Therapeutic monitoring

治疗监测
  • 文章类型: Journal Article
    多巴胺是重要的神经递质之一,其在生物体液中的监测是医疗保健和现代生物医学技术中的关键问题。这里,我们开发了一种基于表面等离子体共振(SPR)的多巴胺生物传感器。为此,以羧甲基葡聚糖SPR芯片为表面固定化漆酶作为生物亲和识别元件。数据分析表明,酸性pH值是多巴胺相互作用的最佳条件。计算的动力学亲和力(KD)(48,545nM),从分子对接研究中获得,显示多巴胺与漆酶活性位点的强关联。生物传感器的线性范围为0.01至189μg/ml,检测下限为0.1ng/ml(信噪比(S/N)=3),显着高于迄今为止报道的最直接的多巴胺检测传感器。在存在可以与多巴胺检测共存的化合物(如抗坏血酸)的情况下进行特异性实验,尿素和左旋多巴无明显干扰。目前多巴胺生物传感器具有较高的灵敏度和特异性,代表一种新颖的检测工具,提供无标签,简单的程序和成本有效的监测系统。
    Dopamine is one of the significant neurotransmitters and its monitoring in biological fluids is a critical issue in healthcare and modern biomedical technology. Here, we have developed a dopamine biosensor based on surface plasmon resonance (SPR). For this purpose, the carboxymethyl dextran SPR chip was used as a surface to immobilize laccase as a bioaffinity recognition element. Data analysis exhibited that the acidic pH value is the optimal condition for dopamine interaction. Calculated kinetic affinity (KD) (48,545 nM), obtained from a molecular docking study, showed strong association of dopamine with the active site of laccase. The biosensor exhibited a linearity from 0.01 to 189 μg/ml and a lower detection limit of 0.1 ng/ml (signal-to-noise ratio (S/N) = 3) that is significantly higher than the most direct dopamine detecting sensors reported so far. Experiments for specificity in the presence of compounds that can co-exist with dopamine detection such as ascorbic acid, urea and L-dopa showed no significant interference. The current dopamine biosensor with high sensitivity and specificity, represent a novel detection tool that offers a label-free, simple procedure and cost effective monitoring system.
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  • 文章类型: Journal Article
    背景:免疫细胞和细胞因子与HIV感染期间的病毒血症动态和免疫状态有关。它们可以作为监测HIV-1(PLHIV-1)患者的有用生物标志物。目前的工作旨在评估细胞因子和免疫细胞谱是否有助于PLHIV-1的治疗性随访。
    方法:在贝宁的Abomey-Calavi/SóAva大学医院接受治疗成功的40例PLHIV-1(PLHIV-1s)和治疗失败的50例PLHIV-1(PLHIV-1f)。20例健康人作为对照组。通过ELISA和流式细胞术分别定量循环细胞因子和免疫细胞。
    结果:PLHIV-1表现出低比例的CD4+T细胞,NK,NKT,粒细胞,经典和非经典单核细胞,和高比例的CD8+T细胞,特别是在PLHIV-1f组中,与对照组相比。嗜酸性粒细胞,中性粒细胞和B细胞频率在研究组之间没有变化.与PLHIV-1f和对照受试者相比,PLHIV-1s中的循环IFN-γ降低,而IL-4显着增加,尽管PLHIV-1s中的HIV感染下调了对照受试者中观察到的高Th1表型。然而,在PLHIV-1f中,Th1/Th2比率仍然偏向于Th1表型,提示高病毒载量可能在这些患者中维持了潜在的促炎状态.炎性细胞因子的数据显示,PLHIV-1s和PLHIV-1f组的IL-6和TNF-α浓度明显高于对照组。与对照相比,在PLHIV-1f中观察到显著高水平的IL-5和IL-7,而PLHIV-1s仅呈现高水平的IL-5。在研究组之间没有观察到IL-13水平的变化。
    结论:我们的研究表明,除了CD4/CD8T细胞比,NK和NKT细胞以及IL-6,TNF-α,IL-5和IL-7细胞因子可以在PLHIV-1的治疗性监测中作为有价值的免疫生物标志物,尽管需要更多的患者来确认这些结果。
    BACKGROUND: Immune cells and cytokines have been linked to viremia dynamic and immune status during HIV infection. They may serve as useful biomarkers in the monitoring of people living with HIV-1 (PLHIV-1). The present work was aimed to assess whether cytokines and immune cell profiles may help in the therapeutic follow-up of PLHIV-1.
    METHODS: Forty PLHIV-1 in treatment success (PLHIV-1s) and fifty PLHIV-1 in treatment failure (PLHIV-1f) followed at the University Hospital of Abomey-Calavi/Sô-Ava in Benin were enrolled. Twenty healthy persons were also recruited as control group. Circulating cytokines and immune cells were quantified respectively by ELISA and flow cytometry.
    RESULTS: PLHIV-1 exhibited low proportions of CD4 + T cells, NK, NKT, granulocytes, classical and non-classical monocytes, and high proportions of CD8 + T cells, particularly in the PLHIV-1f group, compared to control subjects. Eosinophils, neutrophils and B cell frequencies did not change between the study groups. Circulating IFN-γ decreased whereas IL-4 significantly increased in PLHIV-1s compared to PLHIV-1f and control subjects even though the HIV infection in PLHIV-1s downregulated the high Th1 phenotype observed in control subjects. However, Th1/Th2 ratio remained biased to a Th1 phenotype in PLHIV-1f, suggesting that high viral load may have maintained a potential pro-inflammatory status in these patients. Data on inflammatory cytokines showed that IL-6 and TNF-α concentrations were significantly higher in PLHIV-1s and PLHIV-1f groups than in control subjects. Significant high levels of IL-5 and IL-7 were observed in PLHIV-1f compared to controls whereas PLHIV-1s presented only a high level of IL-5. No change was observed in IL-13 levels between the study groups.
    CONCLUSIONS: Our study shows that, in addition to CD4/CD8 T cell ratio, NK and NKT cells along with IL-6, TNF-α, IL-5 and IL-7 cytokines could serve as valuable immunological biomarkers in the therapeutic monitoring of PLHIV-1 although a larger number of patients would be necessary to confirm these results.
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  • 文章类型: Journal Article
    背景:目前通过白细胞胱氨酸测定法监测肾病性膀胱炎的半胱氨酸消耗疗法,尽管它的应用和有用性受实际和技术问题的限制。因此,广泛可用的替代生物标志物,更经济,技术要求更低,同时可靠地反映了对半胱胺治疗的长期坚持,是可取的。最近,我们提出了壳三糖苷酶酶活性作为一个潜在的新的生物标志物,用于治疗性监测半胱胺治疗的胱氨酸病。在这项研究中,我们的目的是验证我们之前的研究结果,并确认壳三糖苷酶在胱氨酸病治疗中的价值.
    方法:对在美国国立卫生研究院临床中心接受治疗的12名患者进行了回顾性研究,并随访了至少2年。血浆壳三糖苷酶酶活性与相应的临床和生化数据相关。
    结果:血浆壳三糖苷酶活性与白细胞胱氨酸水平显著相关,半胱胺总每日剂量和综合依从性评分。此外,血浆壳三糖苷酶是白细胞胱氨酸水平的显著独立预测因子,并在非肾移植和肾移植的胱氨酸病患者中建立了临界值,以区分对半胱胺治疗依从性好和差的患者。我们的观察结果与我们之前的研究结果一致,并验证了我们的发现。
    结论:壳三糖苷酶活性是监测肾病性膀胱炎患者半胱胺治疗的有效的潜在替代生物标志物。
    结论:壳三糖苷酶活性是监测肾病性膀胱炎患者半胱胺治疗的有效的潜在替代生物标志物。
    BACKGROUND: Cystine-depleting therapy in nephropathic cystinosis is currently monitored via the white blood cell cystine assay, although its application and usefulness are limited by practical and technical issues. Therefore, alternative biomarkers that are widely available, more economical and less technically demanding, while reliably reflecting long-term adherence to cysteamine treatment, are desirable. Recently, we proposed chitotriosidase enzyme activity as a potential novel biomarker for the therapeutic monitoring of cysteamine treatment in cystinosis. In this study, we aimed to validate our previous findings and to confirm the value of chitotriosidase in the management of cystinosis therapy.
    METHODS: A retrospective study was conducted on 12 patients treated at the National Institutes of Health Clinical Center and followed up for at least 2 years. Plasma chitotriosidase enzyme activity was correlated with corresponding clinical and biochemical data.
    RESULTS: Plasma chitotriosidase enzyme activity significantly correlated with WBC cystine levels, cysteamine total daily dosage and a Composite compliance score. Moreover, plasma chitotriosidase was a significant independent predictor for WBC cystine levels, and cut-off values were established in both non-kidney transplanted and kidney transplanted cystinosis patients to distinguish patients with a good versus poor compliance with cysteamine treatment. Our observations are consistent with those of our previous study and validate our findings.
    CONCLUSIONS: Chitotriosidase enzyme activity is a valid potential alternative biomarker for monitoring cysteamine treatment in nephropathic cystinosis patients.
    CONCLUSIONS: Chitotriosidase enzyme activity is a valid potential alternative biomarker for monitoring cysteamine treatment in nephropathic cystinosis patients.
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  • 文章类型: Journal Article
    本研究对Friedreich共济失调(FA)患者的线粒体酶活性进行了深入分析,专注于电子传输链配合物I,II,IV,克雷布斯循环酶柠檬酸合成酶,和辅酶Q10水平。它检查了34名FA患者的队列,比较它们的线粒体酶活性和临床参数,包括疾病持续时间和心脏标志物,17个健康对照者。研究结果表明,复合物II和,具体来说,IV,强调FA中的线粒体损伤。此外,在FA患者中观察到神经丝轻链水平和心脏标志物升高.这项研究增强了我们对FA病理生理学的理解,并提出了监测疾病进展的潜在生物标志物。该研究强调需要进一步的临床试验来验证这些发现,强调线粒体功能障碍在FA评估和治疗中的关键作用。
    This study presents an in-depth analysis of mitochondrial enzyme activities in Friedreich\'s ataxia (FA) patients, focusing on the Electron Transport Chain complexes I, II, and IV, the Krebs Cycle enzyme Citrate Synthase, and Coenzyme Q10 levels. It examines a cohort of 34 FA patients, comparing their mitochondrial enzyme activities and clinical parameters, including disease duration and cardiac markers, with those of 17 healthy controls. The findings reveal marked reductions in complexes II and, specifically, IV, highlighting mitochondrial impairment in FA. Additionally, elevated Neurofilament Light Chain levels and cardiomarkers were observed in FA patients. This research enhances our understanding of FA pathophysiology and suggests potential biomarkers for monitoring disease progression. The study underscores the need for further clinical trials to validate these findings, emphasizing the critical role of mitochondrial dysfunction in FA assessment and treatment.
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  • 文章类型: Journal Article
    化学免疫疗法已发展成为晚期非小细胞肺癌(aNSCLC)的标准治疗方法。然而,不可避免的耐药性限制了其疗效,强调迫切需要化学免疫疗法的生物标志物。一个三阶段的战略来发现,验证,并验证在使用化学免疫疗法前后aNSCLC的纵向预测性自身抗体(AAbs)。共收集了267例抗PD1免疫治疗前后aNSCLC患者的528份血浆样本,加上30个独立的福尔马林固定石蜡包埋样品。在发现阶段,首先使用含有21,000种蛋白质的HuProtTM高密度微阵列选择候选AAb,然后使用aNSCLC聚焦微阵列进行验证。基于应答者与非应答者的比较和无进展存活(PFS)存活分析,选择纵向预测性AAbs用于酶联免疫吸附测定(ELISA)。还使用免疫组织化学和公开可用的免疫疗法数据集验证了预后标志物。我们在接受化学免疫疗法的aNSCLC患者中鉴定并验证了一组两种AAbs(MAX和DHX29)作为治疗前生物标志物,另一组两种AAbs(MAX和TAPBP)作为治疗中的预测标志物。所有三种AAbs均与早期反应和PFS呈正相关(p<0.05)。MAXAAb的动力学在响应者中显示出增加的趋势(p<0.05),在非响应者中显示出最初增加然后减少的趋势(p<0.05)。重要的是,MAX蛋白和mRNA水平可有效区分接受免疫治疗的aNSCLC患者的PFS(p<0.05)。我们的结果提供了接受化学免疫治疗的aNSCLC患者预后AAbs变化的纵向分析。
    Chemoimmunotherapy has evolved as a standard treatment for advanced non-small cell lung cancer (aNSCLC). However, inevitable drug resistance has limited its efficacy, highlighting the urgent need for biomarkers of chemoimmunotherapy. A three-phase strategy to discover, verify, and validate longitudinal predictive autoantibodies (AAbs) for aNSCLC before and after chemoimmunotherapy was employed. A total of 528 plasma samples from 267 aNSCLC patients before and after anti-PD1 immunotherapy were collected, plus 30 independent formalin-fixed paraffin-embedded samples. Candidate AAbs were firstly selected using a HuProt high-density microarray containing 21,000 proteins in the discovery phase, followed by validation using an aNSCLC-focused microarray. Longitudinal predictive AAbs were chosen for ELISA based on responders versus non-responders comparison and progression-free survival (PFS) survival analysis. Prognostic markers were also validated using immunohistochemistry and publicly available immunotherapy datasets. We identified and validated a panel of two AAbs (MAX and DHX29) as pre-treatment biomarkers and another panel of two AAbs (MAX and TAPBP) as on-treatment predictive markers in aNSCLC patients undergoing chemoimmunotherapy. All three AAbs exhibited a positive correlation with early responses and PFS (p < 0.05). The kinetics of MAX AAb showed an increasing trend in responders (p < 0.05) and a tendency to initially increase and then decrease in non-responders (p < 0.05). Importantly, MAX protein and mRNA levels effectively discriminated PFS (p < 0.05) in aNSCLC patients treated with immunotherapy. Our results present a longitudinal analysis of changes in prognostic AAbs in aNSCLC patients undergoing chemoimmunotherapy.
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  • 文章类型: Journal Article
    背景:间变性淋巴瘤激酶-酪氨酸激酶抑制剂(ALK-TKIs)在ALK阳性的非小细胞肺癌(NSCLC)患者中显示出显著的治疗效果。识别预后生物标志物可以增强复发或难治性患者的临床疗效。
    方法:我们使用独立于数据的采集-质谱(DIA-MS)分析了63例ALK阳性NSCLC患者的159例治疗前和治疗中血浆样品中的737种血浆蛋白。一致性聚类算法用于识别具有不同生物学特征的亚型。使用LASSO-Cox方法构建基于血浆的预后模型。我们进行了Mfuzz分析以对治疗期间血浆蛋白的纵向变化模式进行分类。收集来自另一个独立ALK-TKI治疗组群的52个基线血浆样品以使用ELISA验证潜在的预后标志物。
    结果:我们确定了三种具有不同生物学特征和临床疗效的ALK阳性NSCLC亚型。第1亚组患者表现出激活的体液免疫和炎症反应,阳性急性期反应蛋白的表达增加,和最坏的预后。然后,我们构建并验证了一个预后模型,该模型使用五种血浆蛋白(SERPINA4,ATRN,APOA4,TF,和MYOC)在基线。接下来,我们研究了治疗期间血浆蛋白表达的纵向变化,并确定了4种不同的变化模式(1-4簇).治疗过程中急性期蛋白的纵向变化可以反映患者的治疗状态和肿瘤进展。最后,我们验证了基线血浆CRP的预后功效,SAA1,AHSG,另一个接受ALK-TKI治疗的独立NSCLC队列中的SERPINA4和TF。
    结论:本研究有助于寻找血浆样本中ALK-TKI治疗的预后和耐药生物标志物,并为耐药机制和后续治疗选择提供新的见解。
    Anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKIs) has demonstrated remarkable therapeutic effects in ALK-positive non-small cell lung cancer (NSCLC) patients. Identifying prognostic biomarkers can enhance the clinical efficacy of relapsed or refractory patients.
    We profiled 737 plasma proteins from 159 pre-treatment and on-treatment plasma samples of 63 ALK-positive NSCLC patients using data-independent acquisition-mass spectrometry (DIA-MS). The consensus clustering algorithm was used to identify subtypes with distinct biological features. A plasma-based prognostic model was constructed using the LASSO-Cox method. We performed the Mfuzz analysis to classify the patterns of longitudinal changes in plasma proteins during treatment. 52 baseline plasma samples from another independent ALK-TKI treatment cohort were collected to validate the potential prognostic markers using ELISA.
    We identified three subtypes of ALK-positive NSCLC with distinct biological features and clinical efficacy. Patients in subgroup 1 exhibited activated humoral immunity and inflammatory responses, increased expression of positive acute-phase response proteins, and the worst prognosis. Then we constructed and verified a prognostic model that predicts the efficacy of ALK-TKI therapy using the expression levels of five plasma proteins (SERPINA4, ATRN, APOA4, TF, and MYOC) at baseline. Next, we explored the longitudinal changes in plasma protein expression during treatment and identified four distinct change patterns (Clusters 1-4). The longitudinal changes of acute-phase proteins during treatment can reflect the treatment status and tumor progression of patients. Finally, we validated the prognostic efficacy of baseline plasma CRP, SAA1, AHSG, SERPINA4, and TF in another independent NSCLC cohort undergoing ALK-TKI treatment.
    This study contributes to the search for prognostic and drug-resistance biomarkers in plasma samples for ALK-TKI therapy and provides new insights into the mechanism of drug resistance and the selection of follow-up treatment.
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  • 文章类型: Journal Article
    背景:18F-FDG-PET/CT被推荐用于改善人工瓣膜感染性心内膜炎(PVIE)的诊断,并且是ESC-2015分类中的主要标准。然而,在接受药物治疗的PVIE患者的随访中,几乎没有证据表明其有用性.
    方法:对2013年1月至2019年12月因PVIE住院的患者进行单中心回顾性分析,这些患者在医疗管理期间未接受手术治疗且至少接受过两次18F-FDG-PET/CT检查。
    结果:在170例PVIE患者中,117例接受了抗生素治疗,但没有手术。其中,36(31%)进行了至少两次18F-FDG-PET/CT检查。在初始成像时,28例患者在其人工瓣膜上有不均匀的FDG摄取,在其相关的主动脉移植物上有8例。在18和19例患者中观察到脾和骨髓高代谢(HSBM),分别。首次随访18F-FDG-PET/CT,21例(58%)患者仍有异质摄取,提示持续性活动性心内膜炎.在6例复发性PVIE患者中,有4例在最后一次随访成像中仍存在HSBM。
    结论:对接受药物治疗的PVIE患者进行18F-FDG-PET/CT监测提供了有价值的额外信息,应进行前瞻性多中心研究以评估其有效性。
    BACKGROUND: 18F-FDG-PET/CT is recommended to improve the diagnosis of prosthetic valve infective endocarditis (PVIE) and is a major criterion in the ESC-2015 classification. However, there is little evidence for its usefulness in the follow-up of medically treated PVIE patients.
    METHODS: A monocentric retrospective analysis of patients hospitalized for PVIE between January 2013 and December 2019 who were not treated with surgery and who had at least two 18F-FDG-PET/CT examinations during their medical management.
    RESULTS: Among 170 patients with PVIE, 117 were treated with antibiotic therapy but no surgery. Of these, 36 (31%) had at least two 18F-FDG-PET/CT examinations. At initial imaging, 28 patients had heterogeneous FDG uptake on their prosthetic valve and eight on their associated aortic graft. Hypermetabolism of spleen and bone marrow (HSBM) was observed in 18 and 19 patients, respectively. At the first follow-up 18F-FDG-PET/CT, 21 (58%) patients still had heterogeneous uptake, indicating persistent active endocarditis. HSBM was still present at the last follow-up imaging in four of the six patients with recurrent PVIE.
    CONCLUSIONS: 18F-FDG-PET/CT monitoring of medically treated patients with PVIE provides valuable additional information and prospective multicentric study should be conducted to assess its usefulness.
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  • 文章类型: Journal Article
    药物治疗监测,特别是那些有多种代谢物的,由于需要不同的分析方法,这取决于感兴趣的特定代谢物或基质,因此可能是耗时且费力的。在这项研究中,我们采用基于反相和混合模式机制耦合的切心2D-LC分离方法来确定Favipiravir和5种主要代谢物的替代物.这种方法适用于血清,等离子体,尿液,和人外周血单核细胞。该方法经过验证以确保其可靠性。这些发现强调了2D-LC作为治疗药物监测的实用和有效方法的潜力。
    Therapeutic monitoring of drugs, particularly those with multiple metabolites, can be time-consuming and labor-intensive due to the need for different analytical methods depending on the specific metabolite or matrix of interest. In this study, we employed a heart-cutting 2D-LC separation method based on the coupling of reversed-phase and mixed-mode mechanisms to determine Favipiravir and surrogates of five main metabolites. This approach was applied to serum, plasma, urine, and human peripheral blood mononuclear cells. The method underwent validation to ensure its reliability. The findings highlight the potential of 2D-LC as a practical and efficient approach for therapeutic drug monitoring.
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  • 文章类型: Journal Article
    背景:在确定最有效的治疗策略和确定将受益于肾细胞癌辅助或新辅助治疗的患者方面仍然存在挑战。这篇综述的目的是全面概述转移性肾细胞癌(mRCC)中的生物标志物及其在预测治疗反应中的应用。预后,以及接受转移性疾病全身治疗的患者的治疗监测。
    方法:使用PubMed数据库对2017年1月至2022年12月发表的相关研究进行了系统的文献检索。搜索的重点是与mRCC相关的生物标志物及其与免疫检查点抑制剂的关系。靶向治疗,和佐剂中的VEGF抑制剂,新辅助,和转移设置。
    结果:评论确定了各种具有预测性,预后,和mRCC的治疗监测潜力。该综述还讨论了与抗血管生成和免疫检查点单一疗法试验相关的挑战,并强调了基于分子特征的个性化治疗的必要性。
    结论:这篇全面的综述为mRCC中生物标志物的景观及其在预测治疗反应中的潜在应用提供了有价值的见解,预后,和治疗监测。研究结果强调了将生物标志物评估纳入临床实践以指导治疗决策和改善mRCC患者预后的重要性。
    BACKGROUND: Challenges remain in determining the most effective treatment strategies and identifying patients who would benefit from adjuvant or neoadjuvant therapy in renal cell carcinoma. The objective of this review is to provide a comprehensive overview of biomarkers in metastatic renal cell carcinoma (mRCC) and their utility in prediction of treatment response, prognosis, and therapeutic monitoring in patients receiving systemic therapy for metastatic disease.
    METHODS: A systematic literature search was conducted using the PubMed database for relevant studies published between January 2017 and December 2022. The search focused on biomarkers associated with mRCC and their relationship to immune checkpoint inhibitors, targeted therapy, and VEGF inhibitors in the adjuvant, neoadjuvant, and metastatic settings.
    RESULTS: The review identified various biomarkers with predictive, prognostic, and therapeutic monitoring potential in mRCC. The review also discussed the challenges associated with anti-angiogenic and immune-checkpoint monotherapy trials and highlighted the need for personalized therapy based on molecular signatures.
    CONCLUSIONS: This comprehensive review provides valuable insights into the landscape of biomarkers in mRCC and their potential applications in prediction of treatment response, prognosis, and therapeutic monitoring. The findings underscore the importance of incorporating biomarker assessment into clinical practice to guide treatment decisions and improve patient outcomes in mRCC.
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  • 文章类型: Journal Article
    准确检测和监测治疗药物水平对于有效的患者护理和治疗管理至关重要。适体,由单链DNA或RNA分子组成,是为生物样品的定性和定量检测而设计的生物传感器的组成部分。Aptasensor在目标识别中起着至关重要的作用,验证,检测药物-靶标相互作用和筛选候选药物的潜力。这篇综述的重点是aptasensor在早期疾病检测中的关键作用,特别是在识别与癌症等各种疾病相关的生物标志物方面,传染病和心血管疾病。Aptasensor在增强疾病诊断和监测治疗药物水平方面表现出非凡的潜力。基于适体的生物传感器代表了医疗保健领域的变革性技术,实现精确诊断,药物监测和疾病检测。
    Accurate detection and monitoring of therapeutic drug levels are vital for effective patient care and treatment management. Aptamers, composed of single-stranded DNA or RNA molecules, are integral components of biosensors designed for both qualitative and quantitative detection of biological samples. Aptasensors play crucial roles in target identification, validation, detection of drug-target interactions and screening potential of drug candidates. This review focuses on the pivotal role of aptasensors in early disease detection, particularly in identifying biomarkers associated with various diseases such as cancer, infectious diseases and cardiovascular disorders. Aptasensors have demonstrated exceptional potential in enhancing disease diagnostics and monitoring therapeutic drug levels. Aptamer-based biosensors represent a transformative technology in the field of healthcare, enabling precise diagnostics, drug monitoring and disease detection.
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