Homogeneous Binary Visual and Fluorescence Detection of Tetanus Toxoid in Clinical Samples Based on Enzyme-Free Parallel Hybrid Chain Reaction

Here, we report a simple aptamer-based toxoid test with both fluorescence and binary visual readouts. This test is established based on our recent finding that CdTe quantum dots could differentiate DNA templated Cu NPs from Cu^{2+}. Through the further integration with enzyme-free triple parallel hybridization chain reaction, cation exchange reaction, and inkjet printing, we demonstrated specific detection of tetanus toxoid with a limit-of-detection (LOD) of 0.25 fg/mL using fluorescence readout. Using color- and distance-based binary visual readouts, we were able to achieve LODs of 10 fg/mL and 1 fg/mL, respectively. The quantitative test results for tetanus toxoid using both fluorescence and visual readouts were successfully validated in 84 clinical serum samples. Moreover, our strategy also enabled accurate monitoring of tetanus toxoid levels in patients before and after drug treatment. On the basis of our clinical test results, we recommend a cutoff value of 5 fg/mL for tetanus infection.