Development of a Minimally Invasive Microneedle-Based Sensor for Continuous Monitoring of β-Lactam Antibiotic Concentrations in Vivo

New trends in potentiometric sensors: From design to clinical and biomedical applications

Potentiometry, a well-established electrochemical technique, provides a powerful and versatile method for the sensitive and selective measurement of a variety of analytes by measuring the potential difference between two electrodes, allowing for a direct and rapid readout of ion concentrations. This makes it a valuable tool in a variety of applications including industry, agriculture, forensics, medical, environmental assessment, and pharmaceutical drug analysis, therefore it has received significant attention from the scientific community. Their broad implementation in sensing applications arises through their many benefits, including ease of design, fabrication, and modification; rapid response time; high selectivity; suitability for use with colored and/or turbid solutions; and potential for integration into embedded systems interfaces. Owing to these advantages and diverse applicability, sustained research and development in the field has resulted in the emergence of several notable trends in the field. 3D printing is the most recent technique used in potentiometry which offers many benefits such as improved flexibility and precision in the manufacturing of ion-selective electrodes and rapid prototyping decreases the time needed during optimization of important electrochemical parameters. Additionally, paper-based sensors are cost-effective and versatile platforms for in-field (point-of-care, POC) analysis, permitting rapid determination of a variety of analytes. One of the most interesting applications of potentiometry are wearable sensors which allow for the continuous monitoring of biomarkers, electrolytes and even pharmaceuticals, especially those with a narrow therapeutic index. Herein this review, we discuss several recent trends in potentiometric sensors since 2010, including 3D printing, paper-based devices, and other emerging techniques and the translation of potentiometric systems to wearable devices for the determination of ionic species or pharmaceuticals in biological fluids paving the way to various clinical and biomedical uses.

Nanotechnology-Based Wearable Electrochemical Biosensor for Disease Diagnosis

Recently, flexible electronics have significantly transformed information and communications technology (ICT). In particular, wearable devices, via integration with attachable biosensors, have driven the development of new types of biosensors and diagnostic devices for point-of-care testing (POCT). Moreover, wearable electrochemical biosensors can be applied to diagnose diseases in real time based on the synergistic effect generated from the incorporation of the electrochemical technique. Besides, to improve the sensitivity of electrochemical biosensors while retaining their wearability, novel nanomaterials and nanotechnologies have been introduced. In this review, recent studies on nanotechnology-based wearable electrochemical biosensors for accurate disease diagnosis are discussed. First, widely used techniques for developing flexible electrodes, including nanolithography- and nano/microneedle-based patches, are presented. Next, the latest studies on developing wearable electrochemical biosensors for the diagnosis of diseases such as diabetes and dermatitis are discussed by categorizing the biosensors into nanolithography- and nano/microneedle-based categories. Finally, this review explores the latest research trends on the application of nanotechnology-enabled nanopatterning and nano/microneedle technologies to electrochemical wearable biosensors. This review suggests novel approaches and methods for developing wearable electrochemical biosensors for real-time disease diagnosis under POCT applications.

Advances in diagnosis and prognosis of bacteraemia, bloodstream infection, and sepsis using machine learning: A comprehensive living literature review

BACKGROUND

Blood-related infections are a significant concern in healthcare. They can lead to serious medical complications and even death if not promptly diagnosed and treated. Throughout time, medical research has sought to identify clinical factors and strategies to improve the management of these conditions. The increasing adoption of electronic health records has led to a wealth of electronically available medical information and predictive models have emerged as invaluable tools. This manuscript offers a detailed survey of machine-learning techniques used for the diagnosis and prognosis of bacteraemia, bloodstream infections, and sepsis shedding light on their efficacy, potential limitations, and the intricacies of their integration into clinical practice.

METHODS

This study presents a comprehensive analysis derived from a thorough search across prominent databases, namely EMBASE, Google Scholar, PubMed, Scopus, and Web of Science, spanning from their inception dates to October 25, 2023. Eligibility assessment was conducted independently by investigators, with inclusion criteria encompassing peer-reviewed articles and pertinent non-peer-reviewed literature. Clinical and technical data were meticulously extracted and integrated into a registry, facilitating a holistic examination of the subject matter. To maintain currency and comprehensiveness, readers are encouraged to contribute manuscript suggestions and/or reports for integration into this living registry.

RESULTS

While machine learning (ML) models exhibit promise in advanced disease stages such as sepsis, early stages remain underexplored due to data limitations. Biochemical markers emerge as pivotal predictors during early stages such as bacteraemia, or bloodstream infections, while vital signs assume significance in sepsis prognosis. Integrating temporal trend information into conventional machine learning models appears to enhance performance. Unfortunately, sequential deep learning models face challenges, showing minimal performance improvements and significant drops in external datasets, potentially due to learning missing patterns within the scarce data available rather than understanding disease dynamics. Real-life implementation receives limited attention, as meeting design requirements proves challenging within existing healthcare infrastructure. The data collected in an event-based fashion during clinical practice is insufficient to fully harness the potential of these data-hungry models. Despite limitations, opportunities abound in leveraging flexible models and exploiting real-time non-invasive data collection technologies such as wearable devices or microneedles. Addressing research gaps in early disease stages, harnessing patient history data often underused, and embracing continual diagnostics beyond treatment initiation are crucial for improving healthcare decision-making support and adoption across the entire management pathway.

CONCLUSIONS

This comprehensive survey illuminates the landscape of ML applications in blood-related infection management, offering insights for future research and clinical practice. Implementing clinical ML-based clinical decision support systems requires balancing research with practical considerations. Current methodologies often lead to complex models lacking transparency and practical validation. Integration into healthcare systems faces regulatory, privacy, and trust challenges. Clear presentations and adherence to standards are essential to boost confidence in machine learning models for real-world healthcare applications.

Graphene-based electrochemical sensors for antibiotics: sensing theories, synthetic methods, and on-site monitoring applications

Owing to the extensive use of antibiotics for treating infectious diseases in livestock and humans, the resulting residual antibiotics are a burden to the ecosystem and human health. Hence, for human health and ecological safety, it is critical to determine the residual antibiotics with accuracy and convenience. Graphene-based electrochemical sensors are an effective tool to detect residual antibiotics owing to their advantages, such as, high sensitivity, simplicity, and time efficiency. In this work, we comprehensively summarize the recent advances in graphene-based electrochemical sensors used for detecting antibiotics, including modifiers for electrode fabrication, theoretical elaboration of electrochemical sensing mechanisms, and practical applications of portable electrochemical platforms for the on-site monitoring of antibiotics. It is anticipated that the current review will be a valuable reference for comprehensively comprehending graphene-based electrochemical sensors and further promoting their applications in the fields of healthcare, environmental protection, and food safety.

Toward precision medicine: End-to-end design and construction of integrated microneedle-based theranostic systems

With the growing demand for precision medicine and advancements in microneedle technology, microneedle-based drug delivery systems have evolved into integrated theranostic platforms. However, the development of these systems is currently limited by the absence of clear conclusions and standardized construction strategies. The end-to-end concept offers an innovative approach to theranostic systems by creating a seamless process that integrates target sampling, sensing, analysis, and on-demand drug delivery. This approach optimizes each step based on data from the others, effectively eliminating the traditional separation between drug delivery and disease monitoring. Furthermore, by incorporating artificial intelligence and machine learning, these systems can enhance reliability and efficiency in disease management, paving the way for more personalized and effective healthcare solutions. Based on the concept of end-to-end and recent advancements in theranostic systems, nanomaterials, electronic components, micro-composites, and data science, we propose a modular strategy for constructing integrated microneedle-based theranostic systems by detailing the methods and functions of each critical component, including monitoring, decision-making, and on-demand drug delivery units, though the total number of units might vary depending on the specific application. Notably, decision-making units are emerging trends for fully automatic and seamless systems and featured for integrated microneedle-based theranostic systems, which serve as a bridge of real-time monitoring, on-demand drug delivery, advanced electronic engineering, and data science for personalized disease management and remote medical application. Additionally, we discuss the challenges and prospects of integrated microneedle-based theranostic systems for precision medicine and clinical application.

Implantable Fluorogenic DNA Biosensor for Stress Detection

Implantable sensors that can monitor analytes related to cognitive and physiological status have gained significant focus in recent years. We have developed an implantable biosensor to detect dehydroepiandrosterone sulfate (DHEA-S), a biomarker related to stress. The biosensor strategy was based on the principle of forced intercalation (FIT) aptamers designed to detect subtle intramolecular changes during aptamer-target binding events. By incorporating a steroid-specific fluorogenic aptamer into a hydrogel, the sensitivity and biostability of the FIT biosensor fiber were improved, which were essential for designing implantable sensors to monitor biomarker levels in the living body. The polyethylenimine-based hydrogel chosen for this study produced an optically transparent cross-linked network with optimal microstructure, physicochemical, and mechanical properties, making it suitable for optical biosensors. The in vitro studies showed that the biosensor fiber was successfully activated in human serum and skin analogue, providing a linear response to physiological concentrations of the steroid. We believe that this type of implantable platform can be effective in monitoring more complex biomarkers associated with physiological or psychological health.

Vertical Graphene-Based Multiparametric Sensing Array for Integration of Smart Catheter to Electrochemically Monitor Peritoneal Dialysis

Renal failure is typical chronic kidney disease that required peritoneal dialysis as the primary treatment, but current catheter devices lack functionality to monitor changes in chemical analytes during peritoneal dialysis. Fabrication of miniatured sensing modules with good electrochemical performance in tiny catheter devices is the key to realize the smart monitoring of peritoneal dialysis. In this work, a vertical graphene-based multiparametric sensing array (VG-MSA) is developed to continuously measure fluctuations of various analyte concentrations for peritoneal dialysis monitoring. Vertical graphene (VG) electrode with good electrochemical properties serves as the core module in VG-MSA, allowing the development of miniatured sensing modules with sufficient electrochemical performance. The VG-MSA enables sensitive and multiplexed measurement of dialysate components like metabolites (reactive oxygen species, uric acid, and glucose) and ions (K+, Ca2+, and H+). The VG-MSA is demonstrated to effectively detect biochemical signals in peritoneal dialysate in vivo on rat models. The VG-MSA catheter can be inserted into abdominal cavity, allowing full contact with dialysate for in situ, real-time, and continuous collection of biochemical information during peritoneal dialysis. The VG-MSA catheter device offers a valuable tool for monitoring dialysis quality and facilitating treatment adjustments, potentially as a promising platform for high-quality therapy of renal failure.

Single-Walled Carbon Nanotubes as Optical Transducers for Nanobiosensors In Vivo

Semiconducting single-walled carbon nanotubes (SWCNTs) may serve as signal transducers for nanobiosensors. Recent studies have developed innovative methods of engineering molecularly specific sensors, while others have devised methods of deploying such sensors within live animals and plants. These advances may potentiate the use of implantable, noninvasive biosensors for continuous drug, disease, and contaminant monitoring based on the optical properties of single-walled carbon nanotubes (SWCNTs). Such tools have substantial potential to improve disease diagnostics, prognosis, drug safety, therapeutic response, and patient compliance. Outside of clinical applications, such sensors also have substantial potential in environmental monitoring or as research tools in the lab. However, substantial work remains to be done to realize these goals through further advances in materials science and engineering. Here, we review the current landscape of quantitative SWCNT-based optical biosensors that have been deployed in living plants and animals. Specifically, we focused this review on methods that have been developed to deploy SWCNT-based sensors in vivo as well as analytes that have been detected by SWCNTs in vivo. Finally, we evaluated potential future directions to take advantage of the promise outlined here toward field-deployable or implantable use in patients.

Synergistic Strategies of Biomolecular Transport Technologies in Transdermal Healthcare Systems

Transdermal healthcare systems have gained significant attention for their painless and convenient drug administration, as well as their ability to detect biomarkers promptly. However, the skin barrier limits the candidates of biomolecules that can be transported, and reliance on simple diffusion poses a bottleneck for personalized diagnosis and treatment. Consequently, recent advancements in transdermal transport technologies have evolved toward active methods based on external energy sources. Multiple combinations of these technologies have also shown promise for increasing therapeutic effectiveness and diagnostic accuracy as delivery efficiency is maximized. Furthermore, wearable healthcare platforms are being developed in diverse aspects for patient convenience, safety, and on-demand treatment. Herein, a comprehensive overview of active transdermal delivery technologies is provided, highlighting the combination-based diagnostics, therapeutics, and theragnostics, along with the latest trends in platform advancements. This offers insights into the potential applications of next-generation wearable transdermal medical devices for personalized autonomous healthcare.

Microneedle sensors for dermal interstitial fluid analysis

The rapid advancement in personalized healthcare has driven the development of wearable biomedical devices for real-time biomarker monitoring and diagnosis. Traditional invasive blood-based diagnostics are painful and limited to sporadic health snapshots. To address these limitations, microneedle-based sensing platforms have emerged, utilizing interstitial fluid (ISF) as an alternative biofluid for continuous health monitoring in a minimally invasive and painless manner. This review aims to provide a comprehensive overview of microneedle sensor technology, covering microneedle design, fabrication methods, and sensing strategy. Additionally, it explores the integration of monitoring electronics for continuous on-body monitoring. Representative applications of microneedle sensing platforms for both monitoring and therapeutic purposes are introduced, highlighting their potential to revolutionize personalized healthcare. Finally, the review discusses the remaining challenges and future prospects of microneedle technology.

Graphical Abstract

Biocompatible Core-Shell Microneedle Sensor Filled with Zwitterionic Polymer Hydrogel for Rapid Continuous Transdermal Monitoring

Microneedle (MN)-based electrochemical biosensors hold promising potential for noninvasive continuous monitoring of interstitial fluid biomarkers. However, challenges, such as instability and biofouling, exist. This study proposes a design employing hollow MN to encapsulate a zwitterionic polymer hydrogel sensing layer with excellent biocompatibility and antifouling properties to address these issues. MN shell isolates the internal microporous sensing layer from subcutaneous friction, and the hydrogel filling leverages the MNs' three-dimensional structures, enabling high-dense loading of biorecognition elements. The hollow MNs are successfully fabricated from high-molecular-weight polylactic acid via drawing lithography, exhibiting sufficient strength for effective epidermis penetration. Additionally, a high-performance gold nanoconductive layer is successfully deposited inside the MN hollow channel, establishing a stable electrical connection between the polymer MN and the hydrogel sensing layer. To support the design, numerical simulations of position-based diffusive analyte solutes reveal fast-responsive electrochemical signals attributed to the high diffusion coefficient of the hydrogel and the concentrated structure of the hollow channel encapsulation. Experimental results and numerical simulations underscore the advantages of this design, showcasing rapid response, high sensitivity, long-term stability, and excellent antifouling properties. Fabricated MN sensors exhibited biosafety, feasibility, and effectiveness, with accurate and rapid in vivo glucose monitoring ability. This study emphasizes the significance of rational design, structural utilization, and micro-nanofabrication to unlock the untapped potential of MN biosensors.

Unraveling the impact of therapeutic drug monitoring via machine learning for patients with sepsis

Clinical studies investigating the benefits of beta-lactam therapeutic drug monitoring (TDM) among critically ill patients are hindered by small patient groups, variability between studies, patient heterogeneity, and inadequate use of TDM. Accordingly, definitive conclusions regarding the efficacy of TDM remain elusive. To address these challenges, we propose an innovative approach that leverages data-driven methods to unveil the concealed connections between therapy effectiveness and patient data, collected through a randomized controlled trial (DRKS00011159; 10th October 2016). Our findings reveal that machine learning algorithms can successfully identify informative features that distinguish between healthy and sick states. These hold promise as potential markers for disease classification and severity stratification, as well as offering a continuous and data-driven "multidimensional" Sequential Organ Failure Assessment (SOFA) score. The positive impact of TDM on patient recovery rates is demonstrated by unraveling the intricate connections between therapy effectiveness and clinically relevant data via machine learning.

A wearable, rapidly manufacturable, stability-enhancing microneedle patch for closed-loop diabetes management

The development of a wearable, easy-to-fabricate, and stable intelligent minisystem is highly desired for the closed-loop management of diabetes. Conventional systems always suffer from large size, high cost, low stability, or complex fabrication. Here, we show for the first time a wearable, rapidly manufacturable, stability-enhancing microneedle patch for diabetes management. The patch consists of a graphene composite ink-printed sensor on hollow microneedles, a polyethylene glycol (PEG)-functionalized electroosmotic micropump integrated with the microneedles, and a printed circuit board for precise and intelligent control of the sensor and pump to detect interstitial glucose and deliver insulin through the hollow channels. Via synthesizing and printing the graphene composite ink, the sensor fabrication process is fast and the sensing electrodes are stable. The PEG functionalization enables the micropump a significantly higher stability in delivering insulin, extending its lifetime from days to weeks. The patch successfully demonstrated excellent blood glucose control in diabetic rats. This work may introduce a new paradigm for building new closed-loop systems and shows great promise for widespread use in patients with diabetes.

Machine Learning Assists in the Design and Application of Microneedles

Microneedles (MNs), characterized by their micron-sized sharp tips, can painlessly penetrate the skin and have shown significant potential in disease treatment and biosensing. With the development of artificial intelligence (AI), the design and application of MNs have experienced substantial innovation aided by machine learning (ML). This review begins with a brief introduction to the concept of ML and its current stage of development. Subsequently, the design principles and fabrication methods of MNs are explored, demonstrating the critical role of ML in optimizing their design and preparation. Integration between ML and the applications of MNs in therapy and sensing were further discussed. Finally, we outline the challenges and prospects of machine learning-assisted MN technology, aiming to advance its practical application and development in the field of smart diagnosis and treatment.

The New Delhi metallo-β-lactamase-1 biosensor rapidly and accurately detected antibiotic plasma concentrations in cefuroxime-treated patients

OBJECTIVES

Therapeutic drug monitoring (TDM) of β-lactam antibiotics in critically ill patients may benefit dose optimisation, thus improving therapeutic outcomes. However, rapidly and accurately detecting these antibiotics in blood remains a challenge. This research group recently developed a thermometric biosensor called the New Delhi metallo-β-lactamase-1 (NDM-1) biosensor, which detects multiple classes of β-lactam antibiotics in spiked plasma samples.

METHODS

This study assessed the NDM-1 biosensor's effectiveness in detecting plasma concentrations of β-lactam antibiotics in treated patients. Seven patients receiving cefuroxime were studied. Plasma samples collected pre- and post-antibiotic treatment were analysed using the NDM-1 biosensor and compared with liquid chromatography coupled with ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS).

RESULTS

The biosensor detected plasma samples without dilution, and a brief pre-treatment using a polyvinylidene fluoride filter significantly lowered matrix effects, reducing the running time to 5-8 minutes per sample. The assay's linear range for cefuroxime (6.25-200 mg/L) covered target concentrations during the trough phase of pharmacokinetics in critically ill patients. The pharmacokinetic properties of cefuroxime in treated patients determined by the NDM-1 biosensor and the UPLC-MS/MS were comparable, and the cefuroxime plasma concentrations measured by the two methods showed statistically good consistency.

CONCLUSION

These data demonstrate that the NDM-1 biosensor assay is a fast, sensitive, and accurate method for detecting cefuroxime plasma concentrations in treated patients and highlights the NDM-1 biosensor as a promising tool for on-site TDM of β-lactam antibiotics in critically ill patients.

Theory of nanostructured sensors integrated in/on microneedles for diagnostics and therapy

Efficient real-time diagnostics and on-demand drug delivery are essential components in modern healthcare, especially for managing chronic diseases. The lack of a rapid and effective sensing and therapeutic system can result in analyte level deviations, leading to severe complications. Minimally invasive microneedle (MN)-based patches integrating nanostructures (NSs) in their volume or on their surface have emerged as a biocompatible technology for delay-free analyte sensing and therapy. However, a quantitative relationship for the signal response in NS-assisted reactions remains elusive. Existing generalized formalisms are derived for in-vitro applications, raising questions about their direct applicability to in-situ wearable sensors. In this study, we apply the reaction-diffusion theory to establish a generalized physics-guided framework for NS-in-MN platforms in wearable applications. The model relates the signal response to analyte concentration, incorporating geometric, physical, and catalytic platform properties. Approximating the model under NS (binding or catalytic) and environmental (mass transport) limitations, we validate it against numerical simulations and various experimental results from diverse conditions - analyte sensing (glucose, lactic acid, pyocyanin, miRNA, etc.) in artificial and in-vivo environments (humans, mice, pigs, plants, etc.) through electrochemical and optical/colorimetric, enzymatic and non-enzymatic platforms. The results plotted in the scaled response show that (a) NS-limited platforms exhibit a linear dependence, (b) Mass transport-limited platforms saturate to 1, (c) a one-to-one mapping against traditional sensitivity plots unifies the scattered data points reported in literature. The universality of the model provides insightful perspectives for the design and optimization of MN-based sensing technologies, with potential extensions to dissolvable MNs as part of analyte-responsive closed-loop therapeutic applications.

Integrating microneedles and sensing strategies for diagnostic and monitoring applications: The state of the art

Microneedles (MNs) offer minimally-invasive access to interstitial fluid (ISF) - a potent alternative to blood in terms of monitoring physiological analytes. This property is particularly advantageous for the painless detection and monitoring of drugs and biomolecules. However, the complexity of the skin environment, coupled with the inherent nature of the analytes being detected and the inherent physical properties of MNs, pose challenges when conducting physiological monitoring using this fluid. In this review, we discuss different sensing mechanisms and highlight advancements in monitoring different targets, with a particular focus on drug monitoring. We further list the current challenges facing the field and conclude by discussing aspects of MN design which serve to enhance their performance when monitoring different classes of analytes.

Additive manufacturing of microneedles for sensing and drug delivery

INTRODUCTION

Microneedles (MNs) are miniaturized, painless, and minimally invasive platforms that have attracted significant attention over recent decades across multiple fields, such as drug delivery, disease monitoring, disease diagnosis, and cosmetics. Several manufacturing methods have been employed to create MNs; however, these approaches come with drawbacks related to complicated, costly, and time-consuming fabrication processes. In this context, employing additive manufacturing (AM) technology for MN fabrication allows for the quick production of intricate MN prototypes with exceptional precision, providing the flexibility to customize MNs according to the desired shape and dimensions. Furthermore, AM demonstrates significant promise in the fabrication of sophisticated transdermal drug delivery systems and medical devices through the integration of MNs with various technologies.

AREAS COVERED

This review offers an extensive overview of various AM technologies with great potential for the fabrication of MNs. Different types of MNs and the materials utilized in their fabrication are also discussed. Recent applications of 3D-printed MNs in the fields of transdermal drug delivery and biosensing are highlighted.

EXPERT OPINION

This review also mentions the critical obstacles, including drug loading, biocompatibility, and regulatory requirements, which must be resolved to enable the mass-scale adoption of AM methods for MN production, and future trends.

Fabrication of Multiple-Channel Electrochemical Microneedle Electrode Array via Separated Functionalization and Assembly Method

Real-time monitoring of physiological indicators inside the body is pivotal for contemporary diagnostics and treatments. Implantable electrodes can not only track specific biomarkers but also facilitate therapeutic interventions. By modifying biometric components, implantable electrodes enable in situ metabolite detection in living tissues, notably beneficial in invasive glucose monitoring, which effectively alleviates the self-blood-glucose-managing burden for patients. However, the development of implantable electrochemical electrodes, especially multi-channel sensing devices, still faces challenges: (1) The complexity of direct preparation hinders functionalized or multi-parameter sensing on a small scale. (2) The fine structure of individual electrodes results in low spatial resolution for sensor functionalization. (3) There is limited conductivity due to simple device structures and weakly conductive electrode materials (such as silicon or polymers). To address these challenges, we developed multiple-channel electrochemical microneedle electrode arrays (MCEMEAs) via a separated functionalization and assembly process. Two-dimensional microneedle (2dMN)-based and one-dimensional microneedle (1dMN)-based electrodes were prepared by laser patterning, which were then modified as sensing electrodes by electrochemical deposition and glucose oxidase decoration to achieve separated functionalization and reduce mutual interference. The electrodes were then assembled into 2dMN- and 1dMN-based multi-channel electrochemical arrays (MCEAs), respectively, to avoid damaging functionalized coatings. In vitro and in vivo results demonstrated that the as-prepared MCEAs exhibit excellent transdermal capability, detection sensitivity, selectivity, and reproducibility, which was capable of real-time, in situ glucose concentration monitoring.

Investigation of biosensing properties in magnetron sputtered metallized UV-curable polymer microneedle electrodes

Direct management and assessment of metal film properties applied to polymer microneedle (MN) biosensors remains difficult due to constraints inherent to their morphology. By simplifying the three-dimensional structure of MNs and adjusting the deposition time, different thicknesses of Au films were deposited on the UV-cured polymer planar and MN substrates. Several properties relevant to the biosensing of the Au films grown on the polymer surfaces were investigated. The results demonstrate the successful deposition of pure and stable Au nanoparticles onto the surface of UV-curable polymer materials. Initially, Au islands formed within the first minute of deposition; however, as the sputtering time extended, these islands transformed into Au nanoparticle films and disappeared. The hydrophilicity of the surface remains unchanged, while the surface resistance of the thin film decreases with increasing thickness, and the adhesion to the substrate decreases as the thickness increases. In short, a sputtering time of 5-6 min results in Au films with a thickness of 100-200 nm, which exhibit exceptional comprehensive biosensing performance. Additionally, MNs made of Au/UV-curable polymers and produced using magnetron sputtering maintain their original shape, enhance their mechanical characteristics, and gain new functionalities. The Au/UV-curable polymer MNs exhibited remarkable electrode performance despite being soaked in a 37 °C PBS solution for 14 days. These discoveries have important implications in terms of decreasing the dependence on valuable metals in MN biosensors, lowering production expenses, and providing guidance for the choice and design of materials for UV-curable polymer MN metallization films.

Emerging therapeutic drug monitoring technologies: considerations and opportunities in precision medicine

In recent years, the development of sensor and wearable technologies have led to their increased adoption in clinical and health monitoring settings. One area that is in early, but promising, stages of development is the use of biosensors for therapeutic drug monitoring (TDM). Traditionally, TDM could only be performed in certified laboratories and was used in specific scenarios to optimize drug dosage based on measurement of plasma/blood drug concentrations. Although TDM has been typically pursued in settings involving medications that are challenging to manage, the basic approach is useful for characterizing drug activity. TDM is based on the idea that there is likely a clear relationship between plasma/blood drug concentration (or concentration in other matrices) and clinical efficacy. However, these relationships may vary across individuals and may be affected by genetic factors, comorbidities, lifestyle, and diet. TDM technologies will be valuable for enabling precision medicine strategies to determine the clinical efficacy of drugs in individuals, as well as optimizing personalized dosing, especially since therapeutic windows may vary inter-individually. In this mini-review, we discuss emerging TDM technologies and their applications, and factors that influence TDM including drug interactions, polypharmacy, and supplement use. We also discuss how using TDM within single subject (N-of-1) and aggregated N-of-1 clinical trial designs provides opportunities to better capture drug response and activity at the individual level. Individualized TDM solutions have the potential to help optimize treatment selection and dosing regimens so that the right drug and right dose may be matched to the right person and in the right context.

Wearable filamentary continuous sensor for interstitial glucose detection in diabetes management

The development of novel diabetes monitoring sensors is important for the diabetes management of millions of diabetic patients. This work reports a flexible filamentary continuous glucose monitoring (CGM) sensor. A multilayer CGM sensor has been constructed on titanium filament with low cost and ease of use. The sensor, made of flexible material, offers better adaptability and comfort than traditional rigid filament CGM sensors, allowing continuous monitoring of subcutaneous blood glucose levels to provide patients with treatment strategies. The performance and reliability of the sensor were verified through rat experiments. The trend of the increase and decrease of the detected current was generally consistent with the actual blood glucose, and the detected values were located in regions A and B of the Clarke error grid. The results show that the sensor has the advantages of high sensitivity, high accuracy and fast response speed, which is suitable for monitoring the blood glucose level for a long time and has a broad application prospect in diabetes monitoring, exercise monitoring, health management and clinical application.

Advances in biomedical systems based on microneedles: design, fabrication, and application

Wearable devices have become prevalent in biomedical studies due to their convenient portability and potential utility in biomarker monitoring for healthcare. Accessing interstitial fluid (ISF) across the skin barrier, microneedle (MN) is a promising minimally invasive wearable technology for transdermal sensing and drug delivery. MN has the potential to overcome the limitations of conventional transdermal drug administration, making it another prospective mode of drug delivery after oral and injectable. Subsequently, combining MN with multiple sensing approaches has led to its extensive application to detect biomarkers in ISF. In this context, employing MN platforms and control schemes to merge diagnostic and therapeutic capabilities into theranostic systems will facilitate on-demand therapy and point-of-care diagnostics, paving the way for future MN technologies. A comprehensive analysis of the growing advances of microneedles in biomedical systems is presented in this review to summarize the latest studies for academics in the field and to offer for reference the issues that need to be addressed in MN application for healthcare. Covering an array of novel studies, we discuss the following main topics: classification of microneedles in the biomedical field, considerations of MN design, current applications of microneedles in diagnosis and therapy, and the regulatory landscape and prospects of microneedles for biomedical applications. This review sheds light on the significance of microneedle-based innovations, presenting an analysis of their potential implications and contributions to the community of wearable healthcare technologies. The review provides a comprehensive understanding of the field's current state and potential, making it a valuable resource for academics and clinicians seeking to harness the full potential of MN applications.

Wearable Clinic: From Microneedle-Based Sensors to Next-Generation Healthcare Platforms

The rapid development of wearable biosensing calls for next-generation devices that allow continuous, real-time, and painless monitoring of health status along with responsive medical treatment. Microneedles have exhibited great potential for the direct access of dermal interstitial fluid (ISF) in a minimally invasive manner. Recent studies of microneedle-based devices have evolved from conventional off-line detection to multiplexed, wireless, and integrated sensing. In this review, the classification and fabrication techniques of microneedles are first introduced, and then the representative examples of microneedles for transdermal monitoring with different sensing modalities are summarized. State-of-the-art advances in therapeutic and closed-loop systems are presented to formulate guidelines for the development of next-generation microneedle-based healthcare platforms. The potential challenges and prospects are discussed to pave a new avenue toward pragmatic applications in the real world.

A novel strategy for therapeutic drug monitoring: application of biosensors to quantify antimicrobials in biological matrices

Over the past few years, therapeutic drug monitoring (TDM) has gained practical significance in antimicrobial precision therapy. Yet two categories of mainstream TDM techniques (chromatographic analysis and immunoassays) that are widely adopted nowadays retain certain inherent limitations. The use of biosensors, an innovative strategy for rapid evaluation of antimicrobial concentrations in biological samples, enables the implementation of point-of-care testing (POCT) and continuous monitoring, which may circumvent the constraints of conventional TDM and provide strong technological support for individualized antimicrobial treatment. This comprehensive review summarizes the investigations that have harnessed biosensors to detect antimicrobial drugs in biological matrices, provides insights into the performance and characteristics of each sensing form, and explores the feasibility of translating them into clinical practice. Furthermore, the future trends and obstacles to achieving POCT and continuous monitoring are discussed. More efforts are necessary to address the four key 'appropriateness' challenges to deploy biosensors in clinical practice, paving the way for personalized antimicrobial stewardship.

Advances in the detection of β-lactamase: A review

β-lactamase, an enzyme secreted by bacteria, is the main resistant mechanism of Gram-negative bacteria to β-lactam antibiotics. The resistance of bacteria to β-lactam antibiotics can be evaluated by testing the activity of β-lactamase. Traditional phenotypic detection is a golden principle, but it is time-consuming. In recent years, many new methods have emerged, which improve the efficiency by virtue of their sensitivity, low cost, easy operation, and other advantages. In this paper, we systematically review these researches and emphasize their limits of detection, sample operation, and test duration. Noteworthily, some detection systems can identify the β-lactamase subtype conveniently. We mainly divide these tests into three categories to elaborate their characteristics and application status. Both advantages and disadvantages of these methods are discussed. Additionally, we analyze the recent 5 years published researches to predict the trend of development in this field.

Advances in Intelligent Stimuli-Responsive Microneedle for Biomedical Applications

Microneedles (MNs) are a new type of drug delivery method that can be regarded as an alternative to traditional transdermal drug delivery systems. Recently, MNs have attracted widespread attention for their advantages of effectiveness, safety, and painlessness. However, the functionality of traditional MNs is too monotonous and limits their application. To improve the efficiency of disease treatment and diagnosis by combining the advantages of MNs, the concept of intelligent stimulus-responsive MNs is proposed. Intelligent stimuli-responsive MNs can exhibit unique biomedical functions according to the internal and external environment changes. This review discusses the classification and principles of intelligent stimuli-responsive MNs, such as magnet, temperature, light, electricity, reactive oxygen species, pH, glucose, and protein. This review also highlights examples of intelligent stimuli-responsive MNs for biomedical applications, such as on-demand drug delivery, tissue repair, bioimaging, detection and monitoring, and photothermal therapy. These intelligent stimuli-responsive MNs offer the advantages of high biocompatibility, targeted therapy, selective detection, and precision treatment. Finally, the prospects and challenges for the application of intelligent stimuli-responsive MNs are discussed.

A skin patch integrating swellable microneedles and electrochemical test strips for glucose and alcohol measurement in skin interstitial fluid

Microneedle (MN)-based diagnostic devices can efficiently access skin interstitial fluid (ISF) for accurate and minimally invasive detection of health-related biomarkers. This work reports a biomarker (i.e., glucose or alcohol) monitoring MN device that is composed of swellable MNs and electrochemical test strip. This device is constructed by adhering MN patch on the electrochemical strips using the chitosan as the connecting layer. The MNs penetrate the skin for extraction of ISF that flows to the backing layer of MNs and is analyzed by the test strip. In the in vitro skin models, this device accurately detects the glucose from 0 mM to 12 mM and alcohol from 0 mM to 20 mM. In vivo experiment shows this MN device is capable of minimally invasive sampling of ISF and analysis of glucose levels to determine the glycemic status of mice.

Microneedle-enabled therapeutics delivery and biosensing in clinical trials

Microneedles (MNs) are micron-sized protrusions attached to a range of devices that are used in therapeutic delivery and diagnosis. Because MNs can be self-applied, are painless, and can carry multiple therapeutic agents, they have received extensive attention, and have been widely investigated, for local and systemic therapy. Many researchers are currently working to extend the use of MNs to clinical applications. In this review, we provide an update and analysis on MN-based clinical trials since their inception in 2007. The MNs in clinical trials are classified into five types based on their appearance and properties, including: hollow MNs, MN patches, radiofrequency MNs, MN rollers, and other MNs. The various aspects of MN trials are summarized, such as MN types, clinical trial time, and trial regions. This review aims to present an overview of MN development and provide insights for future research in this field. To our knowledge, this is the first review focused on MN clinical trials which showcases the latest applications of this advanced technology in medicine.

Recent advancements in the expedition of microneedles: from lab worktops to diagnostic care centers

Microneedle (MN) technology plays a significant role in bioengineering as it allows for minimally invasive exposure to the skin via the non-invasive procedure, increased drug permeability, and improved biological molecule detectability in the epidermal layers, all while improving therapeutic safety and effectiveness. However, MNs have several significant drawbacks, including difficulty scaling up, variability in drug delivery pattern regarding the skin's external environment, blockage of dermal tissues, induction of inflammatory response at the administration site, and limitation of dosing based on the molecular weight of drug and size. Despite these drawbacks, MNs have emerged as a special transdermal theranostics instrument in clinical research to assess physiological parameters. Bioimaging technology relies on microneedles that can measure particular analytes in the extracellular fluid effectively by crossing the stratum corneum, making them "a unique tool in diagnostics detection and therapeutic application inside the body." This review article discusses the recent advances in the applications especially related to the diagnostics and toxicity challenges of microneedles. In addition, this review article discusses the clinical state and commercial accessibility of microneedle technology-based devices in order to provide new information to scientists and researchers.

Revolutionizing Precision Medicine: Exploring Wearable Sensors for Therapeutic Drug Monitoring and Personalized Therapy

Precision medicine, particularly therapeutic drug monitoring (TDM), is essential for optimizing drug dosage and minimizing toxicity. However, current TDM methods have limitations, including the need for skilled operators, patient discomfort, and the inability to monitor dynamic drug level changes. In recent years, wearable sensors have emerged as a promising solution for drug monitoring. These sensors offer real-time and continuous measurement of drug concentrations in biofluids, enabling personalized medicine and reducing the risk of toxicity. This review provides an overview of drugs detectable by wearable sensors and explores biosensing technologies that can enable drug monitoring in the future. It presents a comparative analysis of multiple biosensing technologies and evaluates their strengths and limitations for integration into wearable detection systems. The promising capabilities of wearable sensors for real-time and continuous drug monitoring offer revolutionary advancements in diagnostic tools, supporting personalized medicine and optimal therapeutic effects. Wearable sensors are poised to become essential components of healthcare systems, catering to the diverse needs of patients and reducing healthcare costs.

Recent Progress in Micro- and Nanotechnology-Enabled Sensors for Biomedical and Environmental Challenges

Micro- and nanotechnology-enabled sensors have made remarkable advancements in the fields of biomedicine and the environment, enabling the sensitive and selective detection and quantification of diverse analytes. In biomedicine, these sensors have facilitated disease diagnosis, drug discovery, and point-of-care devices. In environmental monitoring, they have played a crucial role in assessing air, water, and soil quality, as well as ensured food safety. Despite notable progress, numerous challenges persist. This review article addresses recent developments in micro- and nanotechnology-enabled sensors for biomedical and environmental challenges, focusing on enhancing basic sensing techniques through micro/nanotechnology. Additionally, it explores the applications of these sensors in addressing current challenges in both biomedical and environmental domains. The article concludes by emphasizing the need for further research to expand the detection capabilities of sensors/devices, enhance sensitivity and selectivity, integrate wireless communication and energy-harvesting technologies, and optimize sample preparation, material selection, and automated components for sensor design, fabrication, and characterization.

Porous Colorimetric Microneedles for Minimally Invasive Rapid Glucose Sampling and Sensing in Skin Interstitial Fluid

Though monitoring blood glucose (BG) is indispensable for regulating diabetes, the frequent pricking of the finger by the commonly used fingertip blood collection causes discomfort and poses an infection risk. Since glucose levels in skin interstitial fluid (ISF) correlate with blood glucose levels, monitoring glucose in the skin ISF can be a viable alternative. With this rationale, the present study developed a biocompatible porous microneedle capable of rapid sampling, sensing, and glucose analysis in ISF in a minimally invasive manner, which can improve patient compliance and detection efficiency. The microneedles contain glucose oxidase (GOx) and horseradish peroxidase (HRP), and a colorimetric sensing layer containing 3,3',5,5'-tetramethylbenzidine (TMB) is on the back of the microneedles. After penetrating rat skin, porous microneedles harvest ISF rapidly and smoothly via capillary action, triggering the production of hydrogen peroxide (H₂O₂) from glucose. In the presence of H₂O₂, HRP reacts with TMB contained in the filter paper on the back of microneedles, causing an easily visible color shift. Further, a smartphone analysis of the images quickly quantifies glucose levels in the 50-400 mg/dL range using the correlation between color intensity and glucose concentration. The developed microneedle-based sensing technique with minimally invasive sampling will have great implications for point-of-care clinical diagnosis and diabetic health management.

Enhancing the repeatability and sensitivity of low-cost PCB, pH-sensitive field-effect transistors

Discrete, extended gate pH-sensitive field-effect transistors (dEGFETs) fabricated on printed circuit boards (PCBs) are a low-cost, simple to manufacture analytical technology that can be applied to a wide range of applications. Electrodeposited iridium oxide (IrOx) films have emerged as promising pH-sensitive layers owing to their theoretically high pH sensitivity and facile deposition, but typically exhibit low pH sensitivity or lack reproducibility. Moreover, to date, a combined IrOx and dEGFET PCB system has not yet been realised. In this study, we demonstrate a dEGFET pH sensor based on an extended gate manufactured on PCB that is rendered pH sensitive through an electrodeposited IrOx film, which can reliably and repeatably display beyond-Nernstian pH response. Using a combination of complementary surface analysis techniques, we show that the high pH sensitivity and repeatability of the dEGFETs are dependent on both the chemical composition and critically the uniformity of the IrOx film. The IrOx film uniformity can be enhanced through electrochemical polishing of the extended gate electrode prior to electrodeposition, leading to dEGFETs that exhibit a median pH sensitivity of 70.7 ± 5 mV/pH (n = 56) compared to only 31.3 ± 14 mV/pH (n = 31) for IrOx electrodeposited on non-polished PCB electrodes. Finally, we demonstrate the applicability of these devices by demonstrating the detection and quantification of ampicillin due to β-Lactamase enzyme activity, thus laying the foundation for cheap and ubiquitous sensors which can be applied to a range of global challenges across healthcare and environmental monitoring.

Conductive Polymer-Coated 3D Printed Microneedles: Biocompatible Platforms for Minimally Invasive Biosensing Interfaces

Conductive polymeric microneedle (MN) arrays as biointerface materials show promise for the minimally invasive monitoring of analytes in biodevices and wearables. There is increasing interest in microneedles as electrodes for biosensing, but efforts have been limited to metallic substrates, which lack biological stability and are associated with high manufacturing costs and laborious fabrication methods, which create translational barriers. In this work, additive manufacturing, which provides the user with design flexibility and upscale manufacturing, is employed to fabricate acrylic-based microneedle devices. These microneedle devices are used as platforms to produce intrinsically-conductive, polymer-based surfaces based on polypyrrole (PPy) and poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS). These entirely polymer-based solid microneedle arrays act as dry conductive electrodes while omitting the requirement of a metallic seed layer. Two distinct coating methods of 3D-printed solid microneedles, in situ polymerization and drop casting, enable conductive functionality. The microneedle arrays penetrate ex vivo porcine skin grafts without compromising conductivity or microneedle morphology and demonstrate coating durability over multiple penetration cycles. The non-cytotoxic nature of the conductive microneedles is evaluated using human fibroblast cells. The proposed fabrication strategy offers a compelling approach to manufacturing polymer-based conductive microneedle surfaces that can be further exploited as platforms for biosensing.

Continuous Measurement of Lactate Concentration in Human Subjects through Direct Electron Transfer from Enzymes to Microneedle Electrodes

Microneedle lactate sensors may be used to continuously measure lactate concentration in the interstitial fluid in a minimally invasive and pain-free manner. First- and second-generation enzymatic sensors produce a redox-active product that is electrochemically sensed at the electrode surface. Direct electron transfer enzymes produce electrons directly as the product of enzymatic action; in this study, a direct electron transfer enzyme specific to lactate has been immobilized onto a microneedle surface to create lactate-sensing devices that function at low applied voltages (0.2 V). These devices have been validated in a small study of human volunteers; lactate concentrations were raised and lowered through physical exercise and subsequent rest. Lactazyme microneedle devices show good agreement with concurrently obtained and analyzed serum lactate levels.

Biosensors for healthcare: current and future perspectives

Biosensors are utilized in several different fields, including medicine, food, and the environment; in this review, we examine recent developments in biosensors for healthcare. These involve three distinct types of biosensor: biosensors for in vitro diagnosis with blood, saliva, or urine samples; continuous monitoring biosensors (CMBs); and wearable biosensors. Biosensors for in vitro diagnosis have seen a significant expansion recently, with newly reported clustered regularly interspaced short palindromic repeats (CRISPR)/Cas methodologies and improvements to many established integrated biosensor devices, including lateral flow assays (LFAs) and microfluidic/electrochemical paper-based analytical devices (μPADs/ePADs). We conclude with a discussion of two novel groups of biosensors that have drawn great attention recently, continuous monitoring and wearable biosensors, as well as with perspectives on the commercialization and future of biosensors.

Antimicrobial Pharmacokinetics and Pharmacodynamics in Critical Care: Adjusting the Dose in Extracorporeal Circulation and to Prevent the Genesis of Multiresistant Bacteria

Critically ill patients suffering from severe infections are prone to pathophysiological pharmacokinetic changes that are frequently associated with inadequate antibiotic serum concentrations. Minimum inhibitory concentrations (MICs) of the causative pathogens tend to be higher in intensive care units. Both pharmacokinetic changes and high antibiotic resistance likely jeopardize the efficacy of treatment. The use of extracorporeal circulation devices to support hemodynamic, respiratory, or renal failure enables pharmacokinetic changes and makes it even more difficult to achieve an adequate antibiotic dose. Besides a clinical response, antibiotic pharmacokinetic optimization is important to reduce the selection of strains resistant to common antibiotics. In this review, we summarize the present knowledge regarding pharmacokinetic changes in critically ill patients and we discuss the effects of extra-corporeal devices on antibiotic treatment together with potential solutions.

Wearable microneedle array-based sensor for transdermal monitoring of pH levels in interstitial fluid

Microneedle-based wearable sensors offer an alternative approach to traditional invasive blood-based health monitoring and disease diagnostics techniques. Instead of blood, microneedle-based sensors target the skin interstitial fluid (ISF), in which the biomarker type and concentration profile resemble the one found in the blood. However, unlike blood, interstitial fluid does not have the same pH-buffering capacity causing deviation of pH levels from the physiological range. Information about the skin ISF pH levels can be used as a biomarker for a wide range of pathophysiological conditions and as a marker for the calibration of a wearable sensor. The ISF pH can significantly affect the detection accuracy of other biomarkers as it influences enzyme activity, aptamer affinity, and antibody-antigen interaction. Herein, we report the fabrication of a high-density polymeric microneedle array-based (PMNA) sensing patch and its optimization for the potentiometric transdermal monitoring of pH levels in ISF. The wearable sensor utilizes a polyaniline-coated PMNA having a density of ∼10,000 microneedles per cm², containing individual microneedles with a height of ∼250 μm, and a tip diameter of ∼2 μm. To prevent interference from other body fluids like sweat, an insulating layer is deposited at the base of the PMNA. The wearable pH sensor operates from pH 4.0 to 8.6 with a sensitivity of 62.9 mV per pH unit and an accuracy of ±0.036 pH units. Furthermore, testing on a mouse demonstrates the ability of the PMNA to provide a real-time reading of the transdermal pH values. This microneedle-based system will significantly contribute to advancing transdermal wearable sensors technology, simplifying the fabrication process, and improving the cost-effectiveness of such devices.

Microneedle-based interstitial fluid extraction for drug analysis: Advances, challenges, and prospects

Similar to blood, interstitial fluid (ISF) contains exogenous drugs and biomarkers and may therefore substitute blood in drug analysis. However, current ISF extraction techniques require bulky instruments and are both time-consuming and complicated, which has inspired the development of viable alternatives such as those relying on skin or tissue puncturing with microneedles. Currently, microneedles are widely employed for transdermal drug delivery and have been successfully used for ISF extraction by different mechanisms to facilitate subsequent analysis. The integration of microneedles with sensors enables in situ ISF analysis and specific compound monitoring, while the integration of monitoring and delivery functions in wearable devices allows real-time dose modification. Herein, we review the progress in drug analysis based on microneedle-assisted ISF extraction and discuss the related future opportunities and challenges.

Real-Time, Seconds-Resolved Measurements of Plasma Methotrexate In Situ in the Living Body

Dose-limiting toxicity and significant patient-to-patient pharmacokinetic variability often render it difficult to achieve the safe and effective dosing of drugs. This is further compounded by the slow, cumbersome nature of the analytical methods used to monitor patient-specific pharmacokinetics, which inevitably rely on blood draws followed by post-facto laboratory analysis. Motivated by the pressing need for improved "therapeutic drug monitoring", we are developing electrochemical aptamer-based (EAB) sensors, a minimally invasive biosensor architecture that can provide real-time, seconds-resolved measurements of drug levels in situ in the living body. A key advantage of EAB sensors is that they are generalizable to the detection of a wide range of therapeutic agents because they are independent of the chemical or enzymatic reactivity of their targets. Three of the four therapeutic drug classes that have, to date, been shown measurable using in vivo EAB sensors, however, bind to nucleic acids as part of their mode of action, leaving open questions regarding the extent to which the approach can be generalized to therapeutics that do not. Here, we demonstrate real-time, in vivo measurements of plasma methotrexate, an antimetabolite (a mode of action not reliant on DNA binding) chemotherapeutic, following human-relevant dosing in a live rat animal model. By providing hundreds of drug concentration values, the resulting seconds-resolved measurements succeed in defining key pharmacokinetic parameters, including the drug's elimination rate, peak plasma concentration, and exposure (area under the curve), with unprecedented 5 to 10% precision. With this level of precision, we easily identify significant (>2-fold) differences in drug exposure occurring between even healthy rats given the same mass-adjusted methotrexate dose. By providing a real-time, seconds-resolved window into methotrexate pharmacokinetics, such measurements can be used to precisely "individualize" the dosing of this significantly toxic yet vitally important chemotherapeutic.

Application of therapeutic drug monitoring to the treatment of bacterial central nervous system infection: a scoping review

BACKGROUND

Bacterial central nervous system (CNS) infection is challenging to treat and carries high risk of recurrence, morbidity, and mortality. Low CNS penetration of antibiotics may contribute to poor clinical outcomes from bacterial CNS infections. The current application of therapeutic drug monitoring (TDM) to management of bacterial CNS infection was reviewed.

METHODS

Studies were included if they described adults treated for a suspected/confirmed bacterial CNS infection and had antibiotic drug concentration(s) determined that affected individual treatment.

RESULTS

One-hundred-and-thirty-six citations were retrieved. Seventeen manuscripts were included describing management of 68 patients. TDM for vancomycin (58/68) and the beta-lactams (29/68) was most common. Timing of clinical sampling varied widely between studies and across different antibiotics. Methods for setting individual PK-PD targets, determining parameters and making treatment changes varied widely and were sometimes unclear.

DISCUSSION

Despite increasing observational data showing low CNS penetration of various antibiotics, there are few clinical studies describing practical implementation of TDM in management of CNS infection. Lack of consensus around clinically relevant CSF PK-PD targets and protocols for dose-adjustment may contribute. Standardised investigation of TDM as a tool to improve treatment is required, especially as innovative drug concentration-sensing and PK-PD modelling technologies are emerging. Data generated at different centres offering TDM should be open access and aggregated to enrich understanding and optimize application.

Closed-loop control of continuous piperacillin delivery: An in silico study

Background and objective: Sub-therapeutic dosing of piperacillin-tazobactam in critically-ill patients is associated with poor clinical outcomes and may promote the emergence of drug-resistant infections. In this paper, an in silico investigation of whether closed-loop control can improve pharmacokinetic-pharmacodynamic (PK-PD) target attainment is described.

Method: An in silico platform was developed using PK data from 20 critically-ill patients receiving piperacillin-tazobactam where serum and tissue interstitial fluid (ISF) PK were defined. Intra-day variability on renal clearance, ISF sensor error, and infusion constraints were taken into account. Proportional-integral-derivative (PID) control was selected for drug delivery modulation. Dose adjustment was made based on ISF sensor data with a 30-min sampling period, targeting a serum piperacillin concentration between 32 and 64 mg/L. A single tuning parameter set was employed across the virtual population. The PID controller was compared to standard therapy, including bolus and continuous infusion of piperacillin-tazobactam.

Results: Despite significant inter-subject and simulated intra-day PK variability and sensor error, PID demonstrated a significant improvement in target attainment compared to traditional bolus and continuous infusion approaches.

Conclusion: A PID controller driven by ISF drug concentration measurements has the potential to precisely deliver piperacillin-tazobactam in critically-ill patients undergoing treatment for sepsis.

Film-trigger applicator (FTA) for improved skin penetration of microneedle using punching force of carboxymethyl cellulose film acting as a microneedle applicator

Background

Dissolving microneedle (DMN) is a transdermal drug delivery system that creates pore in the skin and directly deliver drug through the pore channel. DMN is considered as one of the promising system alternatives to injection because it is minimally invasive and free from needle-related issues. However, traditional DMN patch system has limitations of incomplete insertion and need of complex external devices. Here, we designed film-trigger applicator (FTA) system that successfully delivered DMN inside the skin layers using fracture energy of carboxymethyl cellulose (CMC) film via micropillars. We highlighted advantages of FTA system in DMN delivery compared with DMN patch, including that the film itself can act as DMN applicator.

Methods

FTA system consists of DMNs fabricated on the CMC film, DMN array holder having holes aligned to DMN array, and micropillars prepared using general purpose polystyrene. We analyzed punching force on the film by micropillars until the film puncture point at different CMC film concentrations and micropillar diameters. We also compared drug delivery efficiency using rhodamine B fluorescence diffusion and skin penetration using optical coherence tomography (OCT) of FTA with those of conventional DMN patch. In vivo experiments were conducted to evaluate DMN delivery efficiency using C57BL/6 mice and insulin as a model drug.

Results

FTA system showed enhanced delivery efficiency compared with that of the existing DMN patch system. We concluded CMC film as a successful DMN applicator as it showed enhanced DMN penetration in OCT and rhodamine B diffusion studies. Further, we applied FTA on shaved mouse dorsal skin and observed successful skin penetration. The FTA group showed higher level of plasma insulin in vivo than that of the DMN patch group.

Conclusions

FTA system consisting of simple polymer film and micropillars showed enhanced DMN delivery than that of the existing DMN patch system. Because FTA works with simple finger force without sticky patch and external devices, FTA is a novel and promising platform to overcome the limitations of conventional microneedle patch delivery system; we suggest FTA as a next generation applicator for microneedle application in the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40824-022-00302-5.

Hydrogel Microneedle-Assisted Assay Integrating Aptamer Probes and Fluorescence Detection for Reagentless Biomarker Quantification

Analyzing interstitial fluid (ISF) via microneedle (MN) devices enables patient health monitoring in a minimally invasive manner and in point-of-care settings. However, most MN-based diagnostic approaches require complicated fabrication processes and postprocessing of the extracted ISF or are limited to detection of electrochemically active biomarkers. Here, we show on-needle measurement of target analytes by integrating hydrogel microneedles with aptamer probes as the recognition elements. Fluorescently tagged aptamer probes are chemically attached to the hydrogel matrix using a simple and novel approach, while a cross-linked patch is formed. For reagentless detection, we employ a strand displacement strategy where fluorophore-conjugated aptamers are hybridized with a DNA competitor strand conjugated to a quencher molecule. The assay is utilized for rapid (2 min) measurement of glucose, adenosine triphosphate, l-tyrosinamide, and thrombin ex vivo. Furthermore, the system enables specific and sensitive quantification of rising and falling concentrations of glucose in an animal model of diabetes to track hypoglycemia, euglycemia, and hyperglycemia conditions. Our assay can be applied for rapid measurement of a diverse range of biomarkers, proteins, or small molecules, introducing a generalizable platform for biomolecule quantification, and has the potential to improve the quality of life of patients who are in need of close monitoring of biomarkers of health and disease.

Intradermal Glycine Detection with a Wearable Microneedle Biosensor: The First In Vivo Assay

Glycine (GLY) is gaining importance in medical diagnoses due to its relationship with multiple physiological functions. Today, GLY is exclusively analyzed using instrumentation centralized in clinical labs, and a tangible point-of-care tool that gathers real-time data from the patient for effective and fast evaluations is lacking. Relevant clinical advances are expected as soon as the rapid provision of both punctual and continuous measurements is possible. In that context, this work presents a microneedle (MN)-based biosensor for intradermal GLY detection in interstitial fluid (ISF). The MN tip is externally tailored to detect GLY levels through the hydrogen peroxide formed in its reaction with a quinoprotein-based GLY oxidase enzyme. The analytical performance of the MN biosensor indicates a fast response time (<7 s); acceptable reversibility, reproducibility, and stability; as well as a wide linear range of response (25–600 μM) that covers the physiological levels of GLY in ISF. The MN biosensor conveniently exhibits high selectivity for GLY over other compounds commonly found in ISF, and the response is not influenced by temperature, pH, or skin insertions. Validated intradermal measurements of GLY were obtained at the in vitro (with pieces of rat skin), ex vivo (on-body tests of euthanized rats) and in vivo (on-body tests of anesthetized rats) levels, demonstrating its ability to produce accurate physiological data. The developed GLY MN biosensor is skin-wearable and provides reliable, real-time intradermal GLY measurements in ISF by means of a minimally invasive approach.

Development and Characterization of Passivation Methods for Microneedle-based Biosensors

Microneedles (MN) are short, sharp structures that have the ability to painlessly pierce the stratum corneum, the outermost layer of the skin, and interface with the dermal interstitial fluid that lies beneath. Because the interstitial fluid is rich in biomarkers, microneedle-based biosensors have the potential to be used in a wide range of diagnostic applications. To act as an electrochemical sensor, the tip or the body of the MN must be functionalized, while the substrate areas are generally passivated to block any unwanted background interference that may occur outside of the skin. This work presents four different passivation techniques, based on the application of SiO2, polymethyl methacrylate (PMMA), an adhesive film, and varnish to the substrate areas. Optical, SEM and electrochemical measurements were performed to quantitatively assess the performance of each film. The data shows that whilst manual application of varnish provided the highest level of electrical isolation, the spin-coating of a 5 μm thick layer of PMMA is likely to provide the best combination of performance and manufacturability. Clinical Relevance- Substrate passivation techniques will improve the performance of microneedle-based non-invasive continuous monitoring systems.

Physiological adaptations affecting drug pharmacokinetics in space: what do we really know? A critical review of the literature

As human spaceflight progresses with extended mission durations, the demand for effective and safe drugs will necessarily increase. To date, the accepted medications used during missions (for space motion sickness, sleep disturbances, allergies, pain, and sinus congestion) are administered under the assumption that they act as safely and efficaciously as on Earth. However, physiological changes have been documented in human subjects in spaceflight involving fluid shifts, muscle and bone loss, immune system dysregulation, and adjustments in the gastrointestinal tract and metabolism. These alterations may change the pharmacokinetics (PK) and pharmacodynamics of commonly used medications. Frustratingly, the information gained from bed rest studies and from in-flight observations is incomplete and also demonstrates a high variability in drug PK. Therefore, the objectives of this review are to report (i) the impact of the space environmental stressors on human physiology in relation to PK; (ii) the state-of-the-art on experimental data in space and/or in ground-based models; (iii) the validation of ground-based models for PK studies; and (iv) the identification of research gaps.

Recent Progress in Microneedles-Mediated Diagnosis, Therapy, and Theranostic Systems

Theranostic system combined diagnostic and therapeutic modalities is critical for the real-time monitoring of disease-related biomarkers and personalized therapy. Microneedles, as a multifunctional platform, are promising for transdermal diagnostics and drug delivery. They have shown attractive properties including painless skin penetration, easy self-administration, prominent therapeutic effects, and good biosafety. Herein, an overview of the microneedles-based diagnosis, therapies, and theranostic systems is given. Four microneedles-based detection methods are concluded based on the sensing mechanism: i) electrochemistry, ii) fluorometric, iii) colorimetric, and iv) Raman methods. Additionally, robust microneedles are suitable for implantable drug delivery. Microneedles-assisted transdermal drug delivery can be primarily classified as passive, active, and responsive drug release, based on the release mechanisms. Microneedles-assisted oral and implantable drug delivery mechanisms are also presented in this review. Furthermore, the key frontier developments in microneedles-mediated theranostic systems as the major selling points are emphasized in this review. These systems are classified into open-loop and closed-loop theranostic systems based on the indirectness and directness of feedback between the transdermal diagnosis and therapy, respectively. Finally, conclusions and future perspectives for next-generation microneedles-mediated theranostic systems are also discussed. Taken together, microneedle-based systems are promising as the new avenue for diagnosis, therapy, and disease-specific closed-loop theranostic applications.