A new paradigm in sweat based wearable diagnostics biosensors using Room Temperature Ionic Liquids (RTILs)

Recent advances in biosensors based on metal-oxide semiconductors system-integrated into bioelectronics

Metal-oxide semiconductors (MOSs) have emerged as pivotal components in technology related to biosensors and bioelectronics. Detecting biomarkers in sweat provides a glimpse into an individual's metabolism without the need for sample preparation or collection steps. The distinctive attributes of this biosensing technology position it as an appealing option for biomedical applications beyond the scope of diagnosis and healthcare monitoring. This review encapsulates ongoing developments of cutting-edge biosensors based on MOSs. Recent advances in MOS-based biosensors for human sweat analyses are reviewed. Also discussed is the progress in sweat-based biosensing technologies to detect and monitor diseases. Next, system integration of biosensors is demonstrated ultimately to ensure the accurate and reliable detection and analysis of target biomarkers beyond individual devices. Finally, the challenges and opportunities related to advanced biosensors and bioelectronics for biomedical applications are discussed.

Recent advancements in non-invasive wearable electrochemical biosensors for biomarker analysis - A review

A biomarker is a molecular indicator that can be used to identify the presence or severity of a disease. It may be produced due to biochemical or molecular changes in normal biological processes. In some cases, the presence of a biomarker itself is an indication of the disease, while in other cases, the elevated or depleted level of a particular protein or chemical substance aids in identifying a disease. Biomarkers indicate the progression of the disease in response to therapeutic interventions. Identifying these biomarkers can assist in diagnosing the disease early and providing proper therapeutic treatment. In recent years, wearable electrochemical (EC) biosensors have emerged as an important tool for early detection due to their excellent selectivity, low cost, ease of fabrication, and improved sensitivity. There are several challenges in developing a fully integrated wearable sensor, such as device miniaturization, high power consumption, incorporation of a power source, and maintaining the integrity and durability of the biomarker for long-term continuous monitoring. This review covers the recent advancements in the fabrication techniques involved in device development, the types of sensing platforms utilized, different materials used, challenges, and future developments in the field of wearable biosensors.

Sensing patches for biomarker identification in skin-derived biofluids

In conventional clinical disease diagnosis and screening based on biomarker detection, most analysis samples are collected from serum, blood. However, these invasive collection methods require specific instruments, professionals, and may lead to infection risks. Additionally, the diagnosis process suffers from untimely results. The identification of skin-related biomarkers plays an unprecedented role in early disease diagnosis. More importantly, these skin-mediated approaches for collecting biomarker-containing biofluid samples are noninvasive or minimally invasive, which is more preferable for point-of-care testing (POCT). Therefore, skin-based biomarker detection patches have been promoted, owing to their unique advantages, such as simple fabrication, desirable transdermal properties and no requirements for professional medical staff. Currently, the skin biomarkers extracted from sweat, interstitial fluid (ISF) and wound exudate, are achieved with wearable sweat patches, transdermal MN patches, and wound patches, respectively. In this review, we detail these three types of skin patches in biofluids collection and diseases-related biomarkers identification. Patch classification and the corresponding manufacturing as well as detection strategies are also summarized. The remaining challenges in clinical applications and current issues in accurate detection are discussed for further advancement of this technology (Scheme 1).

Super-resolution Multispectral Imaging Nanoimmunosensor for Simultaneous Detection of Diverse Early Cancer Biomarkers

In medical diagnosis, relying on only one type of biomarker is insufficient to accurately identify cancer. Blood-based multicancer early detection can help identify more than one type of cancer from a single blood sample. In this study, a super-resolution multispectral imaging nanoimmunosensor (srMINI) based on three quantum dots (QDs) of different color conjugated with streptavidin was developed for the simultaneous screening of various cancer biomarkers in blood at the single-molecule level. In the experiment, the srMINI chip was used to simultaneously detect three key cancer biomarkers: carcinoembryonic antigen (CEA), C-reactive protein (CRP), and alpha-fetoprotein (AFP). The srMINI chip exhibited 108 times higher detection sensitivity of 0.18-0.5 ag/mL (1.1-2.6 zM) for these cancer biomarkers than commercial enzyme-linked immunosorbent assay kits because of the absence of interfering signals from the substrate, establishing considerable potential for multiplex detection of cancer biomarkers in blood. Therefore, the simultaneous detection of various cancer biomarkers using the developed srMINI chip with high diagnostic precision and accuracy is expected to play a decisive role in early diagnosis or community screening as a single-molecule biosensor.

Longitudinal assessment of sweat-based TNF-alpha in inflammatory bowel disease using a wearable device

Wearable devices can non-invasively monitor patients with chronic diseases. Sweat is an easily accessible biofluid for continuous sampling of analytes, including inflammatory markers and cytokines. We evaluated a sweat sensing wearable device in subjects with and without inflammatory bowel disease (IBD), a chronic inflammatory condition of the gastrointestinal tract. Participants with an IBD related hospital admission and a C-reactive protein level above 5 mg/L wore a sweat sensing wearable device for up to 5 days. Tumor necrosis factor-alpha (TNF-α) levels were continually assessed in the sweat via the sensor, and daily in the blood. A second cohort of healthy subjects without chronic diseases wore the device for up to 48 h. Twenty-eight subjects were enrolled. In the 16 subjects with IBD, a moderate linear relationship between serum and sweat TNF-α levels was observed (R2 = 0.72). Subjects with IBD were found to have a mean sweat TNF-α level of 2.11 pg/mL, compared to a mean value of 0.19 pg/mL in 12 healthy controls (p < 0.0001). Sweat TNF-α measurements differentiated subjects with active IBD from healthy subjects with an AUC of 0.962 (95% CI 0.894-1.000). A sweat sensing wearable device can longitudinally measure key sweat-based markers of IBD. TNF-α levels in the sweat of subjects with IBD correlate with serum values, suggesting feasibility in non-invasive disease monitoring.

Passive sweat wearable: A new paradigm in the wearable landscape toward enabling "detect to treat" opportunities

Growing interest over recent years in personalized health monitoring coupled with the skyrocketing popularity of wearable smart devices has led to the increased relevance of wearable sweat-based sensors for biomarker detection. From optimizing workouts to risk management of cardiovascular diseases and monitoring prediabetes, the ability of sweat sensors to continuously and noninvasively measure biomarkers in real-time has a wide range of applications. Conventional sweat sensors utilize external stimulation of sweat glands to obtain samples, however; this stimulation influences the expression profile of the biomarkers and reduces the accuracy of the detection method. To address this limitation, our laboratory pioneered the development of the passive sweat sensor subfield, which allowed for our progress in developing a sweat chemistry panel. Passive sweat sensors utilize nanoporous structures to confine and detect biomarkers in ultra-low sweat volumes. The ability of passive sweat sensors to use smaller samples than conventional sensors enable users with sedentary lifestyles who perspire less to benefit from sweat sensor technology not previously afforded to them. Herein, the mechanisms and strategies of current sweat sensors are summarized with an emphasis on the emerging subfield of passive sweat-based diagnostics. Prospects for this technology include discovering new biomarkers expressed in sweat and expanding the list of relevant detectable biomarkers. Moreover, the accuracy of biomarker detection can be enhanced with machine learning using prediction algorithms trained on clinical data. Applying this machine learning in conjunction with multiplex biomarker detection will allow for a more holistic approach to trend predictions. This article is categorized under: Diagnostic Tools > Diagnostic Nanodevices Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Diagnostic Tools > Biosensing.

Wearing the Lab: Advances and Challenges in Skin-Interfaced Systems for Continuous Biochemical Sensing

Continuous, on-demand, and, most importantly, contextual data regarding individual biomarker concentrations exemplify the holy grail for personalized health and performance monitoring. This is well-illustrated for continuous glucose monitoring, which has drastically improved outcomes and quality of life for diabetic patients over the past 2 decades. Recent advances in wearable biosensing technologies (biorecognition elements, transduction mechanisms, materials, and integration schemes) have begun to make monitoring of other clinically relevant analytes a reality via minimally invasive skin-interfaced devices. However, several challenges concerning sensitivity, specificity, calibration, sensor longevity, and overall device lifetime must be addressed before these systems can be made commercially viable. In this chapter, a logical framework for developing a wearable skin-interfaced device for a desired application is proposed with careful consideration of the feasibility of monitoring certain analytes in sweat and interstitial fluid and the current development of the tools available to do so. Specifically, we focus on recent advancements in the engineering of biorecognition elements, the development of more robust signal transduction mechanisms, and novel integration schemes that allow for continuous quantitative analysis. Furthermore, we highlight the most compelling and promising prospects in the field of wearable biosensing and the challenges that remain in translating these technologies into useful products for disease management and for optimizing human performance.

The Potential Role of Ionic Liquid as a Multifunctional Dental Biomaterial

In craniofacial research and routine dental clinical procedures, multifunctional materials with antimicrobial properties are in constant demand. Ionic liquids (ILs) are one such multifunctional intelligent material. Over the last three decades, ILs have been explored for different biomedical applications due to their unique physical and chemical properties, high task specificity, and sustainability. Their stable physical and chemical characteristics and extremely low vapor pressure make them suitable for various applications. Their unique properties, such as density, viscosity, and hydrophilicity/hydrophobicity, may provide higher performance as a potential dental material. ILs have functionalities for optimizing dental implants, infiltrate materials, oral hygiene maintenance products, and restorative materials. They also serve as sensors for dental chairside usage to detect oral cancer, periodontal lesions, breath-based sobriety, and dental hard tissue defects. With further optimization, ILs might also make vital contributions to craniofacial regeneration, oral hygiene maintenance, oral disease prevention, and antimicrobial materials. This review explores the different advantages and properties of ILs as possible dental material.

Clinical applications of smart wearable sensors

Smart wearable sensors are electronic devices worn on the body that collect, process, and transmit various physiological data. Compared to traditional devices, their advantages in terms of portability and comfort have made them increasingly important in the medical field. This review takes a unique clinical physician's standpoint, diverging from conventional sensor-type-based classifications, and provides a comprehensive overview of the diverse clinical applications of wearable sensors in recent years. In this review, we categorize these applications according to different diseases, encompassing skin diseases and injuries, cardiovascular diseases, abnormal human motion, as well as endocrine and metabolic disorders. Additionally, we discuss the challenges and perspectives hindering the development of sensors for clinical use, emphasizing the critical need for interdisciplinary collaboration between medical and engineering professionals. Overall, this review would serve as an important reference for the future direction of sensor devices in clinical use.

Recent Advances in Two-Dimensional MXene-Based Electrochemical Biosensors for Sweat Analysis

Sweat, a biofluid secreted naturally from the eccrine glands of the human body, is rich in several electrolytes, metabolites, biomolecules, and even xenobiotics that enter the body through other means. Recent studies indicate a high correlation between the analytes' concentrations in the sweat and the blood, opening up sweat as a medium for disease diagnosis and other general health monitoring applications. However, low concentration of analytes in sweat is a significant limitation, requiring high-performing sensors for this application. Electrochemical sensors, due to their high sensitivity, low cost, and miniaturization, play a crucial role in realizing the potential of sweat as a key sensing medium. MXenes, recently developed anisotropic two-dimensional atomic-layered nanomaterials composed of early transition metal carbides or nitrides, are currently being explored as a material of choice for electrochemical sensors. Their large surface area, tunable electrical properties, excellent mechanical strength, good dispersibility, and biocompatibility make them attractive for bio-electrochemical sensing platforms. This review presents the recent progress made in MXene-based bio-electrochemical sensors such as wearable, implantable, and microfluidic sensors and their applications in disease diagnosis and developing point-of-care sensing platforms. Finally, the paper discusses the challenges and limitations of MXenes as a material of choice in bio-electrochemical sensors and future perspectives on this exciting material for sweat-sensing applications.

Graphene-interfaced flexible and stretchable micro-nano electrodes: from fabrication to sweat glucose detection

Flexible and stretchable wearable electronic devices have received tremendous attention for their non-invasive and personal health monitoring applications. These devices have been fabricated by integrating flexible substrates and graphene nanostructures for non-invasive detection of physiological risk biomarkers from human bodily fluids, such as sweat, and monitoring of human physical motion tracking parameters. The extraordinary properties of graphene nanostructures in fully integrated wearable devices have enabled improved sensitivity, electronic readouts, signal conditioning and communication, energy harvesting from power sources through electrode design and patterning, and graphene surface modification or treatment. This review explores advances made toward the fabrication of graphene-interfaced wearable sensors, flexible and stretchable conductive graphene electrodes, as well as their potential applications in electrochemical sensors and field-effect-transistors (FETs) with special emphasis on monitoring sweat biomarkers, mainly in glucose-sensing applications. The review emphasizes flexible wearable sweat sensors and provides various approaches thus far employed for the fabrication of graphene-enabled conductive and stretchable micro-nano electrodes, such as photolithography, electron-beam evaporation, laser-induced graphene designing, ink printing, chemical-synthesis and graphene surface modification. It further explores existing graphene-interfaced flexible wearable electronic devices utilized for sweat glucose sensing, and their technological potential for non-invasive health monitoring applications.

The Evolving Role of Proteins in Wearable Sweat Biosensors

Sweat is an increasingly popular biological medium for fitness monitoring and clinical diagnostics. It contains an abundance of biological information and is available continuously and noninvasively. Sweat-sensing devices often employ proteins in various capacities to create skin-friendly matrices that accurately extract valuable and time-sensitive information from sweat. Proteins were first used in sensors as biorecognition elements in the form of enzymes and antibodies, which are now being tuned to operate at ranges relevant for sweat. In addition, a range of structural proteins, sometimes assembled in conjunction with polymers, can provide flexible and compatible matrices for skin sensors. Other proteins also naturally possess a range of functionalities─as adhesives, charge conductors, fluorescence emitters, and power generators─that can make them useful components in wearable devices. Here, we examine the four main components of wearable sweat sensors─the biorecognition element, the transducer, the scaffold, and the adhesive─and the roles that proteins have played so far, or promise to play in the future, in each component. On a case-by-case basis, we analyze the performance characteristics of existing protein-based devices, their applicable ranges of detection, their transduction mechanism and their mechanical properties. Thereby, we review and compare proteins that can readily be used in sweat sensors and others that will require further efforts to overcome design, stability or scalability challenges. Incorporating proteins in one or multiple components of sweat sensors could lead to the development and deployment of tunable, greener, and safer biosourced devices.

Skin-Interfaced Wearable Sweat Sensors for Precision Medicine

Wearable sensors hold great potential in empowering personalized health monitoring, predictive analytics, and timely intervention toward personalized healthcare. Advances in flexible electronics, materials science, and electrochemistry have spurred the development of wearable sweat sensors that enable the continuous and noninvasive screening of analytes indicative of health status. Existing major challenges in wearable sensors include: improving the sweat extraction and sweat sensing capabilities, improving the form factor of the wearable device for minimal discomfort and reliable measurements when worn, and understanding the clinical value of sweat analytes toward biomarker discovery. This review provides a comprehensive review of wearable sweat sensors and outlines state-of-the-art technologies and research that strive to bridge these gaps. The physiology of sweat, materials, biosensing mechanisms and advances, and approaches for sweat induction and sampling are introduced. Additionally, design considerations for the system-level development of wearable sweat sensing devices, spanning from strategies for prolonged sweat extraction to efficient powering of wearables, are discussed. Furthermore, the applications, data analytics, commercialization efforts, challenges, and prospects of wearable sweat sensors for precision medicine are discussed.

Biocompatible and Long-Term Monitoring Strategies of Wearable, Ingestible and Implantable Biosensors: Reform the Next Generation Healthcare

Sensors enable the detection of physiological indicators and pathological markers to assist in the diagnosis, treatment, and long-term monitoring of diseases, in addition to playing an essential role in the observation and evaluation of physiological activities. The development of modern medical activities cannot be separated from the precise detection, reliable acquisition, and intelligent analysis of human body information. Therefore, sensors have become the core of new-generation health technologies along with the Internet of Things (IoTs) and artificial intelligence (AI). Previous research on the sensing of human information has conferred many superior properties on sensors, of which biocompatibility is one of the most important. Recently, biocompatible biosensors have developed rapidly to provide the possibility for the long-term and in-situ monitoring of physiological information. In this review, we summarize the ideal features and engineering realization strategies of three different types of biocompatible biosensors, including wearable, ingestible, and implantable sensors from the level of sensor designing and application. Additionally, the detection targets of the biosensors are further divided into vital life parameters (e.g., body temperature, heart rate, blood pressure, and respiratory rate), biochemical indicators, as well as physical and physiological parameters based on the clinical needs. In this review, starting from the emerging concept of next-generation diagnostics and healthcare technologies, we discuss how biocompatible sensors revolutionize the state-of-art healthcare system unprecedentedly, as well as the challenges and opportunities faced in the future development of biocompatible health sensors.

Cortisol Immunosensors: A Literature Review

Cortisol is a steroid hormone that is involved in a broad range of physiological processes in human/animal organisms. Cortisol levels in biological samples are a valuable biomarker, e.g., of stress and stress-related diseases; thus, cortisol determination in biological fluids, such as serum, saliva and urine, is of great clinical value. Although cortisol analysis can be performed with chromatography-based analytical techniques, such as liquid chromatography-tandem mass spectrometry (LC-MS/MS), conventional immunoassays (radioimmunoassays (RIAs), enzyme-linked immunosorbent assays (ELISAs), etc.) are considered the "gold standard" analytical methodology for cortisol, due to their high sensitivity along with a series of practical advantages, such as low-cost instrumentation, an assay protocol that is fast and easy to perform, and high sample throughput. Especially in recent decades, research efforts have focused on the replacement of conventional immunoassays by cortisol immunosensors, which may offer further improvements in the field, such as real-time analysis at the point of care (e.g., continuous cortisol monitoring in sweat through wearable electrochemical sensors). In this review, most of the reported cortisol immunosensors, mainly electrochemical and also optical ones, are presented, focusing on their immunosensing/detection principles. Future prospects are also briefly discussed.

Supersensitive detection of single-histamine molecule on nanoplates by turn-on small molecule fluorescence sandwich immunoassay

We develop a supersensitive "turn-on format" fluorescence sandwich immunoassay for detecting small single molecules. Gold nanoplate-based biotin antibodies and streptavidin-fluorophores were used instead of streptavidin-horseradish peroxidase reacting with a biotin tracer in a microplate-based competitive enzyme-linked immunosorbent assay (ELISA). Our platform showed a low detection limit of 5 zeptomolar (5 × 10^-21 M), 5.4 × 10¹⁰ times higher detection sensitivity than the conventional tune-off format ELISA.

Wearable and flexible electrochemical sensors for sweat analysis: a review

Flexible wearable sweat sensors allow continuous, real-time, noninvasive detection of sweat analytes, provide insight into human physiology at the molecular level, and have received significant attention for their promising applications in personalized health monitoring. Electrochemical sensors are the best choice for wearable sweat sensors due to their high performance, low cost, miniaturization, and wide applicability. Recent developments in soft microfluidics, multiplexed biosensing, energy harvesting devices, and materials have advanced the compatibility of wearable electrochemical sweat-sensing platforms. In this review, we summarize the potential of sweat for medical detection and methods for sweat stimulation and collection. This paper provides an overview of the components of wearable sweat sensors and recent developments in materials and power supply technologies and highlights some typical sensing platforms for different types of analytes. Finally, the paper ends with a discussion of the challenges and a view of the prospective development of this exciting field.

Design and Testing of Autonomous Chargeable and Wearable Sweat/Ionic Liquid-Based Supercapacitors

This work demonstrates ionic liquid electrolyte-inscribed sweat-based dual electrolyte functioning supercapacitors capable of self-charging through sweat electrolyte function under a non-enzymatic route. The supercapacitor electrodes are fabricated from TREN (tris(2-aminoethyl)amine), poly-3,4-ethylenedioxythiophene, and a graphene oxide mixture with copper-mediated chelate, and this polymer-GO-metal chelate film can produce excellent energy harvest/storage performance from a sweat and ionic liquid integrated electrolyte system. The fabricated device is specifically designed to reduce deterioration using a typical planar structure. In the presence of sweat with ionic liquid, the dual electrolyte mode supercapacitor exhibits a maximum areal capacitance of 3600 mF cm-2 , and the energy density is 450 mWhcm-2 , which is more than 100 times greater than that from previously reported supercapacitors. The supercapacitors were fabricated/attached directly to textile fabrics as well as ITO-PET (Indium tin oxide (ITO)-polyethylene terephthalate (PET) film to study their performance on the human body during exercise. The self-charging performance with respect to sweat wetting time for the sweat@ionic liquid dual electrolyte showed that the supercapacitor performed well on both fabric and film. These devices exhibited good response for pH effect and biocompatibility, and as such present a promising multi-functional energy system as a stable power source for next-generation wearable smart electronics.

Wearable biosensors for human fatigue diagnosis: A review

Fatigue causes deleterious effects to physical and mental health of human being and may cause loss of lives. Therefore, the adverse effects of fatigue on individuals and the society are massive. With the ever-increasing frequency of overtraining among modern military and sports personnel, timely, portable and accurate fatigue diagnosis is essential to avoid fatigue-induced accidents. However, traditional detection methods require complex sample preparation and blood sampling processes, which cannot meet the timeliness and portability of fatigue diagnosis. With the development of flexible materials and biosensing technology, wearable biosensors have attracted increased attention to the researchers. Wearable biosensors collect biomarkers from noninvasive biofluids, such as sweat, saliva, and tears, followed by biosensing with the help of biosensing modules continuously and quantitatively. The detection signal can then be transmitted through wireless communication modules that constitute a method for real-time understanding of abnormality. Recent developments of wearable biosensors are focused on miniaturized wearable electrochemistry and optical biosensors for metabolites detection, of which, few have exhibited satisfactory results in medical diagnosis. However, detection performance limits the wide-range applicability of wearable fatigue diagnosis. In this article, the application of wearable biosensors in fatigue diagnosis has been discussed. In fact, exploration of the composition of different biofluids and their potential toward fatigue diagnosis have been discussed here for the very first time. Moreover, discussions regarding the current bottlenecks in wearable fatigue biosensors and the latest advancements in biochemical reaction and data communication modules have been incorporated herein. Finally, the main challenges and opportunities were discussed for wearable fatigue diagnosis in the future.

Fetal programming of human energy homeostasis brain networks: Issues and considerations

In this paper, we present a transdisciplinary framework and testable hypotheses regarding the process of fetal programming of energy homeostasis brain circuitry. Our model proposes that key aspects of energy homeostasis brain circuitry already are functional by the time of birth (with substantial interindividual variation); that this phenotypic variation at birth is an important determinant of subsequent susceptibility for energy imbalance and childhood obesity risk; and that this brain circuitry exhibits developmental plasticity, in that it is influenced by conditions during intrauterine life, particularly maternal-placental-fetal endocrine, immune/inflammatory, and metabolic processes and their upstream determinants. We review evidence that supports the scientific premise for each element of this formulation, identify future research directions, particularly recent advances that may facilitate a better quantification of the ontogeny of energy homeostasis brain networks, highlight animal and in vitro-based approaches that may better address the determinants of interindividual variation in energy homeostasis brain networks, and discuss the implications of this formulation for the development of strategies targeted towards the primary prevention of childhood obesity.

Wearable electrochemical biosensors to measure biomarkers with complex blood-to-sweat partition such as proteins and hormones

Smart electronic devices based on micro-controllers, also referred to as fashion electronics, have raised wearable technology. These devices may process physiological information to facilitate the wearer's immediate biofeedback in close contact with the body surface. Standard market wearable devices detect observable features as gestures or skin conductivity. In contrast, the technology based on electrochemical biosensors requires a biomarker in close contact with both a biorecognition element and an electrode surface, where electron transfer phenomena occur. The noninvasiveness is pivotal for wearable technology; thus, one of the most common target tissues for real-time monitoring is the skin. Noninvasive biosensors formats may not be available for all analytes, such as several proteins and hormones, especially when devices are installed cutaneously to measure in the sweat. Processes like cutaneous transcytosis, the paracellular cell–cell unions, or even reuptake highly regulate the solutes content of the sweat. This review discusses recent advances on wearable devices based on electrochemical biosensors for biomarkers with a complex blood-to-sweat partition like proteins and some hormones, considering the commented release regulation mechanisms to the sweat. It highlights the challenges of wearable epidermal biosensors (WEBs) design and the possible solutions. Finally, it charts the path of future developments in the WEBs arena in converging/emerging digital technologies.

A machine learning-based on-demand sweat glucose reporting platform

Diabetes is a chronic endocrine disease that occurs due to an imbalance in glucose levels and altering carbohydrate metabolism. It is a leading cause of morbidity, resulting in a reduced quality of life even in developed societies, primarily affected by a sedentary lifestyle and often leading to mortality. Keeping track of blood glucose levels noninvasively has been made possible due to diverse breakthroughs in wearable sensor technology coupled with holistic digital healthcare. Efficient glucose management has been revolutionized by the development of continuous glucose monitoring sensors and wearable, non/minimally invasive devices that measure glucose concentration by exploiting different physical principles, e.g., glucose oxidase, fluorescence, or skin dielectric properties, and provide real-time measurements every 1-5 min. This paper presents a highly novel and completely non-invasive sweat sensor platform technology that can measure and report glucose concentrations from passively expressed human eccrine sweat using electrochemical impedance spectroscopy and affinity capture probe functionalized sensor surfaces. The sensor samples 1-5 µL of sweat from the wearer every 1-5 min and reports sweat glucose from a machine learning algorithm that samples the analytical reference values from the electrochemical sweat sensor. These values are then converted to continuous time-varying signals using the interpolation methodology. Supervised machine learning, the decision tree regression algorithm, shows the goodness of fit R² of 0.94 was achieved with an RMSE value of 0.1 mg/dL. The output of the model was tested on three human subject datasets. The results were able to capture the glucose progression trend correctly. Sweet sensor platform technology demonstrates a dynamic response over the physiological sweat glucose range of 1-4 mg/dL measured from 3 human subjects. The technology described in the manuscript shows promise for real-time biomarkers such as glucose reporting from passively expressed human eccrine sweat.

Recent advancement in noninvasive glucose monitoring and closed-loop management system for diabetes

Diabetes can cause many complications, which has become one of the most common diseases that may lead to death. Currently, the number of diabetics continues increasing year by year. Thus,...

Finger sweat analysis enables short interval metabolic biomonitoring in humans

Metabolic biomonitoring in humans is typically based on the sampling of blood, plasma or urine. Although established in the clinical routine, these sampling procedures are often associated with a variety of compliance issues, which are impeding time-course studies. Here, we show that the metabolic profiling of the minute amounts of sweat sampled from fingertips addresses this challenge. Sweat sampling from fingertips is non-invasive, robust and can be accomplished repeatedly by untrained personnel. The sweat matrix represents a rich source for metabolic phenotyping. We confirm the feasibility of short interval sampling of sweat from the fingertips in time-course studies involving the consumption of coffee or the ingestion of a caffeine capsule after a fasting interval, in which we successfully monitor all known caffeine metabolites as well as endogenous metabolic responses. Fluctuations in the rate of sweat production are accounted for by mathematical modelling to reveal individual rates of caffeine uptake, metabolism and clearance. To conclude, metabotyping using sweat from fingertips combined with mathematical network modelling shows promise for broad applications in precision medicine by enabling the assessment of dynamic metabolic patterns, which may overcome the limitations of purely compositional biomarkers.

The biology of stress in cancer: Applying the biobehavioral framework to adolescent and young adult oncology research

The stress response influences the development and trajectory of cancer through a host of complex neuroimmune mechanisms. Basic, translational, and clinical research has elucidated these biobehavioral connections and offers a new paradigm for scientific investigation and patient care. Using a biobehavioral approach could offer new diagnostic and therapeutic opportunities in oncology, and this approach will be particularly impactful for adolescent and young adult (AYA) patients with cancer. To date, nearly all biobehavioral oncology research has been done in the adult population. And yet, AYAs have traditionally poorer mental health and cancer-related outcomes, and thus represent a population that could benefit from parallel psychosocial and biomedical intervention. Future biobehavioral work in oncology should focus on the AYA population, integrating new cancer therapies and technology into the next generation of research.

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Translational research efforts are clarifying the role of stress in cancer biology and patient outcomes.

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AYAs have poorer cancer-related and mental health outcomes, but nearly all biobehavioral oncology studies are in adults.

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Future work in immunotherapy, digital health technology, and interdisciplinary cooperation will advance the field.

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A translational biobehavioral approach brings the paradigm of precision medicine to psychosocial care in cancer.

Label Free, Lateral Flow Prostaglandin E2 Electrochemical Immunosensor for Urinary Tract Infection Diagnosis

A label-free, rapid, and easy-to-use lateral flow electrochemical biosensor was developed for urinary tract infection (UTI) diagnosis in resource challenged areas. The sensor operates in non-faradaic mode and utilizes Electrochemical Impedance Spectroscopy for quantification of Prostaglandin E2, a diagnostic and prognostic urinary biomarker for UTI and recurrent UTI. To achieve high sensitivity in low microliter volumes of neat, unprocessed urine, nanoconfinement of assay biomolecules was achieved by developing a three-electrode planar gold microelectrode system on top of a lateral flow nanoporous membrane. The sensor is capable of giving readouts within 5 min and has a wide dynamic range of 100–4000 pg/mL for urinary PGE2. The sensor is capable of discriminating between low and high levels of PGE2 and hence is capable of threshold classification of urine samples as UTI positive and UTI negative. The sensor through its immunological response (directly related to host immune response) is superior to the commercially available point-of-care UTI dipsticks which are qualitative, have poor specificity for UTI, and have high false-positive rates. The developed sensor shows promise for rapid, easy and cost-effective UTI diagnosis for both clinical and home-based settings. More accurate point-of-care UTI diagnosis will improve patient outcomes and allow for timely and appropriate prescription of antibiotics which can subsequently increase treatment success rates and reduce costs.

Temporal profiling of cytokines in passively expressed sweat for detection of infection using wearable device

This work presents the viability of passive eccrine sweat as a functional biofluid toward tracking the human body's inflammatory response. Cytokines are biomarkers that orchestrate the manifestation and progression of an infection/inflammatory event. Hence, noninvasive, real-time monitoring of cytokines can be pivotal in assessing the progression of infection/inflammatory event, which may be feasible through monitoring of host immune markers in eccrine sweat. This work is the first experimental proof demonstrating the ability to detect inflammation/infection such as fever, FLU directly from passively expressed sweat in human subjects using a wearable "SWEATSENSER" device. The developed SWEATSENSER device demonstrates stable, real-time monitoring of inflammatory cytokines in passive sweat. An accuracy of >90% and specificity >95% was achieved using SWEATSENSER for a panel of cytokines (interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α) over an analytical range of 0.2-200 pg mL-1. The SWEATSENSER demonstrated a correlation of Pearson's r > 0.98 for the study biomarkers in a cohort of 26 subjects when correlated with standard reference method. Comparable IL-8 levels (2-15 pg mL-1) between systemic circulation (serum) and eccrine sweat through clinical studies in a cohort of 15 subjects, and the ability to distinguish healthy and sick (infection) cohort using inflammatory cytokines in sweat provides pioneering evidence of the SWEATSENSER technology for noninvasive tracking of host immune response biomarkers. Such a wearable device can offer significant strides in improving prognosis and provide personalized therapeutic treatment for several inflammatory/infectious diseases.

Tuning SLOCK toward Chronic Disease Diagnostics and Management: Label-free Sweat Interleukin-31 Detection

SLOCK (sensor for circadian clock) is an electrochemical sweat-based biosensing platform designed for the diagnosis and management of circadian abnormalities. Previously, the SLOCK platform was designed to detect adrenal steroids, cortisol, and DHEA for tracking the circadian rhythm. This work aims at tuning this SLOCK platform toward the detection of the cytokine, interleukin-31, for building a noninvasive, chronic disease diagnostics and management platform. This research provides a detailed characterization of the sensing surface and immunochemistry. The results show that SLOCK has good sensitivity to IL-31 concentrations in synthetic and human sweat. The limit of detection is 50 and 100 pg/mL for synthetic and human sweat, respectively. The dynamic range of the system is 50-1000 pg/mL, which encompasses the physiological ranges of 150-620 pg/mL. This is the first demonstration of sweat-based, label-free, electrochemical detection of IL-31. In addition to this, the data show good correlation (R 2 > 0.95) for the signal sensitivity to biomarker concentration. Finally, cross-reactivity studies highlight the specificity of SLOCK even in the presence of highly cross-reactive species. Thus, this novel SLOCK biosensor can be successfully used to track IL-31 in a sensitive and noninvasive manner and could be used to identify chronic pathophysiologies present in the body.

Longitudinal Zeolite-Iron Oxide Nanocomposite Deposited Capacitance Biosensor for Interleukin-3 in Sepsis Detection

Sepsis is an extreme condition involving a physical response to severe microbial infection and causes fatal and life-threatening issues. Sepsis generates during the chemicals release with the immune system into the bloodstream for fighting against an infection, which causes the inflammation and leads to the medical emergency. A complexed longitudinal zeolite and iron oxide nanocomposite was extracted from coal mine fly ash and utilized to improve the surface characteristics of the capacitance biosensor to identify sepsis attacks. Anti-interleukin-3 (anti-IL-3) antibody was attached to the zeolite- and iron oxide-complexed capacitance electrode surface through an amine linker to interact with the sepsis biomarker IL-3. The morphological and chemical components of the nanocomplex were investigated by FESEM, FETEM, and EDX analyses. At approximately 30 nm, the longitudinal zeolite and iron oxide nanocomposite aided in attaining the limit of IL-3 detection of 3 pg/mL on the linear curve, with a regression coefficient (R2) of 0.9673 [y = 1.638x - 1.1847]. A lower detection limit was achieved in the dose-dependent range (3-100 pg/mL) due to the higher amount of antibody immobilization on the sensing surface due to the nanomaterials and the improved surface current. Furthermore, control experiments with relevant biomolecules did not show capacitance changes, and spiked IL-3 in human serum increased capacitance, indicating the specific and selective detection of IL-3. This study identifies and quantifies IL-3 via potentially useful methods and helps in diagnosing sepsis attack.

Switching the solubility of electroactive ionic liquids for designing high energy supercapacitor and low potential biosensor

Ionic liquids are regarded as one of the most prodigious materials for sustainable technological developments with superior performance and versatility. Hence, in this study, we have reported the design and synthesis of electroactive disubstituted ferrocenyl ionic liquids (Fc-ILs) with two different counter anions and demonstrated the significance of their anion tuneable physicochemical characteristics towards multifunctional electrochemical applications. The Fc-IL synthesized with chloride counter anion (Fc-Cl-IL) displays water-solubility and can be used as a redox additive in the fabrication of supercapacitor. Supercapacitor device with Fc-Cl-IL based redox electrolyte exhibits outstanding energy and power densities of 91 Wh kg^-1 and 20.3 kW kg^-1, respectively. Meanwhile, ferrocenyl IL synthesized with perchlorate anion (Fc-ClO₄-IL) exhibits water-insolubility and can serve as a redox mediator towards construction of a glucose biosensor. The biosensor comprising Fc-ClO₄-IL is able to detect glucose at an exceptionally lower potential of 0.2 V, with remarkable sensitivity and selectivity. This study implies that the introduction of electroactive ILs could afford supercapacitor devices with high energy and power densities and biosensors with less detection potential.

CLEAR - Contact lens technologies of the future

Contact lenses in the future will likely have functions other than correction of refractive error. Lenses designed to control the development of myopia are already commercially available. Contact lenses as drug delivery devices and powered through advancements in nanotechnology will open up further opportunities for unique uses of contact lenses. This review examines the use, or potential use, of contact lenses aside from their role to correct refractive error. Contact lenses can be used to detect systemic and ocular surface diseases, treat and manage various ocular conditions and as devices that can correct presbyopia, control the development of myopia or be used for augmented vision. There is also discussion of new developments in contact lens packaging and storage cases. The use of contact lenses as devices to detect systemic disease has mostly focussed on detecting changes to glucose levels in tears for monitoring diabetic control. Glucose can be detected using changes in colour, fluorescence or generation of electric signals by embedded sensors such as boronic acid, concanavalin A or glucose oxidase. Contact lenses that have gained regulatory approval can measure changes in intraocular pressure to monitor glaucoma by measuring small changes in corneal shape. Challenges include integrating sensors into contact lenses and detecting the signals generated. Various techniques are used to optimise uptake and release of the drugs to the ocular surface to treat diseases such as dry eye, glaucoma, infection and allergy. Contact lenses that either mechanically or electronically change their shape are being investigated for the management of presbyopia. Contact lenses that slow the development of myopia are based upon incorporating concentric rings of plus power, peripheral optical zone(s) with add power or non-monotonic variations in power. Various forms of these lenses have shown a reduction in myopia in clinical trials and are available in various markets.

Demonstration of sweat-based circadian diagnostic capability of SLOCK using electrochemical detection modalities

SLOCK is a sweat-based circadian diagnostic platform used for mapping the user's chronobiology via cortisol and DHEA. In this work, we have demonstrated the detection capabilities of this sweat-based sensing platform using two electrochemical sensing modalities: Electrochemical Impedance Spectroscopy (EIS) and chronoamperometry. Wicking simulations for vertical versus horizontal flow patterns under potential bias were evaluated using COMSOL Multiphysics®. This work also highlights the biorecognition element characterization using Surface Plasmon Resonance (SPR) and FTIR. Sensor platform was evaluated for biomarker concentrations using doses spanning physiological ranges of 8-141 ng ml-1 and 2-131 ng ml-1 for cortisol and DHEA, respectively. Detailed analysis of impedance data is supported with electrochemical fitting of circuit components related to the biosensing process. Finally, human subject-based studies have been performed to understand the effect of sweating rate with respect to gland density on biosensing. Also, on-body mechanical resiliency studies have been performed to highlight the flexibility of this serpentine electrode-based sensing platform. The platform responds sensitively to the amount of circadian relevant biomarkers in the system with a limit of detection of 0.1 ng ml-1 for both cortisol and DHEA. Thus, the SLOCK platform offers to be an attractive vessel for facilitating the electrochemical detection of circadian relevant biomarkers and for self-monitoring of user's chronobiology.

Rapid and Selective Biomarker Detection with Conductometric Sensors

The biomarker detection in human body fluids is crucial as biomarkers are important in diagnosing diseases. Conventional invasive techniques for biomarker detection are associated with infection, tissue damage, and discomfort. Non-invasive devices are an attractive alternative. Here, metal oxide (oxygen-deficient zinc oxide, ZnO) based conductometric sensors with two-terminal electrodes for rapid detection of biomarkers in real-time, are presented. This platform can be engineered for non-invasive, sensitive, and on-demand selective detection of biomarkers based on surface functionalization. The three novelties in this biosensing technique include an on-demand target selection device platform, short (<10 min) incubation times, and real-time monitoring of the biomarker of interest by electrical (resistance change) measurements. Cardiac inflammatory biomarkers interleukin 6 (IL-6) and C-reactive protein (CRP) are used as the model antigens. The devices can detect 100× lower concentration of IL-6 than healthy levels in human saliva and sweat and 1000× and ≈50× lower CRP concentrations than healthy levels in human saliva and sweat, respectively. The devices show high selectivity for IL-6 and CRP antigens when tested with a mixture of biomarkers. This sensor platform can be extended to selective measurements for viruses or DNA screening, which enables a new category of compact and rapid point-of-care medical devices.

Short Ligand, Cysteine-Modified Warnericin RK Antimicrobial Peptides Favor Highly Sensitive Detection of Legionella pneumophila

Culture-based methods for the detection of Legionella pneumophila are prohibitively slow and frequently inadequate. The problem has been addressed with biosensing technology that employs a variety of ligands for the specific capture of bacteria. However, the limited success of the application of mammalian antibodies, aptamers, and nucleic acid-based probes for sensitive biosensing has generated growing interest in exploring alternative biosensing architectures, such as those based on antimicrobial peptides (AMP) that are known for their attractive therapeutic applications. We report on the successful employment of cysteine-modified warnericin RK AMP for the operation of a highly sensitive biosensor of L. pneumophila based on digital photocorrosion of GaAs/AlGaAs nanoheterostructures. The replacement of the relatively cumbersome procedure commonly applied for the attachment of antibodies to COOH-terminated mercaptohexadecanoic acid self-assembled monolayers has allowed for a significant reduction in the distance at which bacteria are immobilized above the biosensor surface. An important consequence of this approach is the attractive limit of detection of L. pneumophila estimated at 2 × 102 CFU/mL. The target bacteria were captured four times more efficiently than P. fluorescens, B. subtilis, and E. coli, which is highly promising for environmental monitoring.

A fluorescence sandwich immunoassay for the real-time continuous detection of glucose and insulin in live animals

Biosensors that continuously measure circulating biomolecules in real time could provide insights into the health status of patients and their response to therapeutics. But biosensors for the continuous real-time monitoring of analytes in vivo have only reached nanomolar sensitivity and can measure only a handful of molecules, such as glucose and blood oxygen. Here we show that multiple analytes can be continuously and simultaneously measured with picomolar sensitivity and sub-second resolution via the integration of aptamers and antibodies into a bead-based fluorescence sandwich immunoassay implemented in a custom microfluidic chip. After an incubation time of 30 s, bead fluorescence is measured using a high-speed camera under spatially multiplexed two-colour laser illumination. We used the assay for continuous quantification of glucose and insulin concentrations in the blood of live diabetic rats to resolve inter-animal differences in the pharmacokinetic response to insulin as well as discriminate pharmacokinetic profiles from different insulin formulations. The assay can be readily modified to continuously and simultaneously measure other blood analytes in vivo.

Electrochemical impedimetric biosensors, featuring the use of Room Temperature Ionic Liquids (RTILs): Special focus on non-faradaic sensing

Over the last decade, significant advancements have been made in the field of biosensing technology. With the rising demand for personalized healthcare and health management tools, electrochemical sensors are proving to be reliable solutions; specifically, impedimetric sensors are gaining considerable attention primarily due to their ability to perform label-free sensing. The novel approach of using Room Temperature Ionic Liquids (RTILs) to improve the sensitivity and stability of these detection systems makes long-term continuous sensing feasible towards a wide range of sensing applications, predominantly biosensing. Through this review, we aim to provide an update on current scientific progress in using impedimetric biosensing combined with RTILs for the development of sensitive biosensing platforms. This review also summarizes the latest trends in the field of biosensing and provides an update on the current challenges that remain unsolved.

Non-Invasive Electrochemical Biosensors Operating in Human Physiological Fluids

Non-invasive healthcare technologies are an important part of research and development nowadays due to the low cost and convenience offered to both healthcare receivers and providers. This work overviews the recent advances in the field of non-invasive electrochemical biosensors operating in secreted human physiological fluids, viz. tears, sweat, saliva, and urine. Described electrochemical devices are based on different electrochemical techniques, viz. amperometry, coulometry, cyclic voltammetry, and impedance spectroscopy. Challenges that confront researchers in this exciting area and key requirements for biodevices are discussed. It is concluded that the field of non-invasive sensing of biomarkers in bodily fluid is highly convoluted. Nonetheless, if the drawbacks are appropriately addressed, and the pitfalls are adroitly circumvented, the approach will most certainly disrupt current clinical and self-monitoring practices.

Point-of-use sweat biosensor to track the endocrine-inflammation relationship for chronic disease monitoring

AIM

The hypothalamic-pituitary-adrenal axis is involved in maintaining homeostasis by engaging with the parasympathetic nervous system. During the process of disease affliction, this relationship is disturbed and there is an imbalance driven response observed.

MATERIALS & METHODS

By monitoring the two key components involved in these pathways, cortisol and TNF-α, the manifestations of chronic stress on the body's homeostasis can be evaluated in a comprehensive manner. This work highlights the development of an electrochemical detection system for the two biomarkers through human sweat.

RESULTS

Limit of detection and dynamic ranges are 1 ng/ml, 1-200 ng/ml for cortisol and 1 pg/ml, 1-1000 pg/ml for TNF-α.

CONCLUSION

This wearable system is designed to be a point of use, chronic disease self-monitoring and management platform.

Recent Advances in Portable Biosensors for Biomarker Detection in Body Fluids

A recent development in portable biosensors allows rapid, accurate, and on-site detection of biomarkers, which helps to prevent disease spread by the control of sources. Less invasive sample collection is necessary to use portable biosensors in remote environments for accurate on-site diagnostics and testing. For non- or minimally invasive sampling, easily accessible body fluids, such as saliva, sweat, blood, or urine, have been utilized. It is also imperative to find accurate biomarkers to provide better clinical intervention and treatment at the onset of disease. At the same time, these reliable biomarkers can be utilized to monitor the progress of the disease. In this review, we summarize the most recent development of portable biosensors to detect various biomarkers accurately. In addition, we discuss ongoing issues and limitations of the existing systems and methods. Lastly, we present the key requirements of portable biosensors and discuss ideas for functional enhancements.

SLOCK (sensor for circadian clock): passive sweat-based chronobiology tracker

SLOCK is a human sweat based platform for circadian relevant biomarkers- cortisol and DHEA. It monitors passively expressed eccrine and apocrine sweat towards measuring and reporting cortisol and DHEA concentrations over multiple time points in humans. The sensor works on the principle of affinity based electrochemical detection. The novelty lies in the usage of a hybrid porosity platform for enhancing multibiomarker detection ability through sweat. The platform is the first demonstration of chronobiology tracking using multiple biomarkers supported by human subject based study. The sensor performance is evaluated on a set of six healthy human subjects, which are varied by age, gender, and ethnicity. Following this, the sensor performance is confirmed using ELISA, a commercially used diagnostic technique. From the results, it can be observed that the sensor is highly sensitive to the target biomarker concentrations in the physiological range of 8-141 ng ml^-1. The platform is also able to capture the biomarker rise and fall (i.e., going from a low concentration of 1 ng ml^-1 to a high concentration of 100 ng ml^-1 and back down to 10 ng ml^-1). This is reflected by a percentage change of cumulative sensor response by 10%, 20%, and 22%, respectively from baseline, for cortisol. Similarly for DHEA, the sensor shows sensitivity to rising and falling changes with percentage changes of 45%, 55%, and 56% for 1, 100, and 10 ng ml^-1 biomarker concentrations. This sensitivity is crucial in order to develop the circadian profile for the user. Thus, the sensor offers a first time demonstration of the potential of a passive self-monitoring approach for managing circadian abnormalities and is a good platform for tracking chronobiology.

Development of a flexible, sweat-based neuropeptide Y detection platform

Neuropeptide Y (NPY) biomarker levels have a close association with the diagnosis of Major Depression Disorder (MDD) and anxiety disorders. Quantifying NPY in correlation to self-reported symptoms will be an important measure to ensure a relatively uniform diagnosis and help with disease prognosis of these disorders. The work presented is a novel, passive eccrine sweat based, electrochemical detection platform for quantification of NPY biomarker levels. The paper offers a comparison between non-porous and porous sensor platforms using various electrochemical detection techniques. This work uses a novel strategy towards designing an optimal nanobioelectronic interface to measure NPY. The portability aspect of this detection platform is discussed by the demonstration a novel, portable EmStat Pico based electronic platform. The detection limit of the sensor is 10 pg mL⁻¹ and its range is 20–500 pg mL⁻¹. The NPY detection platform is envisioned to be a wearable point-of need monitoring system for management of chronic anxiety disorders and MDD.

Novel wearable NPY biomarker tracking system, envisioned to be a chronic anxiety and MDD management platform via self-monitoring.