An integrated wearable microneedle array for the continuous monitoring of multiple biomarkers in interstitial fluid.

Implementations of wearable microneedle-based arrays of sensors for the monitoring of multiple biomarkers in interstitial fluid have lacked system integration and evidence of robust analytical performance. Here we report the development and testing of a fully integrated wearable array of microneedles for the wireless and continuous real-time sensing of two metabolites (lactate and glucose, or alcohol and glucose) in the interstitial fluid of volunteers performing common daily activities. The device works with a custom smartphone app for data capture and visualization, comprises reusable electronics and a disposable microneedle array, and is optimized for system integration, cost-effective fabrication via advanced micromachining, easier assembly, biocompatibility, pain-free skin penetration and enhanced sensitivity. Single-analyte and dual-analyte measurements correlated well with the corresponding gold-standard measurements in blood or breath. Further validation of the technology in large populations with concurrent validation of sensor readouts through centralized laboratory tests should determine the robustness and utility of real-time simultaneous monitoring of several biomarkers in interstitial fluid.

Extended Noninvasive Glucose Monitoring in the Interstitial Fluid Using an Epidermal Biosensing Patch.

An effective, noninvasive glucose monitoring technology could be a pivotal factor for addressing the major unmet needs for managing diabetes mellitus (DM). Here, we describe a skin-worn, disposable, wireless electrochemical biosensor for extended noninvasive monitoring of glucose in the interstitial fluid (ISF). The wearable platform integrates three components: a screen-printed iontophoretic electrode system for ISF extraction by reverse iontophoresis (RI), a printed three-electrode amperometric glucose biosensor, and an electronic interface for control and wireless communication. Prolonged on-body glucose monitoring of up to 8 h, including clinical trials conducted in individuals with and without DM, demonstrated good correlation between glucose blood and ISF concentrations and the ability to monitor dynamically changing glucose levels upon food consumption, with no evidence of skin irritation or discomfort. Such successful extended operation addresses the challenges reported for the GlucoWatch platform by using a lower RI current density at shorter extraction times, along with a lower measurement frequency. Such a noninvasive skin-worn platform could address long-standing challenges with existing glucose monitoring platforms.

Electrochemical glucose sensors in diabetes management: an updated review (2010-2020).

While over half a century has passed since the introduction of enzyme glucose biosensors by Clark and Lyons, this important field has continued to be the focus of immense research activity. Extensive efforts during the past decade have led to major scientific and technological innovations towards tight monitoring of diabetes. Such continued progress toward advanced continuous glucose monitoring platforms, either minimal- or non-invasive, holds considerable promise for addressing the limitations of finger-prick blood testing toward tracking glucose trends over time, optimal therapeutic interventions, and improving the life of diabetes patients. However, despite these major developments, the field of glucose biosensors is still facing major challenges. The scope of this review is to present the key scientific and technological advances in electrochemical glucose biosensing over the past decade (2010-present), along with current obstacles and prospects towards the ultimate goal of highly stable and reliable real-time minimally-invasive or non-invasive glucose monitoring. After an introduction to electrochemical glucose biosensors, we highlight recent progress based on using advanced nanomaterials at the electrode-enzyme interface of three generations of glucose sensors. Subsequently, we cover recent activity and challenges towards next-generation wearable non-invasive glucose monitoring devices based on innovative sensing principles, alternative body fluids, advanced flexible materials, and novel platforms. This is followed by highlighting the latest progress in the field of minimally-invasive continuous glucose monitoring (CGM) which offers real-time information about interstitial glucose levels, by focusing on the challenges toward developing biocompatible membrane coatings to protect electrochemical glucose sensors against surface biofouling. Subsequent sections cover new analytical concepts of self-powered glucose sensors, paper-based glucose sensing and multiplexed detection of diabetes-related biomarkers. Finally, we will cover the latest advances in commercially available devices along with the upcoming future technologies.

Wearable Electrochemical Sensors for the Monitoring and Screening of Drugs.

Wearable electrochemical sensors capable of noninvasive monitoring of chemical markers represent a rapidly emerging digital-health technology. Recent advances toward wearable continuous glucose monitoring (CGM) systems have ignited tremendous interest in expanding such sensor technology to other important fields. This article reviews for the first time wearable electrochemical sensors for monitoring therapeutic drugs and drugs of abuse. This rapidly emerging class of drug-sensing wearable devices addresses the growing demand for personalized medicine, toward improved therapeutic outcomes while minimizing the side effects of drugs and the related medical expenses. Continuous, noninvasive monitoring of therapeutic drugs within bodily fluids empowers clinicians and patients to correlate the pharmacokinetic properties with optimal outcomes by realizing patient-specific dose regulation and tracking dynamic changes in pharmacokinetics behavior while assuring the medication adherence of patients. Furthermore, wearable electrochemical drug monitoring devices can also serve as powerful screening tools in the hands of law enforcement agents to combat drug trafficking and support on-site forensic investigations. The review covers various wearable form factors developed for noninvasive monitoring of therapeutic drugs in different body fluids and toward on-site screening of drugs of abuse. The future prospects of such wearable drug monitoring devices are presented with the ultimate goals of introducing accurate real-time drug monitoring protocols and autonomous closed-loop platforms toward precise dose regulation and optimal therapeutic outcomes. Finally, current unmet challenges and existing gaps are discussed for motivating future technological innovations regarding personalized therapy. The current pace of developments and the tremendous market opportunities for such wearable drug monitoring platforms are expected to drive intense future research and commercialization efforts.

Epidermal Enzymatic Biosensors for Sweat Vitamin C: Toward Personalized Nutrition.

Recent advances in wearable sensor technologies offer new opportunities for improving dietary adherence. However, despite their tremendous promise, the potential of wearable chemical sensors for guiding personalized nutrition solutions has not been reported. Herein, we present an epidermal biosensor aimed at following the dynamics of sweat vitamin C after the intake of vitamin C pills and fruit juices. Such skin-worn noninvasive electrochemical detection of sweat vitamin C has been realized by immobilizing the enzyme ascorbate oxidase (AAOx) on flexible printable tattoo electrodes and monitoring changes in the vitamin C level through changes in the reduction current of the oxygen cosubstrate. The flexible vitamin C tattoo patch was fabricated on a polyurethane substrate and combined with a localized iontophoretic sweat stimulation system along with amperometric cathodic detection of the oxygen depletion during the enzymatic reaction. The enzyme biosensor offers a highly selective response compared to the common direct (nonenzymatic) voltammetric measurements, with no effect on electroactive interfering species such as uric acid or acetaminophen. Temporal vitamin C profiles in sweat are demonstrated using different subjects taking varying amounts of commercial vitamin C pills or vitamin C-rich beverages. The dynamic rise and fall of such vitamin C sweat levels is thus demonstrated with no interference from other sweat constituents. Differences in such dynamics among the individual subjects indicate the potential of the epidermal biosensor for personalized nutrition solutions. The flexible tattoo patch displayed mechanical resiliency to multiple stretching and bending deformations. In addition, the AAOx biosensor is shown to be useful as a disposable strip for the rapid in vitro detection of vitamin C in untreated raw saliva and tears following pill or juice intake. These results demonstrate the potential of wearable chemical sensors for noninvasive nutrition status assessments and tracking of nutrient uptake toward detecting and correcting nutritional deficiencies, assessing adherence to vitamin intake, and supporting dietary behavior change.

Microneedle-Based Detection of Ketone Bodies along with Glucose and Lactate: Toward Real-Time Continuous Interstitial Fluid Monitoring of Diabetic Ketosis and Ketoacidosis.

Diabetic ketoacidosis (DKA), a severe complication of diabetes mellitus with potentially fatal consequences, is characterized by hyperglycemia and metabolic acidosis due to the accumulation of ketone bodies, which requires people with diabetes to monitor both glucose and ketone bodies. However, despite major advances in diabetes management mainly since the emergence of new-generation continuous glucose monitoring (CGM) devices capable of in vivo monitoring of glucose directly in the interstitial fluid (ISF), the continuous monitoring of ketone bodies is yet to be addressed. Here, we present the first use of a real-time continuous ketone bodies monitoring (CKM) microneedle platform. The system is based on the electrochemical monitoring of ß-hydroxybutyrate (HB) as the dominant biomarker of ketone formation. Such real-time HB detection has been realized using the ß-hydroxybutyrate dehydrogenase (HBD) enzymatic reaction and by addressing the major challenges associated with the stable confinement of the enzyme/cofactor couple (HBD/NAD+) and with a stable and selective low-potential fouling-free anodic detection of NADH. The resulting CKM microneedle device displays an attractive analytical performance, with high sensitivity (with low detection limit, 50 µM), high selectivity in the presence of potential interferences, along with good stability during prolonged operation in artificial ISF. The potential applicability of this microneedle sensor toward minimally invasive monitoring of ketone bodies has been demonstrated in a phantom gel skin-mimicking model. The ability to detect HB along with glucose and lactate on a single microneedle array has been demonstrated. These findings pave the way for CKM and for the simultaneous microneedle-based monitoring of multiple diabetes-related biomarkers toward a tight glycemic control.

Ionic Liquid-Modified Disposable Electrochemical Sensor Strip for Analysis of Fentanyl.

The increasing prevalence of fentanyl and its analogues as contaminating materials in illicit drug products presents a major hazard to first responder and law enforcement communities. Electrochemical techniques have the potential to provide critical information to these personnel via rapid, facile field detection of these materials. Here we demonstrate the use of cyclic square wave voltammetry (CSWV) with screen-printed carbon electrodes (SPCE), modified with the room temperature ionic liquid (RTIL) 1-butyl-1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide [C4C1pyrr][NTf2], toward such rapid "on-the-spot" fentanyl detection. This CSWV-based disposable sensor strip system provides an information-rich electrochemical fingerprint of fentanyl, composed of an initial oxidation event at +0.556 V (vs Ag/AgCl) and a reversible reduction and oxidation reaction at -0.235 and -0.227 V, respectively. The combined current and potential characteristics of these anodic and cathodic fentanyl peaks, generated using two CSWV cycles, thus lead to a distinct electrochemical signature. This CSWV profile facilitates rapid (1 min) identification of the target opioid at micromolar concentrations in the presence of other cutting agents commonly found in illicit drug formulations. The new protocol thus holds considerable promise for rapid decentralized fentanyl detection at the "point of need".

Wearable electrochemical glove-based sensor for rapid and on-site detection of fentanyl.

Rapid, on-site detection of fentanyl is of critical importance, as it is an extremely potent synthetic opioid that is prone to abuse. Here we describe a wearable glove-based sensor that can detect fentanyl electrochemically on the fingertips towards decentralized testing for opioids. The glove-based sensor consists of flexible screen-printed carbon electrodes modified with a mixture of multiwalled carbon nanotubes and a room temperature ionic liquid, 4-(3-butyl-1-imidazolio)-1-butanesulfonate). The sensor shows direct oxidation of fentanyl in both liquid and powder forms with a detection limit of 10 µM using square-wave voltammetry. The "Lab-on-a-Glove" sensors, combined with a portable electrochemical analyzer, provide wireless transmission of the measured data to a smartphone or tablet for further analysis. The integrated sampling and sensing methodology on the thumb and index fingers, respectively, enables rapid screening of fentanyl in the presence of a mixture of cutting agents and offers considerable promise for timely point-of-need screening for first responders. Such a glove-based "swipe, scan, sense, and alert" strategy brings chemical analytics directly to the user's fingertips and opens new possibilities for detecting substances of abuse in emergency situations.

Wearable Bioelectronics: Enzyme-Based Body-Worn Electronic Devices.

In this Account, we detail recent progress in wearable bioelectronic devices and discuss the future challenges and prospects of on-body noninvasive bioelectronic systems. Bioelectronics is a fast-growing interdisciplinary research field that involves interfacing biomaterials with electronics, covering an array of biodevices, encompassing biofuel cells, biosensors, ingestibles, and implantables. In particular, enzyme-based bioelectronics, built on diverse biocatalytic reactions, offers distinct advantages and represents a centerpiece of wearable biodevices. Such wearable bioelectronic devices predominately rely on oxidoreductase enzymes and have already demonstrated considerable promise for on-body applications ranging from highly selective noninvasive biomarker monitoring to epidermal energy harvesting. These systems can thus greatly increase the analytical capability of wearable devices from the ubiquitous monitoring of mobility and vital signs, toward the noninvasive analysis of important chemical biomarkers. Wearable enzyme electrodes offer exciting opportunities to a variety of areas, spanning from healthcare, sport, to the environment or defense. These include real-time noninvasive detection of biomarkers in biofluids (such as sweat, saliva, interstitial fluid and tears), and the monitoring of environmental pollutants and security threats in the immediate surrounding of the wearer. Furthermore, the interface of enzymes with conducting flexible electrode materials can be exploited for developing biofuel cells, which rely on the bioelectrocatalytic oxidation of biological fuels, such as lactate or glucose, for energy harvesting applications. Crucial for such successful application of enzymatic bioelectronics is deep knowledge of enzyme electron-transfer kinetics, enzyme stability, and enzyme immobilization strategies. Such understanding is critical for establishing efficient electrical contacting between the redox enzymes and the conducting electrode supports, which is of fundamental interest for the development of robust and efficient bioelectronic platforms. Furthermore, stretchable and flexible bioelectronic platforms, with mechanical properties similar to those of biological tissues, are essential for handling the rigors of on-body operation. As such, special attention must be given to changes in the behavior of enzymes due to the uncontrolled conditions of on-body operation (including diverse outdoor activities and different biofluids), for maintaining the attractive performance that these bioelectronics devices display in controlled laboratory settings. Therefore, a focus of this Account is on interfacing biocatalytic layers onto wearable electronic devices for creating efficient and stable on-body electrochemical biosensors and biofuel cells. With proper attention to key challenges and by leveraging the advantages of biocatalysis, electrochemistry, and flexible electronics, wearable bioelectronic devices could have a tremendous impact on diverse biomedical, fitness, and defense fields.

Simultaneous Monitoring of Sweat and Interstitial Fluid Using a Single Wearable Biosensor Platform.

The development of wearable biosensors for continuous noninvasive monitoring of target biomarkers is limited to assays of a single sampled biofluid. An example of simultaneous noninvasive sampling and analysis of two different biofluids using a single wearable epidermal platform is demonstrated here. The concept is successfully realized through sweat stimulation (via transdermal pilocarpine delivery) at an anode, alongside extraction of interstitial fluid (ISF) at a cathode. The system thus allows on-demand, controlled sampling of the two epidermal biofluids at the same time, at two physically separate locations (on the same flexible platform) containing different electrochemical biosensors for monitoring the corresponding biomarkers. Such a dual biofluid sampling and analysis concept is implemented using a cost-effective screen-printing technique with body-compliant temporary tattoo materials and conformal wireless readout circuits to enable real-time measurement of biomarkers in the sampled epidermal biofluids. The performance of the developed wearable device is demonstrated by measuring sweat-alcohol and ISF-glucose in human subjects consuming food and alcoholic drinks. The different compositions of sweat and ISF with good correlations of their chemical constituents to their blood levels make the developed platform extremely attractive for enhancing the power and scope of next-generation noninvasive epidermal biosensing systems.

Food Safety Analysis Using Electrochemical Biosensors.

Rapid and precise analytical tools are essential for monitoring food safety and screening of any undesirable contaminants, allergens, or pathogens, which may cause significant health risks upon consumption. Substantial developments in analytical techniques have empowered the analyses and quantitation of these contaminants. However, conventional techniques are limited by delayed analysis times, expensive and laborious sample preparation, and the necessity for highly-trained workers. Therefore, prompt advances in electrochemical biosensors have supported significant gains in quantitative detection and screening of food contaminants and showed incredible potential as a means of defying such limitations. Apart from indicating high specificity towards the target analytes, these biosensors have also addressed the challenge of food industry by providing high analytical accuracy within complex food matrices. Here, we discuss some of the recent advances in this area and analyze the role and contributions made by electrochemical biosensors in the food industry. This article also reviews the key challenges we believe biosensors need to overcome to become the industry standard.

Detection of vapor-phase organophosphate threats using wearable conformable integrated epidermal and textile wireless biosensor systems.

Flexible epidermal tattoo and textile-based electrochemical biosensors have been developed for vapor-phase detection of organophosphorus (OP) nerve agents. These new wearable sensors, based on stretchable organophosphorus hydrolase (OPH) enzyme electrodes, are coupled with a fully integrated conformal flexible electronic interface that offers rapid and selective square-wave voltammetric detection of OP vapor threats and wireless data transmission to a mobile device. The epidermal tattoo and textile sensors display a good reproducibility (with RSD of 2.5% and 4.2%, respectively), along with good discrimination against potential interferences and linearity over the 90-300mg/L range, with a sensitivity of 10.7µA∙cm3∙mg-1 (R2 = 0.983) and detection limit of 12mg/L in terms of OP air density. Stress-enduring inks, used for printing the electrode transducers, ensure resilience against mechanical deformations associated with textile and skin-based on-body sensing operations. Theoretical simulations are used to estimate the OP air density over the sensor surface. These fully integrated wearable wireless tattoo and textile-based nerve-agent vapor biosensor systems offer considerable promise for rapid warning regarding personal exposure to OP nerve-agent vapors in variety of decentralized security applications.

Wearable Flexible and Stretchable Glove Biosensor for On-Site Detection of Organophosphorus Chemical Threats.

A flexible glove-based electrochemical biosensor with highly stretchable printed electrode system has been developed as a wearable point-of-use screening tool for defense and food security applications. This disposable-mechanically robust "lab-on-a-glove" integrates a stretchable printable enzyme-based biosensing system and active surface for swipe sampling on different fingers, and is coupled with a compact electronic interface for electrochemical detection and real-time wireless data transmission to a smartphone device. Stress-enduring inks are used to print the electrode system and the long serpentine connections to the wireless electronic interface. Dynamic mechanical deformation, bending, and stretching studies illustrate the resilience and compliance of the printed traces against extreme mechanical deformations expected for such on-glove sampling/sensing operation. An organophosphorus hydrolase (OPH)-based biosensor system on the index finger enables rapid on-site detection of organophosphate (OP) nerve-agent compounds on suspicious surfaces and agricultural products following their swipe collection on the thumb finger. The new wireless glove-based biosensor system offers considerable promise for field screening of OP nerve-agents and pesticides in defense and food-safety applications, with significant speed and cost advantages. Such "lab-on-a-glove" demonstration opens the area of flexible wearable sensors to future on-the-hand multiplexed chemical detection in diverse fields.

The influence of organic-film morphology on the efficient electron transfer at passivated polymer-modified electrodes to which nanoparticles are attached.

The impact of polymer-film morphology on the electron-transfer process at electrode/organic insulator/nanomaterial architectures is studied. The experimental data are discussed in the context of the most recent theory modelling the nanoparticle-mediated electron-transfer process at electrode/insulator/nanomaterial architectures proposed by Chazalviel and Allongue [J. Am. Chem. Soc. 2011, 133, 762-764]. A previous report [Anal. Chem. 2013, 85, 1073-1080] by us qualitatively verified the theory and demonstrates a transition from thickness-independent to thickness-dependent electron transfer as the layer thickness exceeds a certain threshold. This follow-up study explores a different polymer, poly(phenylenediamine), and focuses on the effect of the uniformity of organic film on electron transfer at these hybrid structures. Electron-transfer kinetics of modified surfaces, which were assessed using the redox species Ru(NH3)6(3+) in aqueous solution, showed that a thickness-dependent electron-transfer regime is achieved with poly(phenylenediamine). This is attributed to the sufficiently thin films never being fabricated with this polymer. Rather, it is suggested that thin poly(phenylenediamine) layers have a globular structure with poor film homogeneity and pinhole defects.

Distance-dependent electron transfer at passivated electrodes decorated by gold nanoparticles.

The phenomenon of nanoparticles attached to an electrode passivated by an organic layer allowing efficient electron transfer between redox species in solution and the underlying electrode to be restored has resulted in Chazalviel and Allongue proposing a theory [Chazalviel, J.-N.; Allongue, P. J. Am. Chem. Soc.2011, 133, 762-764] to explain this phenomenon. The theory suggests that with electrode-organic layer-nanoparticle constructs, high exchange current densities, compared with when the nanoparticles are absent, results in the rate of electron transfer being independent of the thickness of the organic layer until a threshold thickness is exceeded. Thereafter, the thicker the organic layer, the slower the rate of electron transfer. Herein we provide the first experimental data to support this theory using a single experimental system that can show the transition from thickness independent electron transfer kinetics to distant dependent kinetics. This was achieved using ethylenediamine electrodeposited on a glassy carbon electrode. Different numbers of deposition cycles were applied in order to fabricate different thicknesses of the organic film. The deposited films showed progressively greater blocking abilities toward ruthenium hexamine, as a redox active probe in solution, as the films got thicker. Electron transfer kinetics of nanoparticle-decorated surfaces showed a change from thickness independent to thickness dependent as the organic layer exceeded an average thickness of 20 Å. Electrochemical impedance spectroscopy, cyclic voltammetry, scanning electron microscopy, ellipsometry, and atomic force microscopy were used to characterize the fabricated surfaces.