonal (55B709-3) IgG; mouse, monoclonal (2E5) IgG1; mouse, monoclonal (2E05) IgG1; mouse, monoclonal (M91292) IgG1κ; mouse, monoclonal (IIIIF6) IgG2b; mouse, monoclonal (2E1-1B9) IgG1; mouse, monoclonal (RIK-2) IgG1,κ; mouse, monoclonal M181 IgG1; mouse, monoclonal VI10E IgG2b; mouse, monoclonal MAB375 IgG1; mouse, monoclonal MAB687 IgG1; mouse, monoclonal HS501 IgG1; mouse, monoclonal monoclonal clone 75411.11 mouse IgG1; mouse, monoclonal T8175-50 IgG; mouse, monoclonal 2B2.108 IgG1; mouse, monoclonal B-T24 IgG1; mouse, monoclonal 55B709.3 IgG1; mouse, monoclonal D3 IgG1; goat, monoclonal C19 IgG; rabbit, monoclonal H257 IgG; mouse, monoclonal 500-M49 IgG; mouse, monoclonal 05-607 IgG; mouse, monoclonal B-T24 IgG1; rat, monoclonal (N2B2), IgG2a, kappa; mouse, monoclonal (1A7-2B7), IgG1; mouse, monoclonal (55B709.3), IgG and mouse, monoclonal B-S23 * IgG1, human TRAIL / TNFSF10MAb (clone 75411), mouse IgG1, human TRAIL / TNFSF10MAb (clone 124723), mouse IgG1, human TRAIL / TNFSF10MAb (clone 75402), mouse IgG1.

[0145] Antibodies for measuring TRAIL include antibodies developed to target epitopes from the following non-exhaustive list: recombinant human TRAIL from mouse myeloma cell line, NSO (Thr95-Gly281 Accession #P50591), recombinant human TRAIL from mouse myeloma cell line, NSO (Thr95-Gly281 with N-terminal Met and 6-His tag Accession #P50591), from E. coli, (Vall 14-Gly281, with or without N-terminal Met Accession #:Q6IBA9), human plasma-derived TRAIL, human serum-derived TRAIL, recombinant human TRAIL where the first amino acid is between positions 85-151 and the last amino acid is at positions 249-281.

[0146] The antibody for measuring CRP includes a monoclonal antibody for measuring CRP and a polyclonal antibody for measuring CRP. Examples of the monoclonal antibody for measuring CRP include, but are not limited to, the following: mouse, monoclonal (108-2A2); mouse, monoclonal (108-7G41D2); mouse, monoclonal (12D-2C-36), IgG1; mouse, monoclonal (1G1), IgG1; mouse, monoclonal (5A9), IgG2a Kappa; Mouse, Monoclonal (63F4), IgG1; Mouse, Monoclonal (67A1), IgG1; Mouse, Monoclonal (8B-5E), IgG1; Mouse, Monoclonal (B893M), IgG2b; Lambda; Mouse, Monoclonal (C1), IgG2b; Mouse, Monoclonal (C11F2), IgG; Mouse, Monoclonal (C2), IgG1; Mouse, Monoclonal (C3), IgG1; Mouse, Monoclonal (C4), IgG1; Mouse, Monoclonal (C5), IgG2a; Mouse, Monoclonal (C6), IgG2a; Mouse, Monoclonal (C7), IgG1; Mouse, Monoclonal (CRP103), IgG2b; Mouse, Monoclonal ( CRP11), IgG1; Mouse, Monoclonal (CRP135), IgG1; Mouse, Monoclonal (CRP169), IgG2a; Mouse, Monoclonal (CRP30), IgG1; Mouse, Monoclonal (CRP36), IgG2a; Rabbit, Monoclonal (EPR283Y), IgG; Mouse, Monoclonal (KT39), IgG2b; Mouse, Monoclonal (Na), IgG1; Mouse, Monoclonal (N1G1), IgG1; Monoclonal (P5A9AT); Mouse, Monoclonal (S5G1), IgG1; Mouse, Monoclonal (SB78c), IgG1; Mouse, Monoclonal (SB78d), IgG1 and Rabbit, Monoclonal (Y284), IgG.

[0147] The antibody for measuring IP-10 includes a monoclonal antibody for measuring IP-10 and a polyclonal antibody for measuring IP-10. Monoclonal antibodies for measuring IP-10 include, but are not limited to, the following: IP-10 / CXCL10 mouse anti-human monoclonal (4D5) antibody (LifeSpan Biosciences), IP-10 / CXCL10 mouse anti-human monoclonal (A00163.01) antibody (LifeSpan Biosciences), mouse anti-human IP-10 (AbD Serotec), rabbit anti-human IP-10 (AbD Serotec), IP-10 human mAb 6D4 (Hycult Biotech), mouse anti-human IP-10 monoclonal antibody clone B-C50 (Diaclone), mouse anti-human IP-10 monoclonal antibody B-C55 (Diaclone), human CXCLlO / IP-10 MAb clone 33036 (R&D Systems), CXCL10 / INP10 antibody 1E9 (Novus Biologicals), CXCL10 / INP10 antibody 2C1 (Novus Biologicals), CXCL10 / INP10 antibody 6D4 (Novus Biologicals), CXCL10 monoclonal antibody M01A clone 2C1 (Abnova Corporation), CXCL10 monoclonal antibody (M05), clone 1E9 (Abnova Corporation), CXCL10 monoclonal antibody, clone 1 (Abnova Corporation), IP-10 antibody 6D4 (Abeam), IP10 antibody EPR7849 (Abeam), IP10 antibody EPR7850 (Abeam).

[0148] Antibodies for measuring IP-10 also include antibodies developed to target epitopes from the following non-exhaustive list: recombinant human CXCL10 / IP-10, a non-glycosylated polypeptide chain comprising 77 amino acids (aa 22-98) and N-terminal His-tagged interferon gamma-inducible protein 10 (125 aa in length), IP-10 produced in E. coli comprising the 77 amino acid fragment (22-98) and having a total molecular weight of 8.5 kDa with an amino-terminal hexahistidine tag; His-tagged human recombinant IP-10; E. coli-derived human IP-10 with an N-terminal Met (Val22-Pro98); human plasma-derived IP-10; human serum-derived IP-10; recombinant human IP-10 with the first amino acid between positions 1-24 and the last amino acid at positions 71-98.

[0149] The antibody for measuring procalcitonin (PCT) includes a monoclonal antibody for measuring PCT and a polyclonal antibody for measuring PCT. The monoclonal antibody for measuring PCT includes, but is not limited to, the following: mouse, monoclonal IgG1; mouse, monoclonal IgG2a; mouse, monoclonal IgG2b; mouse, monoclonal 44D9IgG2a; mouse, monoclonal 18B7IgG1; mouse, monoclonal G1 / G1-G4IgG1; mouse, monoclonal NOD-15IgG1; mouse, monoclonal 22A11IgG1; mouse, monoclonal 42IgG2a; mouse, monoclonal 27A3IgG2a; mouse, monoclonal 14C12IgG1; mouse, monoclonal 24B2IgG1; mouse, monoclonal 38F11IgG1; mouse, monoclonal 6F10IgG1.

[0150] The antibody for measuring MxA includes a monoclonal antibody for measuring MxA and a polyclonal antibody for measuring MxA. The monoclonal antibody for measuring MxA includes, but is not limited to, the following: mouse, monoclonal IgG; mouse, monoclonal IgG1; mouse, monoclonal IgG2a; mouse, monoclonal IgG2b; mouse, monoclonal 2G12 IgG1; mouse, monoclonal 474CT4-1-5 IgG2b; mouse, monoclonal AM39, IgG1; mouse, monoclonal 4812 IgG2a; mouse, monoclonal 683 IgG2b.

[0151] A lateral flow device according to the present disclosure includes a capture agent. The capture agent includes an immobilization agent capable of binding to an analyte, including free (unlabeled) analyte and / or a labeled analyte (e.g., a first complex, a second complex, or a third complex described herein). The capture agent includes (i) a labeled analyte of interest, (ii) a labeled or unlabeled analyte, or (iii) an unlabeled specific binding partner specific for an auxiliary specific binding partner, itself specific for the analyte, as in an indirect assay. As used herein, an "auxiliary specific binding partner" is a specific binding partner that binds to a specific binding partner of an analyte. For example, an auxiliary specific binding partner can include an antibody specific for another antibody, such as a goat anti-human antibody. The lateral flow devices described herein can include a "detection area" or "detection zone," which is a region that includes one or more capture areas or capture zones and where a detectable signal can be detected. The lateral flow devices described herein can include a "capture area," which is a region of the lateral flow device where a capture reagent is immobilized. The lateral flow devices described herein may include two or more capture areas. In some cases, different capture reagents are immobilized in different capture areas (e.g., a first capture reagent in a first capture area and a second capture reagent in a second capture area). The multiple capture areas can have any orientation relative to one another on the lateral flow substrate. For example, a first capture area can be distal or proximal to a second (or other) capture area along the path of fluid flow, or vice versa. Alternatively, the first capture area and the second (or other) capture area may be aligned along an axis perpendicular to the path of fluid flow such that fluid contacts the capture areas at or near the same time.

[0152] A lateral flow device according to the present disclosure includes an immobilized capture agent such that movement of the capture agent is restricted during normal operation of the lateral flow device. For example, movement of the immobilized capture agent is restricted before and after a fluid sample is applied to the lateral flow device. Immobilization of the capture agent can be achieved by physical means such as a barrier, electrostatic interactions, hydrogen bonding, bioaffinity, covalent interactions, or combinations thereof.

[0153] The lateral flow device according to the present disclosure can detect, identify, and in some cases quantify biological materials. Biological compounds include chemical or biochemical compounds produced by organisms, which may include prokaryotic, eukaryotic, mammalian, microbial, insect, plant, mixed, naturally occurring, or synthetically engineered cell systems. Biologicals include large macromolecules such as proteins, polysaccharides, lipids, and nucleic acids, as well as small molecules such as primary metabolites, secondary metabolites, and natural products.

[0154] It should be understood that the description, specific examples and data, while indicating exemplary embodiments, are given by way of illustration and are not intended to limit the various embodiments of the present disclosure. Various changes and modifications within the present disclosure will become apparent to those skilled in the art from the description and data contained herein and are therefore considered part of the various embodiments of the present disclosure.

Claims

1. 1. A method for detecting C-reactive protein (CRP) and TNF-related apoptosis-inducing ligand (TRAIL) present at different concentrations in a sample, comprising: providing a lateral flow assay; The lateral flow assay comprises: a first complex bound to a flow path of the lateral flow assay, the first complex comprising a label, an antibody or fragment thereof that specifically binds to CRP, and CRP; a second labeled antibody or fragment thereof coupled to the flow path and configured to specifically bind to TRAIL; a first capture zone downstream of the first complex, the first capture zone comprising a first immobilized antibody or fragment thereof that specifically binds to CRP; a second capture zone downstream of the second labeled antibody or fragment thereof, the second capture zone comprising a second immobilized antibody or fragment thereof that specifically binds to TRAIL; 0, 1, or only 2 control zones, if said control zones are present: i) one positive control zone; ii) one negative control zone, or iii) one positive control zone and one negative control zone; The control zone is selected from the signal generated in the positive control zone, if present, is independent of the presence and concentrations of CRP, TRAIL, and interferon-gamma-inducible protein 10 (IP-10) present in the sample; a negative control zone, if present, comprising an immobilized antibody against an interfering component that may be present in the sample, wherein the signal generated in the negative control zone is independent of the presence and concentration of CRP, TRAIL, and IP-10 present in the sample; and the amount of the first complex and the amount of the second labeled antibody or fragment thereof are such that the lateral flow assay can generate a first signal and a second signal that correlate to CRP present in the sample at a concentration at least six orders of magnitude higher than the concentration of TRAIL present in the sample; The method further comprises: applying the sample to the first complex and the second labeled antibody or fragment thereof; binding TRAIL to the second labeled antibody or fragment thereof to form a second complex; flowing the sample and the first complex through the first capture zone, wherein CRP in the sample and the first complex compete for binding to the first immobilized antibody or fragment thereof in the first capture zone; flowing the second complex in the flow path to the second capture zone, allowing the second complex to bind to the second immobilized antibody or fragment thereof in the second capture zone; detecting a first signal from the first complex bound to the first immobilized antibody or fragment thereof in the first capture zone and a second signal from the second complex bound to the second immobilized antibody or fragment thereof in the second capture zone; a step of correlating the first signal and the second signal with the concentration of the CRP and the concentration of the TRAIL in the sample, respectively, wherein the lateral flow assay is configured such that the first signal decreases as the concentration of the CRP in the sample increases within a certain concentration range, and the second signal increases as the concentration of the TRAIL in the sample increases within a certain concentration range; indicating a viral infection, a bacterial infection, inflammation, or no condition based on said respective concentrations of CRP and TRAIL; A method comprising:

2. The method described in claim 1, wherein the amount of the first complex and the amount of the second labeled antibody or its fragment are such that the lateral flow assay can produce a first signal and a second signal that correlate with CRP present in the sample at a concentration between 1 and 999 μg / ml and TRAIL present in the sample at a concentration between 1 and 999 pg / ml.

3. The method described in claim 1, wherein the amount of the first complex and the amount of the second labeled antibody or fragment thereof are such that the lateral flow assay can produce a first signal and a second signal that correlate to CRP present in the sample at a concentration at least seven orders of magnitude higher than the concentration of TRAIL present in the sample.

4. further comprising the step of detecting IP-10 in the sample, The lateral flow assay comprises: a third labeled antibody or fragment thereof that specifically binds to IP-10 and is coupled to the flow path; the amount of the first complex and the amount of the third labeled antibody or fragment thereof are such that the lateral flow assay is capable of producing a first signal and a second signal that correlate to CRP present in the sample at a concentration at least six orders of magnitude greater than the concentration of IP-10 present in the sample; The lateral flow assay comprises: a third capture zone downstream of the third labeled antibody or fragment thereof, the third capture zone comprising a third immobilized antibody or fragment thereof that specifically binds to IP-10; The method of claim 1.

5. Furthermore, applying the sample to the third labeled antibody or fragment thereof; binding the IP-10 to the third labeled antibody or fragment thereof to form a third complex; flowing the third complex in the flow path to the third capture zone, and allowing the third complex to bind to the third immobilized antibody or fragment thereof in the third capture zone; detecting a third signal from the third complex bound to the third immobilized antibody or fragment thereof in the third capture zone; The method of claim 4, comprising:

6. The method of claim 5, further comprising a step of correlating the third signal with the concentration of IP-10 in the sample, wherein the lateral flow assay is configured such that the third signal increases as the concentration of IP-10 in the sample increases within a certain concentration range.

7. The method of claim 6, wherein the step of indicating viral infection, bacterial infection, inflammation, or no condition is based on the respective concentrations of CRP, TRAIL, and IP-10.

8. The method described in claim 1, wherein the sample is a whole blood sample, a venous blood sample, a capillary blood sample, a serum sample or a plasma sample.

9. The method described in claim 1, wherein the sample is not diluted before applying the sample to the lateral flow assay.

10. The method described in claim 6, wherein the amount of the first complex and the amount of the third labeled antibody or fragment thereof are such that the lateral flow assay can generate a first signal and a third signal that correlate to CRP present in the sample at a concentration at least six orders of magnitude higher than the concentration of IP-10 present in the sample.

11. The method of claim 6, wherein the amount of the first complex, the amount of the second labeled antibody or fragment thereof, and the amount of the third labeled antibody or fragment thereof are such that the lateral flow assay can generate a first signal, a second signal, and a third signal that correlate with CRP present in the sample at a concentration between 1 and 999 μg / ml, TRAIL present in the sample at a concentration between 1 and 999 pg / ml, and IP-10 present in the sample at a concentration between 1 and 999 pg / ml.

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