These results demonstrate that cantilever array sensors have the sensitivity to detect and quantify changes in drug-target binding interactions especially in vancomycin resistance associated with the deletion of a single H-bond from the drug's binding pocket. We show a nanomolar detection sensitivity of Van in agreement with previous Surface Plasmon Resonance (SPR) studies18,19, and reveal that the cantilever method can directly detect and quantify drug molecules in blood at clinically relevant concentrations as routinely applied in clinical practice. Our data suggest that the differential surface stress can be described by a product form equation (1), i.e. (i) a chemical term describing the specific drug-target binding events, and (ii) a geometrical term describing the mechanical connectivity between chemically reacted surface sites, implying that the local chemical interactions decouple from the global mechanical interactions of the cantilever. While the chemical term is given by the classical Langmuir adsorption isotherm, the geometrical term reveals a percolative mechanism of the drug-target induced surface stress changes. The critical threshold pc ~10% (Figure 5) was necessary to detect the differential cantilever bending, showing that surface stress is transduced collectively when a relatively large surface fraction is occupied by antibiotic molecules. For p≥pc, the mechanical connectivity between chemically transformed surface sites is gradually established, and the short-range repulsive interactions such as steric interactions between the nodes of the nanomechanical network gives rise to increasing downward bending of the entire cantilever. It is speculated that our nanomechanical percolation model may play an important role in the glycopeptide antibiotic mode of action in real bacteria. These findings highlight the high sensitivity of cantilever technology for studying antibiotics' mode of action and represent a novel research tool for studying drugs to improve understanding of the operations of antibiotics at the nano-scale to inform and enable discovery of powerful drugs to control the problems of superbug infections. To prepare the cantilever system for reproducible and sensitive measurements, we have addressed a set of targets in the protocol, particularly for sample loading in microfluidic cell and standard operating procedures to allow quantitative nanomechanical detections.
Significance of cantilever technology with respect to existing methods
In summary we point out that while this technology was proposed more than 25 years ago, it has not found its way into the clinic because of lack of careful and repetitive measurements on medically relevant targets. Here we demonstrate the procedures that establish the relevance of using nanomechanical cantilevers to investigate the mechanical influence of antibiotics on the bacterial cell wall targets and to detect antibacterial resistance. Conventional drug screening methods require some type of fluorescent or radioactive labeling of a reporter molecule to measure the binding of an analyte to its target, often in connection with a competitive or enzymatic binding assay and protein assays20. Labeling of biomolecules is not only time-consuming and expensive but the label can also interfere with the molecular interaction by obstructing the binding site, leading to false negatives. In addition, fluorescent compounds are often hydrophobic which can lead to background binding and false positives. Due to these limitations, there is an increasing interest in novel label-free techniques that allow virtually any molecular complex to be screened with minimal assay development. The most established label-free surface technologies at present are SPR and Quartz Crystal Microbalance (QCM). In contrast to SPR that measure the dielectric constant, a label - free cantilever technology detects the surface strain generated by a ligand-receptor interaction, which can directly measure the nanomechanical forces generated by the specific binding of ligands to surface receptors. The uniqueness of these sensors is that their sensitivity does not rely on dielectric properties caused by mass change due to the analyte binding as in SPR and QCM but rather on a minutest induced change in in-plane surface stress, making the technology uniquely suited to study the nanomechanics of drug molecules at clinically relevant antibiotic concentrations (3-27 μM)17. Cantilevers are also particularly well suited to small molecule (such as DNA fragments and drugs) detection under physiological conditions including complex environments which is largely the basis of the pharmaceutical industry and will therefore serve as a complementary tool in drug discovery. Cantilever technology have successfully been applied in the fields of genomics3,5, gas sensing21, proteomics22, and drugs1. Moreover, cantilevers are fabricated using low cost silicon technology and due to their compatibility with microfabrication processes, cantilevers can be miniaturized for improved sensitivity and parallelization into large arrays of sensors for multiple drug compound screening and higher throughput information-rich screening assays. Improvements of the instrumentation and experimental design will allow a wide variety of interactions to be analyzed in real time to help advance the search for a new generation of superdrugs to tackle the problems of multidrug resistant infections.
Critical steps within the protocol
The development of robust measurement protocols is central to the applications of this technology. To achieve satisfactory quantitative drug-target measurements and to determine the lowest concentration of antibiotics that could be detected in buffer or blood serum, critical steps within the protocol were addressed. The first task involves tuning and optimizing surface capture chemistries to enhance cantilever detection specificity and sensitivity. Undeniably, surface stress transduction is a collective phenomenon, requiring a relatively large fraction of the surface to be covered to establish connectivity between chemically reactive regions. We show that by varying the density of the underlying surface peptides, a critical threshold ~p ≥10%, is determined where the surface stress scale as a function of peptide density and zero otherwise (Figure 5). It is important that experiments are designed to investigate the uniformity of stress along the cantilevers to ensure maximum signal deflections for sensitive measurements. In addition, efficient surface regeneration protocols need to be in place, thereby allowing multiple cycle measurements and to reduce costs for each test. While designing a receptor surface using thiolated hydrophobic end, orientation of the receptor molecule and spacing between them is vital to allow self-assembly of dense packing due to Van-der-Waals interactions between the molecules to minimize nonspecific interactions. Furthermore, the capture molecules should contain a polyethylene glycol (PEG) linker to allow some part of the sensing matrix to be hydrophilic to prevent insertion of molecules in the analyte solution from reacting directly with the uncoated gold surface. The PEG linker molecules must act as spacers to reduce steric constraints and therefore allow the solution analytes to interact specifically with the surface receptors to induce measureable surface stress change. The cantilever array sensor must be assayed with at least an in situ reference measurement and the signal displayed in real-time is a differential deflection, obtained by subtracting the absolute deflection of the reference cantilever from the sensing cantilevers. Thus a reference cantilever is essential to account for nonspecific interactions such as temperature changes, changes in refractive index or interactions on the nonfunctionalized underside of the cantilever. Optimization of the flow rate (~30-150 μl/min) forms a critical step within the protocol because it ensures the efficient exchange of liquids and a sufficient steady mass transport of solution materials. The design of a liquid cell must allow optimum volume (5-80 μl) for fast flow rates to enable perfect liquid exchange to overcome mass transport limitations. The flow rate is especially critical while performing kinetic measurements23. Large volume liquid chambers require uncontrollable high flow rates leading to large sample volume requirements, which unnecessarily increases the price of the assay. Previously we have used gravity flow to inject different samples into the measurement liquid chamber. Gravity flow has the advantage that it does not require any mechanical parts and therefore does not introduce additional noise into the system. However, its significant disadvantage is that it only works reliably at relatively high flow rates (~200 μl/min). Obviously, a lower flow rate (≤1 μl/min) would require limited sample volumes per unit time but on the other hand it makes the reactions much slower and hence requires longer contact times. Moreover, gravity flow has a large variance in its flow rate as it depends on the height difference between the inlet and outlet, which decreases as the sample solutions are consumed during the experiment. To avoid gravity flow problems, a syringe pump should be used. The advantage of using a syringe pump is that it allows a constant flow rate over a long period of time allowing the experiments to be realized in a more controlled environment.
Limitations of the protocol
The major challenge in obtaining a reproducible and specific biological detection using cantilever sensors lies in ensuring that the properties of the receptor layer are biochemically "active" and uniform for each and every assay. The secret to experimental success is in a careful pretreatment of the sensor chip with a standardized cleaning and immobilization protocol with linker chemistries to orient the receptor molecules in their active conformation. In our current setup, we functionalize cantilever arrays using small glass capillaries, which could be subject to some drawbacks and can be problematic in some cases. These glass capillaries are open at both ends and therefore the sample solvents can evaporate easily. For example, if the temperature of the functionalization stage is not accurately controlled, the evaporation rate can vary significantly at different times particularly when using volatile solvents like ethanol. There is also a possibility of slight variation in the incubation time from one cantilever to another given that the sensing liquids have to be loaded consecutively into the capillaries. The other limiting factor in capillary functionalization is the lack of the ability to ensure that cantilevers are always inserted into the capillaries in exactly the same way. In addition, sometimes the cantilevers have to be pulled out slightly from the capillaries in order to prevent cross-contamination as the liquid samples can flow onto the chip body. We can solve these problems by employing inkjet spotters as an alternative surface coating procedure to coat cantilevers. While it would allow the exact control of sample coating with the possibility of scaling up for large arrays, the most common drawback is that the small drops that are deposited onto the cantilevers can evaporate within seconds and requires a controlled humidity environment. Therefore, the incubation time cannot be adjusted easily, which might be desirable for some applications. The subtle interplay of the factors such as sample volume, incubation time and evaporation rate have direct impact on the exposure of the cantilevers to the functionalization sample and care must be taken to ensure optimized surface chemistries for cantilever assays as any small variation in the receptor molecular density will have a large effect on the cantilever response.
Experimental design modifications (i.e. alternative techniques or materials)
To overcome the major challenge in obtaining reproducible coating procedure for the future development of the cantilever technology, different strategies are required that would use cantilevers integrated in microfluidic channels. The idea is that special cantilever chips should be designed so that each cantilever is placed into its own channel to allow online in situ functionalization procedures where the channels are addressed individually. These experimental design modifications would allow coating process to be performed in a controlled and closed environment where the exposure to the solvent is precisely monitored by the incubation time and flow rate for automated immobilization of capture molecules on cantilever chips. The same channels could then be used for the actual binding experiments where all cantilevers could be exposed to the same analyte solution. Besides the cantilever functionalization procedure, the cantilever readout mechanism would also need improvement. The optical beam deflection method is highly sensitive and it has been used successfully in Atomic Force Microscopy (AFM) technology for many years. Nevertheless, for the free standing cantilever sensor applications the optical readout has some drawbacks, for example it does not allow measurements in opaque liquids such as blood, the alignment of an array of lasers can be time-consuming and tedious and the current configuration cannot differentiate between tilting and vertical deflections. Thus the future development of the cantilever technology will have to consider aspects of the general sensor design (e.g. cantilever geometries) and the cantilever readout for robust measurement protocols both in the fields and laboratory environments. Manalis and coworkers22 have developed novel types of hollow cantilever sensors where the cantilevers have an embedded microfluidic channel inside the beam, allowing the device to be operated in a vacuum with high-quality factors. In this mode, cantilevers act as microbalance22, and therefore it is no longer necessary to have an asymmetry between the two sides with respect to functionalization, thus the capture molecules can be physisorbed or covalently attached directly on the silicon, typically using SAMs or silanes24. The cantilevers can also be modified with a thin polymer layer which is then conjugated to antibodies25 for biochemical sensing.
Troubleshooting
A common problem associated with the cantilever measurements is the introduction of air bubbles into the microfluidic flow cell. Care must be taken to ensure that no air bubbles are introduced into the liquid cell while mounting the chip. Signal drifting is also another common problem caused by the differences in the temperature of samples. The cantilevers must be equilibrated to stabilize before measurements are undertaken. All the buffers, analytes and regeneration solutions must be stored in the same room as the cantilever instrument to allow all the solutions to have the same temperature. Although the syringe pump can provide very accurate and extremely low flow rates, it is generally associated with mechanical noise in the cantilever measurements. It is therefore important to devise a simple and effective noise reducer to avoid unnecessary noise in the deflection signals. The noise reducer consists of small liquid reservoir located between the syringe pump and the liquid cell, which absorbs the mechanical noise from the pump. Because of the sensitive nature of optical detector, the cantilever measurement system should ideally be operated in an enclosed setup to block any stray lights from interfering with the optical readout system. In addition, the quality of the sensing layers can decrease significantly if a large number of washing steps are performed on the cantilevers limiting the lifetime of the sensor chip.
Alternative or future applications after mastering this technique
Cantilevers coated with SAMs terminating in an amino- or carboxyl-group can be used as pH sensors. The functional end groups protonate or deprotonate depending on the pH of the solution and can generate a surface charge that leads the cantilever to bend24. Given that the cantilever sensors can track drug-target interactions associated with the destabilization of the cell wall of life bacteria1,6,7, they will therefore help in the search and for the development of a new generation of antibiotics to combat drug-resistant infections. In future cantilevers would be used as microbalances to measure the mass and growth rates of single cells26. The cantilever technology will prove beneficial to the study of cellular responses to different growth factors or drugs. It will also offer a novel tool for rapid detection of multiple biomarkers, which has immediate relevance in medical and point-of-care applications. Given the versatility, small size, and robustness of cantilever sensors, they will form a sensitive monitor of harmful environmental factors. They have already demonstrated their sensitivity in detecting toxic and harmful gases that can escape from the laboratory and industrial production units into the environment, such as hydrofluoric acid27 or hydrogen cyanide28.