Noninvasive wearable electroactive pharmaceutical monitoring for personalized therapeutics

Optical sensors for transdermal biomarker detection: A review

This review has explored optical sensors and their important role in non-invasive transdermal biomarker detection. While electrochemical sensors have been thoroughly studied for biomarker tracking, optical sensors present a compelling alternative due to their high sensitivity and selectivity, multiplex capabilities, cost-efficiency, and small form factor. This review examines the latest advancements in optical sensing technologies for transdermal biomarker detection, such as colorimetry, fluorescence, surface plasmon resonance (SPR), fiber optics, photonic crystals, and Raman spectroscopy. These technologies have been applied in the analysis of biomarkers present in sweat and skin gases, which are essential for non-invasive health monitoring. Furthermore, the review has discussed the challenges and future perspectives of optical sensors in in transdermal biomarker detection. The analysis of various sensor types and their applications highlights the transformative potential of optical sensors in enhancing disease diagnostics and promoting proactive health management.

Corn-inspired high-density plasmonic metal-organic frameworks microneedles for enhanced SERS detection of acetaminophen

Effective monitoring of acetaminophen (APAP) dosage is crucial for preventing antipyretic abuse, ensuring therapeutic efficacy, and minimizing toxic effects. However, existing self-monitoring methods are limited. In this study, we designed a plasmonic microneedle (MN) sensor for real-time nondestructive monitoring of acetaminophen levels in dermal interstitial fluid (ISF) by employing a handheld Raman spectrometer. The fabricated MN sensor incorporated a high-density plasmonic MOFs known as HDPM, which unique structure of large specific surface area, specific pore structure as well as high density gold nanospheres packing enabled the excellent performance of selective ISF drug enrichment and surface-enhanced Raman scattering (SERS). The maximum electric field enhancement factor of the HDPM nanostructure could be calculated as 5.73 × 107. The developed HDPM@MNs was characterized with a core-shell type "soft on the outside and rigid on the inside" structure, which exhibited sufficient hardness and flexibility to penetrate the dermal tissue with little damage, and robust SERS enhancement effect in APAP detection without any interfering peaks. Through a hydrogel drug simulation experiment, the sensor demonstrated robust capabilities for acetaminophen enrichment and monitoring, exhibiting excellent stability and repeatability. The quantitative detection window spanned from 1 to 100 μM, with a low detection limit reaching 0.45 μM. Furthermore, by monitoring the concentration of acetaminophen in the interstitial fluid of rat skin at different doses and for different administration times, the HDPM@MNs can be used to determine the pharmacokinetics of acetaminophen in rats and the physiological characteristics associated with various dosage regimens. This work not only holds promise for drug monitoring but also provides a novel approach for nondestructive monitoring of other crucial low-abundance physiological markers.

Pharmacokinetic Research in Pediatric Extracorporeal Therapies: Current State and Future Directions

Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), are life-saving therapies for critically ill children. Despite this, these modalities carry frustratingly high mortality rates. One driver of mortality may be altered drug disposition due to a combination of underlying illness, patient-circuit interactions, and drug-circuit interactions. Children receiving ECMO and/or CRRT routinely receive 20 or more drugs, and data supporting optimal dosing is lacking for most of these medications. The Pediatric Paracorporeal and Extracorporeal Therapies Summit (PPETS) gathered an international group of experts in the fields of ECMO, CRRT, and other ECLS modalities to discuss the current state of these therapies, disseminate innovative support strategies, share clinical experiences, and foster future collaborations. Here, we summarize the conclusions of PPETS and put forward a pathway to optimize pharmacokinetic (PK) research in this population. We must prioritize specific medications for in-depth study to improve drug use in ECLS and patient outcomes. Based on frequency of use, potential for adverse outcomes if dosed inappropriately, and lack of existing PK data, a list of high priority drugs was compiled for future research. Researchers must additionally reconsider study designs, emphasizing pooling of resources through multi-center studies and the use of innovative PK modeling techniques. Finally, the integration of validated PK models into clinical practice must be streamlined to deliver optimal medication use at the bedside. Focusing on the proposed list of highlighted medications and key methodological considerations will maximize the impact of future research.

Constructing a Hydrophilic Microsensor for High-Antifouling Neurotransmitter Dopamine Sensing

Real-time sensing of dopamine is essential for understanding its physiological function and clarifying the pathophysiological mechanism of diseases caused by impaired dopamine systems. However, severe fouling from nonspecific protein adsorption, for a long time, limited conventional neural recording electrodes concerning recording stability. This study reported a high-antifouling nanocrystalline boron-doped diamond microsensor grown on a carbon fiber substrate. The antifouling properties of this diamond sensor were strongly related to the grain size (i.e., nanocrystalline and microcrystalline) and surface terminations (i.e., oxygen and hydrogen terminals). Experimental observations and molecular dynamics calculations demonstrated that the oxygen-terminated nanocrystalline boron-doped diamond microsensor exhibited enhanced antifouling characteristics against protein adsorption, which was attributed to the formation of a strong hydration layer as a physical and energetic barrier that prevents protein adsorption on the surface. This finally allowed for in vivo monitoring of dopamine in rat brains upon potassium chloride stimulation, thus presenting a potential solution for the design of next-generation antifouling neural recording sensors. Experimental observations and molecular dynamics calculations demonstrated that the oxygen-terminated nanocrystalline boron-doped diamond (O-NCBDD) microsensor exhibited ultrahydrophilic properties with a contact angle of 4.9°, which was prone to forming a strong hydration layer as a physical and energetic barrier to withstand the adsorption of proteins. The proposed O-NCBDD microsensor exhibited a high detection sensitivity of 5.14 μA μM-1 cm-2 and a low detection limit of 25.7 nM. This finally allowed for in vivo monitoring of dopamine with an average concentration of 1.3 μM in rat brains upon 2 μL of potassium chloride stimulation, thus presenting a potential solution for the design of next-generation antifouling neural recording sensors.

A Review on Recent Trends and Future Developments in Electrochemical Sensing

Electrochemical methods and devices have ignited prodigious interest for sensing and monitoring. The greatest challenge for science is far from meeting the expectations of consumers. Electrodes made of two-dimensional (2D) materials such as graphene, metal-organic frameworks, MXene, and transition metal dichalcogenides as well as alternative electrochemical sensing methods offer potential to improve selectivity, sensitivity, detection limit, and response time. Moreover, these advancements have accelerated the development of wearable and point-of-care electrochemical sensors, opening new possibilities and pathways for their applications. This Review presents a critical discussion of the recent developments and trends in electrochemical sensing.

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.

The Effect of Polymerization Techniques on the Creation of Molecularly Imprinted Polymer Sensors and Their Application on Pharmaceutical Compounds

Molecularly imprinted polymers (MIPs) have become more prevalent in fabricating sensor applications, particularly in medicine, pharmaceuticals, food quality monitoring, and the environment. The ease of their preparation, adaptability of templates, superior affinity and specificity, improved stability, and the possibility for downsizing are only a few benefits of these sensors. Moreover, from a medical perspective, monitoring therapeutic medications and determining pharmaceutical compounds in their pharmaceutical forms and biological systems is very important. Additionally, because medications are hazardous to the environment, effective, quick, and affordable determination in the surrounding environment is of major importance. Concerning a variety of performance criteria, including sensitivity, specificity, low detection limits, and affordability, MIP sensors outperform other published technologies for analyzing pharmaceutical drugs. MIP sensors have, therefore, been widely used as one of the most crucial techniques for analyzing pharmaceuticals. The first part of this review provides a detailed explanation of the many polymerization techniques that were employed to create high-performing MIP sensors. In the subsequent section of the review, the utilization of MIP-based sensors for quantifying the drugs in their pharmaceutical preparation, biological specimens, and environmental samples are covered in depth. Finally, a critical evaluation of the potential future research paths for MIP-based sensors clarifies the use of MIP in pharmaceutical fields.

Nanomaterial-based Electrochemical Sensors for Multiplex Medicinal Applications

This review explores the advancements in nanomaterial-based electrochemical sensors for the multiplex detection of medicinal compounds. The growing demand for efficient and selective detection methods in the pharmaceutical field has prompted significant research into the development of electrochemical sensors employing nanomaterials. These materials, defined as functional materials with at least one dimension between 1 and 100 nanometers, encompass metal nanoparticles, polymers, carbon-based nanocomposites, and nano-bioprobes. These sensors are characterized by their enhanced sensitivity and selectivity, playing a crucial role in simultaneous detection and offering a comprehensive analysis of multiple medicinal complexes within a single sample. The review comprehensively examines the design, fabrication, and application of nanomaterial- based electrochemical sensors, focusing on their ability to achieve multiplex detection of various medicinal substances. Insights into the strategies and nanomaterials employed for enhancing sensor performance are discussed. Additionally, the review explores the challenges and future perspectives of this evolving field, highlighting the potential impact of nanomaterial-based electrochemical sensors on the advancement of medicinal detection technologies.

3D Printing of Dietary Products for the Management of Inborn Errors of Intermediary Metabolism in Pediatric Populations

The incidence of Inborn Error of Intermediary Metabolism (IEiM) diseases may be low, yet collectively, they impact approximately 6-10% of the global population, primarily affecting children. Precise treatment doses and strict adherence to prescribed diet and pharmacological treatment regimens are imperative to avert metabolic disturbances in patients. However, the existing dietary and pharmacological products suffer from poor palatability, posing challenges to patient adherence. Furthermore, frequent dose adjustments contingent on age and drug blood levels further complicate treatment. Semi-solid extrusion (SSE) 3D printing technology is currently under assessment as a pioneering method for crafting customized chewable dosage forms, surmounting the primary limitations prevalent in present therapies. This method offers a spectrum of advantages, including the flexibility to tailor patient-specific doses, excipients, and organoleptic properties. These elements are pivotal in ensuring the treatment's efficacy, safety, and adherence. This comprehensive review presents the current landscape of available dietary products, diagnostic methods, therapeutic monitoring, and the latest advancements in SSE technology. It highlights the rationale underpinning their adoption while addressing regulatory aspects imperative for their seamless integration into clinical practice.

Recent Advances in Skin-Interfaced Wearable Sweat Sensors: Opportunities for Equitable Personalized Medicine and Global Health Diagnostics

Recent advances in skin-interfaced wearable sweat sensors enable the noninvasive, real-time monitoring of biochemical signals associated with health and wellness. These wearable platforms leverage microfluidic channels, biochemical sensors, and flexible electronics to enable the continuous analysis of sweat-based biomarkers such as electrolytes, metabolites, and hormones. As this field continues to mature, the potential of low-cost, continuous personalized health monitoring enabled by such wearable sensors holds significant promise for addressing some of the formidable obstacles to delivering comprehensive medical care in under-resourced settings. This Perspective highlights the transformative potential of wearable sweat sensing for providing equitable access to cutting-edge healthcare diagnostics, especially in remote or geographically isolated areas. It examines the current understanding of sweat composition as well as recent innovations in microfluidic device architectures and sensing strategies by showcasing emerging applications and opportunities for innovation. It concludes with a discussion on expanding the utility of wearable sweat sensors for clinically relevant health applications and opportunities for enabling equitable access to innovation to address existing health disparities.

A mixed electronic-ionic conductor-based bifunctional sensing layer beyond ionophores for sweat electrolyte monitoring

Noninvasive and continuous monitoring of electrolytes in biofluids based on wearable biotechnology provides extensive health-related physiological information. The state-of-the-art wearable bioelectronic ion sensors depend on the organic ionophore-based solid-contact structure of potentiometric ion-selective electrodes. This structure contains two functional sensing layers, i.e., a solid contact (ion-to-electron signal transduction) and an ionophore-containing ion-selective membrane (ISM, ion recognition). However, the potential drift, biotoxicity, and expensive organic ionophores complicate practical wearable applications. These challenges intrinsically originate from the ISM. Herein, an ISM-free wearable ion sensor based on mixed electronic-ionic conductors of tungsten bronzes is reported. These materials can serve as a bifunctional sensing layer for simultaneous ion-to-electron transduction through the redox reaction of W6+/5+ and ion recognition through crystal ion exchange. The K- and Na-adjusted WO3 disclosed Nernstian responses toward NH4+ and H+, respectively. The selectivity is comparable to or even better than organic ionophores, such as ammonia ionophore of nonactin. Further, the on-body monitoring of sweat ammonia and pH was realized using an integrated ISM-free flexible sensor. Therefore, this work offers an ISM-free concept and emphasizes the importance of developing next-generation ISM-free wearable bioelectronic ion sensors.

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.

Direct Laser Writing of the Porous Graphene Foam for Multiplexed Electrochemical Sweat Sensors

Wearable electrochemical sensors provide means to detect molecular-level information from the biochemical markers in biofluids for physiological health evaluation. However, a high-density array is often required for multiplexed detection of multiple markers in complex biofluids, which is challenging with low-cost fabrication methods. This work reports the low-cost direct laser writing of porous graphene foam as a flexible electrochemical sensor to detect biomarkers and electrolytes in sweat. The resulting electrochemical sensor exhibits high sensitivity and low limit of detection for various biomarkers (e.g., the sensitivity of 6.49/6.87/0.94/0.16 μA μM^-1 cm^-2 and detection limit of 0.28/0.26/1.43/11.3 μM to uric acid/dopamine/tyrosine/ascorbic acid) in sweat. The results from this work open up opportunities for noninvasive continuous monitoring of gout, hydration status, and drug intake/overdose.

Flexible, stretchable, and single-molecule-sensitive SERS-active sensor for wearable biosensing applications

The development of wearable sensors for remote patient monitoring and personalized medicine has led to a revolution in biomedical technology. Plasmonic metasurfaces that enhance Raman scattering signals have recently gained attention as wearable sensors. However, finding a flexible, sensitive, and easy-to-fabricate metasurface has been a challenge for decades. In this paper, a novel wearable device, the flexible, stretchable, and single-molecule-sensetive SERS-active sensor, is proposed. This device offers an unprecedented SERS enhancement factor in the order of 1011, along with other long-desired characteristics for SERS applications such as a high scattering to absorption ratio (∼2.5) and a large hotspot volume (40 nm × 40 nm × 5 nm). To achieve flexibility, we use polydimethylsiloxane (PDMS) as the substrate, which is stable, transparent, and biologically compatible. Our numerical calculations show that the proposed sensor offers reliable SERS performance even under bending (up to 100° angles) or stretching (up to 50% stretch). The easy-to-fabricate and flexible nature of our sensor offers a promising avenue for developing highly sensitive wearable sensors for a range of applications, particularly in the field of personalized medicine and remote patient monitoring.

A Connected World: System-Level Support Through Biosensors

The goal of protecting the health of future generations is a blueprint for future biosensor design. Systems-level decision support requires that biosensors provide meaningful service to society. In this review, we summarize recent developments in cyber physical systems and biosensors connected with decision support. We identify key processes and practices that may guide the establishment of connections between user needs and biosensor engineering using an informatics approach. We call for data science and decision science to be formally connected with sensor science for understanding system complexity and realizing the ambition of biosensors-as-a-service. This review calls for a focus on quality of service early in the design process as a means to improve the meaningful value of a given biosensor. We close by noting that technology development, including biosensors and decision support systems, is a cautionary tale. The economics of scale govern the success, or failure, of any biosensor system.

A strategy for low-cost portable monitoring of plasma drug concentrations using a sustainable boron-doped-diamond chip

On-site monitoring of plasma drug concentrations is required for effective therapies. Recently developed handy biosensors are not yet popular owing to insufficient evaluation of accuracy on clinical samples and the necessity of complicated costly fabrication processes. Here, we approached these bottlenecks via a strategy involving engineeringly unmodified boron-doped diamond (BDD), a sustainable electrochemical material. A sensing system based on a ∼1 cm² BDD chip, when analysing rat plasma spiked with a molecular-targeting anticancer drug, pazopanib, detected clinically relevant concentrations. The response was stable in 60 sequential measurements on the same chip. In a clinical study, data obtained with a BDD chip were consistent with liquid chromatography-mass spectrometry results. Finally, the portable system with a palm-sized sensor containing the chip analysed ∼40 μL of whole blood from dosed rats within ∼10 min. This approach with the 'reusable' sensor may improve point-of-monitoring systems and personalised medicine while reducing medical costs.

Wireless, noninvasive therapeutic drug monitoring system for saliva measurement toward medication management of schizophrenia

As an efficient patient management tool of precision medicine, decentralized therapeutic drug monitoring (TDM) provides new vision for therapy adherence and health management of schizophrenia in a convenient manner. To dispense with psychologically burdensome blood sampling and to achieve real-time, noninvasive, and continual circulating tracking of drugs with narrow therapeutic window, we study the temporal metabolism of clozapine, an antipsychotic with severe side effect, in rat saliva by a wireless, integrated and patient-friendly smart lollipop sensing system. Highly sensitive and efficient sensing performance with acceptable anti-biofouling property was realized based on the synergistic effect of electrodeposited reduced graphene oxide and ionic liquids in pretreatment-free saliva with low detection limit and good accuracy cross-validated with conventional method. On this basis, continual salivary drug levels with distinctive pharmacokinetics were found in different routes of drug administration. Pilot experiment reveals a strong correlation between blood and saliva clozapine and a positive relationship between drug dosage and salivary drug level, indicating potential applications presented by noninvasive saliva analysis towards patient-centered and personalized pharmacotherapy and adherence management via proposed smart lollipop system.

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.

Wearable Plasmonic Sweat Biosensor for Acetaminophen Drug Monitoring

Monitoring the acetaminophen dosage is important to prevent the occurrence of adverse reactions such as liver failure and kidney damage. Traditional approaches to monitoring acetaminophen dosage mainly rely on invasive blood collection. Herein, we developed a noninvasive microfluidic-based wearable plasmonic sensor to achieve simultaneous sweat sampling and acetaminophen drug monitoring for vital signs. The fabricated sensor employs an Au nanosphere cone array as the key sensing component, which poses a substrate with surface-enhanced Raman scattering (SERS) activity to noninvasively and sensitively detect the fingerprint of acetaminophen molecules based on its unique SERS spectrum. The developed sensor enabled the sensitive detection and quantification of acetaminophen at concentrations as low as 0.13 μM. We further evaluated the sweat sensor integrated with a Raman spectrometer for monitoring acetaminophen in drug-administered subjects. These results indicated that the sweat sensor could measure acetaminophen levels and reflect drug metabolism. The sweat sensors have revolutionized wearable sensing technology by adopting label-free and sensitive molecular tracking methods for noninvasive and point-of-care drug monitoring and management.

On-Site Therapeutic Drug Monitoring of Paracetamol Analgesic in Non-Invasively Collected Saliva for Personalized Medicine

Paracetamol or acetaminophen is the main non-opioid analgesic recommended for mild pain by the World Health Organization (WHO) analgesic ladder. However, the high levels used of paracetamol are associated with the hepatotoxicity and nephrotoxicity caused by accumulation of toxic metabolites. The sensor is produced on a polyester substrate containing a full electrochemical device with working, auxiliary, and reference electrodes in which, guiding personalized medicine solutions are not reported. Temporal paracetamol profiles in human saliva are performed with the subject taking different amounts of commercial analgesic pills. The variation of saliva paracetamol levels is demonstrated to be interference free from electroactive interfering species and human saliva constituents. In addition, the sensor displays to be useful as a disposable device for the fast detection of paracetamol in untreated raw saliva following pill intake. The maximum concentration (C_max ) and half-life time (t_1/2 ) for paracetamol are 143.27 µm and 110 min. The results demonstrate the potential of a simple strategy with electrochemical devices for noninvasive personalized therapy toward guiding drug interventions through tracking of active substance, detecting, and correcting insufficiency of absorption to meet individual needs avoiding overdoses, side effects, and intoxication.

Flexible Sweat Sensors: From Films to Textiles

Flexible sweat sensors have found widespread potential applications for long-term wear and tracking and real-time monitoring of human health. However, the main substrate currently used in common flexible sweat sensors is thin film, which has disadvantages such as poor air permeability and the need for additional wearables. In this Review, the recent progress of sweat sensors has been systematically summarized by the types of monitoring methods of sweat sensors. In addition, this Review introduces and compares the performance of sweat sensors based on thin film and textile substrates such as fiber/yarn. Finally, opportunities and suggestions for the development of flexible sweat sensors are presented by summarizing the integration methods of sensors and human body monitoring sites.

Wearable chemical sensors for biomarker discovery in the omics era

Biomarkers are crucial biological indicators in medical diagnostics and therapy. However, the process of biomarker discovery and validation is hindered by a lack of standardized protocols for analytical studies, storage and sample collection. Wearable chemical sensors provide a real-time, non-invasive alternative to typical laboratory blood analysis, and are an effective tool for exploring novel biomarkers in alternative body fluids, such as sweat, saliva, tears and interstitial fluid. These devices may enable remote at-home personalized health monitoring and substantially reduce the healthcare costs. This Review introduces criteria, strategies and technologies involved in biomarker discovery using wearable chemical sensors. Electrochemical and optical detection techniques are discussed, along with the materials and system-level considerations for wearable chemical sensors. Lastly, this Review describes how the large sets of temporal data collected by wearable sensors, coupled with modern data analysis approaches, would open the door for discovering new biomarkers towards precision medicine.

Autonomous wearable sweat rate monitoring based on digitized microbubble detection

Advancements in wearable bioanalytical microsystems have enabled diurnal and (semi)continuous monitoring of physiologically-relevant indices that are accessible through probing sweat. To deliver an undistorted and physiologically-meaningful interpretation of these readings, tracking the sweat secretion rate is essential, because it allows for calibrating the biomarker readings against variations in sweat secretion and inferring the body's hydration/electrolyte homeostasis status. To realize an autonomous wearable solution with intrinsically high signal-to-noise ratio sweat rate sensing capabilities, here, we devise a digitized microbubble detection mechanism-delivered by a hybrid microfluidic/electronic system with a compact footprint. This mechanism is based on the intermittent generation of microliter-scale bubbles via electrolysis and the instantaneous measurement of their time-of-flight (and thus, velocity) via impedimetric sensing. In this way, we overcome the limitations of previously proposed sweat rate sensing modalities that are inherently susceptible to non-targeted secretion characteristics (pH, conductivity, and temperature), constrained by volume, or lack system integration for autonomous on-body operation. By deploying our solution in human subject trials, we validate the utility of our solution for seamless monitoring of exercise- and iontophoretically-induced sweat secretion profiles.

A Bifunctional Fully Integrated Wearable Tracker for Epidermal Sweat and Wound Exudate Multiple Biomarkers Monitoring

Fully integrated wearable electronics that combine the extraordinary feature of incessant and on-body operation with the distinctive external equipment-free trait are the ultimate goal of modern wearables. Epidermal sweat and wound exudate, as two noninvasively accessible biofluids on/surrounding the skin, reflect underlying health conditions. However, the design of universal wearable sensors with the bifunctional capability to monitor both epidermal secretions is still a challenge. Here, a single bifunctional fully integrated wearable tracker for wirelessly, simultaneously, and dynamically in situ measuring multiple epidermal sweat or wound exudate biomarkers is propos. Considering the electrolytes (e.g., Na⁺ , K⁺ , and H⁺ ) and metabolites (e.g., uric acid (UA)) levels in sweat or wound exudate may correlate with health or wound conditions, the dynamic and skin-on tracking of the biomarkers of Na⁺ , K⁺ , pH, and UA levels in sweat under subjects' exercise and in wound exudate during subjects' wound healing are performed through the seamless integration of microfluidic, sensing, and electronic modules. Its applicability is evaluated for noninvasive hyperuricemia management in hyperuricemia/healthy subjects through a purine-rich intake test and for wound management in subjects' infected wounds through a control medical treatment.

Wearable microneedle-based electrochemical aptamer biosensing for precision dosing of drugs with narrow therapeutic windows

Therapeutic drug monitoring is essential for dosing pharmaceuticals with narrow therapeutic windows. Nevertheless, standard methods are imprecise and involve invasive/resource-intensive procedures with long turnaround times. Overcoming these limitations, we present a microneedle-based electrochemical aptamer biosensing patch (μNEAB-patch) that minimally invasively probes the interstitial fluid (ISF) and renders correlated, continuous, and real-time measurements of the circulating drugs' pharmacokinetics. The μNEAB-patch is created following an introduced low-cost fabrication scheme, which transforms a shortened clinical-grade needle into a high-quality gold nanoparticle-based substrate for robust aptamer immobilization and efficient electrochemical signal retrieval. This enables the reliable in vivo detection of a wide library of ISF analytes-especially those with nonexistent natural recognition elements. Accordingly, we developed μNEABs targeting various drugs, including antibiotics with narrow therapeutic windows (tobramycin and vancomycin). Through in vivo animal studies, we demonstrated the strong correlation between the ISF/circulating drug levels and the device's potential clinical use for timely prediction of total drug exposure.

Silk-Based Electrochemical Sensor for the Detection of Glucose in Sweat

The development of reliable glucose sensors for noninvasive monitoring is highly desirable and essential for diabetes detection. As a testing sample, sweat is voluminous and is easy to collect compared to blood. However, the application of sweat glucose sensors is generally limited because of their low stability and sensitivity compared to commercial glucometers. In this manuscript, a silk nanofibril (SNF)/reduced graphene oxide (RGO)/glucose oxidase (GOx) composite was developed as the working electrode of the sweat glucose sensor. The SNF/RGO/GOx composite was prepared via a facile two-step process, which involved the self-assembly of SNF from silk fibroin while reducing graphene oxide to RGO and immobilizing GOx on SNF. The SNF/RGO/GOx glucose sensor exhibited a low limit of detection (300 nM) and high sensitivity (18.0 μA/mM) in the sweat glucose range, covering both healthy people and diabetic patients (0-100 μM). Moreover, the SNF/RGO/GOx glucose sensors showed a long stability for at least 4 weeks. Finally, the SNF/RGO/GOx glucose sensor was applied to test the actual sweat samples from two volunteers and two sweating methods (by dry sauna and exercise). The results indicate the glucose data tested by the SNF/RGO/GOx glucose sensor were reliable, which correlated well to the data obtained from the commercial glucometer. Therefore, the SNF/RGO/GOx glucose sensor developed in this study may have a great potential for glucose control in personalized healthcare monitoring and chronic disease management.

Integrated Aptasensor Array for Sweat Drug Analysis

Drug abuse is seriously endangering human health and jeopardizing society. There is an urgent need for rapid, sensitive, portable, and easy-to-operate methods for the daily detection of drugs in biological matrices. However, current drug detection methods based on chromatography, spectroscopy, immunosorbent assays, etc. are limited by the requirements of high logistical instruments and laboratory. Herein, we proposed a wearable electrochemical aptasensor with high sensitivity and specificity for the direct capture and rapid detection of multiple drugs in sweat. The single aptamer and dual aptamers with different base compositions were designed to compose the aptasensor array. Molecular docking simulations demonstrated different binding affinities between bioamines and aptamers. The developed aptasensor array is shown to be sufficient to generate distinct electrochemical fingerprints for different psychoactive drugs and interfering substances by extracting variable features from electrochemical signals. Sixteen analytes in the same concentration or gradient concentrations were identified with 100% accuracy. In addition, the wearable sensor platform was demonstrated to discriminate various drugs with similar chemical structures in artificial sweat and human sweat samples. The sensor array not only provided a new rapid method for the detection of drugs but also served as a reference for developing wearable sensors for onsite and daily testing of human biochemical information.

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.

A touch-based multimodal and cryptographic bio-human-machine interface

The awareness of the individuals’ biological status is critical for creating interactive environments. Accordingly, we devised a multimodal cryptographic bio-human–machine interface (CB-HMI), which seamlessly translates touch-based entries into encrypted biochemical, biophysical, and biometric indices (i.e., circulating biomarkers levels, heart rate, oxygen saturation level, and fingerprint pattern). As its central component, the CB-HMI features thin hydrogel-coated chemical sensors and a signal interpretation framework to access/interpret biochemical indices, bypassing the challenge of circulating analyte accessibility and the confounding effect of pressing force variability. Upgrading the surrounding objects with CB-HMI, we demonstrated new interactive solutions for driving safety and medication use, where the integrated CB-HMI uniquely enabled one-touch bioauthentication (based on the user’s biological state/identity), prior to rendering the intended services.

The awareness of individuals’ biological status is critical for creating interactive and adaptive environments that can actively assist the users to achieve optimal outcomes. Accordingly, specialized human–machine interfaces—equipped with bioperception and interpretation capabilities—are required. To this end, we devised a multimodal cryptographic bio-human–machine interface (CB-HMI), which seamlessly translates the user’s touch-based entries into encrypted biochemical, biophysical, and biometric indices. As its central component, the CB-HMI features thin hydrogel-coated chemical sensors and inference algorithms to noninvasively and inconspicuously acquire biochemical indices such as circulating molecules that partition onto the skin (here, ethanol and acetaminophen). Additionally, the CB-HMI hosts physical sensors and associated algorithms to simultaneously acquire the user’s heart rate, blood oxygen level, and fingerprint minutiae pattern. Supported by human subject studies, we demonstrated the CB-HMI’s capability in terms of acquiring physiologically relevant readouts of target bioindices, as well as user-identifying and biometrically encrypting/decrypting these indices in situ (leveraging the fingerprint feature). By upgrading the common surrounding objects with the CB-HMI, we created interactive solutions for driving safety and medication use. Specifically, we demonstrated a vehicle-activation system and a medication-dispensing system, where the integrated CB-HMI uniquely enabled user bioauthentication (on the basis of the user’s biological state and identity) prior to rendering the intended services. Harnessing the levels of bioperception achieved by the CB-HMI and other intelligent HMIs, we can equip our surroundings with a comprehensive and deep awareness of individuals’ psychophysiological state and needs.

In Situ Nanocoating on Porous Pyrolyzed Paper Enables Antibiofouling and Sensitive Electrochemical Analyses in Biological Fluids

Electrochemical detection in complex biofluids is a long-standing challenge as electrode biofouling hampers its sensing performance and commercial translation. To overcome this drawback, pyrolyzed paper as porous electrode coupled with the drop casting of an off-the-shelf polysorbate, that is, Tween 20 (T20), is described here by taking advantage of the in situ formation of a hydrophilic nanocoating (2 nm layer of T20). The latter prevents biofouling while providing the capillarity of samples through paper pores, leveraging redox reactions across both only partially fouled and fresh electrodic surfaces with increasing detection areas. The nanometric thickness of this blocking layer is also essential by not significantly impairing the electron-transfer kinetics. These phenomena behave synergistically to enhance the sensibility that further increases over long-term exposures (4 h) in biological fluids. While the state-of-the-art antibiofouling strategies compromise the sensibility, this approach leads to peak currents that are up to 12.5-fold higher than the original currents after 1 h exposure to unprocessed human plasma. Label-free impedimetric immunoassays through modular bioconjugation by directly anchoring spike protein on gold nanoparticles are also allowed, as demonstrated for the COVID-19 screening of patient sera. The scalability and simplicity of the platform combined with its unique ability to operate in biofluids with enhanced sensibility provide the generation of promising biosensing technologies toward real-world applications in point-of-care diagnostics, mass testing, and in-home monitoring of chronic diseases.

Wearable aptamer-field-effect transistor sensing system for noninvasive cortisol monitoring

Wearable technologies for personalized monitoring require sensors that track biomarkers often present at low levels. Cortisol—a key stress biomarker—is present in sweat at low nanomolar concentrations. Previous wearable sensing systems are limited to analytes in the micromolar-millimolar ranges. To overcome this and other limitations, we developed a flexible field-effect transistor (FET) biosensor array that exploits a previously unreported cortisol aptamer coupled to nanometer-thin-film In₂O₃ FETs. Cortisol levels were determined via molecular recognition by aptamers where binding was transduced to electrical signals on FETs. The physiological relevance of cortisol as a stress biomarker was demonstrated by tracking salivary cortisol levels in participants in a Trier Social Stress Test and establishing correlations between cortisol in diurnal saliva and sweat samples. These correlations motivated the development and on-body validation of an aptamer-FET array–based smartwatch equipped with a custom, multichannel, self-referencing, and autonomous source measurement unit enabling seamless, real-time cortisol sweat sensing.

Biosensor-Enabled Multiplexed On-Site Therapeutic Drug Monitoring of Antibiotics

Personalized antibiotherapy ensures that the antibiotic concentration remains in the optimal therapeutic window to maximize efficacy, minimize side effects, and avoid the emergence of drug resistance due to insufficient dosing. However, such individualized schemes need frequent sampling to tailor the blood antibiotic concentrations. To optimally integrate therapeutic drug monitoring (TDM) into the clinical workflow, antibiotic levels can either be measured in blood using point-of-care testing (POCT), or can rely on noninvasive sampling. Here, a versatile biosensor with an antibody-free assay for on-site TDM is presented. The platform is evaluated with an animal study, where antibiotic concentrations are quantified in different matrices including whole blood, plasma, urine, saliva, and exhaled breath condensate (EBC). The clearance and the temporal evaluation of antibiotic levels in EBC and plasma are demonstrated. Influence of matrix effects on measured drug concentrations is determined by comparing the plasma levels with those in noninvasive samples. The system's potential for blood-based POCT is further illustrated by tracking ß-lactam concentrations in untreated blood samples. Finally, multiplexing capabilities are explored successfully for multianalyte/sample analysis. By enabling a rapid, low-cost, sample-independent, and multiplexed on-site TDM, this system can shift the paradigm of "one-size-fits-all" strategy.

State of Sweat: Emerging Wearable Systems for Real-Time, Noninvasive Sweat Sensing and Analytics

Skin-interfaced wearable systems with integrated colorimetric assays, microfluidic channels, and electrochemical sensors offer powerful capabilities for noninvasive, real-time sweat analysis. This Perspective details recent progress in the development and translation of novel wearable sensors for personalized assessment of sweat dynamics and biomarkers, with precise sampling and real-time analysis. Sensor accuracy, system ruggedness, and large-scale deployment in remote environments represent key opportunity areas, enabling broad deployment in the context of field studies, clinical trials, and recent commercialization. On-body measurements in these contexts show good agreement compared to conventional laboratory-based sweat analysis approaches. These device demonstrations highlight the utility of biochemical sensing platforms for personalized assessment of performance, wellness, and health across a broad range of applications.

A Design Strategy for Intrinsically Stretchable High-Performance Polymer Semiconductors: Incorporating Conjugated Rigid Fused-Rings with Bulky Side Groups

Strategies to improve stretchability of polymer semiconductors, such as introducing flexible conjugation-breakers or adding flexible blocks, usually result in degraded electrical properties. In this work, we propose a concept to address this limitation, by introducing conjugated rigid fused-rings with optimized bulky side groups and maintaining a conjugated polymer backbone. Specifically, we investigated two classes of rigid fused-ring systems, namely, benzene-substituted dibenzothiopheno[6,5-b:6',5'-f]thieno[3,2-b]thiophene (Ph-DBTTT) and indacenodithiophene (IDT) systems, and identified molecules displaying optimized electrical and mechanical properties. In the IDT system, the polymer PIDT-3T-OC12-10% showed promising electrical and mechanical properties. In fully stretchable transistors, the polymer PIDT-3T-OC12-10% showed a mobility of 0.27 cm² V^-1 s^-1 at 75% strain and maintained its mobility after being subjected to hundreds of stretching-releasing cycles at 25% strain. Our results underscore the intimate correlation between chemical structures, mechanical properties, and charge carrier mobility for polymer semiconductors. Our described molecular design approach will help to expedite the next generation of intrinsically stretchable high-performance polymer semiconductors.

SLIDE-Novel Approach to Apocrine Sweat Sampling for Lipid Profiling in Healthy Individuals

We designed a concept of 3D-printed attachment with porous glass filter disks—SLIDE (Sweat sampLIng DevicE) for easy sampling of apocrine sweat. By applying advanced mass spectrometry coupled with the liquid chromatography technique, the complex lipid profiles were measured to evaluate the reproducibility and robustness of this novel approach. Moreover, our in-depth statistical evaluation of the data provided an insight into the potential use of apocrine sweat as a novel and diagnostically relevant biofluid for clinical analyses. Data transformation using probabilistic quotient normalization (PQN) significantly improved the analytical characteristics and overcame the ‘sample dilution issue’ of the sampling. The lipidomic content of apocrine sweat from healthy subjects was described in terms of identification and quantitation. A total of 240 lipids across 15 classes were identified. The lipid concentrations varied from 10⁻¹⁰ to 10⁻⁴ mol/L. The most numerous class of lipids were ceramides (n = 61), while the free fatty acids were the most abundant ones (average concentrations of 10⁻⁵ mol/L). The main advantages of apocrine sweat microsampling include: (a) the non-invasiveness of the procedure and (b) the unique feature of apocrine sweat, reflecting metabolome and lipidome of the intracellular space and plasmatic membranes. The SLIDE application as a sampling technique of apocrine sweat brings a promising alternative, including various possibilities in modern clinical practice.

Non-Invasive Sweat-Based Tracking of L-Dopa Pharmacokinetic Profiles Following an Oral Tablet Administration

Levodopa (L-Dopa) is the "gold-standard" medication for symptomatic therapy of Parkinson disease (PD). However, L-Dopa long-term use is associated with the development of motor and non-motor complications, primarily due to its fluctuating plasma levels in combination with the disease progression. Herein, we present the first example of individualized therapeutic drug monitoring for subjects upon intake of standard L-Dopa oral pill, centered on dynamic tracking of the drug concentration in naturally secreted fingertip sweat. The touch-based non-invasive detection method relies on instantaneous collection of fingertip sweat on a highly permeable hydrogel that transports the sweat to a biocatalytic tyrosinase-modified electrode, where sweat L-Dopa is measured by reduction of the dopaquinone enzymatic product. Personalized dose-response relationship is demonstrated within a group of human subjects, along with close pharmacokinetic correlation between the finger touch-based fingertip sweat and capillary blood samples.

Triboelectric Nanogenerators for Therapeutic Electrical Stimulation

Current solutions developed for the purpose of in and on body (IOB) electrical stimulation (ES) lack autonomous qualities necessary for comfortable, practical, and self-dependent use. Consequently, recent focus has been placed on developing self-powered IOB therapeutic devices capable of generating therapeutic ES for human use. With the recent invention of the triboelectric nanogenerator (TENG), harnessing passive human biomechanical energy to develop self-powered systems has allowed for the introduction of novel therapeutic ES solutions. TENGs are especially effective at providing ES for IOB therapeutic systems given their bioconformability, low cost, simple manufacturability, and self-powering capabilities. Due to the key role of naturally induced electrical signals in many physiological functions, TENG-induced ES holds promise to provide a novel paradigm in therapeutic interventions. The aim here is to detail research on IOB TENG devices applied for ES-based therapy in the fields of regenerative medicine, neurology, rehabilitation, and pharmaceutical engineering. Furthermore, considering TENG-produced ES can be measured for sensing applications, this technology is paving the way to provide a fully autonomous personalized healthcare system, capable of IOB energy generation, sensing, and therapeutic intervention. Considering these grounds, it seems highly relevant to review TENG-ES research and applications, as they could constitute the foundation and future of personalized healthcare.

Recent progress, challenges, and opportunities for wearable biochemical sensors for sweat analysis

Sweat is a promising, yet relatively unexplored biofluid containing biochemical information that offers broad insights into the underlying dynamic metabolic activity of the human body. The rich composition of electrolytes, metabolites, hormones, proteins, nucleic acids, micronutrients, and exogenous agents found in sweat dynamically vary in response to the state of health, stress, and diet. Emerging classes of skin-interfaced wearable sensors offer powerful capabilities for the real-time, continuous analysis of sweat produced by the eccrine glands in a manner suitable for use in athletics, consumer wellness, military, and healthcare industries. This perspective examines the rapid and continuous progress of wearable sweat sensors through the most advanced embodiments that address the fundamental challenges currently restricting widespread deployment. It concludes with a discussion of efforts to expand the overall utility of wearable sweat sensors and opportunities for commercialization, in which advances in biochemical sensor technologies will be critically important.

ANTIGONE: A Programmable Energy-Efficient Current Digitizer for an ISFET Wearable Sweat Sensing System

This article describes the design and the characterization of the ANTIGONE (ANalog To dIGital cONvErter) ASIC (Application Specific Integrated Circuit) built in AMS 0.35 m technology for low dc-current sensing. This energy-efficient ASIC was specifically designed to interface with multiple Ion-Sensitive Field-Effect Transistors (ISFETs) and detect biomarkers like pH, Na+, K+ and Ca2+ in human sweat. The ISFET-ASIC system can allow real-time noninvasive and continuous health monitoring. The ANTIGONE ASIC architecture is based on the current-to-frequency converter through the charge balancing principle. The same front-end can digitize multiple currents produced by four sweat ISFET sensors in time multiplexing. The front-end demonstrates good linearity over a dynamic range that spans from 1 pA up to 500 nA. The consumed energy per conversion is less than 1 J. The chip is programmable and works in eight different modes of operation. The system uses a standard Serial Peripheral Interface (SPI) to configure, control and read the digitally converted sensor data. The chip is controlled by a portable device over Bluetooth Low Energy (BLE) through a Microcontroller Unit (MCU). The sweat sensing system is part of a bigger wearable platform that exploits the convergence of multiparameter biosensors and environmental sensors for personalized and preventive healthcare.

A Wearable Surface-Enhanced Raman Scattering Sensor for Label-Free Molecular Detection

A wearable surface-enhanced Raman scattering (SERS) sensor has been developed as a patch type to utilize as a molecular sweat sensor. Here, the SERS patch sensor is designed to comprise a sweat-absorbing layer, which is an interface to the human skin, an SERS active layer, and a dermal protecting layer that prevents damage and contaminations. A silk fibroin protein film (SFF) is a basement layer that absorbs aqueous solutions and filtrates molecules larger than the nanopores created in the β-sheet matrix of the SFF. On the SFF layer, a plasmonic silver nanowire (AgNW) layer is formed to enhance the Raman signal of the molecules that penetrated through the SERS patch in a label-free method. A transparent dermal protecting layer (DP) allows laser penetration to the AgNW layer enabling Raman measurement through the SERS patch without its detachment from the surface. The molecular detection capability and time-dependent absorption properties of the SERS patch are investigated, and then, the feasibility of its use as a wearable drug detection sweat sensor is demonstrated using 2-fluoro-methamphetamine (2-FMA) on the human cadaver skin. It is believed that the developed SERS patch can be utilized as various flexible and wearable biosensors for healthcare monitoring.