Preclinical in vivo study of a fluorescence affinity sensor for short-term continuous glucose monitoring in a small and large animal model.

BACKGROUND: The performance of a fiber-coupled fluorescence affinity sensor (FAS) was studied in vivo in small and large animal models, in order to assess its feasibility and safety for short-term glucose monitoring in humans. METHODS: Determination of interstitial glucose concentrations in skin tissue of hairless rats and small pigs was facilitated by measuring the fluorescence response of the implanted FAS over several hours and multiple days. Blood sugar changes in animals were induced by injections of insulin and dextrose. The Medtronic Minimed CGMS (Medtronic Diabetes, Northridge, CA) was used for comparison. RESULTS: The acute in vivo performance study of the fiber-coupled FAS showed that more than 96% of the paired FAS/venous blood glucose readings were in the clinically acceptable A and B regions of the Clarke Error Grid. Mean absolute relative difference (MARD) and root mean squared error (RMSE) values for small and large animal models were 18.5% and 19.8 mg/dL and 15.9% and 16.3 mg/dL, respectively. In comparison, MARD and RMSE for the Medtronic Minimed CGMS in small and large animal models were similar (in rats, 25.4% and 19.8 mg/dL, respectively; in pigs, 18.4% and 16.2 mg/dL, respectively). No instance of irritation or infection was observed at any implantation site. The in vivo performance of FAS over a 3-day period was successfully demonstrated in both animal models. CONCLUSIONS: Overall, the fiber-coupled FAS was safe, and its performance during 4-h and 3-day testing compared favorably to the commercially available Medtronic Minimed CGMS, indicating its potential value for diabetes management.

Concanavalin A for in vivo glucose sensing: a biotoxicity review.

Over the last two decades there as has been surging scientific interest in employing the glucose- and mannose-specific lectin Concanavalin A (ConA) in affinity biosensors for in vivo glucose monitoring in diabetics. Numerous research groups have successfully shown in in vitro and in vivo studies that ConA-based affinity sensors can monitor glucose very accurately and reproducibly over many months, making ConA-based sensors an extremely interesting prospect for long-term implantation in humans. Despite this progress, there remains concern over the safety of ConA, which has widely been reported as a toxin in the literature. In this article, we review in vitro and in vivo studies related to ConA toxicity in order to assess the health risks posed by ConA in the context of an implantable biosensor. Based on the wealth of information available and on data from our own studies, we can conclude that the site of implantation (subcutaneous skin tissue) and the small amount of ConA (<10 microg/microl) being used in implantable glucose-sensitive detector devices like those proposed by various research groups would pose little or no health risk to its bearer even in the event of unexpected sensor rupture.

In vivo performance evaluation of a transdermal near- infrared fluorescence resonance energy transfer affinity sensor for continuous glucose monitoring.

The in vivo performance of a transdermal near-infrared fluorescence resonance energy transfer (FRET) affinity sensor was investigated in hairless rats, in order to validate its feasibility for glucose monitoring in humans. The sensor itself consists of a small hollow fiber implanted in dermal skin tissue, containing glucose-sensitive assay chemistry composed of agarose-immobilized Concanavalin A (ConA) and free dextran. The glucose-dependent fluorescence change is based on FRET between near-infrared-compatible donor and quencher dyes that are chemically linked to dextran and ConA, respectively. We conducted an acute in vivo evaluation of transdermal sensors with an optical fiber-coupled setup over 4 h, and a chronic in vivo evaluation of fully implanted sensors for up to 16 days. The fiber-coupled sensors followed trends of blood glucose concentrations very well with a delay of less than 5 min. The acute performance of the implanted sensors at the day of implantation was similar to that of the fiber-coupled sensors. After 2 weeks the implanted sensors remained functional, evidenced by an adequate correlation between sensor signal and changes in blood glucose excursions, but exhibited delays of approximately 10-15 min. Preliminary characterization of host response showed signs of mild inflammations around the implanted sensor, which were characterized by formation of a 10-20-microm-thick collagen band, typical for capsule formation. An acute study of systemic ConA biotoxicity was also conducted. A histological analysis of various organs and of clinical chemistry data showed no significant differences between rats receiving intradermal injections of ConA at 10 times the concentration in the sensor and rats in a control group (injection of saline solution). The absence of a toxicological or systemic response to ConA at a 10-fold larger amount than in the sensor should dispel concerns over the in vivo safety of ConA-based sensors. This study clearly demonstrates the feasibility of the proposed transdermal FRET-based sensor interrogation concept for glucose monitoring.

A label-free fiber-optic Turbidity Affinity Sensor (TAS) for continuous glucose monitoring.

In this paper, we describe the concept of a novel implantable fiber-optic Turbidity Affinity Sensor (TAS) and report on the findings of its in-vitro performance for continuous glucose monitoring. The sensing mechanism of the TAS is based on glucose-specific changes in light scattering (turbidity) of a hydrogel suspension consisting of small particles made of crosslinked dextran (Sephadex G100), and a glucose- and mannose-specific binding protein - Concanavalin A (ConA). The binding of ConA to Sephadex particles results in a significant turbidity increase that is much greater than the turbidity contribution by the individual components. The turbidity of the TAS was measured by determining the intensity of light passing through the suspension enclosed within a small semi-permeable hollow fiber (OD: 220 µm, membrane thickness: 20 µm, molecular weight cut-off: 10 kDa) using fiber optics. The intensity of measured light of the TAS was proportional to the glucose concentration over the concentration range from 50mg/dL to 400mg/dL in PBS and whole blood at 37°C (R>0.96). The response time was approximately 4 min. The stability of the glucose response of the TAS decreased only slightly (by 20%) over an 8-day study period at 37°C. In conclusion, this study demonstrated proof-of-concept of the TAS for interstitial glucose monitoring. Due to the large signal amplitude of the turbidity change, and the lack of need for wavelength-specific emission and excitation filters, a very small, robust and compact TAS device with an extremely short optical pathlength could be feasibly designed and implemented for in-vivo glucose monitoring in people with diabetes.

Acute in vivo performance evaluation of the fluorescence affinity sensor in the intravascular and interstitial space in Swine.

OBJECTIVE: We assessed and compared the performance levels of a fiber-coupled fluorescence affinity sensor (FAS) for glucose detection in the intradermal tissue and intravascular bed during glucose clamping and insulin administration in a large animal model. RESEARCH DESIGN AND METHODS: The FAS (BioTex Inc., Houston, TX) was implanted in interstitial tissue and in the intravenous space in nondiabetic, anesthetized pigs over 6-7 h. For intradermal assessment, a needle-type FAS was implanted in the upper back using a hypodermic needle. For intravenous assessment, the FAS was inserted through a catheter into the femoral artery and vein. Blood glucose changes were induced by infusion of dextrose and insulin through a catheterized ear or jugular vein. RESULTS: Based on retrospective analysis, the mean absolute relative error (MARE) of the sensor in blood and interstitial tissue was 11.9% [standard deviation (SD) = ± 9.6%] and 23.8% (SD = ± 19.4%), respectively. When excluding data sets from sensors that were affected by exogenous insulin, the MARE for those sensors tested in interstitial tissue was reduced to 16.3% (SD = ± 12.5%). CONCLUSIONS: The study demonstrated that the performance level of the FAS device implanted in interstitial tissue and blood can be very high. However, under certain circumstances, exogenous insulin caused the glucose concentration in interstitial tissue to be lower than in blood, which resulted in an overall lower level of accuracy of the FAS device. How significant this physiological effect is in insulin-treated persons with diabetes remains to be seen. In contrast, the level of accuracy of the FAS device in blood was very high because of high mass transfer conditions in blood. While the use of the FAS in both body sites will need further validation, its application in critically ill patients looks particularly promising.

A human pilot study of the fluorescence affinity sensor for continuous glucose monitoring in diabetes.

OBJECTIVE: We report results of a pilot clinical study of a subcutaneous fluorescence affinity sensor (FAS) for continuous glucose monitoring conducted in people with type 1 and type 2 diabetes. The device was assessed based on performance, safety, and comfort level under acute conditions (4 h). RESEARCH DESIGN AND METHODS: A second-generation FAS (BioTex Inc., Houston, TX) was subcutaneously implanted in the abdomens of 12 people with diabetes, and its acute performance to excursions in blood glucose was monitored over 4 h. After 30-60 min the subjects, who all had fasting blood glucose levels of less than 200 mg/dl, received a glucose bolus of 75 g/liter dextrose by oral administration. Capillary blood glucose samples were obtained from the finger tip. The FAS data were retrospectively evaluated by linear least squares regression analysis and by the Clarke error grid method. Comfort levels during insertion, operation, and sensor removal were scored by the subjects using an analog pain scale. RESULTS: After retrospective calibration of 17 sensors implanted in 12 subjects, error grid analysis showed 97% of the paired values in zones A and B and 1.5% in zones C and D, respectively. The mean absolute relative error between sensor signal and capillary blood glucose was 13% [±15% standard deviation (SD), 100-350 mg/dl] with an average correlation coefficient of 0.84 (±0.24 SD). The actual average "warm-up" time for the FAS readings, at which highest correlation with glucose readings was determined, was 65 (±32 SD) min. Mean time lag was 4 (±5 SD) min during the initial operational hours. Pain levels during insertion and operation were modest. CONCLUSIONS: The in vivo performance of the FAS demonstrates feasibility of the fluorescence affinity technology to determine blood glucose excursions accurately and safely under acute dynamic conditions in humans with type 1 and type 2 diabetes. Specific engineering challenges to sensor and instrumentation robustness remain. Further studies will be required to validate its promising performance over longer implantation duration (5-7 days) in people with diabetes.

Fiber-coupled fluorescence affinity sensor for 3-day in vivo glucose sensing.

BACKGROUND: To evaluate the feasibility of an implantable fiber-coupled fluorescence affinity sensor (FAS) for glucose monitoring in humans, we studied the acute and chronic in vivo performance in hairless rats and pigs. METHODS: The implantable fiber-coupled FAS was constructed by filling a dialysis chamber made of a regenerated cellulose membrane mounted to the distal tip of an optical fiber with fluorescent chemistry based on concanavalin A. Blood sugar changes in animals were induced by injections of insulin and dextrose. Determination of interstitial glucose concentrations in skin tissue was facilitated by measuring the fluorescence response of the FAS. RESULTS: The acute in vivo response of the fiber-coupled FAS exhibited good correlation coefficients (>0.77) with blood sugar changes and minimal lag times (2-10 min) after 2 hours of sensor implantation. Equilibrium of the sensor signal with interstitial fluid was required less than 60 min after implantation. For both rats and pigs, chronic response of the FAS to blood sugar modulations measured during the third day of implantation successfully demonstrated proof-of-concept for short-term glucose monitoring. A slight decrease in sensitivity after 3 days in the small animal model was assumed to be caused by excessive mechanical forces on the implanted device because of high animal motility. CONCLUSIONS: Overall, the chronic in vivo performance of the FAS in two different animal models over 3 days was clinically acceptable and comparable to other continuous glucose monitoring platforms. The major benefit of the FAS is the absence of "autodestructive" side products and any device-related warm-up time after sensor reconnection.

Affinity-based turbidity sensor for glucose monitoring by optical coherence tomography: toward the development of an implantable sensor.

We investigated the feasibility of constructing an implantable optical-based sensor for seminoninvasive continuous monitoring of analytes. In this novel sensor, analyte concentration-dependent changes induced in the degree of optical turbidity of the sensing element can be accurately monitored by optical coherence tomography (OCT), an interferometric technique. To demonstrate proof-of-concept, we engineered a sensor for monitoring glucose concentration that enabled us to quantitatively monitor the glucose-specific changes induced in bulk scattering (turbidity) of the sensor. The sensor consists of a glucose-permeable membrane housing that contains a suspension of macroporous hydrogel particles and concanavalin A (ConA), a glucose-specific lectin, that are designed to alter the optical scattering of the sensor as a function of glucose concentration. The mechanism of modulation of bulk turbidity in the sensor is based on glucose-specific affinity binding of ConA to pendant glucose residues of macroporous hydrogel particles. The affinity-based modulation of the scattering coefficient was significantly enhanced by optimizing particle size, particle size distribution, and ConA concentration. Successful operation of the sensor was demonstrated under in vitro condition where excellent reversibility and stability (160 days) of prototype sensors with good overall response over the physiological glucose concentration range (2.5-20 mM) and good accuracy (standard deviation 5%) were observed. Furthermore, to assess the feasibility of using the novel sensor as one that can be implanted under skin, the sensor was covered by a 0.4 mm thick tissue phantom where it was demonstrable that the response of the sensor to 10 mM glucose change could still be measured in the presence of a layer of tissue shielding the sensor aiming to simulate in vivo condition. In summary, we have demonstrated that it is feasible to develop an affinity-based turbidity sensor that can exhibit a highly specific optical response as a function of changes in local glucose concentration and such response can be accurately monitored by OCT suggesting that the novel sensor can potentially be engineered to be used as an implantable sensor for in vivo monitoring of analytes.