Advancements and Applications of Lateral Flow Assays (LFAs): A Comprehensive Review

Abstract

Over a decade ago, WHO introduced the ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end-users) criteria to guide diagnostic assay development. Today, lateral flow assays (LFAs) best meet these standards, evolving from simple rapid tests to advanced diagnostics integrating AI and nanotechnology for precise, quantitative results. Notably, nanoparticle-enhanced LFAs have achieved limits of detection (LOD) as low as 0.01 pg/mL (a 100-fold improvement over conventional methods), while AI algorithms have reduced interpretation errors by 40% in low-contrast conditions. The COVID-19 pandemic underscored the societal impact of LFAs, with over 3 billion antigen tests deployed globally, demonstrating 98% specificity in real-world surveillance. Beyond infectious diseases, LFAs are revolutionizing cancer screening through liquid biopsy, achieving a 92% concordance rate with gold-standard assays, food safety and environmental monitoring. Despite these advancements, challenges remain in scalability, reproducibility, sustainable manufacturing, and how to enhance the sensitivities and lower the LOD. However, innovations in biodegradable materials, roll-to-roll printing, CRISPR-integrated multiplexing, and efficient functionalization methods like photochemical immobilization technique offer promising solutions, with projected further cost reductions and scalability. This review highlights the technological evolution, diverse applications, and future trajectories of LFAs, highlighting their critical role in democratizing diagnostics.