Sweat chloride assay by inductively coupled plasma mass spectrometry: a confirmation test for cystic fibrosis diagnosis

Diagnosing Cystic Fibrosis in the 21st Century-A Complex and Challenging Task

Cystic fibrosis (CF) is a chronic and potentially life-threatening condition, wherein timely diagnosis assumes paramount significance for the prompt initiation of therapeutic interventions, thereby ameliorating pulmonary function, addressing nutritional deficits, averting complications, mitigating morbidity, and ultimately enhancing the quality of life and extending longevity. This review aims to amalgamate existing knowledge to provide a comprehensive appraisal of contemporary diagnostic modalities pertinent to CF in the 21st century. Deliberations encompass discrete delineations of each diagnostic modality and the elucidation of potential diagnostic quandaries encountered in select instances, as well as the delineation of genotype-phenotype correlations germane to genetic counseling endeavors. The synthesis underscores that, notwithstanding the availability and strides in diagnostic methodologies, including genetic assays, the sweat test (ST) retains its position as the preeminent diagnostic standard for CF, serving as a robust surrogate for CFTR functionality. Prospective clinical investigations in the realm of CF should be orchestrated with the objective of discerning novel diagnostic modalities endowed with heightened specificity and sensitivity.

Preparation of β-Cyclodextrin Functionalized Platform for Monitoring Changes in Potassium Content in Perspiration

The monitoring of potassium ion (K+) levels in human sweat can provide valuable insights into electrolyte balance and muscle fatigue non-invasively. However, existing laboratory techniques for sweat testing are complex, while wearable sensors face limitations like drift, fouling and interference from ions such as Na+. This work develops printed electrodes using β-cyclodextrin functionalized reduced graphene oxide (β-CD-RGO) for selective K+ quantification in sweat. The β-CD prevents the aggregation of RGO sheets while also providing selective binding sites for K+ capture. Electrodes were fabricated by screen printing the β-CD-RGO ink onto conductive carbon substrates. Material characterization confirmed the successful functionalization of RGO with β-CD. Cyclic voltammetry (CV) showed enhanced electrochemical behavior for β-CD-RGO-printed electrodes compared with bare carbon and RGO. Sensor optimization resulted in a formulation with 30% β-CD-RGO loading. The printed electrodes were drop-casted with an ion-selective polyvinyl chloride (PVC) membrane. A linear range from 10 μM to 100 mM was obtained along with a sensitivity of 54.7 mV/decade. The sensor showed good reproducibility over 10 cycles in 10 mM KCl. Minimal interference from 100 mM Na+ and other common sweat constituents validated the sensor's selectivity. On-body trials were performed by mounting the printed electrodes on human subjects during exercise. The K+ levels measured in sweat were found to correlate well with serum analysis, demonstrating the sensor's ability for non-invasive electrolyte monitoring. Overall, the facile synthesis of stable β-CD-RGO inks enables the scalable fabrication of wearable sensors for sweat potassium detection.

Argentometric chloride determination by inductively coupled plasma-optical emission spectroscopy in a wide range of sample matrices

Chloride determination is of great importance, as chloride plays important roles in human health, pitting corrosion, environmental processes, and agriculture. However, chloride determination by inductively coupled plasma-optical emission spectroscopy (ICP-OES), one of the premier techniques used for elemental analysis, is currently limited to specific instrument types or requires the use of additional equipment. This work presents an argentometric method for the indirect measurement of chloride, applicable to any ICP-OES instrument. The initial Ag⁺ concentration added to samples is of great importance, as it affects both the method's limit of quantification (LOQ) and the top limit of its working range. The developed method found 50 mg L^-1 of Ag⁺ to be the optimal concentration, providing a working range of 0.2-15 mg L^-1 Cl^-. The method was robust to changes in filtration time, temperature, and sample acidity. Using the argentometric method, chloride was determined in a variety of samples (spiked-purified water, seawater, wine, and urine). For validation, the results were compared to those obtained using ion chromatography and showed no statistical differences. Argentometric chloride determination by ICP-OES is therefore applicable to many types of samples and can be easily performed on any ICP-OES instrument.

Molecular imprinting-based sensors: Lab-on-chip integration and biomedical applications

The innovative technology of a marketable lab-on-a-chip platform for point-of-care (POC) in vitro detection has recently attracted remarkable attention. The POC tests can significantly enhance the high standard of medicinal care. In the last decade, clinical diagnostic technology has been broadly advanced and successfully performed in several areas. It seems that lab-on-a-chip approaches play a significant role in these technologies. However, high-cost and time-consuming methods are increasing the challenge and the development of a cost-effective, rapid and efficient method for the detection of biomolecules is urgently needed. Recently, polymer-coated sensing platforms have been a promising area that can be employed in medical diagnosis, pharmaceutical bioassays, and environmental monitoring. The designed on-chip sensors are based on molecular imprinting polymers (MIPs) that use label-free detection technology. Molecular imprinting shines out as a potentially promising technique for creating artificial recognition material with molecular recognition sites. MIPs provide unique advantages such as excellent recognition specificity, high selectivity, and good reusability. This review article aims to define several methods using molecular imprinting for biomolecules and their incorporation with several lab-on-chip technologies to describe the most promising methods for the development of sensing systems based on molecularly imprinted polymers. The higher selectivity, more user-friendly operation is believed to provide MIP-based lab-on-a-chip devices with great potential academic and commercial value in on-site clinical diagnostics and other point-of-care assays.

Rapid chloride and bicarbonate determination by capillary electrophoresis for confirmatory testing of cystic fibrosis infants with volume-limited sweat specimens

Objectives Cystic fibrosis (CF) is a debilitating genetic disorder that benefits from early detection. CF diagnosis relies on measuring elevated sweat chloride that is difficult in neonates with low sweat rates. We introduce a new method for sweat chloride determination from volume-limited specimens, and explore the potential utility of sweat bicarbonate in neonatal CF screening. Methods A rapid assay (< 5 min) was developed to analyze chloride and bicarbonate using capillary electrophoresis with indirect UV detection (CE-iUV). Pilocarpine-stimulated sweat samples from screen-positive CF infants were collected at two hospital sites, including confirmed CF (n = 12), CF screen-positive inconclusive diagnosis (n = 4), and unaffected non-CF cases (n = 37). All sweat chloride samples were analyzed by a coulometric titrator and CE-iUV, and the viability to measure acid-labile bicarbonate was also evaluated. Results Stability studies revealed that bicarbonate can be reliably assessed in sweat if acidification and heating were avoided. Method validation demonstrated that sweat chloride and bicarbonate were quantified with acceptable accuracy (recovery of 102%), precision (CV = 3.7%) and detection limits (∼ 0.1 mM). An inter-laboratory comparison confirmed a mean bias of 6.5% (n = 53) for sweat chloride determination by CE-iUV relative to a commercial chloridometer. However, sweat bicarbonate did not discriminate between CF and non-CF infants (AUC = 0.623, p = 0.215) unlike chloride (AUC = 1.00, p = 3.00 × 10^-7). Conclusions CE-iUV offers a robust method for sweat chloride testing from presumptive CF infants that may reduce testing failure rates. However, sweat bicarbonate does not have clinical value in newborn CF diagnosis.

Green and Integrated Wearable Electrochemical Sensor for Chloride Detection in Sweat

Wearable sensors for sweat biomarkers can provide facile analyte capability and monitoring for several diseases. In this work, a green wearable sensor for sweat absorption and chloride sensing is presented. In order to produce a sustainable device, polylactic acid (PLA) was used for both the substrate and the sweat absorption pad fabrication. The sensor material for chloride detection consisted of silver-based reference, working, and counter electrodes obtained from upcycled compact discs. The PLA substrates were prepared by thermal bonding of PLA sheets obtained via a flat die extruder, prototyped in single functional layers via CO₂ laser cutting, and bonded via hot-press. The effect of cold plasma treatment on the transparency and bonding strength of PLA sheets was investigated. The PLA membrane, to act as a sweat absorption pad, was directly deposited onto the membrane holder layer by means of an electrolyte-assisted electrospinning technique. The membrane adhesion capacity was investigated by indentation tests in both dry and wet modes. The integrated device made of PLA and silver-based electrodes was used to quantify chloride ions. The calibration tests revealed that the proposed sensor platform could quantify chloride ions in a sensitive and reproducible way. The chloride ions were also quantified in a real sweat sample collected from a healthy volunteer. Therefore, we demonstrated the feasibility of a green and integrated sweat sensor that can be applied directly on human skin to quantify chloride ions.

Quantification of chloride in sweat by using ion chromatography instead of chloridometer

This study reports about a new ion chromatography method for the detection of chloride ions in sweat as an alternative to the gold standard of the chloridometer. Information about necessary materials, required preparations, reference ranges, advantages and disadvantages of this method is provided. We finally demonstrate that this method is useful to screen for cystic fibrosis in sweat samples.

Article Highlights.

Sweat Testing and Recent Advances

Cystic fibrosis (CF) is the most common fatal genetic disease of the Caucasian population. Sweat testing is the principal diagnostic test for CF, and it is used for the evaluation of infants with positive CF newborn screening (NBS) and in patients with clinical findings suggesting CF. This article describes the classical sweat test method in detail and also provides an overwiew of recent advances.